PCE Review (Updated 2023) QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS

PCE Review (Updated 2023) QUESTIONS AND

ANSWERS WITH COMPLETE SOLUTIONS

What is the timeline of inflammation and what are three key factors of it? -

Answer 24hrs to 3-4 days

- Myofiber rupture and necrosis

- Hematomas

- Inflammatory cell reaction

What is the timeline of repair phase and what are 4 key factors to know? -

Answer 5-14 days

- Phagocytosis of necrotic fibers

- Regeneration of myofibers

- Formation of scar tissue

- Capillary ingrowth

What are the timelines for remodeling and 3 key factors to know? - Answer

14-21 days (can take up to 2 years)

Maturation of myofibers

Contraction and organization of scar tissue

Recovery of function

What is a contusion?

What causes it?

What is the Rx for initial and recovery time?

What are the common complications? - Answer Muscle injury caused by

sudden external force that results in deep muscle bleed

Rx 1st 48 hrs - PRICE, no HARM (heat, alcohol, running, massage)

- Put muscle on as much stretch as possible, crutches if necessary, gentlre ROM

Recovery time:

1st gr - 2-3 wk

2nd gr - 4-6 wk

3rd - 8wk

Complications - Compartment syndrome & myositis ossificans

Where do the majority of muscle strains occur?

When do the majority occur? - Answer In biarticular muscles at the muscle

tendon junction

Occur during eccentric loading or high intensity activities

- terminal swing phase of high speed running, concurent hip flexion & knee

extension as examples

What are risk factors for muscle strains?

What is the grading for muscle strains? - Answer Risk factors - prior injury,

age, unaccustomed activity, training errors, biomechanics

Grade 1 - microscopic tearing, pain/tightness, no weakness

Grade 2 - partial, macroscopic tear - pain & structural change, laxity, weakness

Grade 3 - complete tear - painless, weak, may lump

What is the Rx for muscle strains? - Answer Acute - PRICE

Repair - Modalities, stretch, strength

Remodeling - strength & stretch

RTP

What is a laceration and what is the Rx? - Answer Cutting of the muscle fibers,

require surgical repair w/ sutures

Inflammation phase - optimize gait, posture, and positioning

Repair phase - gradual ROM & strength

Remodeling - gradual increase load and velocity

What are the two kinds of muscle weakness to differentiate? - Answer

Weakness w/o pain (neurological or severe muscle damage) vs weakness w/ pain

(contractile lesion)

When do DOMs start? - Answer 72 hours after exercise

What nerves are involved (and nerve roots) for pelvic floor dysfunction?

How to assess it? - Answer Pudendal nerve (S2,3,4 from sacral plexus)

Ax - digital, EMG, manometer, dynamometer, real time US, MRI, biofeedback

What are key markers of Chronic Pelvic Pain?

What are the causes?

What is the age range?

What should be assessed?

What is the rx? - Answer Pain >3mo, between diaphragm & knees

Causes - MSK, neuro, gynecological, urogenital

Age - 25-35

Ax - urogenital s/s, lumbar/pelvic/groin mechanical presentation, core activation

Rx - decreased pelvic floor resting tone, increased pelvic floor proprioception,

increased motor control, decreased pain sensitization

What is pelvic girdle pain?

What are the risk factors?

What are the causes? - Answer Pelvic girdle pain is pain in the pelvic region

associated with 50% of pregnancies where there is weakness/laxity of the PFM

during pregnancy/child birth

Risk factors - previous hx of back pain/trauma

Causes - laxity, asymmetry, inadequate motor control

What are the signs/symptoms of pelvic girdle pain?

What should be the ax for pelvic girdle pain? - Answer Symptoms - pain

(ant/lat/post pelvic, groin, ant/post thigh, abdomen, coccyx) - w/ sustained

positions or transitional movements

Signs - posture (locked knees, L spine lordosis, thoracic kyphosis, FHP); asymmetry

(standing & supine); gait (shuffling, waddling, leg drop)

Ax - ASLR w/ force/form closure

Hip quadrants (ER/IR)

SIJ stability -> P4, Gaenslen's, FABERS, palpation

TOP spinous processes

TOP piriformis

Resisted hip ADD/ABD

What is the rx for pelvic girdle pain? - Answer Education - position and

movement strategies for pain management

Posture - lumbar support, soften knees, pillow for neck at night

Manual tx

Exercise - stabilize, symmetry

Movement strategies - use glutes (no rotation)

What is the condition progression for pelvic girdle pain? - Answer Cystocele -

herniation of bladder into vagina

Rectocele - herniation of rectum into vagina

Uterine prolapse - herniation of uterus into vagina

What are the grades of ligament sprains?

What ax?

What rx? - Answer Grade 1 - minor rupture, stable

Grade 2 - partial rupture, some laxity, no gross instability

Grade 3 - complete rupture, gross instability

Ax - Stability testing, laxity & end feel; pain

Rx -

Acute - PRICE

Repair - stability w/ muscle strength, DTFM, modalities, progressive loading

Remodeling- DFTM, progressive load, sport/function

What is the MOI, S/S, Dx, & RX for Syndesmotic Sprains? - Answer MOI -

planted foot + IR of leg (ER of talus); hyper DR + inversion; falls, twisting, MVA

Ligaments affected - AITFL, PITFL, interosseus, possible others

S/S - limited swelling, antalgic gait, TOP @ Injury site (AITFL, PTFL, ant distal

tib/fib)

Dx - ER stress test, squeeze test, crossed leg test, ant/post translation of fibula;

squat test; heel thump test

Rx - Phase1 (0-2wks) protection phase - PRICE, modalities, light ROM, NWB w/

crutches

Phase 2 (2-4 wks) regain mobility, increase strength, joint mobs, PWB ambulation

Phase 3 - increase function, unilateral balance & strength

Phase 4 - RTP, cutting, jumping, strengthening

What is a tendon?

What happens w/ loading tendons? - Answer Tendon is composed of

tenocytes and ECM (collagen, glycosaminoglycan)

Loading tendons - increased collagen synthesis, cellular proliferation, alignment