CCEP Upper Extremity Treatment 3 — Questions and Answers
Question 1: Cubital tunnel syndrome involves compression of which nerve at the elbow, and which test most specifically provokes symptoms?
- Radial nerve; Tinel's sign over the radial head
- Median nerve; Phalen's test at the wrist
- Ulnar nerve; elbow flexion test with wrist extension (Correct answer)
- Musculocutaneous nerve; resisted elbow flexion
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 2: When treating a frozen shoulder (adhesive capsulitis) in the freezing phase, the primary chiropractic goal should be:
- Aggressive end-range manipulation to break adhesions
- Pain management, gentle AROM within pain-free range, and patient education (Correct answer)
- Immediate high-velocity low-amplitude thrust to the glenohumeral joint
- Strengthening the rotator cuff with maximal resistance exercises
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.
Question 3: The normal end-feel for elbow extension is best described as:
- Soft (muscle approximation)
- Boggy (capsular swelling)
- Bony (bone-on-bone) (Correct answer)
- Empty (no tissue resistance, only pain)
Correct answer: Bony (bone-on-bone)
Normal elbow extension end-feel is bony due to the olecranon process seating into the olecranon fossa of the humerus.
Question 4: De Quervain's tenosynovitis involves inflammation of tendons in which extensor compartment of the wrist?
- Second dorsal compartment (ECRL/ECRB)
- First dorsal compartment (APL/EPB) (Correct answer)
- Third dorsal compartment (EPL)
- Sixth dorsal compartment (ECU)
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 5: Scapular dyskinesis most commonly involves which dysfunctional movement pattern?
- Excessive anterior tilting and internal rotation of the scapula (Correct answer)
- Excessive posterior tilting and external rotation of the scapula
- Decreased upward rotation during shoulder elevation
- Superior translation of the scapula during glenohumeral abduction
Correct answer: Excessive anterior tilting and internal rotation of the scapula
Scapular dyskinesis most commonly presents as excessive anterior tilting and internal rotation, often with reduced upward rotation, collectively reducing subacromial space.
Question 6: Which of the following best describes the articular pattern of the glenohumeral joint in adhesive capsulitis?
- Pain-free loss of abduction only
- Equal loss in all planes due to capsular contracture
- Loss of external rotation greater than abduction greater than internal rotation (Correct answer)
- Selective loss of internal rotation with full external rotation preserved
Correct answer: Loss of external rotation greater than abduction greater than internal rotation
The capsular pattern of the glenohumeral joint in adhesive capsulitis is greatest loss of external rotation, followed by abduction, then internal rotation.
Question 7: Thoracic outlet syndrome affecting the neurovascular bundle can be provoked by which orthopedic test?
- Adson's test (head rotation toward involved side, deep inspiration) (Correct answer)
- Spurling's test (cervical compression with lateral flexion)
- Valgus stress test (applied to the elbow)
- Speed's test (resisted shoulder flexion with elbow extended)
Correct answer: Adson's test (head rotation toward involved side, deep inspiration)
Adson's test provokes TOS by rotating the head toward the involved side and taking a deep breath, tensioning the anterior scalene and compressing the subclavian artery.
CCEP Upper Extremity Treatment 3
Cubital tunnel syndrome involves compression of which nerve at the elbow, and which test most specifically provokes symptoms?