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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?

The exercise that most selectively and effectively activates the tibialis posterior is:

You begin study of a T2w sagittal knee study with 4-millimeter slices that begins laterally and progresses medially. What structure will you encounter last as you study the images in chronological order?

A 19-year-old patient had a Boxer’s fracture 4 weeks ago after punching a wall.  The patient had ORIF surgery 3 weeks ago.  Postoperative positioning in an ulnar gutter cast should hold the MP joints in _____.

A patient arrives in your clinic with symptoms of severe cervical pain of 8 days with no specific cause, but states that she has severe pain of an 8/10 that “comes and goes”.  The patient states that she is very worried because these symptoms can come on without any real warning and that the pain is in the suboccipital region and will “stop her in her tracks”.   What following objective finding would heighten your suspicion of VBI?

Which surgical technique would provide the most stability after a bony Bankart injury?

SECTION I – MULTIPLE CHOICE QUESTIONS Please enter your “answer” for the questions in this section using Canvas.  These questions have been selected from the exam associated with the Independent Study course monographs you have read.

What is the next physical examination test that should be conducted to determine their cause of mobility symptoms?