NPTE-PT Test Test Musculoskeletal System Interventions 1 — Questions and Answers
Question 1: A patient with adhesive capsulitis presents with a capsular pattern of restriction at the shoulder. Which mobilization technique is MOST appropriate to address external rotation limitation?
- Posterior glide of the humeral head
- Anterior glide of the humeral head (Correct answer)
- Inferior glide of the humeral head
- Distraction at the acromioclavicular joint
Correct answer: Anterior glide of the humeral head
An anterior glide of the humeral head is used to increase external rotation at the glenohumeral joint, as the convex humeral head must glide anteriorly on the concave glenoid when the arm externally rotates (convex-on-concave rule).
Question 2: A patient 10 days post-total knee arthroplasty lacks full knee extension and has a 15-degree extension lag. Which intervention is MOST appropriate to address this impairment?
- Active-assisted knee flexion in supine
- Prolonged low-load stretch into extension using a prone hang (Correct answer)
- High-intensity isokinetic strengthening of the quadriceps
- Joint mobilization grades III–IV into flexion
Correct answer: Prolonged low-load stretch into extension using a prone hang
A prolonged low-load stretch (e.g., prone hang) applies a sustained force that promotes viscoelastic creep and plastic deformation of the capsule and soft tissue, which is most effective for improving a fixed extension deficit after TKA.
Question 3: A physical therapist is treating a patient with plantar fasciitis. Which intervention has the STRONGEST evidence for reducing pain in the short term?
- Ultrasound to the plantar fascia insertion
- Night splinting combined with stretching of the plantar fascia and gastrocnemius (Correct answer)
- Iontophoresis with dexamethasone
- Extracorporeal shock wave therapy performed during the acute phase
Correct answer: Night splinting combined with stretching of the plantar fascia and gastrocnemius
Night splinting combined with plantar fascia and Achilles/gastrocnemius stretching is strongly supported by evidence for reducing morning pain by maintaining the foot in a dorsiflexed position and lengthening the fascia overnight.
Question 4: A patient presents with rotator cuff tendinopathy confirmed by MRI. Strengthening exercises are prescribed. Which approach is BEST supported by current evidence?
- High-repetition concentric exercise at end-range elevation
- Progressive heavy slow resistance (HSR) training
- Isometric contractions performed at 70% MVC to reduce pain immediately, followed by isotonic strengthening (Correct answer)
- Open-kinetic-chain internal and external rotation at 0° of abduction only
Correct answer: Isometric contractions performed at 70% MVC to reduce pain immediately, followed by isotonic strengthening
Isometric contractions at high intensity (≥70% MVC) have strong evidence for immediate pain reduction in tendinopathy via cortical pain inhibition, and progressive isotonic loading follows to drive tendon adaptation. HSR is also effective but the combination described reflects best current evidence.
Question 5: A patient 8 weeks post-distal radius fracture ORIF has limited forearm supination to 30°. The radius head is the primary site of restriction. Which mobilization is MOST appropriate?
- Posterior glide of the radial head at the proximal radioulnar joint
- Anterior glide of the radial head at the proximal radioulnar joint (Correct answer)
- Posterior glide of the ulna at the distal radioulnar joint
- Distraction of the radiocarpal joint
Correct answer: Anterior glide of the radial head at the proximal radioulnar joint
Supination of the forearm requires an anterior (ventral) glide of the radial head at the proximal radioulnar joint. Mobilizing into anterior glide directly addresses the capsular restriction limiting this motion.
Question 6: A high school athlete sustains a grade I hamstring strain during a sprint. Which intervention is MOST appropriate during the initial 72 hours?
- Aggressive stretching of the hamstrings to prevent shortening
- Eccentric hamstring loading at end-range to stimulate collagen production
- Protected weight-bearing, pain-free active range of motion, and cryotherapy (Correct answer)
- Immediate return to sport with activity modification
Correct answer: Protected weight-bearing, pain-free active range of motion, and cryotherapy
In the acute inflammatory phase (0–72 hours), management should follow PEACE principles: protection, elevation, avoid anti-inflammatory modalities that impair healing, compression, and education. Pain-free AROM maintains mobility without stressing the healing tissue, and cryotherapy controls pain and swelling.
NPTE-PT Test Test Musculoskeletal System Interventions 1
A patient with adhesive capsulitis presents with a capsular pattern of restriction at the shoulder.
Which mobilization technique is MOST appropriate to address external rotation limitation?