CCEP Lower Extremity Treatment 4 — Questions and Answers
Question 1: A dancer presents with pain at the posterior ankle reproduced by passive plantarflexion compression. The most likely diagnosis is:
- Achilles tendinopathy
- Os trigonum syndrome (Correct answer)
- FHL tenosynovitis
- 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 2: Which nerve is most at risk during a proximal fibular manipulation for peroneal nerve entrapment?
- Tibial nerve
- Common peroneal nerve (Correct answer)
- Sural nerve
- Saphenous nerve
Correct answer: Common peroneal nerve
The common peroneal nerve wraps around the fibular head and is directly at risk during proximal fibula joint procedures.
Question 3: What is the recommended chiropractic approach for a Grade II lateral ankle sprain in the subacute phase (days 4-14)?
- Strict immobilization and avoidance of all movement
- HVLA thrust to restore subtalar motion, with proprioceptive rehabilitation (Correct answer)
- Surgical referral for ligament reconstruction
- Corticosteroid injection into the ATFL
Correct answer: HVLA thrust to restore subtalar motion, with proprioceptive rehabilitation
Subacute ankle sprains benefit from gentle HVLA to restore restricted talocrural and subtalar motion paired with early proprioceptive training.
Question 4: A patient with hallux limitus has restricted first MTP dorsiflexion. The preferred joint mobilization glide direction is:
- Plantar glide of the proximal phalanx on the metatarsal head
- Dorsal glide of the proximal phalanx on the metatarsal head (Correct answer)
- Medial tilt of the first MTP
- Long-axis distraction only
Correct answer: Dorsal glide of the proximal phalanx on the metatarsal head
To restore dorsiflexion (extension) at the first MTP, a dorsal glide of the proximal phalanx is applied per the concave-convex rule.
Question 5: Which muscle, if weak, most commonly contributes to 'too many toes' sign during posterior observation of gait?
- Tibialis posterior (Correct answer)
- Peroneus longus
- Tibialis anterior
- Flexor hallucis longus
Correct answer: Tibialis posterior
Tibialis posterior weakness allows hindfoot valgus and forefoot abduction, causing more toes to be visible lateral to the heel from behind.
Question 6: In the CCEP examination context, the Lachman test differs from the anterior drawer test in that it:
- Tests PCL integrity at 90 degrees
- Evaluates ACL at 20-30 degrees of flexion where hamstrings are less able to mask laxity (Correct answer)
- Assesses meniscal integrity
- Is performed with the hip in external rotation
Correct answer: Evaluates ACL at 20-30 degrees of flexion where hamstrings are less able to mask laxity
The Lachman test at 20-30 degrees of knee flexion reduces hamstring contribution, making it more sensitive for ACL rupture than the 90-degree drawer.
Question 7: Trigger point therapy applied to the short head of the biceps femoris most commonly refers pain to:
- Anterior knee and shin
- Posterior lateral knee and lower leg (Correct answer)
- Medial knee only
- Lateral hip and greater trochanter
Correct answer: Posterior lateral knee and lower leg
Short head biceps femoris trigger points typically refer pain posterolaterally through the knee and into the upper posterior calf.
CCEP Lower Extremity Treatment 4
A dancer presents with pain at the posterior ankle reproduced by passive plantarflexion compression.
The most likely diagnosis is: