ABPTS OCS cheat sheet

Capsular patterns (Cyriax): shoulder ER most limited; hip IR most limited; knee flexion most limited; ankle plantarflexion most limited.

Ottawa Ankle Rules: radiograph if pain in malleolar zone plus bony tenderness at posterior edge/tip of either malleolus or inability to bear weight 4 steps both immediately and in clinic.

Ottawa Knee Rules: radiograph if age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight 4 steps.

Lachman test is most sensitive for ACL at ~30° flexion; pivot shift is most specific.

Straight leg raise sensitivity ~91% but low specificity for lumbar disc herniation; crossed SLR is highly specific.

Upper limb tension test (ULNT1/median) is positive with symptom reproduction plus contralateral cervical side-bend, shoulder abduction/ER, elbow extension, wrist/finger extension.

Spurling (cervical compression) is highly specific but poorly sensitive for cervical radiculopathy.

Beighton score ≥5/9 (or ≥4 with questionnaire) indicates hypermobility spectrum; assess for secondary musculoskeletal complaints.

Manipulation thrust techniques carry rare serious adverse event risk (e.g., cervical artery dissection estimated <1 per 100,000 manipulations); screen for red flags first.

Dry needling: avoid in anticoagulation, local infection, lymphadenopathy, severe needle phobia; pneumothorax risk with upper thoracic/paraspinal needling.

Cryotherapy reduces tissue temperature and pain but impairs collagen synthesis; avoid prolonged icing over superficial nerves (peroneal, ulnar).

Therapeutic ultrasound: continuous for thermal effects (deep heat), pulsed for non-thermal; avoid over epiphyses in children, malignancy, pregnancy over abdomen.

Eccentric loading is first-line for tendinopathy (Achilles, patellar, lateral elbow); progressive load with 3–4 sets of 15 reps typical.

Motor control/segmental stabilization exercise reduces recurrence in chronic low back pain compared to general exercise in some trials; combine with graded activity.

Traction for cervical radiculopathy may reduce pain short-term; contraindicated in myelopathy, instability, vertebral artery insufficiency.

Blood flow restriction training: 40–80% arterial occlusion pressure; avoid in DVT history, sickle cell, uncontrolled hypertension.

Total hip arthroplasty precautions (posterior approach): avoid hip flexion >90°, adduction past midline, internal rotation; typically 6–12 weeks depending on surgeon.

Total knee arthroplasty: weight-bearing as tolerated, CPM may be used; monitor for DVT (Wells criteria) and wound infection signs.

ACL reconstruction: early ROM and quadriceps activation; return-to-sport typically ≥9 months with limb symmetry index ≥90% on hop tests.

Rotator cuff repair: sling 4–6 weeks; passive ROM early, active-assisted at 4–6 weeks, resisted at 8–12 weeks depending on tear size.

Fracture healing: inflammatory (0–2 wk), reparative/soft callus (2–6 wk), hard callus (6–12 wk), remodeling (months–years); load progression follows stage.

Post-op DVT prophylaxis typically 10–35 days after major orthopaedic surgery; mobility and calf pumps encouraged unless contraindicated.

Long-bone fracture red flags: compartment syndrome (pain out of proportion, pain with passive stretch, paresthesia, pallor, pulselessness, paralysis).

Cauda equina red flags: saddle anesthesia, bowel/bladder dysfunction, bilateral leg weakness - emergent referral.

Pediatric growth plates (physis) are weaker than ligaments; Salter-Harris classification I–V guides prognosis; avoid high-impact loading over open physes.

Osgood-Schlatter and Sever disease are traction apophysitides managed with load modification, not rest; typically resolve with skeletal maturity.

Older adults: sarcopenia prevalence increases after age 60; resistance training ≥2 days/week with progressive load improves strength and function.

Osteoporosis: avoid spinal flexion with load and high-impact exercise if T-score ≤ −2.5 with fracture history; emphasize extension and weight-bearing.

Pregnancy: relaxin increases ligament laxity; avoid supine exercise after first trimester; monitor for diastasis recti and pelvic girdle pain.

Adolescent athletes: early sport specialization increases overuse injury risk; recommend diversified training and monitor training load (acute:chronic ratio).

Frailty screening (Fried phenotype: weight loss, exhaustion, weakness, slow gait, low activity) predicts falls and functional decline.

Down syndrome: atlantoaxial instability screening (lateral cervical radiograph in flexion/extension) before contact sports.

Nociception ≠ pain; pain is a biopsychosocial output influenced by context, expectation, and prior experience.

Central sensitization signs: hyperalgesia, allodynia, spreading pain, disproportionate response to stimuli; manage with graded exposure and education.

Yellow flags (psychosocial): fear-avoidance beliefs, catastrophizing, depression, work dissatisfaction - predict chronicity more than imaging findings.

Pain Catastrophizing Scale and Tampa Scale of Kinesiophobia are validated measures; high scores guide education and graded exposure.

Pain neuroscience education reduces pain and disability short-term when combined with active exercise; education alone is insufficient.

Graded motor imagery sequence: laterality recognition → imagined movement → mirror therapy - used for CRPS and phantom limb pain.

Placebo/nocebo: verbal suggestion and expectation modulate pain; avoid alarming language and unnecessary imaging that reinforces threat.

Sleep disturbance and pain are bidirectional; address sleep hygiene and screen for depression/anxiety in chronic musculoskeletal pain.

Levels of evidence (Oxford CEBM): 1 = systematic reviews of RCTs; 2 = individual RCT; 3 = non-randomized cohort; 4 = case series; 5 = expert opinion.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive LR = sens/(1−spec); negative LR = (1−sens)/spec.

Likelihood ratios: LR+ >10 and LR− <0.1 yield large, often conclusive shifts in probability; LR near 1 is uninformative.

Number needed to treat (NNT) = 1/absolute risk reduction; smaller NNT = greater clinical benefit.

Minimal clinically important difference (MCID) is the smallest change patients perceive as beneficial; distinct from statistical significance.

Intention-to-treat analysis preserves randomization; per-protocol analysis can overestimate treatment effect.

GRADE rates certainty of evidence as high/moderate/low/very low based on risk of bias, inconsistency, indirectness, imprecision, publication bias.

Confidence interval excluding the null (e.g., 1.0 for ratio measures, 0 for mean differences) supports statistical significance at α=0.05.

APTA Code of Ethics core principles: respect, integrity, accountability, altruism, and professional duty; patient welfare is paramount.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, voluntariness, and documentation.

Patient autonomy and shared decision-making: present evidence-based options and respect patient values; document refusal.

Scope of practice: practice within state licensure and APTA standards; refer when findings exceed competence or require medical evaluation.

Confidentiality under HIPAA: minimum necessary disclosure; exceptions include serious threat to self/others, mandated reporting, and legal order.

Impaired colleague: report through appropriate channels (state board, employer) after addressing immediate patient safety; do not ignore.

Conflict of interest: disclose financial or personal interests that could bias clinical recommendations or research.

Documentation: objective, measurable, and timely; supports medical necessity and continuity of care; avoid subjective or derogatory language.