CCEP Upper Extremity Treatment 2 — Questions and Answers
Question 1: Which manipulation technique is most appropriate for a restricted acromioclavicular joint with superior glide limitation?
- Inferior glide mobilization with the arm adducted (Correct answer)
- Anterior glide mobilization with arm at 90° abduction
- Superior glide manipulation with downward pressure on clavicle
- Posterior glide mobilization with arm in neutral
Correct answer: Inferior glide mobilization with the arm adducted
An AC joint with superior glide limitation responds best to inferior glide mobilization performed with the arm in an adducted, relaxed position.
Question 2: A patient presents with lateral epicondylalgia. Which soft tissue technique targets the common extensor tendon most directly?
- Ischemic compression to the brachialis muscle belly
- Cross-friction massage perpendicular to the tendon fibers at the lateral epicondyle (Correct answer)
- Longitudinal stripping of the supinator along the radial shaft
- Pin-and-stretch technique applied to the pronator teres
Correct answer: Cross-friction massage perpendicular to the tendon fibers at the lateral epicondyle
Cross-friction massage applied perpendicular to the common extensor tendon fibers at the lateral epicondyle is the standard soft tissue approach for lateral epicondylalgia.
Question 3: During chiropractic manipulation of the wrist, the pisiform glides on which bone?
- Hamate
- Triquetrum (Correct answer)
- Lunate
- Capitate
Correct answer: Triquetrum
The pisiform is a sesamoid bone that articulates solely with the triquetrum, forming the pisotriquetral joint.
Question 4: When rehabilitating rotator cuff tendinopathy, which exercise progression principle should guide treatment loading?
- Begin with high-load eccentric exercise and progress to concentric
- Start with pain-free isometric loading, then progress to isotonic and functional loading (Correct answer)
- Initiate with plyometric drills to stimulate tissue remodeling immediately
- Use only open-kinetic-chain exercises throughout the entire rehabilitation continuum
Correct answer: Start with pain-free isometric loading, then progress to isotonic and functional loading
Current evidence supports beginning with isometric exercises for pain modulation and tendon loading, then progressing to isotonic and functional/sport-specific activities.
Question 5: A Grade II Maitland mobilization applied to the glenohumeral joint is best described as:
- Large-amplitude movement performed at end range
- Small-amplitude movement performed at the beginning of range
- Large-amplitude movement that does not reach end range (Correct answer)
- Small-amplitude movement performed at end range
Correct answer: Large-amplitude movement that does not reach end range
Maitland Grade II mobilizations are large-amplitude movements that move through the range but do not reach the end of available motion.
Question 6: Which carpal bone is most commonly fractured and may require special radiographic views for detection?
- Lunate
- Triquetrum
- Scaphoid (Correct answer)
- Trapezium
Correct answer: Scaphoid
The scaphoid is the most commonly fractured carpal bone, and its fractures often require scaphoid views or MRI because standard X-rays may miss them initially.
Question 7: The 'empty can' test for supraspinatus integrity is performed with the shoulder in which position?
- 90° flexion, full internal rotation, thumb pointing down
- 90° abduction in the scapular plane, full internal rotation, thumb pointing down (Correct answer)
- 90° abduction in the coronal plane, external rotation, palm up
- 45° abduction, neutral rotation, elbow flexed to 90°
Correct answer: 90° abduction in the scapular plane, full internal rotation, thumb pointing down
The empty can test is performed at 90° abduction in the scapular plane (30° anterior to the coronal plane) with full internal rotation so the thumb points toward the floor.
CCEP Upper Extremity Treatment 2
Which manipulation technique is most appropriate for a restricted acromioclavicular joint with superior glide limitation?