Certified Chiropractic Extremity Practitioner (C.C.E.P.) — Questions and Answers

Question 1: Adhesive capsulitis (frozen shoulder) demonstrates which characteristic finding on shoulder arthrography?

Superior labral detachment
Hill-Sachs filling defect
Reduced joint volume and contracted capsule (rim sign) (Correct answer)
Contrast extravasation through a full-thickness cuff tear

Correct answer: Reduced joint volume and contracted capsule (rim sign)

Adhesive capsulitis shows markedly reduced joint volume on arthrography with a contracted capsule and reduced contrast filling known as the rim sign.

Question 2: Which clinical finding most strongly suggests a complete Achilles tendon rupture rather than a severe Achilles tendinopathy?

Significant swelling at the calcaneal insertion
Palpable gap in the tendon and positive Thompson test (Correct answer)
Severe pain with passive dorsiflexion
Crepitus along the tendon sheath with motion

Correct answer: Palpable gap in the tendon and positive Thompson test

A palpable defect combined with a positive Thompson test (no plantarflexion with calf squeeze) confirms complete Achilles rupture.

Question 3: De Quervain's tenosynovitis involves inflammation of tendons in which extensor compartment of the wrist?

Third dorsal compartment (EPL)
Sixth dorsal compartment (ECU)
First dorsal compartment (APL/EPB) (Correct answer)
Second dorsal compartment (ECRL/ECRB)

Correct answer: First dorsal compartment (APL/EPB)

De Quervain's tenosynovitis affects the abductor pollicis longus and extensor pollicis brevis within the first dorsal compartment of the wrist.

Question 4: A dancer presents with pain at the posterior ankle reproduced by passive plantarflexion compression. The most likely diagnosis is:

FHL tenosynovitis
Os trigonum syndrome (Correct answer)
Achilles tendinopathy
Stieda process fracture

Correct answer: Os trigonum syndrome

Passive plantarflexion compressing a posterior ankle bony or soft tissue prominence is the hallmark provocative test for os trigonum syndrome.

Question 5: A 'Segond fracture' seen as a small bony fragment on the lateral aspect of the proximal tibia is pathognomonic for which injury?

Tibial plateau fracture
ACL tear with lateral capsular avulsion (Correct answer)
Lateral meniscus root tear
PCL injury

Correct answer: ACL tear with lateral capsular avulsion

The Segond fracture is an avulsion of the lateral tibial capsule that is highly specific for ACL rupture and is seen at the lateral margin of the proximal tibia.

Question 6: What is the first priority in lower extremity treatment for CCEP practitioners?

Ensuring patient safety and well-being (Correct answer)
Following insurance requirements
Meeting productivity targets
Completing documentation

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 7: Which muscle is the primary dynamic stabilizer preventing superior translation of the humeral head during arm elevation?

Infraspinatus
Deltoid (middle fiber)
Biceps brachii long head
Supraspinatus (Correct answer)

Correct answer: Supraspinatus

The supraspinatus compresses the humeral head into the glenoid and resists superior migration during arm elevation, functioning as the primary dynamic restraint against superior translation.

Question 8: Which structure is most at risk of injury if excessive force is applied during a posterior glide mobilization of the proximal tibiofibular joint?

Anterior cruciate ligament
Posterior cruciate ligament
Common peroneal nerve (Correct answer)
Popliteal artery

Correct answer: Common peroneal nerve

The common peroneal nerve wraps around the fibular head and is at risk of injury with excessive force during proximal tibiofibular mobilization.

Question 9: Which manipulation technique is most appropriate for a hypomobile subtalar joint with calcaneal varus positioning?

Joint distraction in the neutral position
Long-axis traction of the first MTP joint
High-velocity low-amplitude thrust into eversion (Correct answer)
Soft tissue mobilization only

Correct answer: High-velocity low-amplitude thrust into eversion

A calcaneal varus with subtalar hypomobility responds best to an HVLA thrust directed into eversion to restore pronation motion.

Question 10: The 'scapular-thoracic' adjustment performed with the patient seated and the arm draped over the practitioner's thigh primarily mobilizes which joint?

Sternoclavicular joint
Scapulothoracic articulation (Correct answer)
Glenohumeral joint
Acromioclavicular joint

Correct answer: Scapulothoracic articulation

This technique levers the scapula away from the thorax to mobilize the scapulothoracic articulation, improving dyskinesis.

Question 11: Pronator teres syndrome differs from carpal tunnel syndrome in that paresthesias typically:

Spare the palm and affect only the ring and little fingers
Affect only the dorsal aspect of the hand
Include the thenar eminence and proximal palm, not just distal digits (Correct answer)
Are worsened by nighttime wrist flexion rather than activity

Correct answer: Include the thenar eminence and proximal palm, not just distal digits

In pronator teres syndrome, median nerve compression is proximal to the palmar cutaneous branch, so symptoms include the thenar eminence and proximal palm — areas spared in carpal tunnel syndrome.

Question 12: The FABER Test (Patrick's Test) is positive when it reproduces groin or posterior hip pain; anterior groin pain suggests pathology of which joint?

Pubic symphysis
Sacroiliac joint
Lumbar facet joint
Hip joint (Correct answer)

Correct answer: Hip joint

FABER positions the hip in Flexion, Abduction, and External Rotation; anterior groin pain suggests hip joint pathology, while posterior pain suggests sacroiliac joint involvement.

Question 13: What is the role of informed consent in upper extremity treatment?

It ensures the patient understands and agrees to the plan (Correct answer)
It protects only the provider
It is a mere formality
It is only needed for surgery

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 14: A patient presents with pain at the posterior heel worsening with the first steps in the morning. The most likely diagnosis is:

Plantar fasciitis (Correct answer)
Retrocalcaneal bursitis
Tarsal tunnel syndrome
Achilles tendinopathy

Correct answer: Plantar fasciitis

Morning post-static dyskinesia (pain with first steps after rest) is the hallmark presentation of plantar fasciitis.

Question 15: A CCEP practitioner identifies restricted shoulder abduction beyond 90°. Which glenohumeral accessory movement is most likely limited?

Superior glide
Anterior glide
Posterior glide
Inferior glide (Correct answer)

Correct answer: Inferior glide

Inferior glide of the humeral head is required for full glenohumeral abduction beyond 90°; its restriction limits this motion.

Question 16: A patient presents with foot drop following a fall. Which nerve is most likely injured based on this presentation?

Sural nerve
Tibial nerve
Femoral nerve
Common peroneal nerve (Correct answer)

Correct answer: Common peroneal nerve

The common peroneal nerve wraps around the fibular head and is vulnerable to injury there, causing foot drop due to weakness of ankle dorsiflexion and eversion.

Question 17: A patient with chronic shoulder pain has a positive Neer impingement sign and positive empty can test. Which structure is most likely compromised?

Supraspinatus tendon (Correct answer)
Long head of biceps tendon
Subscapularis tendon
Infraspinatus tendon

Correct answer: Supraspinatus tendon

The empty can test (Jobe's test) isolates the supraspinatus, and combined with Neer's sign, suggests supraspinatus impingement or tear.

Question 18: Which rehabilitative exercise specifically targets the lower trapezius to improve scapular upward rotation and posterior tilting?

Shoulder shrug against resistance
Prone Y-exercise (arm elevation at 135° in the scapular plane with thumbs up) (Correct answer)
Seated row with forearm pronation
Wall push-up with a plus (serratus activation)

Correct answer: Prone Y-exercise (arm elevation at 135° in the scapular plane with thumbs up)

The prone Y-exercise targets the lower trapezius by positioning the arm at 135° (Y-shape) in the scapular plane, which specifically demands lower trapezius force production for upward rotation and posterior tilt.

Question 19: Which finding on a shoulder examination is most consistent with a full-thickness supraspinatus tear rather than tendinopathy?

Positive Speed's test for biceps involvement
Pain with the Neer impingement sign
Painful arc between 60°–120° of abduction
Complete inability to initiate abduction with a positive drop arm test (Correct answer)

Correct answer: Complete inability to initiate abduction with a positive drop arm test

A positive drop arm test with inability to maintain or initiate abduction suggests a full-thickness rotator cuff tear disrupting active force transmission.

Question 20: Which contact point is used in a long-axis distraction technique for the glenohumeral joint?

Coracoid process
Posterior aspect of the humeral head
Lateral epicondyle
Distal humerus with axial traction (Correct answer)

Correct answer: Distal humerus with axial traction

Long-axis distraction of the glenohumeral joint applies traction along the shaft, contacting the distal humerus to gap the joint space.

Question 21: In the Thompson Drop technique applied to the knee, which table piece is typically lowered during the thrust?

Pelvic piece
Cervical piece
Leg piece (Correct answer)
Thoracic piece

Correct answer: Leg piece

The Thompson Drop leg piece drops during knee adjustments to add momentum and reduce the force needed by the practitioner.

Question 22: For a posterior-inferior calcaneal adjustment, the chiropractor's thenar contact is placed on the:

Posterior superior calcaneal tuberosity (Correct answer)
Sustentaculum tali
Anterior process of the calcaneus
Peroneal tubercle

Correct answer: Posterior superior calcaneal tuberosity

The posterior superior calcaneal tuberosity is the primary contact for a posterior-inferior calcaneal adjustment thrust.

Question 23: Cubital tunnel syndrome involves compression of which nerve at the elbow, and which test most specifically provokes symptoms?

Ulnar nerve; elbow flexion test with wrist extension (Correct answer)
Musculocutaneous nerve; resisted elbow flexion
Median nerve; Phalen's test at the wrist
Radial nerve; Tinel's sign over the radial head

Correct answer: Ulnar nerve; elbow flexion test with wrist extension

Cubital tunnel syndrome involves ulnar nerve compression at the medial elbow, and the elbow flexion test (sustained elbow flexion with wrist extension) is the most sensitive provocative test.

Question 24: A patient with chronic Achilles tendinopathy begins an eccentric heel drop program. What weekly progression is MOST evidence-based?

Switch to concentric-only loading after 2 weeks
Maintain 3x15 reps and progressively add external load using a weighted vest or backpack (Correct answer)
Increase repetitions from 15 to 30 per set each week
Decrease sets and increase explosive plyometric volume

Correct answer: Maintain 3x15 reps and progressively add external load using a weighted vest or backpack

The Alfredson eccentric heel drop protocol progresses by maintaining 3x15 repetitions and systematically adding external load once the exercise becomes pain-free.

Question 25: Which special orthopedic test evaluates for posterior hip labral tears by flexing, adducting, and internally rotating the hip?

Ober's test
FABER (Patrick's) test
Thomas test
FADIR (impingement) test (Correct answer)

Correct answer: FADIR (impingement) test

The FADIR test (Flexion, ADduction, Internal Rotation) is a provocation test for femoroacetabular impingement and posterior labral pathology.

Question 26: Which of the following best distinguishes a Grade III AC joint sprain from a Grade II sprain?

Grade III involves only the AC ligament; Grade II involves only the CC ligament
Grade III shows horizontal instability only; Grade II shows both horizontal and vertical instability
Grade III is treated conservatively; Grade II requires surgery
Grade III involves complete disruption of both AC and CC ligaments with clavicle elevation; Grade II involves partial CC ligament tear (Correct answer)

Correct answer: Grade III involves complete disruption of both AC and CC ligaments with clavicle elevation; Grade II involves partial CC ligament tear

Grade III AC sprains involve complete rupture of both the acromioclavicular and coracoclavicular ligaments causing visible clavicle elevation, while Grade II involves AC ligament rupture with only partial CC ligament injury.

Question 27: The valgus stress test of the knee evaluates the integrity of the:

Posterior cruciate ligament
Anterior cruciate ligament
Lateral collateral ligament
Medial collateral ligament (Correct answer)

Correct answer: Medial collateral ligament

Applying valgus force to the knee stresses the medial collateral ligament; gapping or pain at the medial joint line indicates MCL injury.

Question 28: Which of the following best describes the close-packed position of the hip joint?

Extension, abduction, and internal rotation
Flexion, adduction, and internal rotation
Full extension, internal rotation, and abduction (Correct answer)
Flexion, abduction, and external rotation

Correct answer: Full extension, internal rotation, and abduction

The hip's close-packed position is full extension with internal rotation and slight abduction, creating maximum ligamentous tension.

Question 29: In gait analysis, 'Trendelenburg gait' results from weakness of which muscle group?

Knee extensors on the swing-side
Hip flexors on the stance-side
Ankle plantarflexors on the stance-side
Hip abductors on the stance-side (Correct answer)

Correct answer: Hip abductors on the stance-side

Weakness of the stance-side hip abductors (primarily gluteus medius) prevents pelvis stabilization, causing contralateral pelvic drop (Trendelenburg sign) or trunk lean.

Question 30: Which taping technique is used to offload the Achilles tendon by reducing tensile load during rehabilitation?

Low-dye taping
Heel lift with calcaneal taping in mild plantarflexion (Correct answer)
Gibney basketweave taping
Dorsal blocking tape

Correct answer: Heel lift with calcaneal taping in mild plantarflexion

A calcaneal lift tape in slight plantarflexion reduces Achilles tensile stress by shortening the functional length of the tendon unit.

Question 31: When treating a frozen shoulder (adhesive capsulitis) in the freezing phase, the primary chiropractic goal should be:

Immediate high-velocity low-amplitude thrust to the glenohumeral joint
Strengthening the rotator cuff with maximal resistance exercises
Pain management, gentle AROM within pain-free range, and patient education (Correct answer)
Aggressive end-range manipulation to break adhesions

Correct answer: Pain management, gentle AROM within pain-free range, and patient education

In the painful freezing phase of adhesive capsulitis, treatment focuses on pain control and gentle range-of-motion exercises while avoiding aggressive techniques that can worsen inflammation.

Certified Chiropractic Extremity Practitioner (C.C.E.P.)

The CCEP certification, offered by the Council on Extremity Adjusting, validates a Doctor of Chiropractic's advanced competency in diagnosing and treating extremity injuries and conditions through a 105-hour, seven-module program culminating in written and practical examinations.

Questions

35 min

Time Limit

75%

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