CCEP Adjusting Techniques for Extremities 4 — Questions and Answers
Question 1: For the acromioclavicular joint, a superior-to-inferior adjustment thrust targets which specific listing?
- Anterior clavicle
- Posterior clavicle
- Superior clavicle (high AC) (Correct answer)
- Inferior clavicle
Correct answer: Superior clavicle (high AC)
A superior clavicle listing (high AC) is adjusted with a superior-to-inferior thrust on the distal clavicle to restore inferior glide.
Question 2: During a subtalar joint adjustment for eversion restriction, the patient is prone and the foot is positioned in:
- Full plantar flexion
- Full dorsiflexion and eversion
- Slight plantar flexion and inversion (Correct answer)
- Neutral with foot off the table
Correct answer: Slight plantar flexion and inversion
Slight plantar flexion with inversion pre-tensions the subtalar joint capsule and opens the medial joint space for a lateral-to-medial thrust.
Question 3: Which maneuver differentiates a glenohumeral posterior capsule restriction from a rotator cuff tear before adjustment?
- Drop arm test (Correct answer)
- Posterior capsular stretch (sleeper stretch) pain reproduction
- Speed's test
- Hawkins-Kennedy impingement test
Correct answer: Drop arm test
The drop arm test specifically screens for rotator cuff (supraspinatus) tear, which is an absolute contraindication to high-velocity glenohumeral adjustment.
Question 4: When using the 'knife-edge' (pisiform) contact for a cuboid adjustment, the thrust is directed:
- Lateral to medial
- Superior to inferior (plantar)
- Inferior to superior (dorsal) (Correct answer)
- Anterior to posterior
Correct answer: Inferior to superior (dorsal)
The cuboid whip/notch technique uses an inferior-to-superior (dorsal) thrust through the plantar surface of the cuboid to correct a plantar-flexed cuboid.
Question 5: Which prerequisite assessment finding specifically justifies adjusting the proximal radioulnar joint rather than the elbow as a whole?
- Restricted elbow flexion greater than 30°
- Isolated restriction of pronation or supination with normal flexion/extension (Correct answer)
- Positive Mills' test
- Lateral elbow pain with resisted wrist extension
Correct answer: Isolated restriction of pronation or supination with normal flexion/extension
Isolated pronation or supination restriction with intact flexion/extension implicates the proximal or distal radioulnar joint specifically, not the hinge mechanism.
Question 6: A 'double-thumb' contact technique is most commonly employed for adjusting which small extremity joint?
- Proximal interphalangeal joint of the toe
- First carpometacarpal joint (Correct answer)
- Distal radioulnar joint
- Sternoclavicular joint
Correct answer: First carpometacarpal joint
The double-thumb contact provides precise bilateral force delivery on the small, saddle-shaped 1st carpometacarpal joint for thumb opposition restriction.
Question 7: In a wrist adjustment for a dorsally-restricted lunate, which wrist position pre-loads the adjustment?
- Full radial deviation
- Full dorsiflexion
- Slight palmar flexion with ulnar deviation (Correct answer)
- Full supination
Correct answer: Slight palmar flexion with ulnar deviation
Slight palmar flexion with ulnar deviation gaps the dorsal radiocarpal interval and pre-tensions the dorsal ligaments for the adjustment.
CCEP Adjusting Techniques for Extremities 4
For the acromioclavicular joint, a superior-to-inferior adjustment thrust targets which specific listing?