Spine and peripheral joint conditions

60 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Spine and peripheral joint conditions, part of Musculoskeletal Rehabilitation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   After eight weeks of splinting and a steroid injection with little lasting relief, a patient shows thenar wasting, and EMG shows axonal loss with fibrillations in abductor pollicis brevis. What is the next step?

   1. ARefer to a hand surgeon for carpal tunnel release
   2. BContinue splinting for a further six months
   3. CAdd heavier grip strengthening
   4. DRepeat the steroid injection weekly

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   Answer: A · Refer to a hand surgeon for carpal tunnel release

   Thenar wasting and axonal loss mean severe compression with risk of permanent motor damage, and a failed conservative trial. Surgical decompression is indicated to protect nerve function. Delay worsens recovery.

   • B: More splinting delays decompression in severe disease.
   • C: Grip strengthening raises tunnel pressure.
   • D: Repeated weekly steroid injections risk tendon damage.

   Remember this

   Thenar wasting or axonal loss with failed conservative care calls for surgical referral.

2. Question 2 · Medium

   After carpal tunnel release, which early rehabilitation measure is appropriate?

   1. AImmobilisation of all the fingers in a splint for six weeks
   2. BHeavy gripping exercises started from the first day after surgery
   3. CTendon and nerve gliding exercises with scar desensitisation
   4. DSustained wrist hyperextension stretches beyond the pain limit

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   Answer: C · Tendon and nerve gliding exercises with scar desensitisation

   Early gentle gliding, finger movement and scar massage help prevent adhesions and tenderness, while heavy gripping is delayed until wound healing. Prolonged immobilisation causes stiffness.

   • A: Immobilising the fingers causes stiffness.
   • B: Heavy gripping early risks wound pain and swelling.
   • D: Forceful hyperextension loads the healing wound.

   Remember this

   After release, start gentle gliding and scar care early; delay heavy gripping.

3. Question 3 · Medium

   Which exercise approach has the strongest support for chronic lateral epicondylalgia?

   1. AProgressive loading, such as slow eccentric or heavy slow resistance wrist extension
   2. BRepeated corticosteroid injections used on their own for relief
   3. CComplete immobilisation in a splint for a period of six weeks
   4. DPassive stretching of the wrist extensors used on its own

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   Answer: A · Progressive loading, such as slow eccentric or heavy slow resistance wrist extension

   Tendinopathy responds to progressive load that stimulates collagen remodelling. Eccentric and heavy slow resistance exercises for the wrist extensors reduce pain and improve grip. Long-term outcomes of steroid injection are worse.

   • B: Steroid injections give short relief but poorer outcomes at 6-12 weeks.
   • C: Immobilisation weakens the tendon.
   • D: Stretching alone does not load the tendon.

   Remember this

   Chronic tendinopathy is treated with progressive tendon loading.

4. Question 4 · Easy

   In Phalen's test, how is the wrist positioned and for how long?

   1. AMaximal wrist flexion for about 60 seconds
   2. BRadial deviation for 10 seconds
   3. CMaximal wrist extension for about 5 seconds in a prayer position
   4. DFist clenched for 2 minutes

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   Answer: A · Maximal wrist flexion for about 60 seconds

   The patient holds the wrists flexed, back to back or against the table, for up to 60 seconds. Reproduction of numbness or tingling in the median territory is positive.

   • B: Radial deviation is not the test position.
   • C: Wrist extension is the reverse Phalen position, usually held longer.
   • D: A fist clench is not Phalen's test.

   Remember this

   Phalen's test is sustained wrist flexion for about 60 seconds.

5. Question 5 · Easy

   Which muscle is the main target of the abdominal drawing-in manoeuvre used in lumbar stabilisation training?

   1. AIliacus and psoas major
   2. BExternal oblique muscle
   3. CRectus abdominis muscle
   4. DTransversus abdominis

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   Answer: D · Transversus abdominis

   Gently drawing the lower abdomen inwards without moving the pelvis activates transversus abdominis, the deep corset muscle that stiffens the lumbar spine ahead of limb movement. It acts with multifidus. Trunk flexors such as rectus abdominis should stay relaxed.

   • A: Iliopsoas flexes the hip and is not part of the drawing-in action.
   • B: External oblique is a superficial rotator and flexor.
   • C: Rectus abdominis is a superficial trunk flexor, not the target.

   Remember this

   Drawing-in trains transversus abdominis, the deep stabiliser, with multifidus.

6. Question 6 · Medium

   A woman has heel pain with a tight calf. Which stretch is most beneficial alongside plantar fascia stretching?

   1. AGastrocnemius and soleus stretching
   2. BQuadriceps muscle stretching
   3. CHip abductor muscle stretching
   4. DHamstring muscle stretching on its own, without any calf work

   Answer and explanation in LearnFree account

7. Question 7 · Easy

   A therapist finds the glenohumeral capsule restricted. In which order do the movements lose range in the capsular pattern?

   1. AInternal rotation most limited, then abduction, then external rotation
   2. BExternal rotation most limited, then abduction, then internal rotation
   3. CAbduction most limited, then flexion, then extension
   4. DFlexion most limited, then external rotation

   Answer and explanation in LearnFree account

8. Question 8 · Easy

   In the windlass test, which action reproduces heel pain in plantar fasciitis?

   1. ASqueezing the calcaneus from the sides
   2. BPassive extension of the great toe while weight-bearing
   3. CResisted ankle inversion
   4. DPassive plantarflexion of the ankle

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   In the craniocervical flexion test, the pressure biofeedback unit is inflated to what baseline before the patient nods?

   1. A20 mmHg
   2. B10 mmHg
   3. C30 mmHg
   4. D40 mmHg

   Answer and explanation in LearnFree account

10. Question 10 · Hard

    A man with knee osteoarthritis weighs 110 kg and loses 10% of his weight. Using the rule that each 1 kg lost reduces the knee load by about 4 kg per step, by how much does the compressive load per step fall?

    1. AAbout 4 kg
    2. BAbout 110 kg
    3. CAbout 11 kg
    4. DAbout 44 kg

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    Why is aquatic exercise useful for an obese patient with painful knee osteoarthritis?

    1. ABuoyancy reduces joint loading while allowing movement and strengthening
    2. BWater compresses the joint surfaces and so lubricates them
    3. CIt prevents all further cartilage wear in the knee joint
    4. DCold water removes any need for a strengthening programme in the clinic at all

    Answer and explanation in LearnFree account

12. Question 12 · Medium

    A man has bilateral hand clumsiness, an unsteady gait and a positive Hoffmann sign. Which diagnosis should be suspected, and what should be done?

    1. AThoracic outlet syndrome, so stretch the scalene muscles
    2. BCervical myelopathy, so refer promptly for a medical opinion
    3. CTension-type headache, so teach relaxation and posture
    4. DCervical radiculopathy, so start intermittent cervical traction

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A clerk has forward head posture with chronic neck ache. Which pair of muscle groups should be strengthened?

    1. ASternocleidomastoid and the scalene muscles
    2. BSuboccipital muscles and pectoralis minor
    3. CUpper trapezius and levator scapulae muscles
    4. DDeep cervical flexors and lower trapezius

    Answer and explanation in LearnFree account

14. Question 14 · Easy

    Which medical condition is most strongly associated with adhesive capsulitis?

    1. AEssential hypertension
    2. BPostmenopausal osteoporosis
    3. CBronchial asthma
    4. DDiabetes mellitus

    Answer and explanation in LearnFree account

15. Question 15 · Hard

    During sustained cervical rotation and extension before treatment, a patient develops dizziness, double vision and slurred speech. What is the best response?

    1. APerform a high-velocity thrust once the symptoms have settled down
    2. BTreat with soft tissue work and reassess at the next weekly visit
    3. CReturn to neutral, stop manual therapy and refer urgently for medical review
    4. DHold the position for another 30 seconds to confirm the finding before stopping

    Answer and explanation in LearnFree account

16. Question 16 · Hard

    A man has median-distribution paraesthesia with positive Phalen's and Tinel's signs, and also neck pain with a positive Spurling's test. What is the best interpretation and plan?

    1. APossible double crush, so assess and treat both the neck and the wrist
    2. BCubital tunnel syndrome, so splint the elbow in extension
    3. CPure cervical radiculopathy, so the wrist findings can be ignored
    4. DPure carpal tunnel syndrome, so the neck findings can safely be ignored

    Answer and explanation in LearnFree account

17. Question 17 · Easy

    Where is the pain of plantar fasciitis typically felt, and when?

    1. AAt the medial calcaneal tubercle, worst with the first steps in the morning
    2. BOver the lateral malleolus, worst after exercise on uneven ground or after sport
    3. CIn the forefoot, worse at night and after a long period of rest
    4. DOver the mid-portion of the Achilles tendon when climbing stairs

    Answer and explanation in LearnFree account

18. Question 18 · Easy

    Cozen's test is positive in lateral epicondylalgia when which action reproduces lateral elbow pain?

    1. AResisted wrist extension
    2. BResisted elbow flexion
    3. CResisted shoulder abduction
    4. DResisted wrist flexion

    Answer and explanation in LearnFree account

19. Question 19 · Hard

    A 26-year-old man has bilateral heel pain for four months, morning back stiffness lasting over an hour, and improvement with exercise. What is the best action?

    1. ARefer for medical assessment of possible spondyloarthropathy
    2. BPrescribe a night splint and discharge the patient
    3. CTreat as simple plantar fasciitis using calf stretches and taping
    4. DAdvise rest until the pain stops completely

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    Firm bony swellings are found over the distal interphalangeal joints of an older woman's fingers. Her morning stiffness lasts about 10 minutes. What are these swellings?

    1. AHeberden's nodes of osteoarthritis
    2. BBouchard's nodes of osteoarthritis
    3. CGanglia of the flexor tendon sheaths
    4. DRheumatoid nodules of rheumatoid arthritis

    Answer and explanation in LearnFree account

21. Question 21 · Hard

    A cricket ball strikes a batsman's fingertip, and he cannot actively straighten the distal joint of the middle finger. Radiographs show no fracture. Which management is standard?

    1. AStart active distal joint flexion exercises at once
    2. BSplint the distal joint in extension continuously for 6 to 8 weeks
    3. CBuddy-strap the finger and return to play straight away
    4. DSplint both finger joints in flexion for 2 weeks

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22. Question 22 · Hard

    A 52-year-old man with diabetes has had a stiff shoulder for six months. Pain is 2/10 at rest, night pain has settled, and flexion is 100, abduction 80 and external rotation 10 degrees with a firm end-feel. What is the best plan?

    1. APain-relief oscillations only, with rest, as for the painful stage
    2. BEarly rotator cuff strengthening with heavy resistance through range
    3. CReassurance that it will resolve without treatment within two weeks
    4. DStiffness-stage care: grade III-IV mobilisation, sustained stretching and a home programme

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23. Question 23 · Hard

    A woman has pain over the right posterior superior iliac spine. Distraction, thigh thrust and sacral thrust tests reproduce her pain, and repeated lumbar movements do not centralise it. Which conclusion is best supported?

    1. AThe sacroiliac joint is excluded because compression was not tested
    2. BThe sacroiliac joint is a probable source of her pain
    3. CA lumbar disc is the likely source because pain did not centralise
    4. DThe hip joint is the source because the thigh thrust was positive

    Answer and explanation in LearnFree account

24. Question 24 · Easy

    Carpal tunnel syndrome typically causes sensory symptoms in which area?

    1. ADorsum of the thumb web space
    2. BLittle finger and ulnar half of the ring finger
    3. CThumb, index, middle and the radial half of the ring finger
    4. DThe whole forearm

    Answer and explanation in LearnFree account

25. Question 25 · Easy

    A carpenter has pain at the lateral epicondyle on gripping and extending the wrist. Which tendon origin is most often the source?

    1. ATriceps brachii
    2. BBiceps brachii
    3. CFlexor carpi radialis
    4. DExtensor carpi radialis brevis

    Answer and explanation in LearnFree account