OCS Study Guide

Welcome to the OCS Study Blog. I will be sitting for the OCS Exam in 2018. This blog is created to spark conversation and discussion regarding the preparation for the exam. I hope that this blog can help others aspiring to sit for the exam, and or increase conversation within our profession. I will be trying to update this blog on a weekly basis. Let it be known that this in no way is affiliated with the OCS or the American Board of Physical Therapy Specialties (ABPTS). This is an unofficial study guide on topics that I feel are important as I prepare for the exam. If others have a suggested topic of interest, I will attempt to provide up to date evidence based research regarding topics requested. I hope this to be an open forum that will help myself and others deliver quality care to our patients.

Let us first look at the knowledge areas that the OCS exam draws from. The exam pulls from the approximate percentages below:

1. Human anatomy and physiology 10%
2. Movement Science 10%
3. Pathophysiology 10%
4. Orthopedic medical and surgical intervention 10%
5. Evidence based Orthopedic theory and Practice 10%
6. Critical inquiry and evidence based practice 10%
7. Examination 20%
8. Procedural Intervention 20%
Next look at how the different body regions approximately are covered:

1. Cranial and mandibular 5%
2. Cervical Spine 15%
3. Thoracic spine and ribs 5%
4. Lumbar Spine 20%
5. Shoulder 15%
6. Elbow 5%
7. Wrist Hand 5%
8. Pelvic girdle/SI 5%
9. Hip 5%
10. Thigh/knee 10%
11. Leg/Ankle/Foot 10%
Shoulder
“EVAL and TREAT”
For the typical shoulder referral with a prescription as “Eval and treat”, an exact shoulder diagnosis can be very difficult to find. What we must understand is that most shoulder pathologies lie within a continuum of sxs, starting benign and progressing to more severe dysfunctions/pathologies. In many cases patients sxs may begin with scapula dyskinesia, secondary to muscle imbalances, eventually causing repetitive stress injuries as tendonitis or impingement, that eventually can lead to rotator cuff pathology or structural damage. Recognizing that a patient may fall anywhere within this progression is a difficult challenge. There are very few definitive special tests that rule in or out a SLAP lesion versus an anterior impingement. Let’s begin with an examination screening process that will begin to first rule in the shoulder, and second focus our direction.

History:
How did the symptoms begin?
  •  Insidious onset, or trauma?
  •  What brings on the sxs?
  •  Repetitive overhead activity
  •  Sitting Statically
  •  Elbow hand Motion?
Where are the sxs located?
  • Anterior shoulder?
  • Posterior?
  • Scapular region?
What other complaints do they demonstrate?
  • Looseness or instability, may indicate GH instability or labral activity
  • Global pain with tightness, may indicate Adhesive capsulitis
  • Weakness, may be indicative or subacromial impingement, rotator cuff pathology
What is the patient’s profession?
  • Laborer
  • Desk work
Outcomes:
Outcomes can and should be performed to establish initial disability and to track progress
  • Dash
  • Shoulder pain and disability index
  • Upper limb Lift and carry 
Screening Red Flags:
Left shoulder referred pain:
  • Myocardial infarction
  • Ruptured spleen
Right shoulder referred pain:
  • Liver disease
  • Pancreatic disease
  • Gallbladder 
Both shoulder referred pain:
  • Pancoast tumor
Yellow flags:
  • Fear and avoidance
  • Psychological illness
  • Workman’s comp or attorney involvement
  • Depression
Cervical Spine clearing:
  • AROM in all directions
  • PROM with over pressure
  • Distraction/compression
Any reproduction of sxs may indicate further investigation of cervical spine
  • Accessory motion assessment
  • ULTT
  • Repeated movement examination
  • Traction
  • Dermatome: 
    •  C4 - Top of shoulder
    •  C5 – Lateral shoulder
    •  C6 – Tip of thumb
    •  C7 – Tip of Middle 3rd digit
    •  C8 – Tip fifth digit
    •  T1 Medial Forearm
  • Myotome:
    • C4 – Shoulder shrug
    • C5 – Abduction
    • C6 – Elbow flexion, wrist extension
    • C7 – Elbow extension, Wrist flexion
    • C8 – Thumb abduction
    • T1 – Finger abduction
  • DTR:
    • C5- Biceps
    • C6- Brachioradialis
    • C7- Triceps
Observation
Static:
  •  Scapula position
  •  Winging, rounded, tilted
  •  Humeral Position
  •  IR
  •  Head position
  •  Forward
  •  AC joint
  •  SC joint
Dynamic:
  • Scapulae rhythm
  • Shoulder Hiking
  • Shaking, juttering, quivering
PROM with overpressure:
  • Flexion
  • Abduction
  • IR
  • ER
  • Horizontal Abduction
  • Horizontal adduction
MMT
  • Shoulder Flexion- Anterior Deltioid, Biceps, pec
  • Shoulder extension- Mid and lower trap
  • Shoulder Abduction- Deltoid, Supraspinatus
  • Internal Rotation- Subscapularis, Teres major
  • External Rotation- teres minor, infraspinatus
Other Resistive testing to consider:
  • Serratus Anterior
  • Lower and Middle Trap
  • Rhomboid
Joint Accessory Motion
  • GH: Anterior, posterior, inferior, lateral distraction
  • AC: Posterior, anterior
  • SC: Posterior, Inferior and superior
Scapulothoracic
  • Medial mobility
  • Lateral mobility
  • Superior and inferior
  • Upward and downward rotation
Special tests
  • See special test in additional sections
OK, so there are your typical screening options.Let me know in the comments if you have any other questions or suggestions for the screening process. We will discuss special tests in another section along with specific pathologies and treatment strategies. Resources include Current concepts of orthopedic physical therapy, eMed, Physiopedia.