NPTE-PT Musculoskeletal System Examination 4 — Questions and Answers
Question 1: The capsular pattern of the glenohumeral joint is restriction in which order of movements?
- Flexion > Abduction > External rotation
- External rotation > Abduction > Internal rotation (Correct answer)
- Abduction > Internal rotation > Flexion
- Internal rotation > External rotation > Abduction
Correct answer: External rotation > Abduction > Internal rotation
The glenohumeral capsular pattern as described by Cyriax is greatest restriction in external rotation, followed by abduction, then internal rotation.
Question 2: A patient demonstrates weakness in toe extension (hallux) and foot drop. Which nerve is most likely injured?
- Tibial nerve
- Common peroneal nerve (deep branch) (Correct answer)
- Superficial peroneal nerve
- Femoral nerve
Correct answer: Common peroneal nerve (deep branch)
The deep peroneal (fibular) nerve innervates the tibialis anterior and extensor hallucis longus; injury causes foot drop and inability to extend the great toe.
Question 3: During the scapular winging test, medial scapular winging during a wall push-up is caused by weakness of which muscle?
- Trapezius (lower fibers)
- Serratus anterior (Correct answer)
- Rhomboid major
- Subscapularis
Correct answer: Serratus anterior
Serratus anterior weakness (long thoracic nerve palsy) causes medial scapular winging during pushing activities as the medial border lifts off the thorax.
Question 4: Which of the following BEST describes the end-feel of a normal elbow extension?
- Firm (capsular)
- Soft (soft tissue approximation)
- Hard (bony) (Correct answer)
- Empty
Correct answer: Hard (bony)
Normal elbow extension has a hard/bony end-feel due to the olecranon process contacting the olecranon fossa, abruptly stopping motion.
Question 5: Which test differentiates between lumbar spinal stenosis and vascular claudication?
- Straight leg raise
- Bicycle test (van Gelderen's test) (Correct answer)
- Slump test
- Prone knee bend
Correct answer: Bicycle test (van Gelderen's test)
The bicycle test differentiates neurogenic (spinal stenosis) from vascular claudication: symptoms with upright cycling but relief with forward-flexed cycling suggest neurogenic origin.
Question 6: A patient with SLAP (superior labrum anterior to posterior) tear would most likely test positive on which examination?
- Empty can test
- Speed's test and O'Brien's active compression test (Correct answer)
- Drop arm test
- Sulcus sign
Correct answer: Speed's test and O'Brien's active compression test
Speed's test (resisted shoulder flexion with elbow extended) and O'Brien's test are commonly positive with SLAP lesions involving the biceps anchor.
Question 7: In a patient with Achilles tendinopathy, which clinical finding would indicate a chronic degenerative (tendinosis) pattern rather than acute reactive tendinopathy?
- Pain worse in the morning that eases with activity
- Diffuse warmth and swelling along the tendon
- Nodular thickening and pain mid-tendon with load (Correct answer)
- Severe pain at rest with marked swelling
Correct answer: Nodular thickening and pain mid-tendon with load
Nodular mid-tendon thickening and load-dependent pain are characteristic of chronic tendinosis (degenerative collagen disarray) rather than acute reactive changes.
NPTE-PT Musculoskeletal System Examination 4
The capsular pattern of the glenohumeral joint is restriction in which order of movements?