Episode 6 – Clinical Decision Making

A physical therapist notes a decrease in passive range of motion in a patient’s affected shoulder as compared to their unaffected shoulder. Which of the following would provide the physical therapist with the MOST valuable information to determine the cause of this discrepancy?

1. Manual muscle testing
2. Joint mobility
3. Sensory testing
4. Active range of motion

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders Team with the opportunity to explore challenging multiple choice examination questions with students actively preparing for the licensing examination.

My name is Scott Giles and I will be your host for today’s journey. 

I want to remind you that at this point it’s important not to become too high or too low based on your performance. If you are 0 for 5 on your last 5 questions, so be it. If you are 5 for 5 on your last 5 questions, good for you but you still have work to do. Instead, let each question serve as an opportunity to strengthen your academic base and improve your decision making skills.

Time to jump into a question. Ready?, let’s go! 

A physical therapist notes a decrease in passive range of motion in a patient’s affected shoulder as compared to their unaffected shoulder. Which of the following would provide the physical therapist with the MOST valuable information to determine the cause of this discrepancy?

1. Manual muscle testing
2. Joint mobility
3. Sensory testing
4. Active range of motion

This is a classic exam question where you’re given an objective piece of data and then asked to drill down and determine the cause of the identified impairment. I feel when you encounter this type of question you should come to a stop sign and attempt to generate an answer to the question, prior to looking at the presented options. 

This strategy allows you to objectively process in advance or upfront, meaning prior to being biased by the options. Processing obviously needs to occur again after the options have been exposed, but this second step can be much easier if you have a clear understanding of the question and know what is being asked.

The question is specifically asking which assessment activity would be most valuable to determine the cause of a decrease in passive range of motion in an affected extremity compared to the contralateral limb. 

Remember, passive range of motion is movement that is produced by an external force without muscular activation from the patient. As a result, if passive range of motion is impaired, a contractile tissue is not likely to be responsible for the range of motion deficit. Additionally, when passive range of motion is impaired, active range of motion is also impaired.

Armed with this information, let’s explore each of the options:

Option 1- Manual muscle testing
Manual muscle testing should be performed as part of a physical therapy examination. However, manual muscle testing values would not directly explain a lack of passive range of motion, as the patient does not need to contract their muscles during passive range.

Option 2 - Joint mobility
Joint mobility assessment provides information about the movement of the bones that articulate to form the affected joint. A finding of hypomobility of the joint can explain a finding of decreased passive range of motion.

Option 3 - Sensory testing
Sensory testing includes superficial, deep (proprioceptive), and cortical (combined) sensations. This information would not be the most appropriate to explain a difference in passive range of motion.

Option 4 - Active range of motion
Active range of motion should have been performed prior to passive range of motion. An observed deficit in active range of motion should cue the therapist to examine passive range of motion. Active range of motion assesses both contractile and noncontractile structures. However, an identified deficit in active range of motion is not necessarily associated with a deficit in passive range of motion.

The correct answer is Option 2

Let’s explore the all student data:

6% of students selected Option 1, Manual muscle testing
62% of students selected Option 2, Joint mobility, the correct response
2% of students selected Option 3, Sensory testing
30% of students selected Option 4, Active range of motion

I like it when I see question data like this, meaning that most students, actually 92% of them, selected the two most viable options. If you were in the 6% camp (option 1) or the 2% camp (option 3), I think you need to ask yourself why you selected that particular option. Basically, why you missed the boat that 92% of people boarded. If you are in that small group and feel bad about it, remember one very important fact – You know how to spell WAS!

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 118-120 from our review book PTEXAM: The Compelte Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/QMEO721PfkE?si=1-z-VL50uwAjF4y_