CCEP Upper Extremity Treatment 4 — Questions and Answers
Question 1: During assessment of finger MCP joints, which end-feel is normal for MCP flexion?
- Bony
- Firm/capsular (Correct answer)
- Soft (tissue approximation)
- Empty
Correct answer: Firm/capsular
Normal MCP flexion end-feel is firm or capsular due to tension in the joint capsule and collateral ligaments.
Question 2: A CCEP practitioner uses the 'long-axis distraction' technique for the glenohumeral joint primarily to:
- Increase inferior glide and address inferior capsule tightness
- Decompress the joint space and restore joint play (Correct answer)
- Strengthen the rotator cuff by engaging muscle spindles
- Reduce anterior labral tears through capsule remodeling
Correct answer: Decompress the joint space and restore joint play
Long-axis distraction of the glenohumeral joint decompresses the joint surfaces and restores normal joint play, which is essential before applying other mobilization techniques.
Question 3: Pronator teres syndrome differs from carpal tunnel syndrome in that paresthesias typically:
- Spare the palm and affect only the ring and little fingers
- Include the thenar eminence and proximal palm, not just distal digits (Correct answer)
- Are worsened by nighttime wrist flexion rather than activity
- Affect only the dorsal aspect of the hand
Correct answer: Include the thenar eminence and proximal palm, not just distal digits
In pronator teres syndrome, median nerve compression is proximal to the palmar cutaneous branch, so symptoms include the thenar eminence and proximal palm — areas spared in carpal tunnel syndrome.
Question 4: When performing an HVLA manipulation to the radiocarpal joint for a restricted extension restriction, the line of drive should be directed:
- Dorsal to volar along the axis of the forearm
- Volar to dorsal with a slight ulnar deviation component (Correct answer)
- Lateral to medial across the carpals
- Proximal to distal along the long axis of the radius
Correct answer: Volar to dorsal with a slight ulnar deviation component
For a radiocarpal extension restriction, the manipulative thrust is directed from volar to dorsal (pushing the carpals dorsally) to gap the restricted extension direction.
Question 5: The 'drawer test' for the shoulder evaluates stability in which direction when performed with the arm at 90° abduction?
- Superior-inferior translation
- Anterior-posterior translation (Correct answer)
- Inferior translation only
- Rotational instability
Correct answer: Anterior-posterior translation
The load-and-shift (drawer) test with the arm at 90° abduction evaluates anterior and posterior glenohumeral translation by loading the humeral head and shifting it on the glenoid.
Question 6: Which muscle is the primary dynamic stabilizer preventing superior translation of the humeral head during arm elevation?
- Deltoid (middle fiber)
- Biceps brachii long head
- Infraspinatus
- Supraspinatus (Correct answer)
Correct answer: Supraspinatus
The supraspinatus compresses the humeral head into the glenoid and resists superior migration during arm elevation, functioning as the primary dynamic restraint against superior translation.
Question 7: Trigger finger (stenosing tenosynovitis) most commonly affects which tendon sheath?
- The flexor digitorum superficialis at the wrist
- The A1 pulley region of the flexor tendon sheath at the MCP joint (Correct answer)
- The extensor digitorum at the dorsal wrist retinaculum
- The flexor pollicis brevis at the IP joint of the thumb
Correct answer: The A1 pulley region of the flexor tendon sheath at the MCP joint
Trigger finger results from stenosis of the A1 pulley at the level of the MCP joint, causing the flexor tendon to catch or lock as it passes through the narrowed sheath.
CCEP Upper Extremity Treatment 4
During assessment of finger MCP joints, which end-feel is normal for MCP flexion?