SPT 4 2019

The classification of impingement. Select the correct statement:

Impingement can be described based on the area of impingement or thecause of impingement.
External impingement refers to the encroachment of the rotator cuff tendons between the glenoid rim and the humeral head.
A primary impingement refers to a functional problem which causes impingement.
There is only one system of classification of impingement.

A patient with a rotator cuff pathology will not present in the following way:

A positive Jobes test, a positive apprehension test, a negative relocation test and a positive full can test.
A negative Jobes test, a positive apprehension and relocation test with a positive full can
A positive Jobes test, a positive Neer test, a positive apprehension test, a positive relocation test with decreased internal rotation

Evaluation of SLAP lesions. Identify the positive statement.

Clinical symptoms of clicking and “deep” shoulder pain are the most reliable indicators of a labral injury
Speeds test is sensitive and specific for picking up labral and biceps pathology
Arthroscopy remains the most reliable assessment for labral injury
The O’Briens and Bicep Load II test are relatively sensitive tests.

GIRD – which of the following statement is true

GIRD refers to a dysfunction in the shoulder internal rotation motor function and is best tested with isometric tests.
GIRD is best measured with the arm in 0° of abduction
Inter-tester reliability of the goniometric assessment of GIRD is better than the intra-tester reliability.
GIRD refers to the deficit of internal rotation ROM which is an indication of posterior capsule tightness.

Identify the false statement about scapula dyskinesis:

The effect of decreased flexibility of the levator scapulae muscle on scapular kinematics has been well established.
Decreased strength of the serratus anterior muscle and early activity of the upper trapezius is well described in the literature
Scapular dyskinesis has also been identified in healthy overhead athletes.
Healthy individuals with a short pectoralis minor muscles demonstrate increased scapular internal rotation and anterior tilting.

Identify the incorrect statement below. The scapular rehabilitation algorithm:

Differentiates between the muscle control and muscle strength of the scapula muscles
Differentiates between a lack of flexibility of the scapula and the glenohumeral muscles.
It is not necessary to determine if flexibility deficits are primary or secondary
Attention to the function of the force couples is an aspect of motor control.

Identify the false comment about under-loaded tendons

The rotator cuff crescent and supraspinatous articular surface are most commonly affected.
Changes at this stage are reversible
If the tissue is overloaded at this stage it will progress directly to a reactive tendinopathy.
Under-loaded tendon occurs as a result of a decrease in physiological stress

Identify the correct statement below

Asymptomatic rotator cuff pathology in elite athletes may be due to a reduced pain response as a result of a relatively low innervations of the tissue.
Internal rotation exercises have been found to reduce the subacromial pressure.
The link between a reduction in neovascularity and a decrease in tendon symptoms has been identified in the shoulder rotator cuff.
An under-loaded tendon which is overloaded temporarily becomes oedematous but is never associated with a degenerative tendon.

The following statement/s is true of a degenerative tendon

Passive movements are less than active movements
Even with structural degeneration increases in strength may be observed simply by managing pain.
Fat infiltration is seldom observed at this stage.
Structural damage is reversible.

Treatment of a degenerative tendon (identify the false statement):

Is aimed at pain control and restoring normal movement
Decreased pain is associated with increased power and ROM
Initially increased pain is associated with increased power
Surgery of a degenerative needs to be considered very carefully.

Which statement is true with regards to current shoulder musculoskeletal
assessment tests:

They have a low sensitivity but can reproduce symptoms and have a high specificity.
They have a high sensitivity, can reproduce symptoms but have a low specificity
They have a high sensitivity, low specificity and are unable to reproduce symptoms
They have a low sensitivity and specificity but are able to reproduce symptoms.

Identify the incorrect statement describing the humeral head procedure of the SSMP.

This procedure includes a series of pressure displacement techniques.
This procedure can involve muscle contraction techniques.
The pressure is maintained during the aggravating activity
If the symptoms are partially reduced using the humeral head procedure the SSMP testing need not be continued.

Which statement is true:

RSP stands for the retracted scapular position
RSP refers to the forward inclination of the shoulders which is associated with protracted scapulae.
FHP is associated with lengthening of the upper trapezius, erector spine and splenius capitis.
FHP is most commonly treated with strengthening the long structures in the neck.

The results of this study were interesting. Choose the correct statement/s.

There was a significant improvement in posture but this was not associated with a significant reduction in pain in the intervention group.
Only the exercise intervention group demonstrated any improvements in strength.
The improvement in posture in the intervention group was correlated with a direct increase in strength and decrease in pain.
Only the intervention group improved strength in the targeted muscles over the 8 weeks.

Choose the correct statements as ‘take-home messages’ about neurodynamic (ND) testing, in patients with
neural entrapments:

A ND test in isolation has no diagnostic value when assessing potential entrapment neuropathies, but it could detect increased neural mechanosensitivity.
A ND test may result in reproduction of the patient’s symptoms with reduced ROM compared to the asymptomatic side. If not, a partial reproduction of the symptoms and structural differentiation is essential for a relevant positive test.
A negative ND test does not rule out a nerve dysfunction, as in patients with severe loss of small nerve fibre function.
A ND test showing increased nerve mechanosensitivity, does imply the presence of neuropathic pain.

Choose the most correct answers, for the aims in treatment for neurodynamics as a technique:

It restores the homeostasis in and around the targeted nerve.
Maintaining a neural stretch at the end ROM, is healthy for a neural structure.
It facilitates movement between the neural structures and their surroundings (interface).
It breaks down scar tissue within the neural structures (intra-neural).
Reduces intra-neural oedema and improves intraneural fluid dispersion.
A neurodynamic treatment technique remains an integral part of management, even when central mechanisms are present.

Choose the most correct answers for a definition and an example of a ‘slider’ technique of the median nerve:

Elbow extension and shoulder abduction, alternated with elbow flexion and shoulder adduction.
Elbow extension and wrist flexion, alternated with elbow flexion and wrist extension.
Combinations of movements of at least two joints, in which one movement lengthens the nerve bed to increase tension in the nerve, while the other movement simultaneously decreases the length of the nerve bed to reduce tension in the nerve.
Elbow extension and wrist extension, alternated with elbow flexion and wrist flexion.
Combining movements for nerve gliding is obtained by moving at least two joints in such a manner to elongate the nerve bed.

In the diagram above, which nerve would potentially have altered neurodynamics:

Tibialis nerve
Peroneal nerve
Sural nerve

What best describe pathodynamics:

An interaction between mechanics and physiology of the nervous system
Predominantly mechanics
Predominantly physiology

As a physiotherapist, for management of the scenario seen in the diagram above, select 3 phrases below you feel may need to be considered as priorities:

Exercise to improve motor control for foot position eg dysfunction of the tibialis posterior
Assessing and treating neurodynamics
Refer the patient for X-rays
Refer to an orthopaedic surgeon
Assessing and treating the ipsilateral knee and hip

A classification of low-back related leg pain is proposed based on predominant mechanisms, and assessed with a physical examination protocol. Select the order of the algorithm for the clinical classification.

Musculoskeletal, peripheral nerve sensitisation, denervation, central sensitisation.
Peripheral nerve sensitisation, musculoskeletal, central sensitisation, denervation.
Central sensitisation, denervation, peripheral nerve sensitisation, musculoskeletal
Denervation, peripheral nerve sensitisation, central sensitisation, musculoskeletal.
All the above are appropriate.

Which of the following are not anatomical differences unique to the thoracic spine?

Superior and inferior demifacets on the vertebral bodies
Costovertebral joint capsules
4th column of support
90 degree orientation of z-joints

Which of the following is not a consideration in a thoracic burst fracture?

Retropulsion of fracture fragments into spinal column
Posterior ligamentous complex injuries
Neurological deficits
Instability of the spinal column

Which of the following is not true about thoracic kyphosis and shoulder pain?

Resting thoracic kyphosis is not related to shoulder pain
Decreased thoracic kyphosis is related to an increased ROM in the shoulder
Decreased thoracic kyphosis is related to a decrease in shoulder pain
Taping the thoracic spine into extension increases the maximal shoulder ROM

Which of the following is not a characteristic of a true rib?

Have their own costal cartilage
Attach directly to the sternum via cartilage
Have a synchrondosis with the rib above it
Allow gliding movements at sternal joints for breathing

Which of the following is not a traumatic injury caused by rib fractures?

Aortic rupture
Cauda Equina disruption
Pneumothorax
Liver lacerations

Which of the following is not true about rib stress fractures?

Seen in athletes
Occur along a continuum
Follow repetitive throwing action
Also defined as a fragility fracture

Which of the following statements is not true?

Sternal fractures are common in sports
Chronic rib fracture complications may include dyspnoea
Costal cartilage fractures may occur in collision sports
The fibrocartilaginous joint in the sternum may become synovium over time

Choose the incorrect statement: Spinal mobilisations _____.

Can decrease erector spinae activity
Can decrease pain
Can decrease pressure pain threshold
Can increase tranversus abdominus activity

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