Tomorrow is my physiotherapy in orthopedics practical examination of my university. Kindly give me the important topics that I should focus on and study.
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I now have enough information to give you a thorough, well-organized answer. Here it is:
Physiotherapy in Orthopedics - Practical Exam: High-Priority Topics
Practical exams in orthopedic physiotherapy typically test you on assessment skills, special tests, treatment techniques, and case-based reasoning. Here's a structured breakdown of what you must know cold before tomorrow.
1. Assessment Framework (Core Practical Skill)
Every station or viva will expect you to demonstrate a systematic assessment. Memorize this sequence:
S - Subjective → O - Objective → A - Assessment → P - Plan (SOAP)
The objective assessment covers:
- Observation/Inspection - posture, deformity, swelling, muscle wasting, gait
- Palpation - bony landmarks, joint line tenderness, temperature, crepitus
- ROM (Range of Motion) - active, passive, and resisted; know normal values
- MMT (Manual Muscle Testing) - MRC grading 0-5
- Special Tests (see below per joint)
- Neurological screen - dermatomes, myotomes, reflexes
- Functional assessment
2. Goniometry - Normal ROM Values (High-frequency practical topic)
| Joint | Movement | Normal ROM |
|---|---|---|
| Shoulder | Flexion / Extension | 180° / 60° |
| Shoulder | Abduction | 180° |
| Shoulder | IR / ER | 70° / 90° |
| Elbow | Flexion / Extension | 150° / 0° |
| Wrist | Flexion / Extension | 80° / 70° |
| Hip | Flexion / Extension | 120° / 30° |
| Hip | Abduction / Adduction | 45° / 30° |
| Hip | IR / ER | 45° / 45° |
| Knee | Flexion / Extension | 135° / 0° |
| Ankle | DF / PF | 20° / 50° |
| Cervical spine | Flexion / Extension | 45° / 45° |
| Lumbar spine | Flexion | 80-90° |
3. Special Tests by Joint (Must-Know)
Shoulder
| Test | Condition Tested |
|---|---|
| Neer's sign / Hawkins-Kennedy | Subacromial impingement |
| Empty Can (Jobe's) | Supraspinatus tear |
| Painful arc | Impingement / rotator cuff |
| Apprehension + Relocation test | Anterior instability |
| Speed's test / Yergason's | Bicipital tendinopathy / SLAP |
| O'Brien's (Active Compression) | SLAP lesion, AC joint |
| Sulcus sign | Inferior instability |
| Drop arm test | Complete rotator cuff tear |
Elbow
| Test | Condition |
|---|---|
| Cozen's / Mill's test | Lateral epicondylitis (Tennis elbow) |
| Golfer's elbow test | Medial epicondylitis |
| Valgus / Varus stress test | UCL / RCL integrity |
| Tinel's at cubital tunnel | Ulnar nerve entrapment |
Wrist & Hand
| Test | Condition |
|---|---|
| Finkelstein's test | De Quervain's tenosynovitis |
| Phalen's / Tinel's at wrist | Carpal tunnel syndrome |
| Frog test / Thumb grind test | CMC osteoarthritis |
Hip
| Test | Condition |
|---|---|
| FABER (Patrick's) test | Hip pathology, SI joint |
| FADIR test | Femoroacetabular impingement |
| Thomas test | Hip flexor tightness |
| Trendelenburg test | Gluteus medius weakness |
| Ober's test | IT band / TFL tightness |
| Leg length measurement | True vs. apparent LLD |
| DREHMANN sign | SCFE |
Knee
| Test | Condition |
|---|---|
| Anterior / Posterior drawer | ACL / PCL tear |
| Lachman's test | ACL (most sensitive) |
| Pivot shift test | ACL rotatory instability |
| Valgus / Varus stress at 0° and 30° | MCL / LCL tears |
| McMurray's / Thessaly's / Apley's | Meniscal pathology |
| Clarke's (Patella grind) | Patellofemoral syndrome |
| Patellar apprehension test | Patellar instability |
| Sweep / Bulge sign | Knee effusion |
Ankle & Foot
| Test | Condition |
|---|---|
| Anterior drawer (ankle) | ATFL tear |
| Talar tilt test | CFL tear |
| Thompson's test | Achilles tendon rupture |
| Windlass test | Plantar fasciitis |
| Bump/Tuning fork test | Stress fracture |
Spine
| Test | Condition |
|---|---|
| SLR (Straight Leg Raise) | L4-S1 nerve root (positive < 70°) |
| Crossed SLR | L4-S1 large disc herniation |
| Slump test | Neural tension / disc |
| ULNT (Upper Limb Neurodynamic Test) | Cervical nerve root tension |
| Spurling's test | Cervical radiculopathy |
| Kemp's test | Lumbar facet/foraminal pathology |
| FABER for SI joint | SI joint dysfunction |
| Stork / One-leg standing test | Spondylolysis |
4. Fracture Rehabilitation - Phase-Wise Protocol
This is extremely common in practicals - be ready to present a rehab plan for common fractures.
Phases:
- Acute/Immobilization phase - RICE, edema control, pain management, proximal/distal joint exercises, isometrics
- Subacute/Post-immobilization phase - ROM restoration, gentle strengthening, scar management if open
- Strengthening phase - Progressive resistance, proprioception training
- Functional phase - Sport/work-specific training, return-to-function criteria
Common fractures to know:
- Colles' fracture (distal radius)
- Neck of femur fracture (post-ORIF or hemiarthroplasty)
- Tibial plateau fracture
- Clavicle fracture
- Vertebral compression fracture
5. Post-Surgical Rehabilitation Protocols
| Surgery | Key Early Steps |
|---|---|
| TKR (Total Knee Replacement) | Day 1 quadriceps sets, SLR, ankle pumps; early weight-bearing |
| THR (Total Hip Replacement) | Hip precautions (posterior approach: no flexion > 90°, no IR, no adduction past midline) |
| ACL Reconstruction | Brace, immediate patellar mobilization, quad sets; return to sport at 9-12 months |
| Rotator cuff repair | Sling 4-6 weeks, pendulum exercises, staged ROM; avoid active IR/ER early |
| Spinal fusion | Log-roll technique, back school, core stabilization |
6. Common Orthopedic Conditions - Physiotherapy Management
Know the assessment + treatment for each:
- Osteoarthritis (knee/hip) - strengthening, hydrotherapy, orthotics, patient education
- Rheumatoid arthritis - joint protection, splinting, graded exercise
- Lumbar disc prolapse - McKenzie exercises, neural mobilization, core stabilization
- Cervical spondylosis - traction, mobilization, postural correction
- Adhesive capsulitis - Maitland's Grade III-IV, stretching, ultrasound
- Plantar fasciitis - stretching, taping, orthotics, night splint
- Scoliosis - Schroth method, Cobb angle measurement, bracing criteria
- Clubfoot (CTEV) - Ponseti casting sequence
7. Gait Analysis
Know normal gait parameters and deviations:
- Trendelenburg gait - weak gluteus medius; ipsilateral hip drops
- Antalgic gait - shortened stance phase on affected side
- Steppage gait - foot drop; common in common peroneal nerve palsy
- Scissor gait - spastic diplegia
- High-stepping / Equinus gait - Achilles tightness or spasticity
8. Posture Assessment
- Plumb line reference points
- Common deformities: kyphosis, lordosis, scoliosis, genu varum/valgum, pes planus/cavus, forward head posture, rounded shoulders
9. Electrotherapy Modalities (Often Asked in Viva)
| Modality | Indication | Key Parameters |
|---|---|---|
| TENS | Analgesia | Gate control (high freq 80-150 Hz) or endorphin (low freq 1-5 Hz) |
| Ultrasound | Soft tissue healing, tendinopathy | 1 MHz (deep), 3 MHz (superficial); continuous vs. pulsed |
| IFT (Interferential) | Deep analgesia, edema | Carrier frequency 4000 Hz; AMF 80-150 Hz for pain |
| SWD (Short Wave Diathermy) | Deep heating | Contraindicated: metal implants, pacemaker |
| LASER | Wound healing, pain | Cold laser (LLLT); don't treat over eyes |
| Hot/Cold pack | Acute vs. chronic | Ice acute (0-72h); heat in chronic/subacute |
10. Outcome Measures (Practical stations may test these)
- VAS / NPRS - pain
- WOMAC - knee/hip OA
- DASH / QuickDASH - upper limb disability
- Oswestry Disability Index (ODI) - lumbar spine
- Neck Disability Index (NDI) - cervical spine
- KOOS / HOOS - knee/hip outcomes
- BERG Balance Scale - falls risk
- Timed Up and Go (TUG) - functional mobility
11. Nerve Injuries (Commonly Examined)
| Nerve | Level | Key Deficit | Test |
|---|---|---|---|
| Radial nerve | Posterior cord | Wrist drop, weak finger extension | Wrist/finger extension |
| Median nerve | Carpal tunnel | Ape hand, thenar wasting | Phalen's, Tinel's |
| Ulnar nerve | Cubital tunnel | Claw hand (ring/little), interosseous wasting | Froment's sign |
| Common peroneal | Fibular neck | Foot drop | Ankle DF weakness |
| Femoral nerve | L2-4 | Weak quad, absent knee jerk | SLR (reverse) |
| Sciatic nerve | Piriformis/buttock | Weak hip extensors + all below knee | SLR |
Quick Revision Priority (Time is limited - focus here first)
- Special tests for shoulder, knee, spine (highest frequency)
- Gait deviations (almost always asked)
- Fracture rehab phases - especially NOF fracture and Colles'
- TKR and THR post-operative protocol with hip precautions
- MMT grading 0-5 with demonstration
- ROM normal values for major joints
- Electrotherapy modalities - indications and contraindications
Good luck with your exam tomorrow! Stay confident in your demonstrations, speak out your reasoning aloud during examiner observation, and always begin any case with a systematic subjective history before moving to objective testing.
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