SEM 3 - MSK wk 11-13 + Knee CPG

hv to do pollev and classes, lect 11-13 slides

Principal Functions of the Foot

1. Stability and support base

2. Mechanism for tib-fib rotation during stance

3. Flexibility for shock absorption and adaptation

4. Rigid lever for push-off

Based on your knowledge of closed-chain arthrokinematics of the talocrural joint, in what direction does the tibia glide over the fixed talus?

 

• Laterally

• Medially

• Anteriorly

• Posteriorly

• Anteriorly

A patient demonstrates excessive pronation during mid-stance. Which combination of subtalar joint motions MOST accurately describes the biomechanical components of pronation?

 

Eversion and Abduction

 

Plantarflexion and Adduction

 

Dorsiflexion and Inversion

 

Inversion and Adduction

Eversion and Abduction

A patient presents with a collapsing medial longitudinal arch during gait. What muscle is MOST LIKELY to demonstrate weakness?

 

Peroneus brevis

 

Tibialis anterior

 

Extensor digitorum longus

 

Tibialis posterior

Tibialis posterior

A 38-year-old recreational runner reports sharp plantar heel pain that began 3 months ago. The pain is worst with the first few steps, improves after walking for a few minutes, but returns after prolonged periods of standing. Based on subjective history alone, which diagnosis is MOST likely?

 

Tarsal tunnel syndrome

 

Medial tibial stress syndrome

 

Plantar neuropathy

 

Plantar fasciitis

Plantar fasciitis

A competitive gymnast is examined by the physical therapist. The chief complaint is nagging, localized pain in the anterior left lower leg that is consistently present at night and increases during activity with swelling. What are these complaints MOST characteristic of?

 

Shin Splints

Anterior Compartment Syndrome

Bone tumor

Stress fracture

Bone tumor

A patient presents with burning and paresthesiae along the medial and plantar foot that worsens throughout the day. Symptoms are reproduced with passive eversion and forced dorsiflexion-eversion. Which structure is MOST LIKELY compressed?

 

Common peroneal nerve

 

Tibial nerve beneath the flexor retinaculum

 

Sural nerve near the lateral malleolus

 

Medial plantar nerve at the navicular tuberosity

Tibial nerve beneath the flexor retinaculum

Which [subjective] historical factor MOST strongly supports a diagnosis of ankle osteoarthritis?

 

Bilateral ankle pain

 

History of distance running

 

History of trauma

 

Sudden onset of symptoms

History of trauma

A basketball player presents with lateral ankle pain after an awkward landing on another player's foot. Examination reveals swelling, tenderness over the ATFL, and a positive anterior drawer test. Which grade of ankle sprain is MOST consistent with these findings?

 

Grade III

 

Grade I

 

Grade II

 

High ankle sprain

Grade II

A patient presents to physical therapy following a crush injury to the lower leg. They report severe, deep pain that worsens with passive stretching. The leg is tense and swollen on observation. Which additional finding MOST strongly suggests acute compartment syndrome?

 

Diffuse numbness in the entire foot

 

Diminished dorsalis pedis pulse

 

Pain that improves with rest

 

Pain relief with elevation

Diminished dorsalis pedis pulse

A 72-year-old patient reports chronic great toe pain, and the most pain and difficulty during terminal stance. The physical examination reveals limited 1st MTP extension and dorsal osteophyte formation. Which compensatory gait deviation is MOST likely?

 

Early toe-off to avoid 1st MPT extension

 

Excessive pronation during mid-stance

 

Increased push-off through the hallux

 

Toe-in gait pattern

Early toe-off to avoid 1st MPT extension

A patient ambulates with excessive foot pronation and flat feet. What will the therapist's examination most likely reveal upon observation in static stance?

 

Valgus position of the heel

 

Varus position of the heel

 

Adducted forefoot positioning

 

Plantar fasciitis

 

Valgus position of the heel

A patient demonstrates a navicular drop of 12 mm. What does this MOST LIKELY indicate?

 

• Excessive supination

• Normal foot mechanics

• Excessive pronation

• Rigid pes cavus

 

Excessive pronation

A 72-year-old patient completes the Timed Up and Go (TUG) in 16 seconds. How should this be interpreted?

 

Normal for age

Indicated excellent functional mobility

Indicates a high fall risk

Indicates need for immediate referral

Indicates a high fall risk

A patient presents with pain during forced dorsiflexion and eversion, and a positive squeeze test. Which structure is MOST LIKELY injured?

 

ATFL

 

Syndesmotic ligaments

 

CFL

 

Deltoid ligament

Syndesmotic ligaments

Which special test has the highest specificity for plantar fasciitis?

 

Dosiflexion-eversion tet

Tinel's sign

Windlass test

Triple compression test

Windlass test

A patient presents with reproduction of burning plantar foot pain with the dorsiflexion-eversion test. What does this MOST LIKELY indicate?

 

Tarsal tunnel syndrome

 

Sural nerve neuropathy

 

Medial plantar neuropathy

 

Plantar fasciitis

Tarsal tunnel syndrome

A patient performs a weight-bearing lunge test and demonstrates limited dorsiflexion with the knee-to-wall distance significantly reduced. Which structure is MOST LIKELY contributing?

 

• Weak peroneals

• Tight gastrocnemius/soleus complex

• Tight hip flexors

• Limited 1st MTP extension

Tight gastrocnemius/soleus complex

A patient performs the single-leg hop test for a distance that is 75% of the uninvolved limb. What does this indicate?

 

Normal limb symmetry

 

Indicates presence of calf tightness

 

Below threshold; impaired ankle function

 

Acceptable for return to sport

Below threshold; impaired ankle function

A 42-year-old recreational runner presents with burning pain at the medial ankle that radiates to the plantar foot. They report symptoms worsen with standing. On exam, you find full inversion and plantarflexion AROM, normal heel-rise performance, mild tenderness to palpation of the posterior medial malleolus, and normal subtalar and talocrural mobility. Which special test should you perform next to help rule in your suspicion of tarsal tunnel syndrome?

 

Navicular drop test

 

Dorsiflexion-eversion test

 

Windlass test

 

Single-leg heel raise test

Dorsiflexion-eversion test

A 33-year-old soccer player reports posterior heel pain aggravated by sprinting and jumping. On exam, you find:

• No visible swelling or deformity at the calcaneal tubercle

• Normal gait except reduced push-off on the involved side

• Pain with active plantarflexion

• Decrease pain in passive plantarflexion (tendon on slack)

• Slightly limited but painfree dorsiflexion

• Normal talocrural and subtalar joint mobility.

• 3/5 MMT with plantarflexion

• Mild gastrocnemius tightness with flexibility testing

Based on the exam sequence, which test or exam step should you perform next to help confirm your suspected diagnosis of Achilles tendinopathy?

 

Conduct the Royal London Test

 

Palpate approximately 3cm proximal to the Achilles insertion

 

Reassess accessory mobility

 

Perform the triple compression test

Palpate approximately 3cm proximal to the Achilles insertion

A soccer player sustained a grade II inversion ankle sprain 2 weeks ago. What is the BEST intervention to use in the early subacute phase of rehabilitation?

 

Closed-chain strengthening and proprioceptive exercises

 

Functional soccer-related drills

 

Plyometric-based exercise program

 

Mobilization at the talocrural and subtalar joints

 

Closed-chain strengthening and proprioceptive exercises

A patient presents with a grade II lateral ankle sprain. According to the CPG, which of the following interventions is MOST APPROPRIATE in the acute phase?

 

Immediate return to sport with athletic taping

 

Immobilization for 4-6 weeks

 

Early mobilization without external support

 

Semi-rigid bracing with progressive weigh-bearing

Semi-rigid bracing with progressive weigh-bearing

Which manual therapy technique has the strongest evidence for improving dynamic postural control in chronic ankle instability?

 

Soft tissue mobilization to the plantar fascia

 

Subtalar distraction manipulation

 

1st MTP mobilization

 

Talocrural poterior glide mobilization

Talocrural poterior glide mobilization

Which loading strategy is MOST APPROPRIATE as the starting point for Achilles tendinopathy when pain is > 5/10?

 

Eccentric heel lowering

 

Heavy-load slow resistance

 

Plyometrics

 

Isometric loading

Isometric loading

For which modality is there grade A evidence that it SHOULD NOT be used for acute lateral ankle sprains?

 

Shortwave diathermy

 

Low-level laser therapy

 

Therapeutic ultrasound

 

Cryotherapy

Therapeutic ultrasound

A recreational runner presents to your clinic with medial tibial stress syndrome. Which gait training cue is MOST APPROPRIATE for a runner with MTSS?

 

Increase cadence

 

Increase trunk extension

 

Encourage heel strike on weight acceptance

 

Increase stride length

 

Increase cadence

A 55-year-old woman presents with progressive medial ankle pain, difficulty with single‑leg heel raises, and a positive too‑many‑toes sign. She demonstrates hindfoot valgus and weakness with inversion in plantarflexion. You diagnose posterior tibialis tendinopathy. Based on current evidence, which initial intervention strategy is MOST appropriate?

 

High-load plyometric training to improve tendon stiffness

 

Isometric inversion holds followed by progressive heavy-load strengthening

 

Night splinting for 3-4 weeks until symptoms subside

 

Dry needling to the posterior tibialis tendon

Isometric inversion holds followed by progressive heavy-load strengthening

A 42-year-old recreational runner reports sharp plantar heel pain with the first steps in the morning and tenderness at the medial calcaneal tubercle. Windlass test is positive. You diagnose plantar fasciitis. Which evidence‑based intervention is MOST appropriate for short‑term pain reduction (up to 3 weeks)?

 

Therapeutic ultrasound to the plantar fascia

 

Custom orthotics as a stand-alone treatment

 

High-load plantarflexor strengthening alone

 

Antipronation taping techniques

Antipronation taping techniques

You perform the initial evaluation for a 27-year-old soccer player who is 10 days post-grade II lateral ankle sprain. On exam, you decide the primary impairment is restricted dorsiflexion AROM. You perform a grade III-IV posterior talar glide and they demonstrated an increase in dorsiflexion AROM. How might you progress your manual therapy interventions at the next visit based on this within-session improvement? 

 

Grade V subtalar distraction manipulation

 

Closed-chain anterior tibial glide mobilization-with-movement while performing a kneeling half lunge

 

Cross-friction massage to the Tibialis anterior muscle belly

 

Subtalar medial glide while performing cutting movements

Closed-chain anterior tibial glide mobilization-with-movement while performing a kneeling half lunge

A 45-year-old delivery driver is on modified work duties and recovering from a chronic lateral ankle instability flare-up. He currently reports 'giving way,' difficulty walking on uneven surfaces, and not feeling confident when carrying packages up stairs. He is highly motivated to return to full work duties, which involves walking on uneven terrain, stair climbing, and lifting/carrying. Based on evidence-supported interventions for CAI, which intervention is MOST APPROPRIATE for facilitating functional task training?

 

Resisted eversion in long-sitting with a theraband

 

Single-limb stance on a BOSU ball while holding weighted item

 

30 repetitions of step-ups, leading with involved limb

 

Rigid taping with graded talocrural posterior glide mobilizations

Single-limb stance on a BOSU ball while holding weighted item

Anterior drawer test

Lateral Ankle sprain

Talar tilt - inversion

Lateral Ankle sprain

Lateral Talar Tilt Stress Test

Medial Ankle sprain

Fibular Translation Test

High Ankle Sprain

Syndesmosis Squeeze Test

High ankle sprain

Windlass test

Plantar fasciosis

Tinel's Sign

Tarsal Tunnel Syndrome

Triple Compression Stress Test

Tarsal Tunnel Syndrome