Dunaway Shoulder-related questions (A & B)

While assssing the standing posture of a patient, the therapist notes that a spinous process in the thoracic region is shifted laterally. The therapist estimates that T2 is the involved vertebra because he or she notes that it is at the approximate level of the:

• inferior angle of the scapula

• superior angle of the scapula

• spine of the scapula

• xiphoid process of the sternum

Answer explanation

The superior angle of the scapula commonly rests at the same level as Vertebra T2. The spine of the scapula is approximately at T3. The inferior angle of the scapula and xiphoid process represent T7

A pitcher is exercising in a clinic with a sports cord mounted behind and above his head. The pitcher simulates pitching motion using the sports cord as resistance. Which proprioceptive neuromuscular facilitation (PNF) diagonal is the pitcher using to strengthen the muscles involved in pitching a baseball?

• D1 extension

• D1 flexion

• D2 extension

• D2 flexion

Answer explanation

The pitcher is moving into D2 extension with the throwing motion.  He is strengthening the muscles involved in shoulder internal rotation, adduction, and forearm pronation.

A therapist is mobilizing a patient’s right shoulder. The movement taking place at the joint capsule is not completely to end range. It is a large amplitude movement from near the beginning of available range to near the end of available range. What grade of mobilization according to Maitland, is being performed?

• Grade I

• Grade II

• Grade III

• Grade IV

Answer explanation

Grade I is a small oscillating movement at the beginning of range. Grade III is a large movement up to the end of available range. Grade IV is a small movement at the end of available range

A therapist has been treating a patient who received a rotator cuff surgical repair with sessions consisting only of passive range of motion (for an extended period). The patient has just returned from a follow-up doctor’s visit with an additional order to continue with passive range of motion only. Which of the following is the best course of action for the therapist?

• Continue with passive range of motion as instructed, and call the physician to consult with him or her about the initiation of active range of motion.

• Begin active range of motion within the pain-free range, and continue passive range of motion.

• Continue passive range of motion, and do not question the physician’s decision.

• Perform passive range of motion and any other exercise that is within the normal protocol for this diagnosis.

Answer explanation

It is best to consult with a physician because of an extended amount of passive range of motion. A therapist should not deviate from a physician’s order, but a telephone call to clarify the order is necessary when the therapist feels that another treatment plan is more appropriate.

The therapist is treating a male patient for a second-degree acromioclavicular sprain. The patient has just finished the doctor’s prescription of 3 sessions/week for 4 weeks. The therapist is treating the patient with iontophoresis (driving dexamethasone), deltoid-strengthening exercises, pectoral strengthening exercises, and ice. The patient reports no decline in pain level since the initial evaluation. Which of the following is the best course of action for the therapist?

• Phone the doctor and request continued physical therapy.

• Tell the patient to go back to the doctor because he is not making appropriate progress.

• Discharge the patient because he will improve on his own.

• Take the problem to the supervisor of the facility.

Answer explanation

The patient should have made adequate progress in this period with this protocol. Because of the lack of progress, the patient needs further evaluation by the physician

A therapist working in an outpatient physical therapy clinic evaluates a patient with a diagnosis of rotator cuff bursitis. The physician’s order is to evaluate and treat. During the evaluation the following facts are revealed: Active shoulder flexion = 85o with pain; Passive shoulder flexion = 177 o ; Active shoulder abduction = 93 o with pain; Passive shoulder abduction = 181 o ; Active external rotation = 13 o ; Passive external rotation = 87 o ; Drop arm test = positive; Impingement test = negative; Biceps tendon subluxation test = negative; Sulcus sign = negative. Of the following, which is the best course of action?

• Treat the patient for 1 week with moist heat application, joint mobilization, and strengthening. then suggest to the patient that he or she return to the physician if there are no positive results.

• Treat the patient for 1 week with ultrasound, strengthening, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.

• Treat the patient for 1 week with a home exercise program, strengthening, passive range of motion by the therapist, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.

• Treat the patient for 1 week with strengthening, a home exercise program, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.

Answer explanation

The patient most likely has a rotator cuff tear. Choices A and B are incorrect because there is no need for heating modalities. Choice C is wrong because the patient has full passive range of motion; thus there is no need for stretching provided by the therapist at this point.

What is the closed-packed position of the shoulder?

• Internal rotation and abduction

• External rotation and abduction

• Internal rotation and adduction

• External rotation and adduction

Answer explanation

The area of contact between the humerus and the glenoid fossa is maximal in this position.

A patient with a diagnosis of a rotator cuff tear has just begun active range of motion. The therapist is strengthening the rotator cuff muscles to increase joint stability and oppose the superior shear of the deltoid. Which of the rotator cuff muscles participate least in opposing the superior shear force of the deltoid?

• infraspinatus

• subscapularis

• teres minor

• supraspinatus

Answer explanation

The subscapularis, teres minor, and infraspinatus muscles oppose the superior pull of the deltoid muscle. The supraspinatus does not oppose the pull of the deltoid but is important because (along with other cuff muscles), it provides a compression force to the glenohumeral joint.

A 14-year-old girl with right thoracic scoliosis is referred to physical therapy. The therapist should expect which of the following findings?

• Left shoulder high, left scapula prominent, and right hip high

• Left shoulder low, right scapula prominent, and left hip high

• Right shoulder high, right scapula prominent, and right hip high

• Right shoulder low, right scapula prominent, and left hip high

Answer explanation

The patient probably has a low left shoulder, prominent right scapula and high left hip.

A 67-year-old woman presents to an outpatient facility with a diagnosis of right adhesive capsulitis. The therapist plans to focus mostly on gaining abduction range of motion. In which direction should the therapist mobilize the shoulder to gain abduction range of motion?

• Posteriorly

• Anteriorly

• Inferiorly

• Superiorly

Answer explanation

The therapist must stretch the inferior portion of the capsule in an effort to gain abduction of the involved shoulder. This principle is supported by the convex-concave rule.