Mod 3: Musculoskeletal Conditions & Interventions Part 3

If a patient is able to perform full AROM using their right upper extremity but only in a gravity eliminated plane, what manual muscle test (MMT) score would you give this patient? A. 2 B. 2+ C. 3 D. 3+

A. 2

An OT is working with a patient who sustained a proximal humerus fracture which required surgical intervention using the surgical approach of open reduction internal fixation (ORIF) to reduce the displaced bone fragments. Post op, when should this patient be able to begin AAROM? A. 4-6 weeks B. 6-8 weeks C. Once patient has been medically cleared D. Right away

A. 4-6 weeks

What type of shoulder range of motion is being demonstrated when an OT asks a patient to place his hand behind his head and reach for his opposite shoulder blade? A. Abduction and external rotation B. Abduction and internal rotation C. Adduction and external rotation D. Adduction and internal rotation

A. Abduction and external rotation

What type of shoulder range of motion is being demonstrated when an OT asks the patient to place their hand behind their back and instructs them to reach as high up their spine as possible, and observes the extent of their reach in relation to the scapula and/or thoracic spine? A. Adduction and internal rotation B. Adduction and external rotation C. Abduction and internal rotation D. Abduction and external rotation

A. Adduction and internal rotation

A COTA® is educating a patient on proper body mechanics. He has chronic lower back pain. He works as a library technician and as part of his daily tasks, he is required to lift and carry books and place them on the shelves. Which techniques would be beneficial for the COTA® to teach the patient to help him cope with the demands of his job? Choose the best 3 answer choices. A. Bend the knees and keep the back straight, when unpacking new books from a box B. Hold the books below waist level with elbows extended C. Keep feet together while lowering the books onto the lower shelves D. Maintain spinal alignment when holding the books E. Carry the books at chest height with elbows fully flexed F. Extend the lumbar spine slightly while carrying heavier books

A. Bend the knees and keep the back straight, when unpacking new books from a box D. Maintain spinal alignment when holding the books E. Carry the books at chest height with elbows fully flexed

What deformity is a PIP finger extension splint used for? A. Boutonniere deformity B. Mallet finger C. Swan neck deformity D. De Quervain's

A. Boutonniere deformity

A patient who presents with arthritic deformities in her hands is unable to grasp a fork due to these deformities. How can this patient's fork and other eating utensils be adapted to enable her to grasp and use them more effectively? A. Built up handle or foam tubing B. Blunt ended fork C. Universal cuff D. Weighted utensil

A. Built up handle or foam tubing

A patient in the acute stage of RA has been referred to the hand clinic for intervention. As splinting is an important part of the intervention plan, what is the MOST important characteristic the splinting material should have so that it is suitable for this patient? A. Lightweight B. Durable C. High degree of rigidity D. Perforated for increased ventilation

A. Lightweight

A mother of twins appears to have developed De Quervain's syndrome due to repeatedly lifting her children up. Which test is used to confirm this diagnosis? A. Positive Finkelstein B. Negative Finkelstein C. Repetitive microtrauma D. Tenosynovitis of finger flexors at A1 pulley

A. Positive Finkelstein

A patient recently experienced shoulder trauma and as a result sustained a brachial plexus injury. What single upper limb movement would be the MOST appropriate to ask the patient to perform in order to assess the functioning of their C5 myotome? A. Shoulder abduction B. Elbow flexion C. Elbow extension D. Shoulder elevation

A. Shoulder abduction

A 58-year-old male who is a carpenter by trade, was diagnosed with subluxation of the CMC joint of his right, dominant hand. After conservative treatment failed, surgery was performed. Since the surgery however, contractures of the stabilizers of the CMC joint including the thumb flexors and adductors, have developed resulting in a diminished web space. The patient's goal is to return to his full-time employment within 2 months, once his course of therapy has been completed. To help this patient achieve his goal, what hand therapy protocol (splint, exercises, hand-function activities) should the OT select as part of the patient's OT intervention? A. Thumb spica splinting, edema control, isometric abduction of the thenar eminence, grasp of small tools, and manipulation of nuts and bolts B. Anti-contracture hand-based immobilization splint, MCP extension exercises, clothespin exercises, and cylindrical grasping activities C. Radial palsy mobilization splint, lateral pinching exercises, and sorting and organizing paper work D. Figure of eight splint to reduce a hyperextended thumb IP joint during pinch, therapy ball grip exercises, and molding clay into pots

A. Thumb spica splinting, edema control, isometric abduction of the thenar eminence, grasp of small tools, and manipulation of nuts and bolts

A 23-year-old student sustained an injury to her left forearm when she fell during a college basketball tournament. She has now developed a flexion contracture of her left elbow as a result of her arm being immobilized in a long-arm cast for the past 6-weeks. Before participating in an upper dressing task, the OTR® decides to apply a warm pack over the tendon of the patient's Biceps. What is the PRIMARY purpose for using this modality? A. To facilitate tissue extensibility for increasing elbow extension B. To decrease inflammation at the wrist C. To stimulate the radial nerve for improved wrist extension D. For bicep muscle reeducation following prolonged immobilization

A. To facilitate tissue extensibility for increasing elbow extension

A 64-year-old patient who fractured his left femur when he fell onto a barricade, is currently 4 weeks post-op, and is attending outpatient rehab services. The patient has recently consulted with his orthopedic surgeon for a routine follow-up. At his next OT session, the patient presents the clinician with new orders from the surgeon, stating that the patient can progress from non-weight-bearing (NWB) to toe-touch weight bearing (TTWB) of the affected extremity. With this new change in his weight-bearing status, how would you BEST adapt a dish washing task, to incorporate the patient's new weight-bearing precautions? A. Wash dishes in a seated position B. To adhere to weight bearing precautions, the patient can hold onto the sink with one hand for added support C. Have a reminder taped above the sink instructing the patient to be mindful of only taking 50% of their body weight on their affected leg while standing D. Place the dishes in a cart and while pushing it, weight bear on the affected leg as tolerated

A. Wash dishes in a seated position

Karen, a 70-year-old woman who is a retired secretary, recently sprained her left (non-dominant) wrist while lifting a heavy object. As a result, she requires an immobilization splint to support her wrist to promote healing and for pain management. Karen is an avid gardener who has expressed her desire to continue working in her garden. She has agreed to learn 1-handed techniques with her dominant hand, while her wrist heals, and will only use her left hand for light stabilization, for bilateral activities. What type of splint is the MOST appropriate to address Karen's needs during the acute stage of healing? A. A mobilization dorsal-based MCP extension splint B. A volar wrist immobilization splint with forearm trough and an MP and hypothenar bar with the wrist positioned in neutral C. A wrist, cock-up splint that places the wrist in 20 degrees of extension for typing D. A C-bar hand splint

B. A volar wrist immobilization splint with forearm trough and an MP and hypothenar bar with the wrist positioned in neutral

An OTA instructs a patient to place his hand behind his head and then reach as far down his spine, as possible. What type of shoulder range of motion is this an example of? A. Adduction and external rotation B. Abduction and external rotation C. Abduction and internal rotation D. Adduction and internal rotation

B. Abduction and external rotation

Barbara is a 68-year old retired professional baker who has been diagnosed with RA. Recently, Barbara has started to develop severe anxiety associated with her having to deal with her progressive RA symptoms. To help her cope with her diagnosis and limitations, Barbara recently joined a support group. During a group session, the OTR® observes Barbara becoming increasingly anxious and distracted by her thoughts. How should the OTR® react in this scenario? A. Recommend the patient carry a journal to document her feelings B. Acknowledge her concerns and redirect her onto a neutral topic C. Encourage the patient to express her feelings and describe her physical symptoms D. Ask the patient to leave the group as she may be upsetting the other group members

B. Acknowledge her concerns and redirect her onto a neutral topic

A patient who recently sustained a distal radius fracture has been fitted with a splint, as prescribed by the physician. Which type of movement of the non-immobilized joints of the affected upper limb is MOST likely to assist with edema reduction in the acute phase of healing? A. Passive range of motion (PROM) B. Active range of motion (AROM) C. No movement D. Circumferential

B. Active range of motion (AROM)

A COTA® is working with an OTR® on fabricating a customized resting hand splint for an 80-year-old patient with rheumatoid arthritis. The patient has also been diagnosed with hyperthyroidism and poor circulation. One of the symptoms of hyperthyroidism is the development of a tremor , which usually presents as a fine trembling in the hands and fingers. The patient lives alone in an apartment and his daughter regularly checks up on him and helps him with his meals and light house cleaning. The daughter is concerned that her father will have difficulty removing and re-applying his splint as his tremors interfere with his hand function. What is the BEST way the COTA® can ensure that the patient can independently manage his splint? A. Place posted instructions in the bedroom and bathroom to ensure compliance B. Attach wide-based stretchy Velcro straps with D-rings C. Adhere narrow-based hook and loop straps with additional bandage D. Recommend a splint with neoprene material to be wrapped along the forearm and wrist

B. Attach wide-based stretchy Velcro straps with D-rings

4 months ago, a 35-year-old patient was involved in a MVA which resulted in his spinal cord being completely severed. The focus of his OT intervention has been on strengthening his wrist so that he can have the opportunity to actively participate in his dressing tasks, at home. The patient however has very weak wrist extensors and requires the assistance of a tenodesis splint. What level of spinal cord injury does this patient most likely have? A. C5 SCI B. C6 SCI C. L1 SCI D. T11 SCI

B. C6 SCI

A patient has been provided with a wrist-immobilization splint but the splint tends to move when the patient moves their fingers or elbow. As a result, the splint is not offering stable support and there is a risk of friction causing damage to the skin. What measure should be used FIRST to prevent the splint from moving? A. Change the size of the splint B. Cover the skin with a stockinette bandage or elastic tubular bandage (such as Tubigrip) C. Increase the number of straps securing the splint D. Tighten the straps securing the splint

B. Cover the skin with a stockinette bandage or elastic tubular bandage (such as Tubigrip)

An OTR® is fabricating bilateral volar resting hand splints for an 8-year-old child who has quadriplegic CP. The aim of these splints is to prevent or reduce joint deformity from developing, from the moderate spasticity in the child's hands. The components of the resting hand splints include a forearm trough, a C-bar, a thumb trough, and a pan for the fingers. What should the FIRST STEP be, during splint fabrication and strap application? A. Application of an Ace wrap to hold the forearm trough in place while the therapist works on the hand portion B. Determining the best splinting position by handling the child's extremity and feeling the amount of passive resistance C. Wearing the splint prior to engagement in activities or occupations D. Watching the child's facial expression and listening for vocalizations that indicate discomfort

B. Determining the best splinting position by handling the child's extremity and feeling the amount of passive resistance

Following a mastectomy, a 37-year-old patient had breast reconstructive surgery to her right breast which involved using her latissimus dorsi as part of the reconstruction. The patient is now having great difficulty with many of her ADLs due to the surgery performed on her latissimus dorsi. With which activity will this patient need the MOST assistance? A. Picking up her children's toys from the floor B. Getting cups from an upper cabinet C. Zipping up a jacket D. Putting on makeup

B. Getting cups from an upper cabinet

What type of activity would a patient with an ulnar nerve injury have the MOST difficulty with? A. Donning a shirt B. Gripping a pillow C. Flushing the toilet D. Turning a key

B. Gripping a pillow

Name the type of exercise that uses the force generated by the contraction in which there is no joint movement and minimal change in its muscle length. A. Passive range of motion B. Isometric C. Concentric D. Isotonic

B. Isometric

A patient who has been diagnosed with radial tunnel syndrome is being treated conservatively. The OT practitioner is fabricating a splint for this patient to manage their condition. What type of splint is the MOST appropriate for this patient, at this stage of their intervention? A. Dorsal blocking splint B. Long arm splint C. Wrist volar splint with wrist in neutral D. Opponens splint

B. Long arm splint

An OTA is working with a patient who sustained an injury to their upper extremity which required surgical intervention and immobilization of the affected joint. The OT intervention plan includes "active range of motion" for this patient's injured upper extremity. What does active range of motion mean in this scenario? A. Actively wiggling the fingers while protecting injured joints or structures B. Maximal available ROM of uninjured joints while protecting injured joints or structures C. Full available ROM of the shoulder while protecting injured joints or structures D. Full available ROM of the elbow while protecting injured joints or structures

B. Maximal available ROM of uninjured joints while protecting injured joints or structures

A COTA® is using a standard goniometer to measure the ROM of a patient's elbow. What basic principle for ROM testing is essential for obtaining the most accurate results? A. Reposition the moveable arm, check the axis placement, and note the number of degrees at the starting position B. Move the body part passively through the ROM to estimate available ROM and get a feel for joint mobility C. Stabilize the joints distally to the joint being measured D. Record the reading to the nearest 10 degrees

B. Move the body part passively through the ROM to estimate available ROM and get a feel for joint mobility

What are the characteristics of a swan neck deformity? A. PIP joint flexed, and the DIP joint hyperextended B. PIP hyperextension and DIP flexion C. Wrist flexed with PIP hyperextension D. Wrist extended with DIP joint hyperextended

B. PIP hyperextension and DIP flexion

You are running a topical group to educate patients on "What to Look for in RA-Friendly Devices". What are the 3 most important properties to consider when purchasing any product for the kitchen? Select 3 best choices. A. Cast iron pots are durable and easy to wash B. Put safety first C. Consider the benefits of texture D. Avoid anything heavy E. Ceramic bowls are durable and easy to maintain F. Avoid containers with flip tops

B. Put safety first C. Consider the benefits of texture D. Avoid anything heavy

Frederick, a professional guitarist has been diagnosed with Dupuytren's contracture affecting his left hand. Since developing Dupuytren's contracture, playing his guitar has become increasingly difficult for him and subsequently he has been unable to perform with his band. What part of Frederick's left hand is MOST LIKELY impacting on his ability to play his guitar? A. The distal interphalangeal joint of his middle finger B. The proximal interphalangeal joint of his ring finger C. The CMC joint of his thumb D. The web space

B. The proximal interphalangeal joint of his ring finger

How many points of control does a silver ring splint provide to support, correct or protect finger joints? A. Two points B. Three points (Tri-point) C. Four points D. Five points

B. Three points (Tri-point)

Which nerve in the hand will MOST likely become compressed with long-distance cycling? A. Radial B. Ulnar C. Median D. Collateral

B. Ulnar

A manual muscle test (MMT) is being performed on a patient who is recovering from a musculoskeletal condition. The patient is able to extend his elbow through a full ROM against gravity, with moderate resistance. What muscle grade is most appropriate to give to this patient? A. 2 (Poor/P) B. 3 (Fair/F) C. 4 (Good/G) D. 5 (Normal/N)

C. 4 (Good/G)

Which splint is typically used for a patient who has a Flexor Tendon Injury? A. Ulnar gutter splint B. DIP extension splint C. Dorsal blocking splint D. Resting hand splint

C. Dorsal blocking splint

An OTR ® is assessing a patient who has been diagnosed with a rupture of the ulnar collateral ligament of the thumb. What is this type of injury most commonly known as? A. Mallet thumb B. De Quervain's tenosynovitis C. Gamekeeper's thumb D. Trigger Thumb Injury

C. Gamekeeper's thumb

An OT is performing a manual muscle test on a patient who is recovering from a TBI. The patient is able to move his R arm through all planes with no assistance. However, when the OT asks the patient to hold his arm straight in front of him while the OT pushes down on his arm, the patient is unable to maintain the position due to insufficient strength, and when the patient is asked to lift a 2 pound dumb bell off a table, he is unable to perform this movement. What muscle grade would BEST reflect the patient's R upper limb strength? A. Grade 5 B. Grade 4 C. Grade 3 D. Grade 2

C. Grade 3

A patient with an ulnar nerve injury would have difficulty with which of the following activities? A. Donning a shirt B. Flushing the toilet C. Gripping a pillow D. Pressing the ON button on the TV remote.

C. Gripping a pillow

Jeff, a 23-year-old college athlete, recently sustained an injury to his right dominant upper limb during football practice. He was diagnosed with a brachial plexus injury, which required surgical intervention. 2 weeks post-surgery, Jeff continues to experience weakness in his right upper limb and his shoulder movements are limited, with both flexion and abduction measuring at 120º. One of Jeff's main goals, at this stage of his recovery is to use his affected upper limb for function and to continue doing his own laundry without enlisting the help of his roommate. Which of the following tasks would be the MOST CHALLENGING for Jeff to perform? A. Emptying the hamper B. Folding laundry while sitting on the sofa C. Hanging his clothes in the closet D. Stabilizing load of towels with both arms while transporting into the basket

C. Hanging his clothes in the closet

A 28-year-old student who is studying computer science is being treated at an outpatient hand clinic for carpal tunnel syndrome. The nature of her studies requires her to spend many hours working on the desktop computers at the computer lab which is based on the college campus. The student has been assessed by the OT, and a dorsal wrist splint was provided. During a follow-up appointment, the student reports that she is finding it difficult to hold the mouse while wearing the splint as the splint covers the proximal portion of her palm and the palmar transverse bar tends to get in the way. In order to recommend a suitable ergonomic mouse which would preserve the student's cutaneous feedback and thereby increase her task efficiency, what characteristics should the OT consider in terms of the features of the mouse and the anthropometric measurements of the hand (width of hand and length of hand, palm, and index finger)? A. Thumb opposition, hand width, and the height and position of the hump of the mouse B. The resistance of the bottom portion of the mouse, middle finger length, and the width of the mouse C. Index finger length, the height and position of the hump of the mouse, and hand size D. Since the wrist splint interferes with cutaneous feedback at the palmar aspect of the hand, it would best to use a laptop touchpad instead

C. Index finger length, the height and position of the hump of the mouse, and hand size

Matilda, a woman in her late 70s who has RA, lives on her own in a ground-floor apartment, and has enlisted the help of a part-time caregiver. Matilda arrives for her weekly water aerobics class, which is run at the local community center, with a visible first degree burn on her non-dominant hand. When questioned about this burn, Matilda reports that she is having difficulty opening and closing her sink taps and she cannot always get the temperature right. What recommendations would be the MOST beneficial for Matilda so that washing her hands can become a safe and efficient task for her? A. Install bigger ball faucets and switch off the water heater B. Have the caregiver fill the sink with warm water so that the patient can wash her hands in that water when the caregiver is not there C. Install levered handles and a water temperature control device to prevent scalding in order to maintain constant water temperature D. Instruct the patient to rather use an alcohol-based hand sanitizer instead of using soap and water to clean her hands

C. Install levered handles and a water temperature control device to prevent scalding in order to maintain constant water temperature

Asking a patient with a suspected peripheral neuropathy to make an "O.K." sign is used as a quick screening to assess which nerve? A. Ulnar B. Radial C. Median D. Peroneal

C. Median

When working with a patient who has been diagnosed with complex regional pain syndrome, what aspect of OT intervention should the therapist focus on initially? A. AROM B. PROM C. Pain D. ADLs

C. Pain

A patient who has been diagnosed with RA has been referred for OT intervention. Based on this patient's diagnosis, what types of screenings/evaluations will the OT MOST likely need to use? A. Physical and functional B. Physical, functional, and psychosocial C. Physical, functional, cognitive and psychosocial D. Functional and emotional

C. Physical, functional, cognitive and psychosocial

An OT is working with a patient who is a carpenter by trade. His job requires him to handle several types of tools while building homes. What grasp pattern does the carpenter use when he has to hold a hammer to pound a nail into the wall? A. Hook grasp B. Conoid grasp C. Power grasp D. Spherical grasp

C. Power grasp

Which nerve is the primary motor supplier to the extensor and supinator muscles and also innervates the dorsum and radial border of the hand. A. Tenodesis B. Ulnar nerve C. Radial nerve D. Median nerve

C. Radial nerve

A patient who sustained a recent hand injury presents with diminished sensation in the palm of her hand. What type of activity would be the MOST appropriate to incorporate into this patient's OT intervention to address her sensory issues? A. Picking up small beans and putting them in a box B. Flipping through magazine pages C. Rolling TheraPutty into a large ball D. Pouring water into a cup

C. Rolling TheraPutty into a large ball

A patient who sustained a deep partial thickness burn to the radial side of the palm of his right hand is having a thermoplastic splint fabricated for him, in the hand clinic. His burn covers the thenar eminence and extends up to the PIP joints of the index and middle fingers. His wound has closed and is healing with scar tissue developing. How should this patient's hand be splinted? A. Splint on dorsal surface with MCP joints in 50 to 70 degrees of flexion, IP joints in extension, thumb in abduction and extension B. Splint on volar surface with wrist in 30 degrees of extension C. Splint on the volar surface with MCP joints in full extension, IP joints in full extension, thumb in horizontal abduction D. Provide a C-bar splint that positions the thumb in abduction and extension

C. Splint on the volar surface with MCP joints in full extension, IP joints in full extension, thumb in horizontal abduction

An entry-level OT is assessing a patient who has ALS. The OT is measuring the patient's active range of elbow flexion using a standard goniometer. In an attempt to get an accurate measurement, the OT asks the patient to flex his elbow 4 times in succession, and still finds that the measurements vary 2-10 degrees. In this scenario, what should the OT do NEXT? A. Ask the OT supervisor for assistance B. Take the average number C. Verify correct placement of the goniometer D. Rest the arm for 15 minutes and test again

C. Verify correct placement of the goniometer

Dan, a 36-year-old male, is accompanied by his wife to an outpatient hand therapy clinic. Dan who works as a truck driver, recently sustained an injury to his right dominant hand when he fell off a ladder at home. Before fabricating a splint for Dan, the COTA® becomes aware that there is a lot of tension between Dan and his wife. Dan verbalizes that he is extremely concerned about lost time from work as he is the only breadwinner. His wife, however, is reluctant to engage in any part of the conservation and Dan excuses her behavior by saying "she's very upset with me!" Taking the couple's emotional state into consideration, what approach should the OTR® use to initiate the discussion about the need for a splint for Dan's recovery? A. Discuss the imminent presence of pain and the importance of staying calm during fabrication to ensure protocol is followed appropriately B. Determine the person's learning style and cultural values to select appropriate material and educational handouts C. Conduct the conversation in an isolated room with low-lighting for mood enhancer and speak slowly D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order

D. Clarify concerns and allow them to vent before determining their understanding about the diagnosis and splint order

A patient who works as a custodian for a local high school reports having difficulty lifting chairs, mopping, and performing other janitorial duties due to tightness in his right wrist and fingers. The physician diagnosed the patient with having a non-displaced distal radius fracture to his right-dominant upper extremity. How should the OT incorporate the biomechanical approach in the first intervention to help the patient with his job tasks? A. Provide the patient with a dynamic splint to use 24 hours a day, except when the patient is in the shower B. Have the patient practice dexterity tasks to improve fine motor skills C. Educate the patient on modifications he can use when working D. Incorporate gentle range of motion exercises

D. Incorporate gentle range of motion exercises

A patient presents with a very painful, swollen and bruised index finger. Functionally, he is unable to extend the DIP joint of his injured finger. What diagnosis and type of injury does the appearance of this patient's finger most likely indicate? A. Swan neck deformity due to an injury to the ulnar nerve B. Mallet finger due to an injury to the median nerve C. Swan neck deformity due to a rupture of the flexor tendon D. Mallet finger due to an avulsion of the terminal extensor tendon

D. Mallet finger due to an avulsion of the terminal extensor tendon

A 22-year-old male professional golfer has been diagnosed with "golfer's elbow" . What is the most appropriate splint for this patient, when being treated conservatively? A. Figure of eight splint B. Dorsal protection splint C. Lateral epicondylitis brace D. Medial epicondylitis brace

D. Medial epicondylitis brace

Which nerve originating from the brachial plexus innervates the flexor-pronator group, including the muscles of the thenar eminence and most of the long flexors? It also supplies the long fingers, index finger, the radial half of the ring finger, and palmar surface of the thumb. A. Ulnar nerve B. Movement activity C. Radial nerve D. Median nerve

D. Median nerve

What is the name of the finger condition when a patient's PIP joint is hyperextended and the DIP joint is in flexion? A. Carpal tunnel B. Boutonniere C. Adhesive capsulitis D. Swan neck deformity

D. Swan neck deformity

An OT has been referred a patient who has a posterior brachial plexus injury. What can the OT expect to observe when meeting this patient for the first time? A. Radial deviation of the wrist B. Ulnar deviation of the wrist C. Claw hand D. Wrist drop

D. Wrist drop