Musculoskeletal Physiotherapy: Orthopaedics, Rheumatology, Manual Therapy and Post-operative Rehabilitation
What the exam tests
Orthopaedic assessment, rheumatology, manual therapy, and post-operative rehabilitation, with emphasis on red flags, safe progression, and respect for surgical precautions.
Core rules and concepts
- Red flags: cauda equina syndrome (saddle anaesthesia, bladder or bowel dysfunction, bilateral leg symptoms), fracture, infection, malignancy, and progressive neurological deficit require urgent referral.
- Ottawa ankle and knee rules guide imaging decisions but do not replace clinical judgement in children, intoxicated patients, or those with distracting injuries.
- Total knee arthroplasty: early mobilisation, quadriceps activation, range within protocol, and DVT prophylaxis; avoid forced flexion when the wound or soft tissues are compromised.
- ACL reconstruction: protect the graft, restore quadriceps control, and respect early open-chain resisted extension precautions; progress to plyometrics only when criteria are met.
- Rheumatoid arthritis: joint protection, caution with unstable joints, and cervical spine screening before neck techniques.
- Manual therapy is adjunctive: screen for contraindications such as fracture, malignancy, infection, and anticoagulation.
Worked example
A 55-year-old presents with acute low back pain, urinary retention, and saddle numbness after a fall. Reasoning: this is a red-flag pattern for cauda equina syndrome. Do not manipulate; arrange emergency medical assessment, document the neurological findings, and avoid delaying referral for imaging.
Traps that cost marks
Missing cauda equina syndrome; overstretching a replaced joint; ignoring post-operative weight-bearing precautions; treating rheumatoid arthritis as if it were osteoarthritis; using manual therapy before screening contraindications.