CCEP Clinical Decision Making 5 — Questions and Answers
Question 1: A patient presents with acute knee effusion following a non-contact deceleration injury. Lachman's test is positive. Which structure is most likely ruptured?
- Posterior cruciate ligament
- Medial collateral ligament
- Anterior cruciate ligament (Correct answer)
- Lateral collateral ligament
Correct answer: Anterior cruciate ligament
A positive Lachman's test (anterior tibial translation at 20–30° knee flexion) with acute effusion after non-contact deceleration is the hallmark of ACL rupture.
Question 2: When applying the clinical prediction rule for manipulation of the ankle, which finding increases the likelihood of a successful outcome?
- Bilateral ankle stiffness present more than 6 months
- Unilateral hypomobility with symptom duration less than 16 days (Correct answer)
- Positive Ottawa rules indicating fracture risk
- Pain with passive plantarflexion only
Correct answer: Unilateral hypomobility with symptom duration less than 16 days
Short symptom duration (under 16 days) and unilateral hypomobility are key predictors in clinical prediction rules favoring successful ankle manipulation outcomes.
Question 3: A CCEP practitioner notes clicking and medial joint line pain with Thessaly's test at 20° knee flexion. This finding is most consistent with:
- ACL insufficiency
- Medial meniscal pathology (Correct answer)
- Lateral compartment osteoarthritis
- Patellofemoral syndrome
Correct answer: Medial meniscal pathology
Thessaly's test at 20° knee flexion loads the menisci through axial rotation; medial joint line pain or clicking indicates medial meniscal pathology.
Question 4: Which clinical finding would most support a diagnosis of thoracic outlet syndrome rather than cervical radiculopathy in a patient with upper extremity numbness?
- Numbness in a single dermatomal distribution with positive Spurling's test
- Positive Adson's test with pulse obliteration and symptom reproduction (Correct answer)
- Pain with passive cervical extension and lateral flexion
- Positive Phalen's test at the wrist
Correct answer: Positive Adson's test with pulse obliteration and symptom reproduction
Adson's test assesses neurovascular compression at the thoracic outlet; pulse obliteration combined with symptom reproduction differentiates TOS from cervical radiculopathy.
Question 5: In a patient with chronic ankle instability, which rehabilitation progression principle is most critical before returning to sport?
- Achieving pain-free passive range of motion
- Restoring proprioception and neuromuscular control before strength (Correct answer)
- Maximizing static strength before dynamic balance
- Achieving full range of motion before any strengthening
Correct answer: Restoring proprioception and neuromuscular control before strength
Proprioceptive training and neuromuscular control restoration are essential in chronic ankle instability, as mechanoreceptor damage contributes to recurrent sprains.
Question 6: A patient with shoulder impingement syndrome has failed conservative care for 6 weeks. Which clinical finding would most strongly indicate the need for surgical referral?
- Persistent weakness with manual muscle testing grade 4/5
- Full-thickness rotator cuff tear confirmed on MRI with significant functional loss (Correct answer)
- Positive Hawkins-Kennedy test at follow-up
- Bilateral mild subacromial bursitis on ultrasound
Correct answer: Full-thickness rotator cuff tear confirmed on MRI with significant functional loss
A confirmed full-thickness rotator cuff tear with significant functional loss that fails conservative management warrants orthopedic surgical referral for possible repair.
Question 7: During extremity examination, a practitioner notices that passive range of motion is pain-free and full, but active range of motion produces pain and weakness. This pattern most suggests:
- Joint capsule contracture
- Intra-articular pathology
- Contractile tissue (muscle or tendon) injury (Correct answer)
- Ligamentous instability
Correct answer: Contractile tissue (muscle or tendon) injury
Pain and weakness with active but not passive motion implicates contractile tissues (muscle-tendon unit), since passive motion does not load these structures.
CCEP Clinical Decision Making 5
A patient presents with acute knee effusion following a non-contact deceleration injury.
Lachman's test is positive.
Which structure is most likely ruptured?