The Ottawa Ankle rules are commonly used to determine the need for imaging after an ankle fracture. Which of the following accurately captures how the Ottawa Ankle Rule performs clinically?

The patient reports, “spraining” his ankle one week ago playing basketball. Pain is 0/10 at rest, but intermittently increases to 5/10 at end of day. He is unable to run, play basketball, and walk long distances (> 1/2 mile) without some discomfort. He is currently playing in a recreational basketball league and would like to return to play in 2 weeks. The patient is currently wearing a lace up stabilizing brace. Radiographs were taken 2 days after injury and were negative with regard to any fracture. He reports having had multiple episodes of rolling his ankle without traumatic injuries.   Objective examination On initial examination there was mild swelling over the lateral ankle.  The patient complained mild pain pain at the anterior talocrural joint line, the anterior talofibular ligament and, and the distal fibula. Ottawa ankle rules are negative. Range of motion at the ankle which involves combined talocrural and subtalar motion was limited in dorsiflexion and eversion on the involved side. An anterior drawer test was positive. Instability of the subtalar joint was evident upon inversion mobilization testing. Gait was antalgic but the patient was able to bear full weight on the ankle. Strength was limited in dorsiflexion (4/5) and eversion (3+/5). Balance was impaired with inability to single limb stand on the involved side for greater than 10 seconds.   Which of the following is considered the most important clinical finding in determining whether a patient will develop chronic ankle instability?

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?

OutcomesThe patient returned to the physical therapy clinic after 2 sessions of physical therapy over a 2‐week period. She regularly performed the prescribed home exercise program and was compliant with allactivity modification recommendations. She was reporting less perceived stiffness upon awakening andwith activities of daily living. She noted the pain intensity decreased to no more than 3/10. The patientnoted feeling encouraged and being ready for a multifaceted rehabilitation program to achieve heractive lifestyle and fitness goals.    This individual considered herself to be a fit and active person. Given her condition and observedimpairments, what cardiovascular activity would be the most appropriate for her to reinitiate ifthe goal was to minimize pain and preserve long‐term integrity of the hip joint?

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?

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?

A 20 yo male sustained a grade I acromioclavicular joint sprain. You are toward the end of the subacute phase of rehab and there is continued limitations in clavicular elevation which is preventing upper extremity elevation. You chose to perform a joint mobilization to the sternoclavicular joint. In what direction should you mobilize the clavicle?

Use the below case information to answer the next 4 questions  A 39 year old right-handed male patient is referred to physical therapy with a chief complaint of neck and arm pain.    The pain is located on the left side of the neck and down the left arm.  He describes the location on left lateral neck, left anterolateral shoulder, and lateral arm down to mid forearm.   The pain is a constant, sharp shooting, radiating pain that he rates as an 8/10 on a numerical pain rating scale.  He also states that he has numbness and tingling along the lateral arm and forearm.  The physical therapist begins the examination with postural assessment.  The physical therapist notices that the patient maintains a slightly sidebend head to the right.  The change in the patient’s pain; extension is limited to 35 degrees with increased pain in the neck, shoulder, and arm; rotation to the right is 78 degrees with no change in symptoms; and rotation to the left is 49 degrees with slight increase in symptoms.  Neurological testing is performed and the patient has weakness in the left biceps brachii and extensor carpi radalis longus and brevis, absent sensation on the left distal thumb, and diminished deep tendon reflexes at the brachioradialis.  All other areas tested normal.  The Spurling test is performed and is positive on the left while negative on the right.  An upper limb tension test with a median nerve bias is also performed on the this patient.  The results on the right show that the patient is able to get shoulder abduction to 100 degrees, external rotation to 85 degrees, full forearm pronation, ulna deviation, wrist extension, and elbow extension 20 degrees from full extension.  The left shows 100 degrees shoulder abduction, external rotation to 60 degrees, forearm pronation to 50 degrees, full ulnar deviation and wrist extension, and elbow extension to 45 degrees from full elbow extension.  

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

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. During your physical examination of this patient you note that, surprisingly, he has full range of motion of his lumbar spine and lower extremities. However, he has great difficulty controlling the position of his spine and pelvis when trying to perform a simulated lift that is similar to his job requirements. This task also increases his pain intensity but does not cause it to peripheralize. Given only this currently obtained information, which of the treatment approaches listed below is most supported by the literature?