DPT Patient Evaluation & Diagnosis 4 — Questions and Answers
Question 1: A patient has right cervical rotation limited to 40° (normal ~80°) with reproduction of right-sided neck and upper trapezius pain at end range. This is MOST consistent with which joint pattern?
- Non-capsular pattern — disc involvement
- Capsular pattern — facet joint arthritis (Correct answer)
- Muscle guarding without joint pathology
- Upper motor neuron lesion
Correct answer: Capsular pattern — facet joint arthritis
Symmetric limitation of cervical rotation and pain at end range in rotation is consistent with a facet joint capsular pattern.
Question 2: When palpating the posterior superior iliac spine (PSIS) during the standing flexion test, the PSIS on the right rises higher. This suggests:
- Left sacroiliac joint hypermobility
- Right innominate rotation restriction
- Left lumbar facet restriction
- Right sacroiliac joint restriction (Correct answer)
Correct answer: Right sacroiliac joint restriction
The moving PSIS (right) suggests the sacroiliac joint on that side is restricted and 'drags' the innominate superiorly during lumbar flexion.
Question 3: A patient presents with paresthesia in the fourth and fifth digits, positive Tinel's sign at the cubital tunnel, and intrinsic muscle atrophy. Which nerve is MOST likely involved?
- Median nerve at the carpal tunnel
- Radial nerve at the radial tunnel
- Ulnar nerve at the cubital tunnel (Correct answer)
- Anterior interosseous nerve
Correct answer: Ulnar nerve at the cubital tunnel
Ring and small finger paresthesia, positive Tinel at the elbow, and intrinsic wasting are classic signs of ulnar nerve entrapment at the cubital tunnel.
Question 4: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is BEST classified as which type of outcome measure?
- Performance-based measure
- Clinician-reported outcome measure
- Patient-reported outcome measure (Correct answer)
- Observer-rated functional scale
Correct answer: Patient-reported outcome measure
The DASH is a patient-reported outcome measure (PROM) because the patient self-rates disability and symptom severity.
Question 5: During cervical AROM assessment, a patient reports radicular pain down the right arm with right lateral flexion combined with extension. This is MOST consistent with:
- Cervical myelopathy
- Right cervical nerve root compression (Correct answer)
- Left cervical nerve root compression
- Vertebral artery insufficiency
Correct answer: Right cervical nerve root compression
Ipsilateral lateral flexion with extension closes the right intervertebral foramen, compressing the nerve root and producing ipsilateral radicular symptoms.
Question 6: In the HOAC II (Hypothesis-Oriented Algorithm for Clinicians), which step occurs BEFORE establishing goals?
- Re-evaluation
- Identify consultation needs
- Generate a problem statement (Correct answer)
- Establish a prognosis
Correct answer: Generate a problem statement
In HOAC II, the clinician first collects data and generates a problem statement, which then informs goal-setting and hypothesis formation.
Question 7: A patient demonstrates a positive Hawkins-Kennedy test but a negative drop arm test. Which shoulder pathology is MOST likely?
- Full-thickness rotator cuff tear
- Subacromial impingement syndrome (Correct answer)
- Acromioclavicular joint sprain
- Glenohumeral instability
Correct answer: Subacromial impingement syndrome
Hawkins-Kennedy is sensitive for subacromial impingement; a negative drop arm test makes a full-thickness tear less likely.
DPT Patient Evaluation & Diagnosis 4
A patient has right cervical rotation limited to 40° (normal ~80°) with reproduction of right-sided neck and upper trapezius pain at end range.
This is MOST consistent with which joint pattern?