Reflex — PM&R Board Review

Shoulder Anatomy, Instability, and Impingement. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: A score of four or higher in an adult, or six or higher in a child, formally defines generalized joint hypermobility. — Correct: By the 2017 hypermobile Ehlers-Danlos criteria, the adult threshold is 5 or higher out of 9 (puberty to age 50), 6 or higher before puberty, 4 or higher after 50. The older Brighton criteria used 4 or higher in adults. (2) In the audio: their recurrence rate approaches an astonishing 90 to 100 percent. — Correct: Recurrence after non-op care of a first dislocation is ~85-90% under 20 or in young contact/overhead athletes, ~two-thirds under 30, and below a third after 30; near 100% only with repeat dislocations. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-01.

Rotator Cuff, Adhesive Capsulitis, and Biceps. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: waiting 12 weeks you allow the initial intense capsular inflammation to mature and weaken slightly — Correct: Twelve weeks marks an adequate trial of conservative care, not a waiting period for the capsule to weaken. The capsule does not soften over that interval, it becomes maximally fibrotic and contracted. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-02.

Shoulder Fractures, Winging, and Nerve Entrapment. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-03.

Elbow Anatomy, Epicondylitis, and Throwing Injuries. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: The radial head is a primary anterior bony stabilizer — Correct: The radial head is a secondary elbow stabilizer, not primary. Primary stabilizers are the ulnohumeral joint (with the coronoid as anterior buttress), the anterior MCL bundle, and the LCL complex. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-04.

Elbow Nerve Entrapments and Adult Fractures. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-05-a.

Wrist, Carpal Bones, Carpal Tunnel, and DeQuervain. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: carpal tunnel syndrome and de Quervain tenosynovitis, which we will cover next, are frequently driven by true active inflammatory tenosynovitis. — Correct: Idiopathic carpal tunnel syndrome is not inflammatory tenosynovitis; specimens show non-inflammatory fibrosis, oedema, and vascular proliferation. It is a compressive mononeuropathy, not an inflammatory condition. (2) In the audio: They recur at a massive 80% rate after simple needle aspiration, but the recurrence drops dramatically to around 10%, — Correct: Recurrence after simple aspiration runs roughly 50 to 75 percent, pooled near 60 percent, and rises with the length of follow-up, so short series report lower numbers. Nothing published reports 90 percent. Excision of the cyst with its stalk brings recurrence to about 20 percent, not 10. (3) In the audio: is statistically the most sensitive bedside — Correct: No single provocative test is reliably the most sensitive for carpal tunnel syndrome. Phalen and Durkan compression perform comparably, at pooled sensitivities of roughly 0.57 to 0.70 each, and both are more sensitive than Tinel, which is the most specific of the three. The original 87 percent figure for the compression test was never replicated; independent testing with the same gauge found 0.36. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-06.

Hand: Flexor Pulleys, Trigger Finger, Dupuytren, and the Fingertip Deformity Quartet. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: into the dartos fascia of the penis, causing curvature. — Correct: The Peyronie plaque forms in the tunica albuginea, the fibrous sheath around the corpora cavernosa, not the dartos fascia. Peyronie disease remains the penile member of the Dupuytren diathesis. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-07-a.

Hand: Thumb UCL Injury, Intrinsic Muscles, and Deformity by Nerve Injury. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-07-b.

Hip Anatomy, Muscles, and Special Tests. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-08.

Hip Fractures, Arthroplasty, and Pediatric Hip. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-09.

Knee Anatomy, ACL, PCL, and Ligaments. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Climbing stairs dictates a hard requirement of 90 degrees of flexion. — Correct: Stair climbing needs about 100 degrees. That is the prescriptive requirement, the mean plus two standard deviations, from the original activity-of-daily-living goniometry, whose measured mean on ascent was in the low 80s; modern gait-laboratory means run roughly 85 to 95. Ninety degrees is the post-arthroplasty benchmark, not the stair-climbing requirement. (2) In the audio: standing back up from that standard chair requires 105 degrees — Correct: Rising from a standard chair needs about 90 to 95 degrees, the same as sitting into it. The 105 degree figure is a misattribution: the source study reports 106 degrees for tying a shoe and one sit-and-rise cycle at 93 degrees, and no study separates sitting from rising. A low chair pushes toward 110 to 120. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-10.

Knee Meniscus, Patellofemoral, and Overuse. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: We also talked about how the second fracture acts as a pathognomonic sign for an anterior cruciate ligament tear. — Correct: It is the Segond fracture, a lateral tibial plateau avulsion from an internal-rotation/varus injury, that is pathognomonic for ACL tear. There is no entity called a "second fracture." (2) In the audio: Level walking on a flat surface creates a compressive force equal to 0.9 times body weight across the patella-femoral joint. — Correct: The board-keyed ladder is about 0.5 times body weight walking, 3.3 times on stairs, and 6 to 7 times in a deep squat. Modern measurements put the squat peak lower (above 3 times), but answer the exam with 0.5 / 3.3 / 6-7. (3) In the audio: The true number is above 3 times body weight. — Correct: For the exam, deep squatting is keyed at 6 to 7 times body weight; the lower modern figure is a caveat, not the answer. (4) In the audio: Because the contact area between the articular surface of the patella and the trochlear groove is maximal at that point. — Correct: Patellofemoral contact area grows with flexion. The joint reaction force is lowest in terminal extension because the quadriceps compresses the patella against the femur least near full extension, and that force climbs steeply with flexion. (5) In the audio: get 6 to 12 weeks of strict conservative management. — Correct: A stable OCD lesion with open physes is managed conservatively for about 3 to 6 months, occasionally longer, before drilling is considered; the window is consensus rather than graded evidence. (6) In the audio: You must know that asymptomatic degenerative meniscal tears appear on imaging in up to 60% of people over age 50. — Correct: The 60 percent figure applies only to people who already have radiographic knee osteoarthritis. In the Framingham MRI cohort, 60 percent of symptom-free adults with Kellgren-Lawrence grade 2 or higher had a meniscal tear, against 23 percent of those without radiographic osteoarthritis; unconditional prevalence runs from 19 percent in women aged 50 to 59 to 56 percent in men aged 70 to 90. The lesson stands: prove the tear is the pain generator before operating. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-11.

Ankle Anatomy, Lateral Sprains, Achilles Pathology, and Compartment Syndrome. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: If you are missing that 10 degrees of upward bend, you see two major compensatory movements. — Correct: The 10 degrees of dorsiflexion is a terminal-stance requirement, so the tibia can advance over the planted foot. Swing phase needs only a return to neutral for the toe to clear; circumduction and steppage appear when a contracture also costs neutral in swing. (2) In the audio: casting the ankle in a slight downward and outward position for six weeks. — Correct: An acute peroneal tendon subluxation is cast in slight plantarflexion and INVERSION for 4 to 6 weeks; inversion slackens the evertor (peroneal) tendons so the superior peroneal retinaculum can scar back to the fibula. Outward (eversion) is the wrong direction. (3) In the audio: for non-elite athletes, the functional bracing outcomes are virtually indistinguishable from surgical outcomes. — Correct: Functional outcomes are comparable for lower-demand patients, but rerupture is not: surgical repair still lowers the rerupture rate (roughly 2 to 4 percent versus 4 to 6 percent), and the largest modern randomized trial found more reruptures without surgery even with accelerated rehabilitation in both arms. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-12.

Foot: Stress Fractures, Plantar Fasciitis, Morton, Lisfranc, and Deformities. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: with weight bearing as tolerated for four to six weeks. — Correct: A Zone 1 tuberosity avulsion is managed in a hard-soled shoe or walking boot with weight bearing as tolerated, but radiographic union averages 6 to 8 weeks (about 7 weeks in a boot and about 9 weeks in a shoe in the largest comparative series), not 4 to 6. (2) In the audio: The five sites are the femoral neck, the anterior tibial cortex, the fifth metatarsal zone, the navicular and the talus. — Correct: Those five are the most quoted, but the board-tested high-risk list also includes the patella, the medial malleolus and the great toe sesamoids: eight sites sharing high tensile load and low blood flow. (3) In the audio: there is a pathognomonic clinical finding, plantar ecchymosis. — Correct: Plantar ecchymosis after midfoot trauma is highly suggestive of a Lisfranc injury and mandates weight-bearing radiographs, but it is not pathognomonic; the diagnosis rests on the fleck sign and first-second metatarsal base widening. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-13.

Spine: Anatomy, Disc Herniation, and Radiculopathy. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: That single articulation between the skull and C1 provides about 50% of all cervical flexion and extension. It is our primary nod joint. — Correct: The atlanto-occipital joint is the primary nod joint, but it does not supply half of the cervical flexion-extension arc. Measured in-vivo contributions cluster around 15 to 20 percent of the whole-neck arc, and the joint is strongly extension-biased, contributing several times more extension than flexion. The paired claim in the same passage, that the atlantoaxial joint supplies about 50% of cervical rotation, is correct and stands. (2) In the audio: Why is threading the needle directly into the foramen, the transforaminal approach, favored over the interlaminar approach when you have a single, specifically identified, hot nerve root? — Correct: That preference holds for the lumbar spine. For a cervical radiculopathy the interlaminar approach (typically C7-T1) is the usual first choice, because cervical transforaminal injection has caused brainstem and spinal cord infarcts when particulate steroid entered the vertebral or radicular arteries. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-14.

Spine: Stenosis, Spondylolisthesis, and Facet-Mediated Pain. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The stark reality is that it does not reliably respond to conservative management. — Correct: Conservative care does not reverse established myelopathy, but that is not the same as never observing. Mild, non-progressive myelopathy (mJOA 15 or higher with a stable examination) may be watched with rehabilitation and neurologic re-examination every 6 to 12 months; moderate, severe or progressing disease goes to decompression. (2) In the audio: In fact, 85 to 95 percent of all spondylolysis cases occur precisely at L5. — Correct: That figure comes from the plain-film era. CT and MRI series put roughly two thirds of pars defects at L5, with L4 accounting for a further 20 to 30 percent. Teach L5-predominant with L4 a real second. (3) In the audio: it strongly correlates with active discogenic low back pain — Correct: Modic type 1 is not established as more painful than type 2. The best systematic review found no consistent difference between the types, the overall association with axial pain is modest, and basivertebral nerve ablation targets types 1 and 2 together. (4) In the audio: Mild curves, defined as under 60 to 70 degrees, — Correct: Observation with exercise applies under about 50 degrees. A 55 to 70 degree curve in a skeletally immature patient is brace territory, and 60 to 70 degrees overlaps the episode's own 50 to 75 degree bracing band. (5) In the audio: You send the patient to surgery for a slip of grade 3 or higher, — Correct: Grade alone is not a surgical indication. An asymptomatic high-grade slip is managed nonoperatively with activity modification and surveillance; surgery is for documented progression, neurologic deficit, dynamic instability or refractory pain. (6) In the audio: but each individual joint receives medial branch fibers from two entirely separate spinal levels — Correct: That is the lumbar rule. Cervical facets take the medial branches of their own two numbers (C5-C6 from C5 and C6), and the C2-C3 joint is supplied by the third occipital nerve alone. (7) In the audio: the critical diagnostic standard for developmental cervical stenosis is a Torg-Pavlov ratio of under 0.8 — Correct: The 0.8 cutoff is a sensitive screen with a positive predictive value well under 1 percent in athletes, because a large vertebral body drives the ratio down without true canal narrowing. It must never by itself disqualify an asymptomatic athlete from contact sport; get MRI canal and cord measurements instead. (8) In the audio: The formal definition of lumbar instability is a forward translation greater than 5 millimeters, or an angular change greater than 15 degrees between the flexed and extended radiographic views. — Correct: The lumbar criteria are translation greater than 4.5 mm or 15 percent of the vertebral body width, and a level-specific sagittal rotation: greater than 15 degrees at L1-2 through L3-4, greater than 20 degrees at L4-5, and greater than 25 degrees at L5-S1. One 15-degree cutoff for the whole lumbar spine under-calls instability at the two lowest segments. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-15.

Spine: Red Flags, Cauda Equina, Scoliosis, and Ankylosing Spondylitis. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: And a normal, healthy chest expands by more than 5 centimeters. — Correct: Roughly 5 cm or more is the usual normal, but a value just under 5 cm is nonspecific and common in healthy older adults. The tighter, more specific threshold for costovertebral joint involvement in ankylosing spondylitis is expansion of less than 2.5 cm at the fourth intercostal space or xiphisternum. (2) In the audio: For curves under 25 degrees, the standard of care is observation. — Correct: Board references draw the observation-to-bracing line at 20 degrees, and the BrAIST trial enrolled 20- to 40-degree curves. Many clinical protocols wait for 25 degrees or documented progression, so treat 20 to 25 degrees as the boundary rather than 25 alone. (3) In the audio: Over 40 to 50 degrees is the standard threshold where you indicate the patient for operative intervention — Correct: The surgical threshold splits by skeletal maturity: greater than 40 degrees in a skeletally immature patient, greater than 50 degrees once skeletally mature, greater than 35 degrees (or any decline in pulmonary function) in neuromuscular scoliosis, and relentless progression at any magnitude. (4) In the audio: rather than destroying the annulus fibrosus like an inflammatory syndesmophyte does — Correct: Both DISH and ankylosing spondylitis characteristically preserve intervertebral disc height. The discriminator is the bridging bone: thick flowing non-marginal ossification of the anterior longitudinal ligament in DISH versus thin vertical syndesmophytes arising from the annulus margins in ankylosing spondylitis. Preserved discs separate DISH from degenerative spondylosis, not from ankylosing spondylitis. (5) In the audio: you must actively suspect hematogenous seeding of Staph aureus into the spine — Correct: Correct as far as it goes: S. aureus is the leading organism in native vertebral osteomyelitis, including in people who inject drugs. The audio omits that Pseudomonas aeruginosa and other gram-negative organisms are disproportionately more frequent in this population, which is why empiric coverage is broadened while cultures are pending. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-16.

Sports Medicine. Topics: Concussion, Return-to-Play Protocol, and Stingers. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Once herniation occurs, the mortality approaches 100%. — Correct: Second impact syndrome carries roughly 50 percent mortality and near-100 percent morbidity. There is no herniation subgroup in which mortality rises to 100 percent; the 100 percent figure belongs to morbidity, and essentially every survivor is left with severe permanent neurologic disability. (2) In the audio: steps that creates a six day absolute floor. — Correct: Six days is the arithmetic of six steps at 24 hours each, but both the 2016 and 2022 consensus statements state a minimum of about one week to complete the graduated return-to-sport strategy. The 24 to 48 hours of relative rest before step 1 sits outside that clock. (3) In the audio: It is functionally impossible to clear the protocol in less than six days. — Correct: The stated consensus minimum is at least one week from the start of the protocol, not six days. (4) In the audio: The rules dictate that you drop back exactly one step. — Correct: The uniform drop-back-one-step rule is the 2016 version. Under the 2022 consensus, more than mild symptom exacerbation during steps 1 to 3 means stopping and retrying the same step the next day, while symptom recurrence during steps 4 to 6 returns the athlete to step 3. (5) In the audio: He drops back to step two. — Correct: The athlete in the example recurred at step 3, which under the 2022 consensus means retrying step 3 the next day rather than dropping to step 2. Only recurrence in steps 4 to 6 sends the athlete back a step, and then to step 3. (6) In the audio: The strict parameters are keeping the heart rate below 70 percent of maximum — Correct: 70 percent is the ceiling for step 2 as a whole. The 2022 consensus grades the step: 2A light activity to about 55 percent of maximum heart rate, then 2B moderate activity to about 70 percent. (7) In the audio: menstrual dysfunction, and bone stress injury. — Correct: The third component of the female athlete triad is low bone mineral density. Bone stress injury is its clinical consequence, not the named component. (8) In the audio: modified balance error scoring system utilizing three 20-second stances with eyes closed and finger to nose. — Correct: The modified Balance Error Scoring System is the three stances only. Finger-to-nose is the separate coordination component of the tool, not part of the balance test. (9) In the audio: His cognitive test is 24 out of 30 — Correct: The SCAT-6 Standardized Assessment of Concussion totals 50 points, not 30, because immediate memory now uses a 10-word list over three trials (30 points) with 10-point delayed recall. The chapter vignette has been rescaled to 38 of 50 against a 46 of 50 baseline. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-17.

Sports Medicine. Topics: Exercise Physiology, Cardiac Equations, and Muscle Physiology. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: climbing a single flight of stairs or performing light occupational work around an office or a house requires four to five mets. — Correct: One flight of stairs (about twelve steps) costs about 3 to 4 METs; two flights come to about 5. Light occupational work is what sits at 4 to 5 METs, which is separately the clearance threshold for most activities of daily living. (2) In the audio: Intensity mandates 40 to 85% of the heart rate reserve utilizing the Karvonen formula. — Correct: 40 to 89 percent of heart rate reserve: moderate intensity is 40 to 59 percent and vigorous is 60 to 89 percent. The 85 percent ceiling understates the vigorous band. (3) In the audio: An eccentric contraction naturally produces 20 to 50% more absolute force than a maximal isometric or concentric contraction executed at the exact same speed. — Correct: About 40 percent more force than a maximal concentric contraction at matched velocity (ratio near 1.4). Eccentric force also exceeds isometric force, but by a smaller and less precisely established margin. (4) In the audio: patients prescribe beta blockers must exclusively use perceived exertion instead of heart rate to monitor intensity. — Correct: A beta-blocker invalidates the age-predicted 220 minus age estimate, not heart-rate-reserve prescription. When a graded exercise test measured the peak on the current dose, a Karvonen target from that peak is an acceptable primary prescription; perceived exertion leads when no such test exists. (5) In the audio: Skeletal muscle extraction of oxygen only improves by about 10 to 20% with years of rigorous endurance training. — Correct: The direction is right but the 10 to 20 percent figure is unsourced. In short training programs, maximal cardiac output rises significantly while the maximal arteriovenous oxygen difference shows no significant average change; in heart failure the gain leans on peripheral adaptation instead. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-18.

Sports Medicine. Topics: Environmental Illness, Rhabdomyolysis, and Special Populations. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Once you go above 3,000 meters, roughly 10,000 feet, you should not increase your sleeping altitude by more than 300 meters or 1,000 feet per day. — Correct: The ceiling is 500 meters of sleeping-altitude gain per day above 3,000 meters, not 300. The mandatory rest day for every 1,000 meters gained is right as stated (some sources phrase the same rule as a rest day every third or fourth day of ascent). (2) In the audio: The new mantra is "drink to thirst," and whenever possible, use sodium containing sports drinks rather than plain water during ultra-endurance events. — Correct: Drinking to thirst is right, and it is the only prevention strategy that carries a strong evidence grade. Sodium-containing sports drinks are not preventive: most are hypotonic relative to plasma, so over-drinking them dilutes serum sodium exactly as over-drinking water does. Sodium supplementation during events shorter than roughly 18 hours has not been shown to prevent exercise-associated hyponatremia. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-19.

Rheumatoid Arthritis, Osteoarthritis, and Crystal Arthropathies. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: the swan neck deformity is characterized by hyperextension at the PIP joint paired with flexion at the DIP joint — Correct: Swan neck is a three-joint pattern: MCP flexion, PIP hyperextension, and DIP flexion. The driver is MCP synovitis with intrinsic (lumbrical and interosseous) tightness pulling the lateral bands dorsal to the PIP axis; boutonniere is the mirror image and adds compensatory MCP hyperextension. (2) In the audio: the four H diseases, hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypothyroidism — Correct: The fourth core H is hypophosphatasia (congenitally low alkaline phosphatase), not hypothyroidism, and not the near-homograph hypophosphatemia. Hypothyroidism is a weaker traditional association, and amyloidosis is a real association that sits outside the mnemonic. (3) In the audio: Hyaluronic acid visco-supplementation is also used as an intraarticular injection, though its actual clinical efficacy remains heavily debated in the literature — Correct: Hyaluronic acid is conditionally recommended against for knee osteoarthritis under the 2019 rheumatology guideline; the benefit over placebo is minimal and inconsistent. Acetaminophen in the same ladder is only conditionally recommended, not an equal escalation step beside oral NSAIDs. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-20.

SLE, Inflammatory Myopathies, and Scleroderma. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: If you apply the massive mechanical shear force of an eccentric contraction to an actively inflamed fragile muscle, you will cause massive necrosis. — Correct: The program is right, the mechanism is not. Eccentric loading is deferred while CK is elevated because it generates the greatest mechanical force of any contraction type, not because it has been shown to cause necrosis in inflamed human muscle. (2) In the audio: Low-dose prednisone, around 10 to 20 milligrams a day, produces dramatic, near-miraculous improvement in their symptoms within 24 to 72 hours. — Correct: 12.5 to 25 mg a day is the recommended initial prednisone-equivalent range for polymyalgia rheumatica. Improvement is dramatic within days and near complete by 2 to 4 weeks. (3) In the audio: Adult dermatomyositis carries a 20 to 25 percent risk of an underlying cancer. — Correct: The commonly cited absolute range is 15 to 25 percent, concentrated about 3 years either side of diagnosis. The cohort figure quoted beside it is a standardised incidence ratio near 3, a relative risk rather than a percentage. (4) In the audio: Diffuse scleroderma with the anti-Scl-70 antibody ends in interstitial lung disease and renal crisis — Correct: Interstitial lung disease leads, then pulmonary arterial hypertension and cardiac causes. Scleroderma renal crisis has fallen well down the list of causes of death since ACE inhibitors became standard. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-21.

Spondyloarthropathies and Fibromyalgia. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Then they measure exactly 10 centimeters straight up the spine and make a second mark... It should increase by at least five centimeters. So from 10 to at least 15. — Correct: The audio names the modified Schober test but describes the original. The modified test marks 10 cm above and 5 cm below the lumbosacral junction, a 15 cm span, and a normal spine lengthens it by more than 5 cm, to 20 cm or more. The positive threshold, a gain under 5 cm, is the same in both versions, so a stem quoting 15 cm increasing to 19 cm describes a restricted spine. (2) In the audio: A normal difference is greater than five centimeters. Less than five means the ribs are locked in place. — Correct: Chest expansion is graded, not pass-fail at 5 cm. Roughly 5 cm or more is the usual normal, a value just under 5 cm is reduced but nonspecific and is common in healthy older adults, and a value below 2.5 cm is the classic threshold for costovertebral involvement. (3) In the audio: Anterior uveitis, or iritis, affects roughly 25% to 30% of AS patients. — Correct: Acute anterior uveitis occurs in approximately one third of ankylosing spondylitis patients (about 33 percent in the largest pooled systematic review), with higher rates in HLA-B27-positive patients. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-22.

Osteoporosis Part 1. Topics: Diagnosis, DEXA, Risk Factors. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: That makes the total hip the best measurement for tracking subtle changes in bone density over time. Use the femoral neck to predict the danger. Use the total hip to track the progress. — Correct: There is no single preferred site for serial monitoring. The PA lumbar spine and the hip are both endorsed, each judged against its own site-specific least significant change (and the mean bilateral total hip when both hips are scanned). The total hip is genuinely more reproducible than the femoral neck, and the femoral neck alone is the site that is not favored for monitoring, because it carries the largest precision error of the three. (2) In the audio: Those margins are typically 3 to 5% at the spine and 4 to 6% at the hip. — Correct: The published least significant change values run about 5.3% at the lumbar spine, about 5.0% at the total hip and about 6.9% at the femoral neck. Teach roughly 5% at spine and total hip and up to about 7% at the femoral neck alone; grouping the hip with the femoral neck hides that the total hip is the more precise of the two, and every facility must measure its own value. (3) In the audio: A prior vertebral fracture confers a five-fold increased risk of another vertebral fracture and a two- to three-fold increased risk of a hip fracture. — Correct: The two most-cited syntheses put the multipliers closer to about four-fold for a further vertebral fracture and about two-fold for hip fracture after any prior fragility fracture. A prior fragility fracture is still the single strongest predictor; only the numbers run high. (4) In the audio: In the first five to 10 years of menopause, women drop bone mass by two to 3% per year. — Correct: The accelerated postmenopausal phase runs about 3 to 5 percent a year for roughly 5 to 7 years, on top of an age-related baseline of about 0.25 to 1 percent a year in both sexes. (5) In the audio: Hypogonadism is the most common secondary cause in men. — Correct: Hypogonadism, glucocorticoid excess and alcohol excess are the three leading identifiable secondary causes of osteoporosis in men, and no source ranks a single most common cause with confidence; the ranking shifts with the population studied. What is well supported is that roughly half to four-fifths of men with osteoporosis have an identifiable secondary cause. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-23.

Osteoporosis Part 2. Topics: Treatment and Fracture Management. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The typical holiday is 2 to 3 years for oral users and 3 to 6 years for IV users. Why longer for the IV? Simply because the IV dose saturates the skeleton more heavily and takes longer to clear. — Correct: The holiday length is not route-specific. The long-term bisphosphonate task force gives one range, about 2 to 3 years, whichever agent came before. What the route changes is the reassessment point that opens the question: 5 years for oral therapy and 3 years for intravenous therapy. A patient still at high fracture risk at that point is a candidate for continued treatment out to 10 years oral or 6 years intravenous rather than a holiday at all. (2) In the audio: First, as you mentioned, it is perfectly safe for patients with severe chronic kidney disease, even those on dialysis, because antibodies are broken down into amino acids. — Correct: Denosumab is not renally cleared, so it stays on-label once creatinine clearance falls below the bisphosphonate floor, dialysis included, but it is not "perfectly safe" there. Since January 2024 it carries an FDA boxed warning for severe hypocalcemia in advanced chronic kidney disease, added after dialysis patients started on denosumab showed severe hypocalcemia far more often than those started on an oral bisphosphonate. Correct hypocalcemia and CKD mineral and bone disorder and assure calcium and active vitamin D before the first dose, then check calcium frequently, particularly 2 to 10 weeks after each injection. (3) In the audio: The cement hardens in minutes, stabilizes the microfractures, and provides almost immediate dramatic pain relief. — Correct: Pain after vertebroplasty usually eases over days rather than immediately, and the evidence is contested. Blinded trials of vertebroplasty against a sham procedure found no significant benefit for pain, function or quality of life, kyphoplasty has no blinded trial of its own, and board sources therefore call vertebral augmentation controversial. (4) In the audio: After about five years of oral therapy, or three to five years of IV zoledronic acid, you stop the drug. — Correct: The intravenous reassessment point is 3 years, not 3 to 5. The long-term bisphosphonate task force reassesses fracture risk after 5 years of oral therapy or 3 years of intravenous therapy; the 3-to-5-year phrasing that appears in the underlying literature is route-agnostic and describes the reassessment window across both routes, not an intravenous-specific figure (PMID 26350171). Reassessment is also not automatically a stop: a patient still at high risk at that point (older age, low hip T-score, high fracture-risk score, prior major fracture, or a fracture sustained on therapy) is a candidate for continued therapy out to 10 years oral or 6 years intravenous rather than a holiday at all. The separate correction on holiday LENGTH is the other entry for this episode. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-24.

MSK Ultrasound and Joint Injection. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: A joint injection, however, primarily threatens only the microscopic patch of tissue sitting directly at the tip of your needle. — Correct: Most of the risk is local, but a single intra-articular corticosteroid injection has real systemic effects: facial flushing, transient hyperglycemia and HPA-axis (adrenal) suppression. Repeated or high-dose injection adds osteoporosis, steroid arthropathy and avascular necrosis, and repeated intra-articular triamcinolone accelerates cartilage volume loss with no added pain benefit. (2) In the audio: as it raises diagnostic accuracy to roughly 88 percent — Correct: The 88 percent is a needle-placement rate, not the diagnostic accuracy of the block. Landmark technique lands the needle in the sacroiliac joint about 22 percent of the time; ultrasound guidance places it intra-articularly in about 88 percent of joints; fluoroscopy with contrast is the reference standard for confirming placement. (3) In the audio: the five test provocation cluster for SI joint pain ... the Patrick or Faber test, the Gaenslen's test, the thigh thrust test, the sacral compression test, and the sacroiliac distraction test ... three or more positive tests out of the five — Correct: The validated cluster is four tests, not five: distraction, thigh thrust, compression and sacral thrust, with two of four positive giving about 88 percent sensitivity and 78 percent specificity. Gaenslen adds little and can be dropped; the Patrick (FABER) test is not part of the validated cluster. (4) In the audio: particulate steroid reaching the artery of Adamkiewicz, usually left-sided between T9 and L1, causes embolic cord infarction and paraplegia — Correct: That is the wrong vessel for a cervical injection. The artery at risk differs by territory. In the cervical spine the danger is the vertebral artery and the cervical radiculomedullary feeders to the anterior spinal artery, and the catastrophe is posterior circulation stroke or cervical cord infarction. The artery of Adamkiewicz (typically left-sided, T9 to L1) is the thoracolumbar vessel, and it is what makes a lumbar or thoracic transforaminal injection dangerous. The non-particulate dexamethasone rule is the same in both territories because the mechanism is the same: crystalline particulate steroid occluding a small end-artery. (5) In the audio: Specifically, the rate is one in 10,000 to one in 50,000. You need to memorize that exact range. — Correct: There is no exact range to memorize. One in 10,000 to one in 50,000 is a published range but not the only one: studies differ in denominator, surveillance window and whether a positive culture is required. Large denominator-based series put post-injection septic arthritis nearer 1 in 1,000 to 1 in 3,000, narrower reviews report 1 in 12,500 to 1 in 50,000, and arthroscopy runs about an order of magnitude higher than injection. Learn the magnitude and the rule it drives: the risk is small, the consequence is joint destruction, and a suspected septic joint is aspirated, never injected. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-25-a.

Nerve Injury Classification and EDX Correlation. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: the timeline is always 12 to 18 months. — Correct: The motor endplate viability window is a rule of thumb of roughly 12 to 24 months, most sources favouring 18 to 24, not a fixed 12 to 18. It is not a hard biological deadline either: human biopsy work has found structurally intact motor endplates surviving more than 3 years after injury. (2) In the audio: Those distal muscles won't fibrillate until three to six weeks after the injury. — Correct: Distal hand and foot muscles develop fibrillation potentials by about three to four weeks (roughly 21 to 30 days for the longest stumps). The six-week upper bound overstates the delay. (3) In the audio: It's often nicknamed honeymoon palsy or strawberry picker's palsy. — Correct: Honeymoon palsy is a radial nerve eponym at the spiral groove, the bedfellow of Saturday night palsy, not a peroneal one. Peroneal compression at the fibular head from leg crossing is crossed-leg palsy; strawberry picker's palsy is a correct name for it. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-26.

Salter-Harris Fractures and Pediatric MSK. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The fractured bone and the dislocated joint always sit at opposite ends of the forearm. — Correct: The fractured bone and dislocated joint are in different bones, not opposite ends of the forearm. In Monteggia both the ulnar fracture and radial head dislocation are proximal; in Galeazzi both are distal. (2) In the audio: and an abnormal Klein line on a frog leg lateral view. — Correct: The Klein line (Trethowan sign) is drawn on the anteroposterior view, as the body of the episode says. The frog-leg lateral is the most sensitive view for detecting an early or subtle slip, not the view the Klein line is drawn on. (3) In the audio: Both the brachial artery and the anterior interosseous nerve sit directly anterior to the distal humerus, — Correct: The brachial artery and the median nerve trunk course directly anterior to the distal humerus. The anterior interosseous nerve is the branch most often injured, because the displaced fragment pinches the median nerve trunk where that branch arises; the anterior interosseous nerve itself does not run anteriorly at the elbow. (4) In the audio: carrying a 10 to 20% association with DDH. — Correct: Developmental dysplasia of the hip coexists with congenital muscular torticollis in roughly 5 to 20 percent of infants across series, depending on whether any sonographic dysplasia or only dysplasia needing treatment is counted. The screening rule is unchanged: examine the hips in every torticollis infant and keep a low threshold for ultrasound. (5) In the audio: if they have a 25 to 45 degree curve. — Correct: The bracing band in adolescent idiopathic scoliosis is about 25 to 40 degrees at Risser 0 to 2. Fusion is considered once the curve passes about 45 degrees in a still-growing spine and 50 degrees or more in a skeletally mature spine. (6) In the audio: is necessary in roughly 90% of cases — Correct: Percutaneous Achilles tenotomy is needed in roughly 70 to 90 percent of Ponseti-treated clubfeet, commonly quoted as about 80 percent, with the highest rates in the most severe feet. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-27-a.

Complex Regional Pain Syndrome and Myofascial Pain. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The four categories are sensory, which includes hyperesthesia or allodynia. — Correct: The sensory category of the Budapest criteria is hyperalgesia and/or allodynia. Hyperalgesia is an exaggerated pain response to an already painful stimulus such as pinprick; hyperesthesia is a different word meaning heightened sensitivity to any stimulus, and the criteria do not use it. (2) In the audio: For the upper extremity, the stellate ganglion block targets C7 anteriorly. — Correct: The ganglion lies anterolateral to the C7 vertebral body at C7 to T1, but the needle is placed at the Chassaignac tubercle, the anterior tubercle of the C6 transverse process, to stay clear of the vertebral artery and the pleural dome. (3) In the audio: Significant pain relief means the pain is sympathetically maintained. — Correct: That labels the pain but does not diagnose CRPS. A positive block response does not confirm the diagnosis and a negative one does not exclude it; current guidelines treat the block as an empiric therapeutic trial, and CRPS remains a clinical diagnosis made against the Budapest criteria. (4) In the audio: It affects women three times as often as men, and the incidence peaks in the fifth through seventh decades of life. — Correct: Roughly three to four times as often as men, and there is no single narrow peak in onset age. One population study found a median onset in the mid-40s and a larger one found the highest incidence in postmenopausal women in their 60s. (5) In the audio: or up to 100 to 200 milligrams a day, tapered over roughly two weeks. — Correct: The high-dose convention is not supported for early CRPS. The controlled trial regimen was about 30 mg of prednisone daily continued until remission, and guidelines synthesize this as approximately 30 mg per day for 2 to 12 weeks with a taper; the one high-dose trial studied longstanding, treatment-resistant disease and was negative. (6) In the audio: It's cheap, safe, and highly effective. — Correct: Vitamin C 500 mg daily for 50 days is the regimen the trials used and stays the board answer, but the evidence is mixed: a later large randomized trial at the same dose found no benefit, and the orthopaedic guideline dropped the topic in its 2020 update. (7) In the audio: the intravenous route reduces pain and improves function in CRPS. And this actually has strong randomized data behind it, — Correct: The randomized data are low certainty and the benefit is short-term pain only. The largest synthesis (11 trials, 754 patients) finds bisphosphonates may reduce pain in the short term by about 10 points on a 0 to 100 scale at low certainty, with little to no difference at 3 to 6 months or beyond, and probably more adverse events. Improved function is not supported. They are an adjunct, not a mainstay. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-28.

Groin Injuries, Athletic Pubalgia, and Leg Length Discrepancy. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: a full grade three complete rupture might require surgical repair. That can take up to six months — Correct: Grade 1 adductor strain: 1-2 weeks; grade 2: 3-6 weeks; grade 3 complete tear (non-operative): 2-3 months. Six months applies only to surgical repair of a retracted proximal avulsion. (2) In the audio: which usually involves a pelvic floor repair or release of the adductor longus fascia to decompress the area — Correct: Athletic pubalgia surgery repairs the posterior inguinal wall (transversalis fascia, conjoint tendon, rectus abdominis insertion), often with adductor longus tenotomy, not the pelvic floor. Recovery averages 6-12 weeks. (3) In the audio: the instability is defined as over two millimeters of vertical displacement, two millimeters. — Correct: Confirmed correct as stated: more than 2 mm of vertical displacement on a single-leg flamingo view indicates symphyseal instability (not 2 cm). (4) In the audio: adductor strains account for a full 10% of all sports injuries — Correct: The 10 percent figure counts injuries within specific sports, roughly 10 to 11 percent of all injuries in professional ice hockey and soccer, not 10 percent of sports injuries generally. Adductor-related groin pain is the most common defined entity among athletes presenting with groin pain, about 61 percent. (5) In the audio: greater than five centimeters in a growing child, conservative management is inadequate, and you are looking at surgical equalization — Correct: The two operations sit in different bands. Epiphysiodesis of the longer limb is the standard operation for a projected 2 to 5 cm; limb lengthening is what is considered above a projected 5 cm. Below that, an insole covers up to about 2 cm and an external sole lift up to about 5 cm, and the roughly 1 cm in-shoe ceiling is a footwear rule of thumb rather than a published limit. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-29.

Sports Cardiac Issues, Special Populations, and Exercise-Induced Bronchospasm. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The Special Olympics mandates lateral cervical spine x-rays in both flexion and extension — Correct: Special Olympics no longer requires cervical radiographs. Since its General Rules were amended in 2015, unchanged in the 2025 revision, screening is a symptom check at the preparticipation physical; only a symptomatic athlete needs a neurological evaluation plus signed informed consent, and may then still compete. The withdrawn film requirement traces to the 1984 pediatric statement. (2) In the audio: present radiographically in ten to thirty percent — Correct: About 14.6 percent, with a published range of 6.8 to 27 percent depending on technique. Roughly 13 percent are radiographically abnormal but asymptomatic and about 1.5 percent are symptomatic. (3) In the audio: Hypothyroidism affects fifteen to twenty percent of this population. — Correct: Stratify it: congenital hypothyroidism in about 1 in 141 newborns, subclinical hypothyroidism in 25 to 60 percent of children, and overt clinical hypothyroidism near 15 percent, accumulating with age. (4) In the audio: It must be inhaled 15 to 20 minutes before exercise begins. — Correct: 15 to 30 minutes before exercise. The teaching point is unchanged: dosing at the starting line is too late. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-30.

Gait Analysis and Biomechanics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-01.

Amputation Levels and Epidemiology. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-02.

Surgical Principles and Post-Amputation Rehabilitation. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-03-a.

Transtibial Prosthetics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: and also the popliteal fossa in the back, the massive gastrocnemius and soleus bulk, and the anteromedial tibial surface. — Correct: The fifth pressure-tolerant area is the lateral shaft of the fibula, not the anteromedial tibial surface. The medial tibial *shaft*, unlike the flare, is subcutaneous and belongs with the relief areas. (2) In the audio: The patient causes for this same deviation are a hip flexion contracture or weak quadriceps. — Correct: For excessive knee flexion (drop-off) the patient cause to look for is a knee flexion contracture, which this chapter calls the most common post-amputation complication, together with weak quadriceps. Hip flexion contracture is the patient cause of a *short prosthetic step*, which the episode states correctly a few lines later. (3) In the audio: it gives near zero pistoning. To be specific with the numbers, elevated vacuum allows only 1.3 centimeters of pistoning compared to 1.8 centimeters for passive suction. — Correct: The numbers are right; the word around them is wrong. 1.3 cm and 1.8 cm are real published figures, but they are total axial bone-socket displacement measured under digital video fluoroscopy across loading from zero to full body weight, not gait pistoning. 1.3 cm is more than a finger's breadth and is not near zero, and the advantage arose almost entirely during initial loading. Gait pistoning by motion capture is an order of magnitude smaller, roughly 1 to 6 millimeters. (4) In the audio: elevated vacuum ... pin lock produces the most pistoning. — Correct: Pin lock is not established as the worst of the three. No study has compared elevated vacuum, passive suction and pin lock in a single protocol, and the one study using the same fluoroscopic paradigm found pin lock numerically better than a suction sleeve, not worse (18.24 mm vs 21.42 mm total axial displacement, p = 0.21). The three-way ranking is an inference stitched across incompatible measurement methods. (5) In the audio: 78% of patients report some blister formation with elevated vacuum. — Correct: The 78% figure is a survey of practitioners, not of patients. A practitioner reporting that they have seen blistering is a different quantity from a patient reporting that they blistered. (6) In the audio: that metabolic demand jumps to 60 to 70 percent more energy — Correct: Traumatic transfemoral is 55 to 65 percent, as oxygen cost per unit distance at self-selected speed. Primary values cluster 49 to 65 percent; 60 to 70 sits above that range and could not be verified as a Waters 1976 value. The transtibial figure it is contrasted with, 10 to 25 percent, is unchanged. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-04.

Transfemoral Prosthetics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: exacting a massive 65 to 100 percent energy cost above baseline — Correct: The vascular transfemoral figure is 100 to 120 percent of oxygen cost per unit distance above able-bodied, with the 2021 meta-analysis giving 102 percent. The 65 to 100 percent band understates it by roughly half at the lower bound, which matters because the point being made is that this cost exceeds the patient's cardiovascular reserve. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-05.

Upper Limb Prosthetics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-06-a.

Lower Extremity Orthoses. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-07.

Spinal Orthoses. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: It restricts extension about 70%. Side bending restriction is about 66% and rotation restriction is about 74%. ... they are stopped with roughly 30% of their normal arc remaining. — Correct: The 66% figure is the percentage of lateral bending the collar permits, not the percentage it restricts. The reference table reports mean percent of normal motion, so the Philadelphia collar restricts lateral bending by roughly 34%, and rotation by roughly 56%. The inference drawn from it in this passage, that the wearer is left about 30% of the arc in every plane, does not hold for lateral bending. (2) In the audio: Yeah, side bending and rotation both land around 66%. — Correct: For the SOMI the lateral bending figure is again motion permitted: the restriction is roughly 34%. The rotation figure of 66% is already a restriction figure and is correct. (3) In the audio: Side bending is actually the Minerva's weak plane, sitting at about 51% restriction. — Correct: The Minerva has no weak plane. The circumferential forehead band controls every cervical plane, and the reference's own table puts the Minerva lowest of all non-halo devices in the lateral bending column, which makes lateral bending one of its strengths. Its limitations are bulk, discomfort and cost. (4) In the audio: located posterior and slightly above the ears, — Correct: The posterior halo pins are placed posterolateral and just below the widest part of the skull. Below the equator is what stops the ring migrating upward; at or above ear level the pin sits at or above the greatest skull diameter and the ring can ride up. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-08.

Upper Limb Orthoses. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-09-a.

Advanced Prosthetic Technology. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: The common materials used across these platforms include PLA, ABS, nylon, PETG, and flexible PPU. — Correct: The flexible thermoplastic is TPU (thermoplastic polyurethane). PPU is not a material used in this application and appears nowhere else in the chapter. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-10.

Materials and Fabrication. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-11.

Pediatric Prosthetics and Orthotics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: 80 to 90 percent of patients require a percutaneous Achilles tenotomy. — Correct: Percutaneous Achilles tenotomy is needed in roughly 70 to 90 percent of Ponseti-treated clubfeet, commonly quoted as about 80 percent, with the highest rates in the most severe feet. The episode narrates the top of the range as the whole range. (2) In the audio: At six to nine months, which is the developmental window when a child begins pulling to stand, they get a non-articulated device. — Correct: Pulling to stand is a nine to twelve month milestone, and that is when the first lower-extremity prosthesis, a non-articulated device for standing support, is fitted. Six to nine months is not the pull-to-stand window. (3) In the audio: However, you must note a specific literature caveat. Some sources name the fibula as the most commonly affected bone overall. Be prepared to recognize both the humerus and the fibula as high risk structures depending on how the question is phrased. — Correct: Retract the caveat, not the ordering. The humerus is the single most commonly affected bone. The fibula is second, and within transtibial amputations it overgrows more often than the tibia, but that is a within-level comparison and does not displace the humerus. A stem asking which bone is most commonly affected has one answer. (4) In the audio: The trial was actually stopped early by the Data and Safety Monitoring Board because the efficacy of bracing was so clear that it was deemed unethical to continue randomizing patients to the observation arm. — Correct: BrAIST was stopped early for demonstrated benefit. Its monitoring board halted it because bracing had shown efficacy, which is not the same as declaring continued observation unethical, and the chapter retracted the unethical framing. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-12-a.

Special Populations in Prosthetics and Orthotics. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: The cast force is 100% adherence to the offloading protocol — Correct: A non-removable cast enforces offloading by removing the option of taking the device off. It does not guarantee 100% adherence: a patient can still bear weight in the cast, which is why closure rates are about 89% rather than universal. (2) In the audio: only about 16% of diabetic foot ulcer patients receive total contact casting nationally. — Correct: The 16% figure belongs to patients in the US Wound Registry, not to diabetic foot ulcer patients nationally. Those are different populations with different utilization, and the registry denominator is the one the figure was drawn from. (3) In the audio: Option A covers one pair of extra depth shoes plus three pairs of molded inserts. ... Option B is for more severe deformities. — Correct: CMS does not letter these baskets. Identify them by shoe type: the depth-shoe basket is one pair of extra-depth shoes plus three pairs of inserts, and the custom-molded basket is one pair of custom-molded shoes, inserts included, plus two additional pairs. The letters appear in no statute or CMS document, and the review books that use them do not agree with each other on which is which. (4) In the audio: Option A provides extra depth shoes plus three inserts. Option B provides custom shoes plus two inserts. — Correct: Same correction as the earlier passage: the baskets are not lettered by CMS. Name them by shoe type. (5) In the audio: and 64 designates a double below-knee amputee who is running. — Correct: T/F64 is the single below-knee running class. The doubles come first in the 60s series: T/F61 double above-knee, T/F62 double below-knee, T/F63 single above-knee, T/F64 single below-knee. The 40s are the standing classes, T/F42 single above-knee and T/F44 single below-knee. (6) In the audio: A normal ankle brachial index falls precisely between 1.00 and 1.30. That's your healthy baseline. Okay, 1.00 to 1.30. — Correct: Normal is 1.00 to 1.40. The 2024 ACC/AHA lower extremity PAD guideline reports the resting ABI as abnormal (0.90 or below), borderline (0.91 to 0.99), normal (1.00 to 1.40) or noncompressible (above 1.40), the same four bands as the 2016 guideline and the 2011 focused update. A value of 1.35 is normal and does not by itself call for a toe-brachial index; the TBI trigger is above 1.40. The 1.30 top-of-normal is the 2005 convention, replaced in 2011. The episode carries the contradiction internally, stopping normal at 1.30 and then putting the non-compressible trap above 1.40, which leaves 1.31 to 1.40 unnamed. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-13.

Outcomes and Energy Expenditure. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: Rehabilitation raises the metabolic rate only about 9% above resting per minute. — Correct: The 9% figure is measured against normal walking, not against resting metabolic rate. Level-ground wheelchair propulsion in paraplegia costs roughly 9% more energy than walking; almost any activity raises metabolic rate far more than a tenth above rest. (2) In the audio: patients are eligible for multi-axial feet, polycentric knees, and hydraulic swing control ... At K2, hydraulic swing control uses fluid resistance that increases as velocity increases. — Correct: At K2 the fluid-controlled option in the coverage table is pneumatic swing control. Hydraulic swing control sits on the K3 row, alongside the microprocessor knee and the energy-storing foot. (3) In the audio: Traumatic transtibial adds 10 to 25%. Vascular transtibial adds 20 to 40%. Traumatic transfemoral adds 60 to 70%. Vascular transfemoral adds 65 to 100%. Hip disarticulation adds 82 to 125%. — Correct: Three of those five are wrong. Vascular transtibial is about 40 percent, not 20 to 40: the lower bound is the traumatic figure. Traumatic transfemoral is 55 to 65 percent, since primary values cluster 49 to 65 percent and 60 to 70 could not be verified as a Waters 1976 value. Vascular transfemoral is 100 to 120 percent, not 65 to 100 - off by roughly a factor of two at the lower bound, with the 2021 meta-analysis giving 102 percent. Hip disarticulation is 80 to 125 percent, not 82 to 125, and that range covers hip disarticulation and hemipelvectomy together rather than hip disarticulation alone. Every figure is oxygen cost per unit distance at self-selected speed. (4) In the audio: Hip disarticulation sits precisely between unilateral and bilateral transfemoral at 82-125%. — Correct: At 80 to 125 percent the band overlaps the unilateral vascular transfemoral figure of 100 to 120 percent rather than sitting cleanly above it. The ordering cue only worked because the vascular transfemoral number was too low. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-14.

Wheelchair and Power Mobility. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: They specify that you need 25 to 30 degrees of posterior tilt to achieve a clinically meaningful reduction — Correct: Tilt used on its own has to reach at least 45 degrees before it shifts enough load off the ischial tuberosities to count as an adequate weight shift, which is why powered tilt systems are commonly built with a 45 to 60 degree range. The 25 to 30 degree figure applies only when tilt is combined with recline to roughly 100 to 120 degrees. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-15.

Ambulation Aids. Topics: Canes, Crutches, Walkers, and Weight-Bearing Status. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: the interphalangeal joints, the IP joints, held in slight flexion of 10 to 20 degrees, — Correct: In the resting hand (safe position) splint the IP joints are held in full extension. This is the intrinsic-plus position: the MCP collaterals are taut in flexion so the MCPs are flexed, while the IP collaterals and volar plate shorten in flexion so the IPs are held straight. Holding the IPs flexed produces the PIP flexion contracture the splint exists to prevent. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-16-a.

Adaptive Driving, Environmental Control Units, and Medicare DME Criteria. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: we discussed the amputation rates of 82, 55 and 50 and a diabetic ankle brachial index greater than 1.40 being non compressible. — Correct: The dysvascular triad is not three amputation rates: 82% of LE amputations are dysvascular, 55% of diabetic amputees lose the contralateral limb in 2-3 years, and 50% is five-year MORTALITY, not an amputation rate. (2) In the audio: stress that failure in any single domain is fully disqualifying. — Correct: Each of the four CDRS domains can independently disqualify, and the domains are not averaged, but a single abnormal domain is not automatically a permanent disqualification. A domain finding triggers further evaluation, adaptive equipment or restriction, and the on-road test remains the decisive gate that a patient can still pass. (3) In the audio: Spontaneous breathing opens up head tracking because of strong head and neck control. — Correct: Head and neck control does not arrive with the diaphragm. The neck muscles are driven largely by the spinal accessory nerve and survive even a C1 to C3 injury, which is why head arrays and chin control are standard at those levels. What genuinely changes at C4 is ventilator independence, which makes voice control more reliable and makes head tracking the cleanest choice rather than a newly available one. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-16-b.

Complications of Prosthetics, Orthotics, and Mobility. Part of the Prosthetics & Orthotics series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: Notably, it never occurs in the femur. — Correct: The femur is affected by terminal bony overgrowth. The order of frequency is humerus, then fibula, then tibia, then femur; the femur is fourth of four, not excluded. The exclusion also removes the reason knee disarticulation is preferred over a diaphyseal transfemoral cut in a growing child. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/PO-17-a.

Vascular Anatomy and Stroke Syndromes. Part of the Cerebrovascular / Stroke series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/CVA-01.