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According to the Ross et al. article regarding clinical tests of the posterior tibialis tendon, the most reliable test which correlated to observable changes on ultrasound imaging was the:

Magnitude of change for an individual patient is much greater than the clinically important difference between two groups of patients, such as comparison done in clinical trials.

A 38 y/o male presents to the clinic with a chief complaint of heel cord pain, which worsens with running. He reports onset of symptoms was about 4 months ago around the time he increased his training level for an upcoming marathon he is competing in.  Clinical presentation at initial evaluation reveals the absence of observable increase in swelling, redness, or warmth.  According to the Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopahty Clinical Practice Guidelines:   Which of the following statements is TRUE, in regards to the Tendon changes associated with the pathological process of midsubstance Achilles Tendinopathy?

Your patient is a 25 y/o recreational hockey goalie who was playing in a men’s league game when he made a save as an opposing player collided into the anterior-medial aspect of his knee and forcing his R knee into hyperextension.  He felt a “pop” and had immediate pain and swelling in the knee.  He went to the ER, where radiographs were obtained and were negative for fx.  He was evaluated by an orthopedist, had MRI (results pending) and was referred to physical therapy.  One week after his injury, he has a primary complaint of 5/10 pain with walking, stairs, and bending.  He also reports intermittent perception of instability during pivoting movements.  Gait pattern is consistent with knee hyperextension thrust (“quadriceps avoidance pattern’) during loading response.  He lacks 15* of active ROM into both flexion and extension as compared to the L side.  Decreased tone and muscle activation was noted with quadriceps setting on the R, and SLR revealed a 10* extension lag.  Anterior-lateral knee pain with a step-down test was reproduced at 30-40** of knee flexion.  R quadriceps maximum voluntary isometric contraction was 900 N as compared to 1200 N on the L.  (The R was 75% of the L)  The dial test, Posterior sag, and posterior drawer test at 90*were all + on the R.  The Lachman’s test, and varus stress test at 30* knee flexion were negative on the R. Trace effusion was noted inferior and lateral to the patella on the R.  The patient’s Knee Outcome Survey was 57% and his LEFS score was 60%. Upon integrating the data from the initial evaluation, your hypothesis about the patient’s problem would be:  

Which of the following red flags, used for patients with low back pain, actually INCREASES the likelihood of having cancer?  

The patient is a 43-year-old man who works in a factory where he is responsible for operating a drill press and lifting heavy (25kg) cases of metal plates over his head several times throughout the day. He presents with a chief complaint of chronic low back pain that ranges from 3/10 at rest to 9/10 at the end of the day. He denies lower limb pain; he also denies lower limb numbness or muscle weakness. His symptoms began several years ago when he tried to stop a pallet of metal plates from falling off a truck. He felt a tearing sensation in his back and indicates that it has not been “right” since that time. He has had several periods of lost work time due to low back pain and has currently been out of work on a worker’s compensation claim for one month. This patient has had 2 lumbar magnetic resonance imaging examinations that revealed mildly degenerative, bulging disks at L4-5 and L5-S1. His previous physical therapy treatment has been centered on pain control approaches using moist heat and ultrasound. He indicates that he was instructed in the performance of sit-up exercises but stopped doing them after a couple of days because they increased his pain. He has avoided physical activity and exercise since that time. Which of the factors listed below is LEAST likely to contribute to a poor prognosis for improvement of this patient’s functional capacity?

The patient was able to perform lateral step-downs on a 4-inch step 15 times before she became fatigued. During her execution of this exercise, you noticed that her pelvis was dropping on the uninvolved side.  What is your hypothesis regarding the cause of the pelvic drop?

A pt is referred to your outpatient clinic from a local PCP with a dx of R knee pain, ? meniscus tear. The PCP wants you to confirm his diagnosis (you are the 2nd opinion).  Additionally, the pt wants to try “conservative” management and delay any surgical intervention at this time.  Based on the Orthropaedic Sections’s Knee Pain and Mobility Impairments CPG’s and best available evidence, which cluster of clinical exam tests/measures would you perform at this time to best assist you in confirming or ruling-in involvement of this structure?

The patient is a 22-year-old female with complaints of bilateral medial leg pain. She started “boot camp” at the regional army training facility 3 weeks ago and the pain has been progressively increasing since that time. She states she has had similar pain before but it has always resolved on its own. This time it seems to be getting worse, and she really wants to get back to her squad. The current pain ranged from 4/10 to 7/10 increasing with activity. The pain can be mostly described as a relative ache but local to the medial side of her leg. She is overweight with a BMI of 29 but has been losing weight over the last year after she decided to enlist with the army. She also starting running. She quit smoking 6 months ago. Upon observation the patient had low medial longitudinal arches and a valgus position of the hindfoot bilaterally. Sensation tested with light touch was normal in bilateral lower extremities. Pain to palpation was present along the distal half of the posterior medial tibial border extending down to just above the medial malleolus. Passive ROM at the ankle was full in all planes except limited dorsiflexion to 8° when the knee was flexed. The patient was able to complete 25 single leg heel raises on the right with pain and 20 on the left, again with pain.   The presence of the following signs may support a diagnosis of medial tibial stress syndrome:

Use this information for the next three questions.  A 32‐year‐old recently post‐partum female presents to outpatient therapy with widespread left buttockpain. She is positive for concordant pain during sacral thrust, left thigh thrust, sacroiliac joint gapping,and sacroiliac joint compression. She has vague, nonconcordant pain and tenderness with lumbar jointaccessory mobility assessment. Quantitative sensory testing reveals widespread reduced pressure painthresholds. She also expresses signs of post‐partum depression. She reports difficulty managing herweight since she recently stopped breast‐feeding. Prior to and during pregnancy she enjoyed walkingand Pilates; however, she now is fearful of returning to previous levels of activity due to her pain. Shereports a lack of sleep due to frequent feedings for her newborn during the night.     Which of the following special tests during pregnancy is most associated with greater post‐partum disability and lower post‐partum health‐related quality of life?