NPTE-PT Musculoskeletal System Interventions 3 — Questions and Answers
Question 1: A patient 6 weeks post total knee arthroplasty is having difficulty achieving full knee extension. Which intervention should be prioritized?
- Aggressive high-load knee flexion
- Terminal knee extension exercises and prone knee extension stretching (Correct answer)
- Aquatic therapy for knee flexion
- Electrical stimulation for quadriceps only
Correct answer: Terminal knee extension exercises and prone knee extension stretching
Achieving full knee extension after TKA is critical to prevent flexion contracture; terminal knee extension exercises and prolonged low-load stretching in prone are prioritized.
Question 2: Which soft tissue mobilization technique involves applying pressure perpendicular to the muscle fiber direction to break up adhesions?
- Effleurage
- Petrissage
- Cross-friction massage (Correct answer)
- Tapotement
Correct answer: Cross-friction massage
Cross-friction massage (Cyriax technique) applies transverse pressure perpendicular to tissue fibers to break adhesions and promote proper collagen remodeling.
Question 3: A patient with patellofemoral pain syndrome shows weakness in which muscle group that most commonly contributes to the condition?
- Ankle plantarflexors
- Hip abductors and external rotators (Correct answer)
- Knee flexors (hamstrings)
- Ankle dorsiflexors
Correct answer: Hip abductors and external rotators
Weakness in hip abductors and external rotators leads to dynamic valgus collapse and increased lateral patellar stress, contributing to PFPS.
Question 4: When using neuromuscular electrical stimulation (NMES) for quadriceps strengthening post-ACL reconstruction, which parameter produces the strongest muscle contraction?
- Low frequency (2–10 Hz), long pulse width
- High frequency (50–80 Hz), long pulse width (Correct answer)
- High frequency (50–80 Hz), short pulse width
- Low frequency (2–10 Hz), short pulse width
Correct answer: High frequency (50–80 Hz), long pulse width
High frequency (50–80 Hz) with a longer pulse width (200–400 µs) recruits more motor units and produces the strongest tetanic muscle contraction for NMES.
Question 5: Which orthopedic special test is used to assess for a SLAP lesion of the shoulder?
- Hawkins-Kennedy test
- Active compression (O'Brien's) test (Correct answer)
- Neer impingement test
- Empty can test
Correct answer: Active compression (O'Brien's) test
O'Brien's active compression test is specifically designed to detect SLAP lesions and AC joint pathology through resisted internal and external rotation in flexion.
Question 6: A patient with a Colles' fracture is 6 weeks post-cast removal. What is the PRIMARY therapeutic goal at this stage?
- Strengthening with heavy resistance
- Restoring wrist and forearm range of motion (Correct answer)
- High-impact loading activities
- Full return to sport
Correct answer: Restoring wrist and forearm range of motion
Immediately after cast removal for Colles' fracture, restoring wrist and forearm ROM is the primary goal before progressive strengthening can begin.
Question 7: Which type of muscle contraction generates the greatest force output?
- Concentric contraction
- Isometric contraction
- Eccentric contraction (Correct answer)
- Isokinetic concentric contraction
Correct answer: Eccentric contraction
Eccentric contractions produce the greatest force because passive elastic elements (titin) contribute alongside active cross-bridge cycling, resulting in supramaximal force.
NPTE-PT Musculoskeletal System Interventions 3
A patient 6 weeks post total knee arthroplasty is having difficulty achieving full knee extension.
Which intervention should be prioritized?