NPTE-PT Test Musculoskeletal System Interventions Questions and Answers — Questions and Answers
Question 1: A physical therapist is treating a patient with posterior glenohumeral instability. Which of the following exercises would be MOST appropriate to include in the initial phase of rehabilitation?
- Wall push-ups with a plus
- Prone horizontal abduction with external rotation (Correct answer)
- Sidelying internal rotation with a dumbbell
- Cross-body adduction stretching
Correct answer: Prone horizontal abduction with external rotation
For posterior glenohumeral instability, it is crucial to strengthen the posterior deltoid and external rotators while avoiding positions that stress the posterior capsule. Prone horizontal abduction with external rotation effectively targets these muscles. Wall push-ups, internal rotation, and cross-body adduction can all potentially increase posterior stress and should be avoided or modified in the early stages.
Question 2: A patient is 4 weeks post-arthroscopic partial meniscectomy of the right knee. The patient presents with minimal effusion and full active range of motion. Which of the following interventions is MOST appropriate to add at this stage?
- High-impact plyometric drills
- Deep squats with heavy resistance
- Closed-chain quadriceps strengthening, such as mini-squats (Correct answer)
- Isokinetic testing for return to sport
Correct answer: Closed-chain quadriceps strengthening, such as mini-squats
At 4 weeks post-partial meniscectomy, with good ROM and minimal swelling, the focus should shift to developing strength. Closed-chain exercises like mini-squats are appropriate for improving quadriceps strength and control in a functional manner. High-impact activities, heavy resistance, and isokinetic testing are typically introduced much later in the rehabilitation process.
Question 3: A physical therapist is using the hold-relax proprioceptive neuromuscular facilitation (PNF) technique to increase hamstring flexibility. What are the correct parameters for the isometric contraction phase?
- A maximal contraction for 1-2 seconds
- A submaximal contraction for 20-30 seconds
- A concentric contraction through the full range of motion
- A submaximal contraction for 6-10 seconds (Correct answer)
Correct answer: A submaximal contraction for 6-10 seconds
The hold-relax PNF technique involves moving the limb to the point of tissue resistance, followed by a submaximal isometric contraction of the muscle being stretched (the hamstrings, in this case). Research and clinical guidelines suggest this contraction should be held for about 6-10 seconds to trigger autogenic inhibition via the Golgi tendon organs, allowing for a greater subsequent passive stretch.
Question 4: A patient presents with acute subacromial impingement syndrome with significant pain during active range of motion. A physical therapist decides to use joint mobilization to decrease pain. Which Maitland grade of mobilization is MOST appropriate?
- Grade III
- Grade IV
- Grade II (Correct answer)
- Grade V
Correct answer: Grade II
Maitland Grades I and II are used primarily for pain modulation. Grade II mobilizations are large-amplitude movements performed within the pain-free range of motion. Since the patient is pain-dominant, a Grade II mobilization would be appropriate to reduce pain and improve mobility without provoking symptoms. Grades III and IV are used to address stiffness and stretch into tissue resistance, which would be too aggressive for an acute, painful condition.
Question 5: A physical therapist is developing a plan of care for a patient who has elected for non-operative management of a complete Achilles tendon rupture. According to current evidence-based protocols, which of the following is the MOST likely instruction for the first two weeks?
- Partial weight-bearing in a neutral walking boot
- Immobilization in a cast or boot in a position of plantar flexion, non-weight-bearing (Correct answer)
- Gentle active range of motion into dorsiflexion to prevent contractures
- Full weight-bearing as tolerated with bilateral crutches
Correct answer: Immobilization in a cast or boot in a position of plantar flexion, non-weight-bearing
Non-operative management of an acute Achilles tendon rupture initially requires immobilization with the foot in a plantar flexed position to approximate the torn ends of the tendon. This is typically done in a cast or a boot with heel lifts, and the patient is kept non-weight-bearing for the initial 2 weeks to allow healing to begin.
Question 6: A patient underwent an arthroscopic Bankart repair for anterior shoulder instability 8 weeks ago. The patient has achieved full passive range of motion and demonstrates good initial strength of the rotator cuff. Which of the following activities should the patient continue to AVOID?
- Active-assisted supine external rotation to 90 degrees
- Resisted internal rotation in the scapular plane
- Isometrics for the deltoid and rotator cuff
- Coupled motion of 90 degrees of abduction and 90 degrees of external rotation (Correct answer)
Correct answer: Coupled motion of 90 degrees of abduction and 90 degrees of external rotation
Following a Bankart repair, the 'at-risk' position of combined abduction and external rotation places significant stress on the repaired anterior labrum and capsule. This position is typically avoided for at least 12 weeks post-operatively to protect the healing tissues. The other activities listed are generally appropriate and part of the progressive strengthening phase at 8 weeks post-op.
NPTE-PT Test Musculoskeletal System Interventions Questions and Answers
A physical therapist is treating a patient with posterior glenohumeral instability.
Which of the following exercises would be MOST appropriate to include in the initial phase of rehabilitation?