CCEP Upper Extremity Treatment 5 — Questions and Answers
Question 1: The 'clunk test' for the shoulder is designed to detect:
- Acromioclavicular joint instability
- Glenohumeral labral tears (Correct answer)
- Long head biceps tendon subluxation
- Posterior capsule tightness
Correct answer: Glenohumeral labral tears
The clunk test is performed by rotating the humerus while applying axial load in full abduction; a clunk sound or sensation indicates a labral tear.
Question 2: In chiropractic extremity care, 'joint play' refers to:
- The active range of motion available to the patient through voluntary contraction
- The passive accessory movement within a joint beyond active control, necessary for normal function (Correct answer)
- The elastic recoil of periarticular ligaments after stretch
- The angular ROM measured with a goniometer at end range
Correct answer: The passive accessory movement within a joint beyond active control, necessary for normal function
Joint play is the small passive accessory movement (roll, glide, spin, distraction) that occurs within a joint beyond the patient's voluntary control and is prerequisite to pain-free physiologic movement.
Question 3: Coracoclavicular ligament integrity is best assessed by which finding on stress radiograph?
- Increased AC joint space with horizontal instability
- Increased coracoclavicular distance compared to the unaffected side (Correct answer)
- Downward displacement of the clavicle relative to the acromion
- Loss of the normal AC joint overlap on axillary view
Correct answer: Increased coracoclavicular distance compared to the unaffected side
Disruption of the coracoclavicular ligaments (trapezoid and conoid) causes the clavicle to ride superiorly, increasing the coracoclavicular distance on stress or weighted radiographs.
Question 4: When treating a restricted first carpometacarpal (CMC) joint of the thumb, the primary motion limitation in osteoarthritis typically involves:
- Abduction and opposition due to dorsal capsule contracture (Correct answer)
- Flexion due to anterior capsule tightness
- Extension due to posterior capsule tightness
- Adduction due to interosseous muscle spasm
Correct answer: Abduction and opposition due to dorsal capsule contracture
Thumb CMC osteoarthritis characteristically restricts abduction and opposition as the dorsal capsule tightens and the joint subluxes radially-dorsal.
Question 5: Which rehabilitative exercise specifically targets the lower trapezius to improve scapular upward rotation and posterior tilting?
- Shoulder shrug against resistance
- Prone Y-exercise (arm elevation at 135° in the scapular plane with thumbs up) (Correct answer)
- Seated row with forearm pronation
- Wall push-up with a plus (serratus activation)
Correct answer: Prone Y-exercise (arm elevation at 135° in the scapular plane with thumbs up)
The prone Y-exercise targets the lower trapezius by positioning the arm at 135° (Y-shape) in the scapular plane, which specifically demands lower trapezius force production for upward rotation and posterior tilt.
Question 6: Posterior interosseous nerve (PIN) entrapment at the radial tunnel most commonly occurs between the superficial and deep heads of which muscle?
- Brachioradialis
- Extensor carpi radialis brevis
- Supinator (arcade of Frohse) (Correct answer)
- Pronator teres
Correct answer: Supinator (arcade of Frohse)
The PIN is most commonly entrapped as it passes beneath the arcade of Frohse, the fibrous proximal edge of the superficial head of the supinator muscle.
Question 7: Which of the following best distinguishes a Grade III AC joint sprain from a Grade II sprain?
- Grade III involves only the AC ligament; Grade II involves only the CC ligament
- Grade III involves complete disruption of both AC and CC ligaments with clavicle elevation; Grade II involves partial CC ligament tear (Correct answer)
- Grade III shows horizontal instability only; Grade II shows both horizontal and vertical instability
- Grade III is treated conservatively; Grade II requires surgery
Correct answer: Grade III involves complete disruption of both AC and CC ligaments with clavicle elevation; Grade II involves partial CC ligament tear
Grade III AC sprains involve complete rupture of both the acromioclavicular and coracoclavicular ligaments causing visible clavicle elevation, while Grade II involves AC ligament rupture with only partial CC ligament injury.
CCEP Upper Extremity Treatment 5
The 'clunk test' for the shoulder is designed to detect: