A physical therapist assistant is treating a 71-year-old woman two days after a right total hip arthroplasty performed through a posterolateral approach. The supervising PT's plan of care lists standard posterior hip precautions. During the session the patient reaches down from the edge of the bed to pull on her right sock. Which of the following is the MOST appropriate action?

Stop the activity, review the precaution against hip flexion beyond 90 degrees, and train sock donning with a long-handled sock aid

Allow the activity, since dressing is an essential daily task and the hip is stable after surgery

Stop the activity and ask the patient to cross the right leg over the left so she can reach the foot without bending

Have the patient complete the task standing on the right leg with the trunk rotated toward the left

A physical therapist assistant is treating a 48-year-old man three weeks after arthroscopic rotator cuff repair of the supraspinatus. The supervising PT's plan of care specifies passive range of motion only, with no active elevation until week six. The patient reports that his shoulder feels strong and asks to begin lifting the arm on his own. Which of the following is the MOST appropriate response?

Continue passive range of motion within the protocol, explain that the repaired tendon is not yet strong enough for active loading, and note the request in the chart for the PT

Begin active-assisted elevation with a cane, since the patient reports feeling strong

Begin active elevation in the scapular plane against gravity, since pain-free motion indicates the repair is healed

Discharge the patient from physical therapy because he no longer requires skilled care

A physical therapist assistant is measuring knee flexion range of motion in supine for a patient six weeks after a tibial plateau fracture, as directed in the supervising PT's plan of care. Which of the following goniometer alignments is correct?

Fulcrum over the lateral epicondyle of the femur, stationary arm toward the greater trochanter, moving arm toward the lateral malleolus

Fulcrum over the medial epicondyle of the femur, stationary arm toward the anterior superior iliac spine, moving arm toward the medial malleolus

Fulcrum over the tibial tuberosity, stationary arm along the femoral shaft, moving arm toward the head of the fibula

Fulcrum over the lateral joint line, stationary arm toward the ischial tuberosity, moving arm toward the fifth metatarsal

A physical therapist assistant is treating a 24-year-old woman referred two days after an inversion ankle sprain. The supervising PT's plan of care calls for protection, compression, elevation, and weight bearing as tolerated. Today the patient reports she has been unable to take four steps on the limb since the injury, and the PTA finds bone tenderness along the posterior edge of the distal six centimeters of the lateral malleolus. Which of the following is the MOST appropriate action?

Hold the session and contact the supervising physical therapist, because the findings meet criteria for radiographic evaluation

Continue the plan of care, since swelling and tenderness are expected after an acute sprain

Add grade III anterior-to-posterior talocrural mobilizations to restore dorsiflexion

Fit the patient with a lace-up ankle brace and begin single-leg balance training

A physical therapist assistant is treating a 19-year-old athlete two weeks after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. The supervising PT's plan of care includes quadriceps strengthening in the early protective phase. The patient asks to use the seated knee extension machine with resistance through the last 30 degrees of extension. Which of the following is the MOST appropriate intervention for quadriceps strengthening at this stage?

Closed-chain mini squats and leg press within a limited range of roughly 0 to 45 degrees of knee flexion

Resisted open-chain knee extension from 30 degrees to full extension, as the patient requested

Resisted open-chain knee extension from 90 to 30 degrees with heavy load

No quadriceps activation of any kind until the graft has fully matured at six months

A physical therapist assistant is treating a 56-year-old woman with rheumatoid arthritis whose plan of care includes progressive resistive exercise for grip and wrist strength. She arrives today reporting that she woke with morning stiffness lasting over two hours, and the PTA observes that the metacarpophalangeal joints of both hands are warm, swollen, and painful to touch. Which of the following is the MOST appropriate modification?

Replace the resistive exercises with gentle active range of motion in the pain-free range, protect the joints, and notify the supervising PT of the flare

Proceed with the resistive hand exercises as planned, because strengthening reduces joint inflammation

Apply vigorous passive stretching to the MCP joints to prevent the deformities associated with rheumatoid arthritis

Discontinue all hand activity and apply deep heat with ultrasound to the MCP joints

A physical therapist assistant is performing gait training with a 79-year-old man four days after open reduction and internal fixation of a left intertrochanteric hip fracture. The surgeon's order and the supervising PT's plan of care specify toe-touch weight bearing on the left lower extremity. During ambulation with a front-wheeled walker, the PTA observes the patient loading the left leg with what appears to be about half of his body weight. Which of the following instructions is MOST appropriate?

Instruct the patient that the left foot may rest on the floor for balance only, with the body's weight carried through the arms and the right leg, and reinforce it with a bathroom scale

Instruct the patient to keep the left foot completely off the floor at all times until the order is changed

Allow the current loading because about half of body weight is within the toe-touch limit

Advance the patient to partial weight bearing at 50 percent, since he is already tolerating it without pain

A physical therapist assistant is treating a 38-year-old man with low back pain and intermittent right leg symptoms. The supervising PT's evaluation found a directional preference for extension, and the plan of care includes repeated prone press-ups. During today's session, after a set of ten press-ups, the patient reports that his back feels better but the pain has moved from his buttock down to his calf for the first time. Which of the following is the MOST appropriate action?

Stop the extension exercises and contact the supervising physical therapist, because the symptoms have peripheralized

Continue the press-ups, because decreased back pain confirms the exercise is working

Increase the repetitions to twenty, since more extension produces more relief

Switch to repeated lumbar flexion in standing to balance the extension

A physical therapist assistant is seeing a 62-year-old woman on postoperative day two after a two-level posterior lumbar fusion. The supervising PT's plan of care includes bed mobility and transfer training with spinal precautions. To get out of bed, the patient begins to sit straight up by flexing the trunk and pulling with the arms on the bed rail. Which of the following is the MOST appropriate instruction?

Instruct the patient to log roll to side-lying as a unit, then push up to sitting with the arms while lowering the legs, keeping the spine neutral

Encourage the movement, since trunk flexion is needed to strengthen the abdominals after fusion

Instruct the patient to sit up with a twisting motion toward the edge of the bed to reduce the lever arm on the fusion

Instruct the patient to remain flat in bed until the surgeon clears unrestricted movement

10 Free NPTE-PTA Musculoskeletal Practice Questions (2026)

About This Content Area

NPTE-PTA Musculoskeletal Content Breakdown

The musculoskeletal system is the largest content area on the NPTE-PTA, 31 to 40 of the 140 scored items per the official FSBPT NPTE-PTA content outline, effective January 2024. The Federation of State Boards of Physical Therapy splits those items into three categories: physical therapy data collection (9 to 12 items), diseases and conditions that impact effective treatment (10 to 13), and interventions (12 to 15). Try our free 20-question NPTE-PTA practice test, Neuromuscular practice questions, or the 10 general NPTE-PTA practice questions to see how this content sits alongside the rest of the exam.

What the PTA musculoskeletal section covers

→Data collection: goniometry landmarks, manual muscle test grades, posture and movement analysis, gait observation, outcome measures

→Joint biomechanics and anatomy of the musculoskeletal system: synovial joints and their arthrokinematics, synarthroses such as the sutures and the pubic symphysis, the glenohumeral joint and scapular rhythm, hip internal rotation and the capsular pattern, ankle dorsiflexion and foot pronation during gait

→Diseases and conditions: fractures, arthroplasty, ligament and tendon repair, osteoarthritis, rheumatoid arthritis, connective tissue disorders

→Medical management that changes the plan: imaging, surgical procedures, weight-bearing orders, pharmacology

→Interventions: range of motion, stretching, strengthening progression, mobilization grades within the plan of care, gait and functional training

→Adverse effects and complications of interventions, including those from treatment of other systems

What makes the PTA version different from the PT exam is the question frame. The NPTE-PT musculoskeletal questions ask you to examine, diagnose, and decide, which is why the PT exam leans on the orthopedic special test: the Lachman test and anterior drawer test for the anterior cruciate ligament, the posterior drawer test for the PCL, and the impingement and labral tests of the shoulder. The PTA exam does not ask you to select or perform a special test to make a diagnosis. It expects you to recognize what a documented special test result means for the plan of care (a positive Lachman test in the chart tells you why the knee is braced and why open-chain extension is restricted) and to carry out the interventions the PT chose. See our full NPTE-PTA exam format breakdown for how these items fit into the 180-question structure.

Conditions the PTA musculoskeletal section returns to most

→Shoulder: adhesive capsulitis (the frozen shoulder, with its capsular pattern of lost external rotation), rotator cuff repair, glenohumeral joint instability, pectoralis major and biceps tendon injury

→Elbow, wrist, and hand: lateral epicondylalgia, carpal tunnel syndrome, thoracic outlet syndrome and its postural contributors, rheumatoid arthritis of the hand

→Hip and knee: arthroplasty precautions, hip fracture and weight bearing, osteoarthritis, ACL and meniscal repair, patellofemoral pain

→Foot and ankle: Achilles tendon rupture and tendinopathy, plantar fasciitis, lateral ankle sprain, ankle dorsiflexion loss and compensatory pronation

→Spine: lumbar fusion precautions, directional preference, spinal stenosis, cervical radiculopathy, osteoporosis and compression fracture

→Pediatric and systemic: scoliosis, juvenile idiopathic arthritis, Osgood-Schlatter disease, osteogenesis imperfecta

The pattern to recognize

Almost every PTA vignette in the musculoskeletal system contains a boundary: a post-op week, a precaution, a weight-bearing order, a mobilization grade, or a plan of care that says what the PTA may do. The wrong answers cross that boundary, either by doing more than the plan allows (a thrust, a new exercise, an advanced weight-bearing status) or by ignoring a finding that should stop the session (peripheralization, Ottawa criteria, an inflamed joint). Find the boundary first, then pick the answer that stays inside it or escalates to the PT.

Cross-Content Reasoning

Where Musculoskeletal Content Connects Across the NPTE-PTA

Musculoskeletal items borrow from every other section. The weight-bearing and precaution rules on this page are the same ones the non-systems section tests through assistive device selection and gait patterns, and the Ottawa rules and red-flag reasoning here reappear as safety and professional responsibility items. The ACL and rotator cuff timelines connect to therapeutic modalities, where the same healing phases decide whether cryotherapy, electrical stimulation, or ultrasound is appropriate.

The neuromuscular section shares the orthopedic surgery population: a patient with Parkinson’s disease after a hip fracture, or a stroke survivor with a glenohumeral joint subluxation, is written as a system-interaction item that counts toward the other systems total, alongside the integumentary, lymphatic, endocrine, and genitourinary items. Rheumatoid arthritis sits at the same intersection, an autoimmune condition with musculoskeletal, cardiopulmonary, and medication effects that the exam can file under more than one system, and so does lymphatic involvement after breast cancer surgery, where lymphedema precautions change how the shoulder is loaded. Integumentary items overlap the same way: an Achilles tendon repair carries an incision and a cast, and the skin check is part of the musculoskeletal session.

And the cardiopulmonary section supplies the monitoring layer: vital-sign responses during gait training after hip fracture, sternal precautions after cardiac surgery, and the exercise tolerance of a deconditioned patient all decide how far a musculoskeletal intervention can be pushed in a single session.

Study tip

Build a one-page precaution sheet: posterior and anterior hip approaches, lumbar fusion, rotator cuff repair, Achilles tendon repair, ACL reconstruction with each graft type, and sternal precautions, each with the motions to avoid and the week the restriction lifts. Pair it with the weight-bearing ladder (NWB, TTWB, PWB, WBAT, FWB), the goniometry landmark triads for the shoulder, elbow, hip, knee, and ankle, and the capsular patterns (adhesive capsulitis loses external rotation first, the hip loses internal rotation first). Those sheets cover most of the recall the musculoskeletal system demands, and our complete NPTE-PTA study guide shows how to fold them into a full study plan.

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