Clinical Physiotherapy MCQ | With Explanation | Part: 6 |
00:00 Introduction
00:06 Question: 26
With a muscle grade of Fair plus, the patient should not need active assistive exercise. Resistive exercise against gravity would be most appropriate to strengthen this muscle. Since the gastrocnemius crosses both the knee and ankle, bending the knee would put the gastrocnemius in a shortened position and lessen its ability to produce tension. Therefore, exercising with the knee straight would put the gastrocnemius on stretch, increasing its ability to produce tension.
[ Reference: Smith LD. LK, Weiss EL, Clinical Brunnstrom’s Lehmkuhl Kinesiology. 5th ed. Philadelphia, PA: FA Davis; 1996: 345-346. ]
1:12 Question: 27
Pain with resisted medial (internal) rotation and pain with passive lateral (external) rotation is indicative of subscapularis tendonitis. Bicipital tendonitis is suspected if resisted supination is painful when the patient’s arm is at the side and the elbow is flexed to 90 ° . Painful resisted abduction and resisted lateral (external) rotation is indicative of supraspinatus tendinitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.
[ Reference: Cyriax J. Illustrated Manual of Orthopaedic Medicine. London, England: OM Publications; 1983: 225-227. ]
2:29 Question: 28
For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates the joint surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be used in conjunction with the other mobilization techniques listed. Later mobilization techniques would most likely include anterior glide.
[ Reference: Kaltenborn FM. Manual Mobilization of the Extremities. 4th ed. Oslo, Norway: Olaf Norlis Bokhandel; 1989: 103-114. ]
3:32 Question: 29
The median nerve supplies sensory innervation to the palmar surface of the thumb, index and middle fingers. A positive Tinel’s sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) and weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory and motor changes in the little and ring fingers not the thumb. Tenosynovitis of the abductor pollicis longus muscle would most likely reveal a positive Finkelstein’s test (stretching of the abductor muscle) with pain over the dorsum of the thumb. Thoracic outlet syndrome would most likely be revealed with special tests that cause alteration of the radial pulse.
[ Reference: Magee DJ. Orthopedic Physical Assessment. 3rd ed. Philadelphia, PA: WB Saunders; 1997: 314-315. ]
5:10 Question: 30
The only one of the above interventions that requires precaution because of the total hip replacement is continuous ultrasound. However, that does not mean that ultrasound is contraindicated for this patient. Transcutaneous electrical nerve stimulation may be used over metal implants. Hot packs and massage would not affect the total hip prosthesis.
[ Reference: Sweitzer Mehreteab RW. In: Hecox B, TA, Weisberg J, eds. Physical Agents. Englewood Cliffs, NJ: Prentice Hall; 1994: 176-178 ]
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