OCS Clinical Management of Musculoskeletal Disorders 3 — Questions and Answers
Question 1: A patient with lumbar spinal stenosis reports that walking downhill increases their symptoms more than walking uphill. What is the primary reason?
- Downhill walking increases lumbar flexion
- Downhill walking increases lumbar extension, further narrowing the canal (Correct answer)
- Downhill walking increases compressive forces on the discs
- Downhill walking reduces core activation
Correct answer: Downhill walking increases lumbar extension, further narrowing the canal
Walking downhill promotes lumbar extension which reduces foraminal and central canal dimensions, exacerbating neurogenic claudication symptoms in stenosis.
Question 2: A 40-year-old presents with acute wrist pain after a FOOSH injury. X-ray is negative, but anatomical snuffbox tenderness is present. What is the most appropriate next step?
- Discharge with activity modification
- MRI of the wrist to rule out scaphoid fracture (Correct answer)
- Splint the thumb and reassess in 6 weeks
- Begin early mobilization exercises
Correct answer: MRI of the wrist to rule out scaphoid fracture
Anatomical snuffbox tenderness with a negative X-ray warrants MRI to rule out an occult scaphoid fracture, as untreated fractures can lead to avascular necrosis.
Question 3: Which manual therapy technique is most appropriate for a patient with a cervicogenic headache originating from C1-C2 dysfunction?
- Upper cervical high-velocity low-amplitude thrust manipulation
- Cervical traction at 20° flexion
- Sustained natural apophyseal glide (SNAG) at C1-C2 (Correct answer)
- Soft tissue massage to the suboccipital region only
Correct answer: Sustained natural apophyseal glide (SNAG) at C1-C2
SNAGs applied to C1-C2 are evidence-supported for cervicogenic headache and are considered safer than thrust manipulation for the upper cervical spine.
Question 4: A patient with adhesive capsulitis in the freezing stage has 60° shoulder flexion and 15° external rotation. What is the primary treatment priority?
- Aggressive end-range joint mobilization
- Pain management and gentle active ROM (Correct answer)
- Rotator cuff strengthening
- Scapular stabilization exercises
Correct answer: Pain management and gentle active ROM
During the freezing (painful) stage of adhesive capsulitis, pain management and gentle active ROM take priority, as aggressive mobilization worsens inflammation.
Question 5: An athlete sustains a grade II MCL sprain of the knee. When can return to sport typically be expected?
- 1-2 weeks
- 2-4 weeks
- 3-6 weeks (Correct answer)
- 8-12 weeks
Correct answer: 3-6 weeks
Grade II MCL sprains (partial tear) typically allow return to sport in 3-6 weeks with appropriate rehabilitation targeting quadriceps strength and proprioception.
Question 6: Which outcome measure is most appropriate for tracking functional disability in a patient with lumbar radiculopathy?
- Numerical Pain Rating Scale alone
- Oswestry Disability Index (ODI) (Correct answer)
- Patient-Specific Functional Scale (PSFS)
- Visual Analog Scale for pain
Correct answer: Oswestry Disability Index (ODI)
The Oswestry Disability Index is the gold standard outcome measure for lumbar spine disorders, capturing functional limitations across multiple daily activities.
Question 7: Which tissue has the poorest intrinsic healing capacity in the musculoskeletal system?
- Bone
- Muscle
- Articular cartilage (Correct answer)
- Tendon
Correct answer: Articular cartilage
Articular cartilage has the poorest intrinsic healing capacity due to its avascular nature and limited chondrocyte proliferative ability.
OCS Clinical Management of Musculoskeletal Disorders 3
A patient with lumbar spinal stenosis reports that walking downhill increases their symptoms more than walking uphill.
What is the primary reason?