Musculoskeletal System
Tissue healing drives every choice
Match the intervention to the healing phase. In the acute/inflammatory phase (roughly days 1–5), protect the tissue, control pain and edema, and use gentle protected motion. In proliferation (roughly weeks 1–6), add controlled loading. In remodeling (months), progress to functional and sport-specific loading. Test writers frequently dangle an aggressive stretch or heavy resistance program during acute inflammation as a distractor.
Strength and range of motion
Know the manual muscle test scale precisely: 0 no contraction, 1 trace, 2 full range with gravity eliminated, 3 full range against gravity, 4 full range against gravity plus some resistance, 5 normal. Distinguish active, active-assistive and passive range; passive exceeding active suggests weakness, while both limited equally suggests stiffness. Joint mobilization grades I–II are small-amplitude oscillations for pain; grades III–IV end at tissue resistance and target stiffness; grade V is a thrust manipulation.
Postoperative precautions
Posterior hip approach: avoid flexion past 90°, internal rotation and adduction. Anterior approach: avoid combined extension with external rotation. After median sternotomy, observe sternal precautions (no lifting beyond about 5–10 lb, avoid pushing or pulling with the arms). Rotator cuff repair limits early active motion; ACL reconstruction emphasizes early quadriceps activation and often delays open-chain knee extension.
Traps
Questions blur the words contraindicated, precaution and progression, and they reward identifying the tissue being loaded rather than the diagnosis label.
Worked example: a patient completes full passive and active knee extension but cannot hold the leg against even light manual resistance; that is 3/5, not 4/5.