🧠 We're Back! Is your brain ready?

#4 🎡 The Fringe Performer

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Dear Colleagues, every month, we drop one clinical question to test your MSK brain and keep you sharp + answer of the previous quiz. Please help spread the quiz by forwarding this email to others in your clinic, or printing out the lunchroom pdf linked below.

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🎡 The Fringe Performer ​ A 45-year-old performance artist known for her one-woman show “My Hernia and Me” presents with shoulder pain following an interpretive dance sequence involving a wheelbarrow and two hula hoops. You find a limitation in flexion and abduction. After repeated shoulder extension, her movement improves significantly and remains better.

What does this suggest?

A. A structural rotator cuff tear
B. A frozen shoulder
C. A derangement in the shoulder
D. A cervical referral

✅ Correct Answer: Feel free to reply with your answer so you remember what you chose! We’ll share the correct one next time (and give you the why so you can learn something new).

📣 Share the quiz with your team

Make it a lunchroom challenge. Print our PDF quiz sheet and pin it up. Debate your answers. Brag when you get it right.

This quiz is about bringing clinicians together, through smart thinking and a bit of healthy competition.

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Last Quiz Answer: 📦 The Cult Courier

A 29-year-old logistics coordinator for a doomsday cult complains of right-sided back and leg pain after 3 months of carrying canned goods and burying long-drop toilets on remote Southland farmland. He responds with an Amber Light of Decrease/No Better (NB) from Sustained Extension and Repeated Extension In Lying (EIL). What’s your next best step based on Force Progression Principles?

A. Change direction to Flexion In Lying (FIL)

B. Try traction

C. Repeated Extension in Lying with Patient Overpressure

D. Immediately refer for imaging

✅ Correct Answer: C

💡 Why:
If initial loading strategies produce an Amber Light (No better, no worse, or no effect to baseline symptoms), MDT recommends progressing the force, not immediately changing direction or abandoning the strategy. Using patient-applied overpressure is the force progression to determine if greater mechanical load reveals a Green Light response.

Note: We want to use the least force required to achieve improvement in patient symptoms. Patient generated forces are reproducible at home and promote self management and patient empowerment. That said, if this remains to produce an Amber Light, then clinician overpressure would come next, then mobilisation and finally manipulation.

Concepts to learn more about in this question are;

1. Force progressions
2. Traffic Light Guide

Want more info on these? Let us know by replying :)

See you in a few weeks 👀

Ngā mihi,
The McKenzie Institute New Zealand Team
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