Massage & Bodywork Licensing Examination (MBLEx) Quiz: Range Of Motion Assessment
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Range Of Motion AssessmentQuestion 1 of 20

During a reassessment session, a client reports that their shoulder pain has improved. In the initial assessment, resisted external rotation was weak and painful (3/5). Today, resisted external rotation is strong and painful (4+/5). Passive internal rotation (stretching the external rotators) remains painful at the end of range.

How should the therapist interpret the change from 'weak and painful' to 'strong and painful' in the resisted test?

This indicates a positive sign of healing in the contractile tissue.
The condition has worsened, as the pain is still present with strong contraction.
The client's primary issue has shifted from a contractile to an inert tissue lesion.
This suggests the development of a neurological adaptation to the chronic pain.
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Massage & Bodywork Licensing Examination (MBLEx) Quiz

Massage & Bodywork Licensing Examination (MBLEx) Quiz: Range Of Motion Assessment

Practice Range Of Motion Assessment in Massage & Bodywork Licensing Examination (MBLEx) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Range Of Motion Assessment, giving you a quick way to practice the rules, question types, and explanations that matter most for Massage & Bodywork Licensing Examination (MBLEx).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

During a reassessment session, a client reports that their shoulder pain has improved. In the initial assessment, resisted external rotation was weak and painful (3/5). Today, resisted external rotation is strong and painful (4+/5). Passive internal rotation (stretching the external rotators) remains painful at the end of range.

How should the therapist interpret the change from 'weak and painful' to 'strong and painful' in the resisted test?

  1. This indicates a positive sign of healing in the contractile tissue. (correct answer)
  2. The condition has worsened, as the pain is still present with strong contraction.
  3. The client's primary issue has shifted from a contractile to an inert tissue lesion.
  4. This suggests the development of a neurological adaptation to the chronic pain.
Explanation: When evaluating muscle testing results, you need to understand the relationship between strength and pain patterns to track healing progress. Manual muscle testing uses a 0-5 scale where strength and pain responses together indicate the tissue's condition and recovery status. The progression from "weak and painful" (3/5) to "strong and painful" (4+/5) demonstrates significant improvement in contractile tissue function. When a muscle can generate stronger force against resistance, it indicates the muscle fibers are healing and regaining their capacity to contract effectively. The persistent pain during strong contraction is expected during recovery - it shows the tissue is still healing but functional capacity is returning. This is exactly what you want to see in a recovering contractile tissue lesion. Looking at the wrong answers: (B) misinterprets the pain component - pain alone doesn't indicate worsening when strength has clearly improved. The combination of increased strength with pain actually suggests progressive healing. (C) incorrectly assumes a diagnostic shift. The fact that passive internal rotation (stretching external rotators) remains painful doesn't negate the contractile tissue improvement shown in the strength gains. (D) introduces neurological adaptation, which isn't supported by the evidence of actual strength improvement in the muscle tissue itself. Remember this pattern for the MBLEx: when interpreting muscle testing changes, always consider both components together. Increasing strength with persistent pain typically indicates healing contractile tissue, while decreasing strength with increasing pain would suggest deterioration. Focus on the functional capacity changes as your primary indicator of tissue recovery.

Question 2

A client complains of foot pain. During passive range of motion testing of the great toe, the therapist notes that dorsiflexion is significantly limited and concludes with a hard, unyielding end-feel. The client reports pain at the end of this limited range. Active motion is similarly limited. Resisted flexion and extension of the toe are strong and painless.

What does the combination of limited passive range and a hard end-feel at the first metatarsophalangeal joint suggest?

  1. A contractile lesion of the flexor hallucis longus tendon.
  2. An acute sprain of the joint's collateral ligaments.
  3. A neurological condition affecting motor control of the great toe.
  4. A structural change in the joint, such as hallux rigidus (arthritis). (correct answer)
Explanation: When evaluating joint dysfunction, you need to systematically analyze the pattern of findings from passive range of motion, active range of motion, and resistive testing to determine whether the problem is contractile (muscle/tendon) or non-contractile (joint/ligament). The key finding here is the combination of limited passive range of motion with a hard, unyielding end-feel. A hard end-feel indicates bone-on-bone contact or rigid structural changes within the joint itself. Since passive motion eliminates muscle activity as a limiting factor, this restriction must come from the joint structures. The fact that both active and passive motion are equally limited, while resisted movements remain strong and painless, confirms this is a non-contractile lesion affecting the joint capsule or bony structures. Option A is incorrect because contractile lesions (like flexor hallucis longus problems) would show pain or weakness during resisted testing, which is absent here. Option B is wrong because acute ligament sprains typically produce a soft, protective end-feel due to muscle guarding and pain, not the hard end-feel described. Option C is incorrect because neurological conditions would primarily affect active motion and muscle strength, while passive range would remain normal. Option D correctly identifies hallux rigidus, a degenerative arthritis of the first metatarsophalangeal joint that causes joint space narrowing and bone spur formation. This creates the classic presentation of limited dorsiflexion with a hard end-feel due to actual bony impingement. Remember: Hard end-feel with limited passive range almost always indicates structural joint changes, while soft end-feels suggest soft tissue restrictions or protective muscle guarding.

Question 3

A client presents with pain on the lateral aspect of the right elbow, which they state is aggravated by gripping activities. The therapist performs a range of motion assessment. Active wrist extension is painful. Passive wrist flexion is painful at the end range. Resisted wrist extension is weak and elicits sharp pain. Passive range of motion of the elbow joint itself is full and pain-free.

Based on this combination of findings, which conclusion is the most accurate?

  1. The assessment indicates an inert tissue lesion within the humeroulnar joint, requiring mobilization.
  2. The findings suggest a contractile tissue lesion of the common extensor tendon at the lateral epicondyle. (correct answer)
  3. The results point toward a lesion of the wrist flexor muscles, likely due to overuse from gripping.
  4. The primary issue is likely ulnar nerve entrapment, causing referred pain and weakness.
Explanation: The classic pattern for a contractile lesion is pain with active contraction, pain with passive stretching, and pain with resisted contraction. Here, active wrist extension (contraction), passive wrist flexion (stretch), and resisted wrist extension (contraction) are all painful, pointing directly to the wrist extensor group. This pattern is characteristic of lateral epicondylitis.

Question 4

A 55-year-old client reports progressively worsening shoulder stiffness and pain over the last several months. During assessment, the therapist finds active shoulder abduction is limited to 85 degrees. Passive abduction is also limited to 90 degrees with a firm, capsular end-feel. Both active and passive external rotation are significantly more limited than internal rotation. Resisted strength testing of all rotator cuff muscles is strong and painless.

Which interpretation best synthesizes these range of motion findings?

  1. The painless resisted tests rule out a rotator cuff tear, indicating the issue is likely a subacromial bursitis.
  2. The findings are consistent with a capsular pattern of the glenohumeral joint, suggesting adhesive capsulitis. (correct answer)
  3. The limitation in active motion with full passive motion suggests a neurological deficit affecting the deltoid.
  4. A severe strain of the supraspinatus muscle is indicated by the significant limitation in shoulder abduction.
Explanation: The combination of limited active and passive range of motion in a specific, proportional pattern (in this case, external rotation more limited than internal rotation, with abduction also limited) is known as a capsular pattern. This, along with a capsular end-feel and strong, painless resisted tests, strongly indicates a pathology of the joint capsule itself, such as adhesive capsulitis (frozen shoulder).

Question 5

A client reports an acute onset of knee pain after twisting it during a soccer game. The therapist assesses range of motion. Active knee flexion is painful and limited. During passive knee flexion, the therapist encounters a springy, rebounding sensation that blocks full movement well before the expected end of range. Resisted tests for the quadriceps and hamstrings are strong and pain-free.

What is the most significant implication of the end-feel noted during this assessment?

  1. The springy block end-feel suggests internal derangement, such as a meniscal tear, which requires medical evaluation. (correct answer)
  2. This type of end-feel indicates severe hamstring hypertonicity is the primary cause of the limited flexion.
  3. The finding is characteristic of advanced osteoarthritis, where osteophytes are blocking the joint movement.
  4. It signifies acute swelling within the joint capsule, which is a normal response to a ligamentous sprain.
Explanation: A springy block end-feel is a classic sign of internal derangement within a joint, most commonly a torn meniscus in the knee. It feels like a rebound at the end of range. This finding, especially after a traumatic twisting injury and with painless resisted tests, is a significant red flag that warrants referral for diagnosis. A hard end-feel would suggest osteoarthritis, and a boggy end-feel would suggest swelling.

Question 6

A client complains of significant weakness in their dominant shoulder following a fall two weeks ago. During the assessment of shoulder abduction, active range of motion is severely limited. Passive range of motion is full and pain-free. When performing resisted abduction, the therapist notes profound weakness, but the client reports no pain during the contraction.

Which of these interpretations is most warranted by the finding of weak and painless resisted motion?

  1. This indicates a minor contractile lesion, such as a first-degree strain of the deltoid muscle.
  2. The pattern suggests a non-contractile (inert) tissue lesion like a ligament sprain is the primary issue.
  3. This combination of findings points to a severe contractile lesion, such as a second-degree muscle tear.
  4. Painless, significant weakness is a red flag that could indicate a complete tendon rupture or a neurological injury. (correct answer)
Explanation: According to the principles of selective tissue tension testing, weak and painless resisted movement is a significant red flag. It suggests either a complete (third-degree) rupture of the muscle or tendon, where the fibers are no longer intact to generate tension and pain, or a neurological deficit affecting muscle innervation. Minor strains and inert tissue lesions would present with different patterns.

Question 7

A client presents with neck pain and stiffness that began after a motor vehicle accident three days ago. During assessment, the client is very apprehensive. Active range of motion in all planes is severely restricted by pain. As the therapist attempts passive range of motion, the client forcefully stops the movement due to intense pain long before any tissue resistance is felt.

What is the term for the end-feel encountered in this situation, and what is its clinical significance?

  1. This is a capsular end-feel, indicating the development of post-traumatic adhesive capsulitis.
  2. This is a muscle spasm end-feel, suggesting that gentle stretching is the most appropriate treatment.
  3. This is an empty end-feel, which is a contraindication to further assessment and requires immediate medical referral. (correct answer)
  4. This is a bone-to-bone end-feel, signifying that degenerative changes are complicating the acute injury.
Explanation: An 'empty' end-feel occurs when the client's pain is so severe that they prevent the therapist from reaching the end of the physiological range of motion. No true tissue resistance is felt. In the context of recent, significant trauma, this is a major red flag for serious pathology, such as a fracture or instability, and contraindicates further massage or assessment until cleared by a physician.

Question 8

A client with low back pain is assessed in a prone position. The therapist performs passive knee flexion, bringing the client's heel toward their buttock. As the knee flexes past 90 degrees, the client's hip on the same side begins to flex and lift off the table, and they report a pulling sensation in the anterior thigh. Resisted knee extension is strong and painless.

This response during passive knee flexion is most indicative of what finding?

  1. Adaptive shortening of the hamstring muscles.
  2. Hypertonicity and adaptive shortening of the rectus femoris. (correct answer)
  3. Spasticity of the gastrocnemius muscle.
  4. A capsular restriction of the tibiofemoral joint.
Explanation: This procedure describes the Ely's Test, which assesses the flexibility of the rectus femoris muscle. Because the rectus femoris is a two-joint muscle (crossing both the hip and knee), flexing the knee while the hip is extended puts it on stretch. If the muscle is tight (adaptively shortened), it will pull the hip into flexion as the knee is flexed. Painless resisted knee extension rules out an acute strain.

Question 9

During an initial assessment, a client demonstrates full and pain-free passive range of motion in their left knee. However, when asked to perform active range of motion, they are unable to fully extend the knee, and the movement appears weak and shaky. Resisted knee extension is graded as 3/5 (able to move through range against gravity, but not resistance).

What does the discrepancy between full passive range of motion and limited active range of motion primarily suggest?

  1. A structural blockage within the joint, such as a loose body.
  2. An inert tissue lesion, like an anterior cruciate ligament sprain.
  3. Significant joint inflammation and effusion causing pain inhibition.
  4. A problem with muscle activation or weakness in the quadriceps. (correct answer)
Explanation: When passive range of motion (PROM) is greater than active range of motion (AROM), it indicates that the joint structure itself is capable of moving through the full range. The limitation is therefore not due to a structural block (inert tissue). The inability to achieve the full range actively points to a problem with the contractile tissues responsible for the movement—in this case, weakness or poor neuromuscular control of the quadriceps.

Question 10

While performing passive range of motion on a client's ankle two days after a moderate inversion sprain, the therapist notes a boggy, soft end-feel when moving into dorsiflexion and plantarflexion. The movement is limited by this sensation rather than a firm tissue stretch.

What does this 'boggy' end-feel most likely signify in this acute context?

  1. Significant fluid (effusion or hemarthrosis) within the joint capsule. (correct answer)
  2. A chronic arthritic condition in the tibiotalar joint.
  3. A complete rupture of the anterior talofibular ligament.
  4. Protective muscle guarding of the peroneal muscles.
Explanation: When evaluating end-feel during passive range of motion testing, you're assessing what stops the movement at the joint's terminal range. Understanding different end-feel qualities helps you identify the underlying pathology, especially in acute injury situations. In this scenario, the "boggy" or soft end-feel occurring two days after an inversion sprain indicates fluid accumulation within the joint capsule. This spongy sensation happens because the movement is being limited by fluid pressure rather than normal tissue resistance. After an ankle sprain, bleeding from damaged tissues and inflammatory fluid commonly collect in the joint space, creating this characteristic boggy feeling during passive motion. Option A is correct because acute ankle sprains frequently produce joint effusion or hemarthrosis (blood in the joint), which creates exactly this type of soft, yielding end-feel that limits movement. Option B is incorrect because chronic arthritis typically produces a firm, capsular end-feel rather than the boggy sensation described, and wouldn't develop just two days post-injury. Option C is wrong because while ligament rupture could occur with inversion sprains, a complete tear would more likely produce an empty or loose end-feel rather than the boggy resistance described here. Option D is incorrect because muscle guarding creates a hard, abrupt stopping sensation (muscle spasm end-feel), not the soft, spongy feeling characteristic of fluid accumulation. Study tip: Remember that boggy/soft end-feel in acute injuries almost always indicates fluid in the joint. Learn to associate specific end-feel qualities with their underlying causes—this pattern appears frequently on the MBLEx.

Question 11

A therapist assesses a client who has difficulty initiating shoulder abduction. The client can only actively abduct the arm about 20 degrees. However, if the therapist passively lifts the arm to 90 degrees of abduction, the client is then able to hold it there and actively complete the rest of the range of motion to 180 degrees. Resisted abduction initiated from the side is weak and painful.

This specific pattern of difficulty with the initial phase of abduction most strongly suggests a pathology of which muscle?

  1. The supraspinatus muscle. (correct answer)
  2. The middle fibers of the deltoid.
  3. The serratus anterior muscle.
  4. The upper fibers of the trapezius.
Explanation: When you encounter questions about shoulder movement patterns, focus on understanding which muscles initiate specific motions versus which ones assist or complete the movement. This question tests your knowledge of the rotator cuff's role in shoulder mechanics. The key diagnostic clue here is that the client struggles specifically with initiating abduction but can maintain and complete the motion once assisted to 90 degrees. This pattern points directly to supraspinatus dysfunction. The supraspinatus is the primary initiator of shoulder abduction, responsible for the critical first 15-30 degrees of movement. It essentially "unlocks" the humeral head from the glenoid fossa and begins the abduction sequence. Once this initial phase is complete, other muscles like the deltoid can take over effectively. Answer A is correct because supraspinatus pathology (often rotator cuff tears or impingement) creates exactly this presentation: difficulty initiating abduction with preserved ability to maintain the position once achieved. Answer B is incorrect because the middle deltoid, while crucial for abduction, primarily works from 30-90 degrees. If this muscle were impaired, the client would struggle throughout the mid-range, not just at initiation. Answer C is wrong because serratus anterior primarily stabilizes the scapula and assists with overhead reaching, not initial glenohumeral abduction. Answer D is incorrect because upper trapezius elevates the scapula and wouldn't specifically affect the initiation of arm abduction at the shoulder joint. Remember: When you see "difficulty initiating" a movement, think about which muscle fires first in that motion sequence. For shoulder abduction, that's always the supraspinatus.

Question 12

A client complains of medial knee pain. Range of motion assessment reveals that active and passive knee extension are full and pain-free. Active and passive knee flexion are also full and pain-free. However, when the therapist applies a valgus stress to the knee (passively abducting the tibia on the femur) with the knee slightly flexed, it reproduces the client's medial pain.

Given that standard active and passive ROM are clear, what type of tissue does the provocative valgus stress test implicate?

  1. A contractile tissue, such as the vastus medialis.
  2. The articular cartilage on the lateral femoral condyle.
  3. An inert tissue, specifically the medial collateral ligament (MCL). (correct answer)
  4. The lateral meniscus, which is being compressed.
Explanation: A valgus stress test is a specific form of passive range of motion designed to challenge the integrity of the medial collateral ligament (MCL). By pushing the knee medially, it puts the MCL on stretch. Reproduction of pain on the medial aspect of the knee during this test, especially when cardinal plane AROM/PROM is clear, points directly to a lesion of this inert, ligamentous structure.

Question 13

A client who works as a painter complains of shoulder pain. During assessment, the therapist observes that active abduction is painful between 70 and 110 degrees of motion, but is less painful before and after this arc. Passive range of motion is full but also elicits some discomfort in the same arc. Resisted abduction is strong but painful.

What is the clinical term for this specific range of motion finding, and what does it typically suggest?

  1. A capsular pattern, suggesting adhesive capsulitis.
  2. A painful arc, suggesting subacromial impingement. (correct answer)
  3. An empty end-feel, suggesting a severe, acute pathology.
  4. Apprehension sign, suggesting glenohumeral instability.
Explanation: Pain that occurs only within a specific portion of the range of motion, typically in the middle of the range, is known as a painful arc. In the shoulder, a painful arc between roughly 60-120 degrees of abduction is a classic sign of subacromial impingement, where sensitive tissues (like the supraspinatus tendon or subacromial bursa) are compressed under the acromion process.

Question 14

A client presents with jaw pain and clicking. The therapist performs a range of motion assessment of the temporomandibular joint. Active mouth opening is limited to two knuckles' width and deviates to the left side. Passive range of motion does not increase the opening. Resisted protrusion is weak and painful, while resisted closing of the jaw is strong and painless.

The deviation to the left upon opening and pain with resisted protrusion points most directly to a dysfunction of which muscle?

  1. The left masseter, which is hypertonic.
  2. The right temporalis, which is in spasm.
  3. The right medial pterygoid, which has a trigger point.
  4. The left lateral pterygoid, which is weak or injured. (correct answer)
Explanation: When analyzing temporomandibular joint dysfunction, you need to connect the movement patterns with the specific muscles responsible for jaw motion. The key muscles are the masseter and temporalis (which close the jaw), and the medial and lateral pterygoids (which have more complex functions including opening, protrusion, and lateral movement). The critical clues here are the leftward deviation during opening and the weak, painful resisted protrusion. The lateral pterygoid muscle is primarily responsible for protrusion of the jaw and assists with mouth opening. When one lateral pterygoid is weak or injured, the jaw deviates toward the affected side during opening because the stronger, unaffected side pulls the jaw toward itself. Since the jaw deviates left and protrusion is weak and painful, this points to left lateral pterygoid dysfunction. Answer A is incorrect because the masseter primarily closes the jaw, and hypertonicity would more likely cause limited opening without the specific deviation pattern seen here. Answer B is wrong because the temporalis also functions mainly in jaw closure, and right-side temporalis spasm wouldn't explain leftward deviation during opening. Answer C is incorrect because the medial pterygoid assists with closing and side-to-side movement but isn't the primary muscle for protrusion, and right-side dysfunction wouldn't cause leftward deviation. Remember this pattern: jaw deviation during opening typically points toward the weaker side, and when combined with weak protrusion, suspect lateral pterygoid dysfunction on the side of deviation. This muscle pairing of symptoms is a common clinical presentation you'll need to recognize.

Question 15

During a hip assessment for a runner complaining of anterior groin pain, the therapist performs several tests. Active hip flexion is painful. Passive hip flexion is full but painful at the end range. Resisted hip flexion is strong but reproduces the familiar groin pain. Resisted hip adduction, abduction, and rotation are all strong and painless.

These specific findings most strongly implicate a contractile lesion in which muscle or muscle group?

  1. The adductor group, particularly the adductor longus.
  2. The hip abductor group, such as the gluteus medius.
  3. The iliopsoas muscle group, the primary hip flexors. (correct answer)
  4. The rectus femoris, one of the quadriceps muscles.
Explanation: The assessment consistently provokes pain during the action of hip flexion (active and resisted) and with the stretch at the end of passive flexion. Since other hip motions are painless with resistance, the problem is isolated to the primary hip flexors. The iliopsoas is the most powerful hip flexor and a common source of anterior groin pain in athletes. While rectus femoris assists, the iliopsoas is the primary muscle implicated by this pattern.

Question 16

A therapist is assessing a client with right-sided neck pain. Active left lateral flexion is limited and painful on the right. Passive left lateral flexion also produces pain on the right side with a firm tissue-stretch end-feel. Resisted right lateral flexion is strong but reproduces the client's right-sided pain.

How should the therapist interpret these findings?

  1. The findings suggest a contractile lesion of the left sternocleidomastoid muscle.
  2. The pattern indicates a right-sided cervical facet joint impingement or irritation.
  3. The results are most consistent with a contractile lesion in the right upper trapezius or scalenes. (correct answer)
  4. This points to an inert tissue lesion, such as a sprain of the interspinous ligaments on the left side.
Explanation: The pain is consistently on the right side. Pain occurs during active contraction (resisted right lateral flexion) and when the tissues are stretched (active and passive left lateral flexion). This combination of pain on contraction and pain on stretch of the right-sided lateral flexors is the classic sign of a contractile lesion (e.g., muscle strain) in those muscles, such as the right upper trapezius or scalenes.

Question 17

A client complains of pain deep in the buttock that sometimes radiates down the posterior thigh. During assessment, the therapist finds that passive hip flexion combined with adduction and internal rotation strongly reproduces the client's symptoms. Resisted external rotation and abduction of the hip are also painful. Active and passive range of motion of the lumbar spine are normal and pain-free.

This specific combination of provocative range of motion tests is primarily used to assess for which condition?

  1. Sacroiliac joint dysfunction.
  2. Piriformis syndrome. (correct answer)
  3. Ischial bursitis.
  4. A hamstring muscle strain.
Explanation: The assessment describes tests that both stretch and contract the piriformis muscle. Passive flexion, adduction, and internal rotation places the piriformis on stretch, which can compress the sciatic nerve if the muscle is tight. Resisted external rotation and abduction contracts the piriformis. Reproduction of symptoms with both maneuvers, while lumbar ROM is clear, strongly suggests piriformis syndrome.

Question 18

A client is assessed for low back pain that refers into the posterior right thigh. A straight leg raise (passive flexion of the hip with the knee extended) on the right side is limited to 45 degrees by sharp, radiating pain. However, if the therapist lowers the leg slightly to alleviate the pain and then passively dorsiflexes the ankle, the radiating pain returns. Resisted hamstring contraction is strong and painless.

What do these combined findings from the range of motion test indicate?

  1. The primary limitation is caused by severe adaptive shortening of the hamstring muscles.
  2. The assessment suggests a contractile lesion of the gastrocnemius muscle.
  3. The results are highly indicative of adverse neural tension involving the sciatic nerve. (correct answer)
  4. This pattern points to a capsular restriction or pathology within the hip joint.
Explanation: This describes a positive Bragard's test, which is a differentiating maneuver used with the straight leg raise. The reproduction of radicular pain with ankle dorsiflexion (which tensions the sciatic nerve but does not further stretch the hamstrings) strongly suggests the client's symptoms are due to nerve root irritation or sciatic nerve tension, rather than a simple hamstring muscle issue. Strong and painless resisted hamstring testing further rules out a muscle strain.

Question 19

A client is being evaluated for wrist pain. The therapist performs resisted isometric tests. The results are as follows: wrist extension is strong and painful; wrist flexion is strong and painless; ulnar deviation is strong and painless; radial deviation is strong and painful.

Based on these resisted test results, the lesion is most likely located in the tendons of which two muscles?

  1. Flexor carpi ulnaris and palmaris longus.
  2. Extensor carpi ulnaris and flexor carpi radialis.
  3. Extensor carpi radialis longus and extensor carpi radialis brevis. (correct answer)
  4. Flexor digitorum superficialis and extensor digitorum.
Explanation: The pain is produced during resisted wrist extension and radial deviation. The therapist must identify which muscles perform both of these actions. The extensor carpi radialis longus and brevis are primary wrist extensors and also perform radial deviation. The other muscle groups listed do not match this specific pattern of painful contraction.

Question 20

A client reports pain in the posterior aspect of their shoulder. The therapist's assessment reveals the following: active internal rotation is painful; passive external rotation is painful at its end range; resisted internal rotation is strong and painful. All other active, passive, and resisted tests for the shoulder are pain-free.

This pattern of findings points to a contractile lesion in a muscle that performs which action?

  1. External rotation, such as the infraspinatus.
  2. Internal rotation, such as the subscapularis or teres major. (correct answer)
  3. Abduction, such as the supraspinatus or middle deltoid.
  4. Flexion, such as the anterior deltoid or pectoralis major.
Explanation: The client experiences pain when the muscle is actively contracted (active internal rotation), when it is put on stretch (passive external rotation), and when it is contracted against resistance (resisted internal rotation). This is the hallmark pattern of a contractile lesion (strain) in a muscle that performs internal rotation. Given the posterior pain, the teres major or latissimus dorsi are more likely culprits than the anteriorly located subscapularis.