National Physical Therapy Examination (NPTE) Practice Exam

Which finding suggests that physical therapy intervention may not be appropriate for a patient with right shoulder pain?

1. Pain that subsides with right sidelying

2. Tenderness to palpation at the origin of the biceps tendon

3. Trigger points at the right rib 2-3 intercostal space

4. Pain with resisted shoulder lateral (external) rotation

The correct answer is: Pain that subsides with right sidelying

Choosing the finding indicating that physical therapy intervention may not be appropriate revolves around understanding the implications of the patient's symptoms in relation to potential underlying conditions. When pain subsides with right sidelying, it suggests that the patient's symptoms may be correlated with mechanical factors or postural issues rather than a primary intrinsic shoulder pathology. This relief could indicate an underlying structural problem, possibly requiring alternative interventions, such as diagnostic imaging or referral to a specialist, rather than standard physical therapy techniques. This symptom may imply a need for further evaluation rather than direct intervention. In contrast, tenderness at the origin of the biceps tendon and trigger points in specific intercostal spaces would indicate localized issues that might respond well to physical therapy modalities focusing on strengthening, stretching, or manual therapy. Pain with resisted lateral (external) rotation signifies a direct relationship with shoulder function and suggests underlying impingement or rotator cuff pathology, conditions where physical therapy has proven beneficial. Thus, the finding that the pain reduces with right sidelying signifies that the intervention may be inappropriate as it hints at more complex mechanisms requiring a careful assessment beyond what physical therapy can provide.