PT 521 EXAM 3 QUESTIONS WITRH CORRECT ANSWERS LATEST UPDATE 2026

PT 521 EXAM 3 QUESTIONS WITRH CORRECT ANSWERS LATEST UPDATE 2026 how does joint range of motion differ from muscle length testing - Answers joint ROM: motion available at any single joint that occurs within cardinal planes muscle length testing: ability of the muscles surrounding the joint to lengthen, allowing one joint or a series of joints to move through the available range of motion arthrokinematics - Answers actual movement of the joint surface - spin, roll, glide osteokinematics - Answers -quality and degree of motion observed of the whole bone - occurs in planes of motion around an axis or rotation axis or rotation non-pathologcal joints vs pathological joints - Answers non pathological: AOR is fixed within the convex portion of the joint pathological: AOR may change its location throughout the range of motion procedure for ROM - Answers 1. explain procedure to patient 2. properly position patient in testing position 3. stabilize the proximal joint segment 4. instruct the patient on the motion to be performed 5. palpate bony landmarks and take an initial measurement 6. move patient through available ROM 7. re palpate bony landmarks and take end measurement 8. return to initial testing position 9. record patients measurement AROM or PROM which is measured first? (no right answer) - Answers AROM: allows examiner to determine how much patient is willing to move joint & observe function task provides examiner with information on multiple joints PROM: allows examiner to determine the totoal range or motion that the patient possesses and provides information to determine any limitations to full ROM = end feel bony end feel - Answers Approximation of two bones with an abrupt, hard stop to obtaining more motion potential end feels - Answers bony firm soft empty muscle spasm springy block boggy firm/capsular end feel - Answers Motion is limited by joint capsule/non-contractile tissues Firm muscular end feel - Answers motion is limited by muscular tension; not as firm as the capsular end-feel soft end feel - Answers approximation of soft tissue that is limiting further ROM empty end feel - Answers motion is limited due to patients complaint of pain muscle spasm end feel - Answers Guarded, restricted by muscular contraction, muscle reaction can be felt, end-feel impossible to test because of pain and guarding springy block end feel - Answers Slight "rebound" at the end ROM may suggest an internal derangement of the joint boggy end feel - Answers swelling limits movements. Joint feels rubbery what factors affect ROM - Answers - changes across lifespan - gender - occupation/recreational activities - patients SINS - anatomy (bony structure, joint capsule, surrounding ligaments, muscle) 4 articulations at shoulder complex - Answers 1. glenohumeral joint (synovial, ball and socket) 2. acromioclavical joint (synovial, planar) 3. sternoclavicular joint (synovial, planar) 4. scapulothoracic joint (not a true joint) motions available at the shoulder - Answers flex/ext add/abd ER/IR mobility and stability of shoulder joint - Answers decreased stability, increased mobility three articulations of the elbow - Answers 1. humeroradial 2. humeroulnar 3. proximal radioulnar what kind of joint is the elbow - Answers hinge joint - humeroulnar = hinge - humeroradial = plane motions available at elbow - Answers flexion and extention forearm joints - Answers proximal and distal radioulnar joints - pivot joints proximal radioulnar joint - what articulates - Answers convex radial head & annular ligament with concave radial notch of ulna distal radioulnar joint- what articulates - Answers concave ulnar notch of radius and convex ulnar head what motion is available at the forearm - Answers supination and pronation articulations at the wrist - Answers distal end of radius with the proximal row of carpal bones motions available at the wrist - Answers flexion and extension ulnar and radial deviation shoulder flexion ROM - Answers 0 to 160-180 shoulder extension ROM - Answers 0 to 50-60 shoulder abduction ROM - Answers 0 to 170-180 shoulder external rotation ROM - Answers 0 to 80-90 shoulder internal rotation ROM - Answers 0 to 60-90 elbow flexion ROM - Answers 0 to 140-150 - soft end feel elbow extension ROM - Answers 0-10 - hard/bony end feel forearm supination ROM - Answers 0 to 90 - firm forearm pronation ROM - Answers 0 to 80-90 - firm wrist flexion ROM - Answers 0 to 80-90 wrist extension ROM - Answers 0 to 70-90 ulnar deviation ROM - Answers 0 to 30-45 radial deviation ROM - Answers 0-15 intervertebral joints are composed of - Answers - superior and inferior facets - vertebral bodies - intervertebral discs Lumbar spine facet orientation - Answers backwards and medial (sagittal plane what limits lumbar flexion ROM - Answers - posterior longitudinal ligament - ligamentum flavum - interspinous ligament - supraspinous ligament what limits lumbar extension ROM - Answers - anterior longitudinal ligament what limits lumbar rotation - Answers facet orientation what limits lumbar side bending - Answers intertransverse ligaments thoracic spine facet orientation - Answers backwards, upwards, lateral (BUL) - frontal plane what limits thoracic extension - Answers - anterior longitudinal ligament - spinous process half of cervical spine ROM occurs where - Answers upper cervical spine (C1 and C2) atlanto-occipital joint atlantoaxial joint lower cervical spine - Answers C3-C7 limitations of upper cerivcal spine rotation - Answers tectorial membrane alar ligament atlantoaxial ligaments - transverse ligament what limits lower cervical flexion ROM - Answers - posterior longitudinal lig - ligamentum flavum - interspinous ligament - supraspinous ligaments what limits lower cervical extension ROM - Answers - anterior longitidinal ligament - spinous process what limits lower cervical rotation - Answers - annular fibers of disc what limits lower cervical side bend ROM - Answers - bony configuration of saddle-shaped surfaces of vertebral bodies lumbar flexion tape measure method measurement - Answers 3-5cm side bending tape measure method measurement - Answers 22cm extension tape measure method measurement - Answers 1-2 cm cervical flexion ROM - Answers 0-45 cervical extension ROM - Answers 0-45 cervical rotation ROM - Answers 70-80 cervical side bend ROM - Answers 0-45 what to document with ROM - Answers - patients name - date measurement is taken - AROM/PROM - patient position if not standard - joint being measured - data - end feel CNS - Answers brain and spinal cord peripheral nervous system - Answers spinal and cranial nerves - motor - sensory - autonomic: sympathetic, parasympathetic, enteric what should you look for during observation- neuro screen - Answers - posture - asymmetry - muscle atrophy - fasciculations - involuntary movement, tremors face: - eye position and involuntary eye movement - speech abnormalities - facial weakness - lack of facial expression autonomic signs: - skin changes - perspiration of lack of - change in pupil sign - abnormal vital signs UE specific neuro subjective questions to ask - Answers - clumsiness or dropping items? - shooting or radiating pain from neck down arm? - weakness? - sensory changes? diplopia - Answers double vision what cranial nerves are associated with diplopia - Answers CN III, IV, VI what cranial nerves are associated with difficulty chewing and speaching - Answers CN V what cranial nerves are associated with sensroy changes on the face - Answers CN V what cranial nerves are associated with weakness of the face - Answers CN VII what cranial nerves are associated with hearing loss, dizziness - Answers CN VIII what cranial nerves are associated with hoarseness, difficulty swallowing - Answers CN IX, X, XII general red flags during a neurologic screening - Answers - bowel/bladder dysfunction - sexual dysfunction - onset of peripheral symptoms with acute neck or back pain - severe headache with other neurologic signs (subarachnoid hemorrhage) - neck stiffness with fever (meningeal irritation) hyperreflexia - Answers Exaggerated reflex response = UMN hyporeflexia - Answers lack of appropriate reflexes = LMN UE deep tendon reflexes and associated spinal nerve - Answers C5: biceps C6: brachioradialis C7: triceps pathologic reflex of UE - Answers hoffman's reflex UE myotomes - Answers C5: elbow flexors (shoulder abductors) C6: wrist extensors (elbow flexors) C7: elbow extensors (wrist flexors) C8: finger flexors T1: finger abductors 5 important nerves in arm & segmentation - Answers radial (C5-T1) median (C6-T1) ulnar (C8-T1) axillary (C5-C6) musculocutaneous (C5-C7) radial nerve motor function - Answers extension at all arm, wrist, and proximal finger joints below the shoulder; forearm supination; thumb abduction in plane of palm radial nerve sensory map - Answers median nerve motor function - Answers thumb flexion and opposition, flexion of digits 2 and 3, wrist flexion and abduction, forearm pronation median nerve sensory map - Answers ulnar nerve motor function - Answers -finger adduction and abduction other than thumb -thumb adduction -flexion of digits 4 and 5 -wrist flexion and adduction ulnar nerve sensory map - Answers axillary nerve motor function - Answers abduction of arm at shoulder beyond first 15 degrees - ER & horiz abd GH axillary nerve sensory map - Answers musculocutaneous nerve motor function - Answers flexion of arm at elbow supination of forearm musculocutaneous nerve sensory map - Answers wrist drop - Answers radial nerve injury/palsy preacher's hand - Answers median nerve palsy ulnar claw - Answers ulnar nerve palsy simian hand - Answers median and ulnar nerve palsy 6 key areas for sensory testing - Answers AC joint: C4, supraclavicular nerves lateral antecubital fossa: C5, lateral antebrachial cutaneous nerve (musculocutaneous n) dorsal thumb: C6, radial nerve palmar surface of middle finger: C7, median nerve palmar surface of 5th finger: C8, ulnar n medial antecubital fossa: T1, medial antebrachial cutaneous nerve (medial cord) neurologic screening components (9) - Answers - observation - subjective - reflexes - sensory exam - motor exam - gait/balance - coordination - cranial nerve function - mental status LE deep tendon reflexes - Answers patellar achilles pathologic reflexes - Answers - babinski and hoffman's - indicate UMN sensory screening examination components - Answers light touch pin prick vibration observing gait and balance - Answers - observe stance, posture, stability, how high feet raise of the floor, trajectory of swing leg, problems in initiating or stopping - assistive device - heel- and toe- walking - romberg, sharpended romberg muscle tone - Answers tension attained at any moment between origin and insertion of a muscle - the tension is determined partly by mechanical factors and degree of motor unity activity hypertonia - Answers - increased resistance to passive ROM of a joint - commonly seen in people with stroke, brain injury, multiple sclerosis, cerebral palsy, or other UMN involvement hypotonia - Answers - decreased resistance to passive ROM of a joint - commonly seen in people with LMN involvement and some cases of CNS involvement (cerebellum) rigidity - Answers increased resistance to movement throughout the entire ROM in both directions of movement - commonly seen in people with parkinson's dysmetria - Answers overshooting or undershooting the intended target with the limb or eye what are you looking for when testing coordination - Answers can they turn muscles on and off at the right time trajectory of movement - fluid/smooth or not? trigemnial nerve (CN V) function - Answers facial sensation to light tough facial nerve (CN VII) function - Answers facial motor function components of mental status - Answers - behavior, language, affect - level of alterness - orientation: self, time, location, situation - assess attention: list months forward and backward - immediate registration or delayed recall: remember 3 items and repeat later what is different about testing children with adult MMT and ROM - Answers differences - smaller bodies - cognition, abilty to follow directions of the test - cooperation similarities - same landmarks - same testing principles what do you need to know to be successful in testing children - Answers - age - cognition - behavior - level of cooperation motivation is key! what is considered pediatrics - Answers birth to 21 yrs old based of skeletal development/maturation newborn ROM - Answers normal contractures - hip flexion - knee flexion - elbow flexion muscle contracture - Answers shortening of muscle tissue, rendering the muscle highly resistant to passive or active movement when do we expect childern to have same ROM values or adults - Answers - somewhere between 2-6 yrs old depending on joint - generally increased flexibility and ROM as compared with adults when should hip flexion contracture resolve - Answers around 2 yrs old when should knee hyperextension resolve - Answers around 6-10 yrs old when should shoulder external rotation resolve - Answers around 2 yrs old when should elbow hyperextension resolve - Answers around 2-3 yrs old wolfs law - Answers bone will adpat to loads under which it is placed - increase stress of long bones will change structure/alignment - contributes to normal changes in torsion of long bones due to muscle force and shear forces placed on developing child's bones lower extremity alignment changes with age - Answers newborn - moderate genu varum 6 months - minimal genu varum 1yr, 7 mo - legs straight 2yrs, 6mo - physiologic genu valgum & protective toeing in 4 to 6 yrs - legs straight what causes infant long bones into a more neutral position - Answers - upright standing and ground reaction forces craigs test, thigh foot angle and transmelleolar axis - Answers used in conjunction to measure rotation/torsion of LE - looks at femoral anteversion/retroversion, tibial torsion and metatarsus adductus special tests for LE alignment - Answers craigs test thigh foot angle transmalleolar axis movement analysis movement patterns in childern may not be what we expect because - Answers childern choose movement patterns based on efficiency, strength, energy expenditure and past experience infant head to body ration - Answers large head, heaviest part of body - drives movement because head influences balance point/COM growth spurt impacts in ROM - Answers - as bones grow rapidly, muscle length takes more time to catch up = loss of ROM and decreased flexibility until muscles accommodate what objective measures would you see impacted during a growth spurt - Answers SLR popliteal angle PKB what are growing pains - Answers muscles pulling at insertion to the bone skeletal changes that occur during growth spurts - Answers - as muscles get stronger and shorter/tighter, increased pull on bondy attachment sites called apophyses - because bones are softer and moldable, we may see pronounced bony prominences at muscle tendinous junction to bone strength increases are due to - Answers - muscle mass - myelination - coordination of activation and relaxation - motor unit activation muscle mass in childern - Answers - affected by gender, genetics, exercise and diet - most skeletal muscle has developed by birth, some increase in muscle fibers during first yr - increase in muscle mass most significantly at adolescence when children go through their pubertal growth spurt myelination - Answers starts in utero and continues into adolescence - plays a role in body's ability to enlist more motor units = muscle mass muscle coordination development - Answers practice and motor learning principles allow for development of coordination of muscle activation and relaxation patterns ex. infants roll with only back extensors -- back extensors + abs co-contract (uncoordinated) -- coordinate activation and relaxation of abs and back extensors to segmentally roll throughout entire axial skeleton development of locomotion patters before 2-2.5 yrs of age - Answers - walking -running - single leap - jumping down or bounce jumping galloping development of locomotion patterns before 3 yrs of age - Answers hopping on dominant foot development of locomotion patterns between 4-7 years of age - Answers hopping on non dominant foot skipping sideways galloping or sliding ROM in children depend on - Answers - cultural variations: biological or lifestyle factors - growth spurts: bone vs muscle length manual muscle testing in children under 5 yrs old - Answers - less reliable: may not understand or be willing to cooperate - must know normal developmental motor milestones and behavior use of force in MMT for children - Answers - use same amount of force in order to be consistent with force application observing functional activities as a test for strength - Answers - know the child is at least a 3/5 if they can move the segment against gravity - can see range, symmetry, rhythm, smoothness, age- appropriate performance specific diagnoses in children related to MMT/strength - Answers - muscular dystrophy - obstetrical brachial plexus injury - scoliosis surgery - spina bifida - trauma factors that influence MMT in children - Answers - cultural - environmental: experiences - motivational - mental state: alert, crying considerations for working with pediatric population - Answers - creativity is key - child friendly language - can you explain what PT does - can you explain what muscles do - remain professional but not scary - have plan A, B, C, D - give child choices - model characteristics and behaviors that elicit positive response - use parent to gather info and help motivate participation - educate parent as they will be with patient at home - SAFETY! attire when working with kids - Answers - professional - non intimidating: no white coats - comfort/ allow for movement common shoulder complaints - Answers - pain - stiffness - weakness - instability - deformity - locking - swelling - catching, grinding, popping diagnoses steps - Answers 1. pathoanatomy 2. determine body structure and function impairments 3. assess irritability of patient common shoulder diagnoses - Answers GH instability scapular instability labral pathology biceps pathology rotator cuff pathology adhesive capsulitis thoracic outlet syndrome brachial plexus traction injury cervical/thoracic spine involvement 4 shoulder classifications - Answers pain and muscle power deficit pain and mobility deficits stability and movement coordination impairments other what classification does rotator cuff syndrome and subacrominal pain syndrome fit into? - Answers pain with muscle power deficits what classification does adhesive capsulitis fit into - Answers pain and mobility deficits what classification does GH instability fit into - Answers stability and movement coordination impairments common diagnoses that does not fit in classification/classify as other - Answers fracture arthritis post surgical neural myofascial pain fibromyalgia GH arthritis presentation - Answers - decreased ROM - pain with movement and or rest - crepitus - weakness (disuse, pain) - no joint space, bone spurs, bony changes ACJ seperation presentation - Answers - traumatic onset: snowboarding, football, falls - step off deformity - palpation pain - pain with overhead activities - C-A & C-C ligaments shoulder pain and muscle power deficits should be ruled in if - Answers - symptoms worse with repetitive overhead activity - symptoms caused by acute strain such as fall - midrange catching sensation/arc of pain with elevation manual resitive tests to rotator cuff muscles, performed in midranges of shldr flexion and abd reproduce pain - rotaotr cuff muscle weakness shoulder pain and muscle power deficits should be ruled out if - Answers - resistive tests are pain free - supraspinatus, infraspinatus, and biceps brachii have normal strength - significant loss of passive range shoulder pain and mobility deficits should be ruled in if - Answers - age 45-55 - gradual onset of symptoms and progressively worsening - pain/stiffness limit sleeping, grooming, dressing and reaching - GH PROM limited with ER most - GH ER and IR ROM decreases at humerus is abducted from 45 to 90 - PROM reproduces pain - joint glides restricted in all directions shoulder pain with mobility deficits should be ruled out if - Answers - passive PROM is normal - radiographic evidence of arthritis - passive GH ER and IR increase as humerus abd from 45 to 90 - shoulder pain is reproduced with palpation of subscapularis - upper limb nerve tension testing reproduces symptoms and shoulder pain is altered by nerve tension - shoulder pain reproduced with palpation of peripheral nerve entrapment site shoulder stability and movement coordination impairments should be ruled in if - Answers - age less than 40 - history of shoulder dislocation - excessive GH accessory motion in multiple directions - apprehension at end ranges of flexion, horizontal abd, or external rotation shoulder stability and movement coordination impairments should be ruled out if - Answers - no history of dislocation - presence of global GH motion limitations - no apprehension with end range active or passive motions shoulder objective exam includes - Answers - observation and posture analysis - movement analysis - functional task analysis - AROM and PROM - scapular alteration tests - flexibility testing - joint accessory motion - selective tissue testing - MMT - palpation - special tests how does thoracic postion affect should - Answers kyphosis can lead to limited shldr flexion how can humeral position cause pain - Answers anterior humeral glide can cause anterior shldr pain scapular position in relation to spine (superior angle, scapular spine, medial border, inferior angle - Answers superior angle: T2 scapular spine: T3-T4 medial border: 3' from spinous process inferior angle: T7-T9 scapulohumeral rhythm - Answers 0-30 deg- no scapular motion, humerus elevated 30-90 deg- scapular upward rotation, humeral elevation (5:4) 90-180 deg- scapular upward rotation, humeral elevation (1:1) humerus and scap contribution to flexion or abduction - Answers humerus does 120 degrees scap moves 60 degrees - scap should initiate at 60 degrees flexion breakdown of the 60 degrees of scapular upward rotation - Answers 30 degrees from AC joint and 30 degrees from SC joint normal scapular motion - Answers stable during initial 30 -60 of humeral elevation, smoothly and continously rotates upward during elevation and downards during arm lowering dysrhythmia definition, mobility deficit and muscle performance impairment - Answers scapula demonstrates premature or delyaed upward rotation, non smooth stuttering, or rapid downward rotation during arm lowering - mobility deficit: levator scapula, rhomboids - muscle performance impairment: upper trap, lower trap, serratus anterior winging definition, mobility deficit and muscle performance impairment - Answers scapular medial border and or inferior angle are posteriorly displaced away from posterior thorax - mobility deficit: pec minor - muscle performance impairment: serratus anterior, middle trapezius, lower trapezius, rhomboids what would be an indication to do the scapular repositioning test - Answers scapular winging what would be an indication to do the scapular assist test - Answers anterior tipping, lack of upward rotation, dysrhythmia humeral translation on glenoid with extension - Answers posterior humeral translation on glenoid with flexion - Answers anterior, inferior humeral translation on glenoid with abudction - Answers anterior, inferior humeral translation on glenoid with adduction - Answers superior humeral translation on glenoid with internal rotation - Answers posterior humeral translation on glenoid with external rotation - Answers posterior obligate translation - Answers humeral head translates in direction opposite of tightness - observed translations of humerus are due to asymmetrical tightness of capsule, not capsular laxity ex. anterior capsule tightness, so humeral head glides posterior capsular restriction pattern of the shoulder - Answers characteristic restriction or loss of ROM due to pathology of joint/joint capsule - ERABDIR onsets of adhesive capsulitis - Answers 1. insidious 2. following trauma pathology or surgery rotator cuff tendinopathy - Answers - commonly due to overuse/overload collagen disorganization/thickening - inflammationdegenerationfailure - increased vascularity and cellularity