OCS Clinical Management of Musculoskeletal Disorders 2 — Questions and Answers
Question 1: A patient with lateral epicondylalgia has failed 6 weeks of conservative treatment. Which intervention has the strongest evidence for chronic cases?
- Corticosteroid injection
- Eccentric strengthening exercise (Correct answer)
- Ultrasound therapy
- Immobilization with a brace
Correct answer: Eccentric strengthening exercise
Eccentric strengthening exercises targeting the wrist extensors have the strongest long-term evidence for chronic lateral epicondylalgia, outperforming corticosteroid injections beyond 6 weeks.
Question 2: During assessment of a patient with suspected De Quervain's tenosynovitis, which provocative test is most specific for this condition?
- Phalen's test
- Finkelstein's test (Correct answer)
- Tinel's sign at the wrist
- Watson's scaphoid shift test
Correct answer: Finkelstein's test
Finkelstein's test, performed by ulnar deviating the wrist with the thumb tucked in the fist, is the classic provocative test for De Quervain's tenosynovitis.
Question 3: A 55-year-old presents with insidious onset hip pain, groin aching, and limited internal rotation. X-ray shows joint space narrowing. Which manual therapy approach is most appropriate initially?
- High-velocity thrust manipulation to the hip
- Inferior hip joint distraction mobilization (Correct answer)
- Sacroiliac joint manipulation
- Lumbar traction
Correct answer: Inferior hip joint distraction mobilization
Inferior hip joint distraction mobilization is appropriate for hip osteoarthritis to restore joint mobility and reduce pain before progressing to other interventions.
Question 4: A runner presents with medial tibial stress syndrome. Which biomechanical factor is most commonly implicated in its development?
- Excessive hip external rotation
- Increased contralateral pelvic drop during stance (Correct answer)
- Forefoot supination at heel strike
- Decreased cadence
Correct answer: Increased contralateral pelvic drop during stance
Contralateral pelvic drop (Trendelenburg pattern) increases tibial internal rotation stress and is a primary biomechanical contributor to medial tibial stress syndrome.
Question 5: Which special test is most sensitive for detecting a posterior cruciate ligament (PCL) injury?
- Posterior drawer test at 90° flexion (Correct answer)
- Valgus stress test at 30° flexion
- McMurray's test
- Dial test at 30°
Correct answer: Posterior drawer test at 90° flexion
The posterior drawer test at 90° knee flexion is the most sensitive and specific clinical test for PCL integrity.
Question 6: A patient post-rotator cuff repair (supraspinatus) is 8 weeks post-op. Which activity is most appropriate at this stage?
- Resisted shoulder abduction with theraband
- Active-assisted shoulder flexion to 90° (Correct answer)
- Closed-chain push-up progression
- Overhead press with light dumbbells
Correct answer: Active-assisted shoulder flexion to 90°
At 8 weeks post rotator cuff repair, active-assisted ROM within protective limits is appropriate; resisted exercises risk re-tear before tendon-to-bone healing is sufficient.
Question 7: Which nerve is most at risk during anterior surgical approach to the hip (Smith-Petersen approach)?
- Sciatic nerve
- Femoral nerve
- Lateral femoral cutaneous nerve (Correct answer)
- Obturator nerve
Correct answer: Lateral femoral cutaneous nerve
The lateral femoral cutaneous nerve courses near the anterior superior iliac spine and is at highest risk of injury during the Smith-Petersen anterior hip approach.
OCS Clinical Management of Musculoskeletal Disorders 2
A patient with lateral epicondylalgia has failed 6 weeks of conservative treatment.
Which intervention has the strongest evidence for chronic cases?