Musculoskeletal System

27% of the NPTE · blueprint NPTE-PT content outline effective January 2024 (v1.1)

Short answer

Musculoskeletal is the largest system on the NPTE-PT at 44-54 of the 180 scored items, spread across examination (14-18 items), foundations for evaluation and differential diagnosis (15-18) and interventions (15-18). It covers special tests and their interpretation, joint mobilisation grades, post-surgical protocols and precautions, gait deviations, posture and biomechanics, therapeutic exercise progression, and distinguishing musculoskeletal pain from referred visceral or neurological pain.

Why it matters on this exam

Roughly one scored question in four. No other block rewards study time as directly.

Key concepts

Special tests: know what a positive result implicates and what you do next, not just the test name — Lachman and anterior drawer, Neer and Hawkins-Kennedy, empty can, McMurray, Spurling, straight-leg raise, Thomas, Ober, FABER and FADIR.
Joint mobilisation: grades I–V, convex-concave rule, capsular patterns, end-feels (normal: bony, soft-tissue approximation, tissue stretch; abnormal: empty, springy block, muscle guarding).
Post-surgical protocols: weight-bearing status, ROM restrictions and timelines after ACL reconstruction, total hip (anterior vs posterior precautions), total knee, rotator-cuff repair and spinal fusion.
Gait deviations: Trendelenburg and its compensations, steppage, antalgic, circumduction, and which muscle or joint restriction produces each.
Therapeutic exercise: tissue-healing phases, open versus closed chain, progressive overload, and the difference between pain that should stop an exercise and pain that should not.
Differential diagnosis: red flags for fracture, infection, malignancy and cauda equina; referred patterns from viscera to the shoulder, scapula and flank.

Common mistakes

Memorising special tests without their follow-on action, which is what the middle column of the outline tests.
Applying posterior total-hip precautions to an anterior approach.

Worked example

A patient six weeks after posterior total hip arthroplasty asks to pick something off the floor. Hip flexion beyond 90 degrees with adduction and internal rotation is the precaution triad — the answer is to teach a reacher and a hip-safe strategy, not to demonstrate a squat.

Original practice questions

Musculoskeletal SystemDifficulty 2/5

Six weeks after a posterior-approach total hip arthroplasty, a patient wants to retrieve an object from the floor. Which instruction respects the precautions?

AUse a reacher, keeping hip flexion under 90 degrees and avoiding adduction
BSit and cross the operated leg over the other to lower the trunk
CBend forward at the waist while internally rotating the operated hip
DSquat with both hips flexed past 90 degrees keeping the trunk upright

Show answer and rationale

Correct: A. Posterior precautions prohibit hip flexion beyond 90 degrees, adduction past midline and internal rotation. A reacher preserves all three; each other option violates at least one.

D — Squatting past 90 degrees of hip flexion breaches the flexion precaution.
B — Crossing the leg adducts and internally rotates the operated hip.
C — Forward bending with internal rotation combines two prohibited motions.

Musculoskeletal SystemDifficulty 3/5

A positive Lachman test in an acutely injured knee most directly implicates which structure?

AThe posterior cruciate ligament resisting posterior tibial translation
BThe anterior cruciate ligament resisting anterior tibial translation
CThe medial meniscus, which produces clicking on rotation
DThe medial collateral ligament resisting valgus stress at the knee

Show answer and rationale

Correct: B. Lachman assesses anterior tibial translation on a fixed femur at 20-30 degrees of flexion, testing the anterior cruciate ligament. It is more sensitive than the anterior drawer in acute injury because hamstring guarding interferes less.

A — Posterior translation is tested by the posterior drawer and posterior sag sign.
C — Meniscal pathology is assessed by McMurray and joint-line tenderness.
D — The MCL is tested with valgus stress at 0 and 30 degrees.

Musculoskeletal SystemDifficulty 3/5

A patient shows a lateral trunk lean over the stance limb during gait. Which impairment most likely explains this compensation?

AWeak ankle dorsiflexors causing a steppage pattern in swing
BKnee-extension contracture limiting stance-phase flexion
CWeak hip abductors on the stance side, compensated by shifting the trunk
DWeak hip flexors on the swing side, shortening the step length

Show answer and rationale

Correct: C. Lateral trunk lean over the stance limb is compensated Trendelenburg: the trunk shifts to move the centre of mass over the weak side and reduce the demand on the hip abductors.

D — Weak hip flexors shorten step length rather than producing trunk lean.
A — Dorsiflexor weakness produces steppage or foot slap in swing.
B — An extension contracture alters knee motion rather than trunk position.

All 4 Musculoskeletal System questions →

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Primary references

NPTE-PT Test Content Outline, effective January 2024 (v1.1) — Federation of State Boards of Physical Therapy (FSBPT) · primary · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-12-21Draft — pending editorial reviewHow we verify facts