marcus williams
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Hey Kristin,
Below are a couple links to some more recent articles that investigated this topic. The key takeaways for this question is to appreciate that these test should be associated with meniscus tears and clusters are best. This is information would only appear in the context of background info for a larger case type question.
https://www.jospt.org/doi/10.2519/jospt.2015.5215
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513660/Marcus
Hey Michaela,
This is actually a key error on our end we’ll get in there an update that one. Thanks for letting us know. Sorry for in confusion this might of caused.
Marcus
Hey Michaela,
You’re correct. This question was designed (intentionally sneaky) to remind test takers to take the information provided literal. 10/10 to 8/10 is subtle, but it should still be considered an improvement until stated otherwise.
Marcus
Hey Kristin!
Thanks for the question. So with the 2021 revision to the LBP CPG came strong supporting evidence for the utilization of both thrust and non-thrust mobilization for patients with chronic LBP (without leg pain). This came in addition to the ongoing strong evidence that supports the use of thrust and non-thrust mobilizations for patients with acute LBP. We intentionally worded the question this way to highlight this new strongly support recommendation. So to you’re question, specifically, this is the correct answer because this patient present with recurring chronic LBP (aka duration of symptoms) which was a new revelation that came from the 2021 revision. prior to that being published that wouldn’t have been the case.
Let me know if you have any more questions.
Happy Studying!
Marcus
Hey Kendra!
You’re absolutely correct in both your answer and the process you used to make that decision.
Thanks for being this to our attention!
Good Luck!!
Marcus
you’re welcome… No there is a lot of strong evidence supporting nerve mobs as a primary treatment for radiating pain. You’re decision making algorithm should always start with which of the highest rated intervention are indicated here, if the patient is in severe unrelenting pain, you’ll want to pick the most conservative intervention option first even if the more aggressive intervention appears to be slightly more supported with the findings provided.
If the patient is in severe pain with all activities, and based on what is provided it’s unclear as to how they have responded to DP exercise, then YES assume that DP is the most appropriate starting point.
The severe pain with all activities, is the key overriding factor, otherwise in any other circumstance you would follow the decision making algorithm per usual.
https://academic.oup.com/ptj/article/96/7/1057/2864925
this article is probably you’re best reference to grasp how to navigate the low treatment classification. You’re absolutely correct that manipulation would be appropriate, but only if you we certain centralization had plateaued with directional exercises, we didn’t state that specifically but set the table knowing that people would easily make that assumption.
On the actual OCS exam, never assume, go strictly with the facts given. They can only test you on what is explicitly asked. And rest assured that if a question is written poorly, it will be consistent answered incorrectly and they will throw the question out.
I hope thats helpful?
Happy Friday Shannon!
Thanks for bring this to our attention. We’ll get an updated summary reflecting the 2018 revision for this CPG posted in a couple days.
Marcus
Gotcha! Thanks for clarifying.
Yes this questions is tricky. Purely looking at it from a CPR standpoint indicates manipulation, but the most recent low back treatment based classification introduced a new paradigm for intervention selection. Given the severity of symptoms, this case falls into the symptom modulation classification which indicates the use patient led directional exercises prior to manipulation.
Hey Amanda! Are you referring to this questions?
“A 30-year-old male IT consultant was referred to you by his personal trainer. He complains of low back pain for the past 2 weeks that has caused him to miss several days of work. He reports that the pain is primarily in the right lower lumbar region, although he occasionally experiences pain and numbness into the right gluteal region when sitting at work or performing a seated leg press at the gym. His symptoms are worse in the morning and typically improve once he gets started with his morning routine. He also complains of intermittent pain in the upper lumbar region. He rates his pain at 2/10 on a visual analog scale (VAS) during the majority of the day. At worst, the pain is rated as 7/10 on a VAS when he is sitting at his desk for prolonged periods. On physical examination, he has a normal gait. Lumbar flexion is painful. Repeated flexion reveals aberrant motion when returning to an upright position. Right rotation and right side-bending are painful and limited. Extension is limited at end-range but not painful. Hip mobility is within normal limits. Hip abduction strength is 4/5 on the right; otherwise, manual muscle testing is within normal limits. His Modified Oswestry Low Back Pain Disability Questionnaire score indicates a 50% disability. His Fear-Avoidance Beliefs Questionnaire work and physical activity scores were both 15. Segmental mobility assessment reveals hypomobility at the L4-L5 and L5-S1 segments”
Based on the available information, what would be the best intervention to start?
If so, the correct answer would be thrust manipulation.
Thanks
Hey Amanda! Below is some further explanation.
#11 – in isolation we wouldn’t expect pain to be a preliminary chief complaint. However, when dealing with an active individual it’s reasonable to assume the impact of repetitive activity will be some development of shoulder pain, likely non-specific posterior shoulder pain. In this questions, the neers test served as a distraction, the painful arc between 90-120 points to the weakness being a contributor to the symptoms verses it being purely a structural irritation according under the compressive forces at end-range.
#31 – if the supraspinatus was involved, due to entrapment at the supra scapular notch, we would expect to see more appreciable weakness in abduction up to 90 degrees, which would likely result in a MMT of less than a 4/5. Also, atrophy would likely be a little more pronounce across the entire posterior scapula and not infraspinatus.
Hey Amanda! Below is some further explanation.
#11 – in isolation we wouldn’t expect pain to be a preliminary chief complaint. However, when dealing with an active individual it’s reasonable to assume the impact of repetitive activity will be some development of shoulder pain, likely non-specific posterior shoulder pain. In this questions, the neers test served as a distraction, the painful arc between 90-120 points to the weakness being a contributor to the symptoms verses it being purely a structural irritation according under the compressive forces at end-range.
#31 – if the supraspinatus was involved, due to entrapment at the supra scapular notch, we would expect to see more appreciable weakness in abduction up to 90 degrees, which would likely result in a MMT of less than a 4/5. Also, atrophy would likely be a little more pronounce across the entire posterior scapula and not infraspinatus.
Hi Amanda,
Thanks for this question! The stem provides some mixed information, indicating a couple possible differentials. Given the limited information, we must make a decision based on prevalence. Isolated C8-T1 radiculopathy is rare. Ulnar nerve entrapments are much more common. The article linked below provides some more information.
https://pubmed.ncbi.nlm.nih.gov/24494175/
Marcus
Kay,
Thanks for the question. This particular question comes from EMG research conducted by Mike Reinold, Kevin Wilk and colleagues. In there studies, They demonstrated that full can scaption and sidelying ER at 0 abduction are the best option to for rotator cuff activation and decreased deltoid activity. In our question that incorrect answer should have been standing ER with towel under arm, not sidelying with towel under arm (as this exercise wasn’t tested). Sorry for that error, and making this question overly complicated. We’ll email you over the articles referenced above.
Marcus
