Musculoskeletal Practice
Musculoskeletal questions reward a systematic, hypothesis-driven examination rather than a memorised list of special tests. You must know the tissue-healing continuum (inflammatory, proliferative, remodelling) and how it drives load progression; the difference between capsular and non-capsular restriction patterns; contractile versus inert tissue sources of pain; and local versus referred symptoms.
Concepts to own
- Red flags (fracture, infection, malignancy, cauda equina, inflammatory arthropathy) and yellow flags (psychosocial risk for chronicity). Screening always precedes treatment.
- Maitland grades I–V and the intent of each; grade V is a thrust manipulation.
- Diagnostic test interpretation: SnNout (high Sensitivity, Negative result rules out) and SpPin (high Specificity, Positive result rules in).
- Exercise dosing and load management: pain-monitoring model, isometric versus eccentric versus heavy-slow resistance work in tendinopathy.
- Post-operative precautions (sternal, hip, spinal) and expected fracture-healing timelines.
Traps
The commonest trap is a stem reporting a "positive" special test with no psychometric data and asking what it confirms. The defensible answer is usually that it raises or lowers suspicion - not that it diagnoses. Other traps hide a red flag inside a plausible mechanical story, or ask for the most appropriate next step when the correct answer is referral or further screening, not another technique. Watch for questions that confuse impairment (range, strength) with activity limitation and participation restriction.
Rule of thumb
Straight leg raise for lumbar disc herniation has high sensitivity (roughly 0.9) and low specificity: a negative test meaningfully lowers the probability of herniation, while a positive test adds little. Crossed SLR reverses this - low sensitivity, high specificity - so a positive crossed SLR substantially raises probability. Match the test's operating characteristic to the clinical question being asked.