COT Visual Assessment 2 — Questions and Answers
Question 1: During a visual assessment of a patient's gait, you observe that the patient's right shoulder drops significantly during left leg stance phase. This gait deviation is MOST likely indicative of:
- Right hip abductor weakness (Trendelenburg sign)
- Left hip abductor weakness (Trendelenburg sign) (Correct answer)
- Right quadriceps weakness
- Left ankle plantarflexor weakness
Correct answer: Left hip abductor weakness (Trendelenburg sign)
A Trendelenburg sign occurs when the hip abductors on the stance leg are too weak to maintain pelvic stability. When the left leg is in stance phase and the right shoulder drops (pelvis tilts down on the right/swing side), this indicates the LEFT hip abductors are weak. The stance leg's abductors must hold the pelvis level; when they fail, the contralateral pelvis drops.
Question 2: A COT is performing a visual assessment of a patient's seated posture. The patient exhibits a forward head posture with increased cervical lordosis and rounded shoulders. Which of the following structures is MOST likely to be adaptively shortened?
- Cervical extensors and serratus anterior
- Suboccipital muscles and pectoralis minor (Correct answer)
- Deep cervical flexors and rhomboids
- Scalenes and lower trapezius
Correct answer: Suboccipital muscles and pectoralis minor
In classic forward head posture with rounded shoulders, the suboccipital muscles (which extend the upper cervical spine, creating the 'chin poke') and pectoralis minor (which protracts and tilts the scapula anteriorly, contributing to rounded shoulders) are adaptively shortened. The deep cervical flexors and rhomboids are typically lengthened and weak in this posture pattern.
Question 3: When visually assessing a patient from the posterior view in static standing, you notice that the patient's left iliac crest appears higher than the right. Before concluding there is a true leg length discrepancy, which of the following visual findings would MOST support that this is a functional rather than structural cause?
- Presence of a lateral spinal curve that disappears when the patient sits (Correct answer)
- Bilateral pes planus observed during weight-bearing
- Asymmetrical arm swing during gait assessment
- Increased lumbar lordosis visible from the lateral view
Correct answer: Presence of a lateral spinal curve that disappears when the patient sits
A lateral spinal curve (scoliosis) that disappears when the patient is seated suggests it is caused by a functional leg length discrepancy (e.g., pelvic tilt, hip adductor tightness, or pronated foot) rather than a true structural difference in bone length. In sitting, the lower extremities are unloaded and the discrepancy no longer influences the pelvis, causing the curve to resolve. A structural leg length difference would maintain the pelvic tilt even in sitting.
Question 4: During visual assessment of upper extremity function, a patient is asked to raise both arms overhead. You observe that the right scapula wings off the thorax during shoulder flexion above 90°. This finding MOST directly suggests weakness in which muscle?
- Infraspinatus
- Serratus anterior (Correct answer)
- Middle trapezius
- Subscapularis
Correct answer: Serratus anterior
Serratus anterior is the primary muscle responsible for holding the medial border of the scapula against the thoracic wall and for upwardly rotating the scapula during arm elevation. Weakness of the serratus anterior classically presents as 'winging' of the medial scapular border, which becomes most prominent during forward flexion or push-up movements. Middle trapezius weakness causes more of a downward rotation issue, not classic medial winging.
Question 5: A COT observes a patient descending stairs and notes that the patient's knee moves medially (valgus collapse) as weight is accepted on the leading leg. This movement pattern is MOST associated with weakness in which muscle group?
- Knee extensors (quadriceps)
- Hip external rotators and abductors (Correct answer)
- Ankle dorsiflexors
- Knee flexors (hamstrings)
Correct answer: Hip external rotators and abductors
Dynamic knee valgus during weight-bearing activities like stair descent is most commonly associated with weakness or poor neuromuscular control of the hip external rotators and abductors (particularly gluteus medius and maximus). These muscles control femoral internal rotation and adduction; when they are insufficient, the femur internally rotates and adducts, causing the knee to track medially relative to the foot — this is the classic 'valgus collapse' pattern.
Question 6: During a visual assessment, a COT observes that a patient's lumbar spine remains flat (lacks normal lordosis) throughout forward bending and does NOT flex segmentally. The pelvis tilts forward at the hips but the lumbar vertebrae move as a rigid block. This pattern is BEST described as:
- Excessive lumbopelvic rhythm reversal
- Lumbar hypermobility with segmental instability
- Loss of lumbar segmental mobility (lumbar stiffness) (Correct answer)
- Normal lumbopelvic rhythm with hip flexor tightness
Correct answer: Loss of lumbar segmental mobility (lumbar stiffness)
During normal forward bending, the movement should be distributed between lumbar flexion (segmental vertebral mobility) and anterior pelvic tilt (hip flexion). When the lumbar spine moves as a rigid block without intervertebral flexion, it indicates loss of lumbar segmental mobility — the lumbar spine is stiff. The pelvis compensating with more anterior tilt at the hips is an adaptive strategy to achieve the forward-bending range. This is a key visual finding suggesting lumbar hypomobility or joint restriction.
COT Visual Assessment 2
During a visual assessment of a patient's gait, you observe that the patient's right shoulder drops significantly during left leg stance phase.
This gait deviation is MOST likely indicative of: