National Physical Therapy Examination (NPTE) Practice Exam

If a patient's shoulder pain does not change with position after therapy, what should the physical therapist ask next?

1. Persistent sore throat

2. Difficulty swallowing food

3. Burning with urination

4. Intolerance to fatty foods

The correct answer is: Intolerance to fatty foods

In this scenario, assessing shoulder pain that remains unchanged with position after therapy suggests that the pain may not be musculoskeletal in origin. This could indicate a potential referral from a visceral source. Among the options provided, asking about intolerance to fatty foods is particularly relevant because it can suggest issues related to the gallbladder or other gastrointestinal functions, which may refer pain to the shoulder area, especially the right shoulder. Visceral pain patterns can often mimic musculoskeletal pain but have different underlying causes. Intolerance to fatty foods, which may indicate gallbladder dysfunction, could lead to secondary shoulder pain due to referred pain mechanisms. This relationship is particularly noted in cases of gallbladder disease where the right shoulder might experience referred pain due to irritation of the diaphragm, which shares nerve pathways with the shoulder. It is important to investigate the patient's symptoms comprehensively to rule out systemic or referred pain sources that could require different management strategies. Other options, such as persistent sore throat, difficulty swallowing food, or burning with urination, lead to different areas of examination and may not connect as directly to the assessment of shoulder pain.