Review: Exam 5, 6, 1, 7

CRPS Type II presents with a corresponding peripheral nerve involvement. (1/1) True False

Correct Answer: True Feedback: Koman LA, Li Z, Smith BA, et al: Complex regional pain syndrome: Types I and II.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1470, Elsevier, 2011, Mosby.CRPS Type I is without peripheral nerve involvement.

What is the term for a skin graft that uses the entire epidermis and a portion of the dermis? (0/1) a) Split-thickness graft b) Full-thickness graft c) Pedicled graft d) Pedicled flap

Correct Answer: a Feedback: Levin LS: Management of skin grafts and flaps. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 245, Elsevier, 2011, Mosby.A full thickness graft includes full sections of the dermis and epidermis. Pedicles are the blood supply for a free or attached flap.

The tissue most sensitive to warm ischemia is: a) Nerve b) Muscle c) Endothelium d) Periosteum

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1228. Muscle is the one tissue most susceptible to ischemia and begins to undergo irreversible changes after 6 hours at room temperature.

Ultrasound at 1 MHz may have an effect on tissue up to what depth? (0/1) a) 5 cm b) 7 cm c) 9 cm d) 10 cm

Correct Answer: a Feedback: Fedorczyk JM: The use of physical agents in hand rehabilitation.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1497, Elsevier, 2011, Mosby.Ultrasound units have 1 and 3 MHz frequencies. The greater the frequency, the less penetration depth. 1 MHZ= 5cm 3 MHZ = 2cm

When can you being AROM/PROM after nailbed repair? (0/1) a) 3-5 days post repair b) 14 days c) 21 days d) 4 weeks

Correct Answer: a Feedback: Full A/PROM begins at 3-5 days after a nail bed repair procedure.Cannon, N. M., & Schnitz, G. (2001). Diagnosis and treatment manual for physicians and therapists. Indianapolis, IN: Hand Rehabilitation Center of Indiana.

A patient presents to clinic with joint stiffness that is long-term and severe with orders for an orthosis. What type of orthosis would manage this stiffness most effectively with least wear time? a) Static-progressive orthosis b) Dynamic orthosis c) Serial static d) All of the above

Correct Answer: a Feedback: Static-progressive has been shown to regain ROM faster and is most appropriate for severe contractures. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 126

Which vein courses from elbow to wrist at the radial side of the forearm? (0/1) a) Cephalic b) Basilic c) Median d) Radial

Correct Answer: a Feedback: Cephalic vein.Iannotti, J. P., & Parker, R. D. (2013). The Netter Collection of Medical Illustrations Musculoskeletal System: Part I: Upper Limb (2nd ed., Vol. 6). Elsevier. Pg166

By week 3, a sutured wound has which percentage of its tensile strength? (0/1) a) 15% b) 40% c) 50% d) 75%

Correct Answer: a Feedback: Colditz JC: Therapist's management of the stiff hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 895, Elsevier, 2011, Mosby.During this fibroplastic phase, the tissues are still immature and cannot tolerate aggressive treatment.

A patient is assessed for fine motor manipulation using the 9-hole peg test and the score lands within two standard deviations of the mean for this test. Within what percentage of the population does this patient's score fall? a) 95% b) 99% c) 68% d) 50%

Correct Answer: a Feedback: 68% of scores fall within one standard deviation, 95% within 2, and 99% within 3. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 502

You have been tasked with assessing the daily work of an individual in her typical work setting in a warehouse. Your goal is to minimize risk for injury, both acute and cumulative trauma disorders. Which of these is NOT a risk for developing injury on the job? a) 9 cm hand tool handle length b) Prolonged sustained posture c) Repetitious actions d) Localized contact stress

Correct Answer: a Feedback: 9 cm is recommended length. The other options are risks for cumulative trauma disorders Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 467-468

Typically, which wrist/ hand fracture takes the longest to heal? a) Proximal phalanx head and neck b) Middle phalanx shaft c) Distal phalanx articular d) First metacarpal base

Correct Answer: b Feedback: Reference: Concepts in Hand Rehab Stanley & Tribuzi, page 281. When considering the above, fractures of the middle phalanx shaft take the longest amount of time for full healing.

After operative repair of a distal biceps tendon rupture, which motions should be initiated in therapy 10-14 days post-OP to protect the repaired tendon from adhesions and the muscle from shortening? (0/1) a) Full passive flexion to tolerance, and full passive forearm rotation with the elbow at 90 degrees of flexion b) Active elbow extension to 30 degrees c) Active elbow extension to 45 degrees d) Passive supination and pronation with the elbow at 45 degrees of flexion. e) A and C f) A, B and D

Correct Answer: a Feedback: A prefabricated elbow hinged brace is recommended to be applied to the patient's elbow post-operatively, with the elbow locked in 90 degrees of elbow flexion, and forearm in neutral. Full passive flexion to patient tolerance, and full passive forearm rotation with the elbow at 90 degrees of flexion are started in therapy sessions, with the patient lockReferencesEvidence Based Hand and Upper Extremity Protocols: a Practical Guide for Therapists and Physicians. Elizabeth De Herder. 2015. Pages 24-27.Blackmore S. Therapy following distal biceps and triceps ruptures. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, ed. Rehabilitation of the Hand and Upper Extremity. 6th Edition. Philidelphia, PA: Elsevier Mosby; 2011: 1122-1133.

A patient presents to the clinic with orders for a custom orthosis following ORIF of an olecranon type 2 fracture. At what position is the elbow to be placed in a long arm cast or long arm splint for 2-3 weeks? a) 45-70 degrees flexion with neutral forearm and wrist b) 90 degrees flexion with neutral forearm and wrist c) 45-70 degrees flexion with supinated forearm and neutral wrist d) 90 degrees flexion with supinated forearm and neutral wrist

Correct Answer: a Feedback: According to the text, this is the proper position to ensure appropriate healing and reduce pressure to the fracture site. Reference: Rehabilitation of the Hand and Upper Extremity, 6th Edition, Pg. 1069

In relation to sympathetic function, vasomotor refers to which of the following? (0/1) a) Skin color b) Sweat c) Gooseflesh response d) Trophic nail changes

Correct Answer: a Feedback: Duff SV, Estilow T: Therapist's management of peripheral nerve injury.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 625, Elsevier, 2011, Mosby.Sweat is a sudomotor function, gooseflesh is a pilomotor function.

What is the first step to replantation of an amputated finger? (0/1) a) Wound debridement b) Identify arteries, nerves and veins c) Bone stabilization d) Flexor tendon repair

Correct Answer: a Feedback: Jones NF, Kashani P: The surgical and rehabilitative aspects of replantation and revascularization of the hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1256, Elsevier, 2011, Mosby.Prior to replantation, the wound must be cleansed of any necrotic tissue to prevent infection.

What is the only joint that attaches the upper limb directly to the axial skeleton? (0/1) a) Sternoclavicular joint b) Acromioclavicular (AC) joint c) Glenohumeral joint d) None of the above

Correct Answer: a Feedback: Lazarus M, Rynning R: Anatomy and kinesiology of the shoulder.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 40, Elsevier, 2011, Mosby.The SC joint consists of the medial clavicle and manubrium of the sternum. It serves to connect the axial and upper limb skeletons

What is the normal range of carrying angle of the elbow in males and females respectively are? (1/1) a) 10 to 14 degrees and 13 to 16 degrees b) 2 to 5 degrees and 18 to 24 degrees c) 17 to 20 degrees and 20 to 24 degrees d) > 20 degrees and > 25 degrees

Correct Answer: a Feedback: McAuliffe JA: Clinical examination of the elbow. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 86, Elsevier, 2011, Mosby.The carrying angle of the elbow may be altered by a fracture, joint instability or arthrosis.

A patient with a distal radius fracture from a motor vehicle accident is on your list of new patients this week. Handwritten on the order from the physician, 'watch out for compartment syndrome'. Which symptoms associated with compartment syndrome are considered "early signs" due to nerve sensitivity? (0/1) a) Pain, paresthesia, paralysis b) Pain, paralysis, pallor c) Pain, pallor, pulselessness d) Pain, paresthesia, pulselessness

Correct Answer: a Feedback: Pain, paresthesia and paralysis are considered early signs of compartment syndrome associated with nerve sensitivity. Pallor and pulselessness are not associated with nerve sensitivity.Meals, R. A., & Mitchell, S. (2006). One hundred orthopaedic conditions every doctor should understand. St. Louis, MO, 73

Your patient lacks the last 25 degrees of elbow extension three weeks after stable nondisplaced small chip fracture of the radial head. There are no range limitations and the doctor wants to progress his ROM. He is using the hand for light ADL and tolerating AROM within his limitations. When might you add PROM to his treatment? a) Immediately, starting with heat and stretch at end range b) At 6 weeks, heat and stretch, progress to mobilization c) At 9 weeks, aggressively d) After all pain and swelling subsides

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1063-1064. With a non displaced chip of the radial head and no limitations imposed by the physician, the therapist can progressive with passive heat and stretch to achieve end range elbow extension.

Mr. O has a positive elbow flexion test and reports worsening sensory changes in the fingers innervated by the offending nerve. In addition to the constant "numbness" in those digits, he complains of more tingling. Abnormal results in which of your sensory tests can help to demonstrate a more late-stage sensory loss? a) Loss of static and moving two-point discrimination b) Reduced sensory thresholds with the Semmes-Weinstein monofilaments c) Reduced vibration perception d) Tinel's test

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 147. Semmes-Weinstein is used to detect early nerve compression. Tinels is simply percussion of the nerve. In late stage compression, static and moving 2-point discrimination are the more accurate sensory assessment tools.

A 34 year old carpenter sustained a deep soft tissue laceration to the long finger, exposing the FDS in zone II. There are no signs of infection, and the surgeon decided to leave the wound open to heal by secondary intention. At the same time, he wants the patient to begin a ROM program. You and the surgeon agree that the best dressing choice for the goal is: a) Tegaderm b) Duoderm c) Nonadherent contact layer + fluffed gauze + coban d) Wet dressing with prophylactic Neosporin

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 227-228. Tegaderm helps to protect the humidity in exposed tendons of the digits. They also are impermeable to water and provide for a moist wound environment.

Scapula 'setting' occurs in which phase of shoulder elevation? a) 0-30° b) 30°-90° c) 60°-90° d) 90°-180°

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 42-43. Magee, page 225 During scapulohumeral rhythm, the setting phase occurs during the initial 30 degrees of elevation and then occurs in a 2:1 ratio thereafter.

After an electrical injury, ________ nerves are more affected than _________ nerves. a) Motor, sensory b) Sensory, motor c) Peripheral, lateral d) Latent, proximal

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 605. The neurologic defects following electrical injury are usually immediate in onset and more commonly involve motor nerves.

Which is not a trophic change? a) Lack of sweating b) Tapering and 'penciling' of finger pulp c) Small and curving nails d) Dark hair growth appears on dorsal hand

Correct Answer: a Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 625. Trophic changes occur when there is interruption of normal nerve supply which interrupts normal nutritive process of the tissues. Sweating is a sudomotor change.

What type of flashback concerning a traumatic event is linked with highest likelihood of returning to work? a) Replay Flashback b) Appraisal Flashback c) Projected Flashback d) Appraisal/Projected Flashback

Correct Answer: a Feedback: Replay flashback promotes mastery of the memory and addresses events leading up to the injury. Appraisal refers to image of injury just after and projected is image beyond real injury. Appraisal/Projected has least chance of return to work. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 481

Which of the following are the primary receptors for light touch? (0/1) a) Merkel cells b) Meissner corpuscle c) Pacinian corpuscles d) Ruffini end organ

Correct Answer: a Feedback: Smith, KL: Nerve response to injury and repair. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 602, Elsevier, 2011, MosbyMerkel cells are slow adapting and respond to light touch.

What is von Recklinghausen's disease associated with? (0/1) a) Neurofibromas b) Neurilemoma c) Lipofibromatous Hartoma d) All of the above

Correct Answer: a Feedback: Sweet S, Kroonen L, Weiss L: Soft tissue tumors of the forearm and hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 297, Elsevier, 2011, Mosby. Von Recklinghaussen's disease is rare and is a condition of multiple neurofibromas. Genetic disorder characterized by the growth of tumors on the nerves. The disease can also affect the skin and cause bone deformities.

Which of the following is a superficial infection of the skin? (0/1) a) Cellulitis b) Mycobacteria c) Pyogenic granuloma d) Felon

Correct Answer: a Feedback: Taras JS, Jacoby SM, Steelman PJ: Common infections of the hand.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 237, Elsevier, 2011, Mosby.Cellulitis will present as redness, pain and swelling of the affected area. A pyogenic granuloma is a tumor and a felon is a deep space infection involving the distal phalanx.

Blisters occurs at this layer of the dermis if there is friction between the epidermis and dermis. (0/1) a) Papillary dermis b) Reticular dermis c) Stratus Basale d) Stratum spinosum

Correct Answer: a Feedback: The Papillary dermis is the layer of dermis where blisters form.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 3 pg 65)

What are the hierarchal levels of sensibility testing as described by Fess and LaMotte? a) Autonomic/sympathetic response, quantification, touch discrimination, detection of touch, identification b) Autonomic/sympathetic response, detection of touch, touch discrimination, quantification, identification c) Autonomic/sympathetic response, detection of touch, touch discrimination, identification, quantification d) Detection of touch, touch discrimination, quantification, identification, autonomic/sympathetic response

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 134 Autonomic/sympathetic response, detection of touch, touch discrimination, quantification, identification is representative of the hierarchical levels of sensitivity

Which of the following statements is correct for care of a patient who had a Swanson MP Arthroplasty to the middle finger (due to OA), with the operative report indicating that the extensor tendon and collateral ligaments are providing good stability to the joint? (0/1) a) Full AROM with buddy straps to adjacent digits to control rotation b) Gentle AROM/PROM to the MP joints and IP joints in isolation, AVOID composite flexion c) MP flexion to 70 degrees within bounds of dynamic outrigger orthosis d) Immobilize in full extension to the MP and IP joints for 3 weeks until the surrounding soft tissue heals

Correct Answer: a Feedback: The protocol for the patient with RA vs. OA who receive the Swanson Silicone MP arthroplasty differ, as the extensor tendons and collateral ligaments are often more stable with the patient with OA. Also, the patient with RA typically receives a replacement to digits 2-5 all at once, while it is common for the patient with OA to only have 1 or 2 joints operated on. Discussion with the physician is important in developing a post-operative protocol for either case, as each patient's soft tissue structure stability is unique and guides the protocol. Care should be taken to control lateral rotation with AROM, and the middle and ring fingers are the easiest to control with buddy straps the adjacent digits. Special care must be taken to protect the index finger form lateral stress from pinching. One should expect ~70-75 degrees of MP flexion by the end of treatment, and it is not uncommon to have a 10-15 degree extensor lag by the end of treatment.

A patient is referred for therapy s/p zone 1 FDP repair over the shaft of the middle phalanx. An adhesion of the repaired tendon is identified by the therapist. What joint is most important to work on to break the adherence to gain ROM? a) DIP b) PIP c) MCP d) Wrist

Correct Answer: a Feedback: The segment of tendon distal to the adherence must be mobilized passively or actively to decrease adhesions. Reference: Rehabilitation of the Hand and Upper Extremity: 6th Edition, Pg. 471-472

A patient is referred to you with orders as follows "Partial TFCC tear, DRUJ stable, conservative management, orthotic immobilization." What type of orthosis would you fabricate? (0/1) a) Long Arm Munster with forearm and wrist in neutral b) Long Arm Munster with forearm in supination, and wrist in neutral c) Long Arm Munster with forearm in pronation and wrist in neutral d) Wrist immobilization orthosis, forearm and elbow free for ROM

Correct Answer: a Feedback: For weeks 0-4/6 s/p a TFCC sprain or tear with a stable DRUJ, the patient should be immobilized with the forearm and wrist in neutral with either a Munster orthosis or forearm based interosseous mold orthosis. The same orthosis should be fabricated post-OP for TFCC debridement or repair surgery, unless the surgeon indicates otherwise.Reference:Evidence Based Hand and Upper Extremity Protocols: a Practical Guide for Therapists and Physicians. Elizabeth De Herder. 2015. Page 130.

What is the position that the CMC and MP joints should be in for gentle active IP flexion (15-20 degrees) for a Zone II thumb extensor tendon repair at 5 days post-OP? (0/1) a) MP joint in full extension with the CMC joint in full radial abduction b) MP joint in full extension with the CMC joint fully adducted c) MP joint in full extension with the CMC joint half way between radial and palmar abduction d) None of these are correct

Correct Answer: a Feedback: Short arc motion is important for Zone II-IV extensor tendon injuries due to the high adherence of bone to tendon in this area. MP extension and CMC joint radial abduction maximizes safe tendon excursion.References:Evans RB. Clinical Management of Extensor tendon Injuries. In: Mackin EJ, Callahan AD, Skirven TM, Schneider LH, Osterman AL, eds: Rehabilitation of the Hand and Upper Extremity, ed 5. St Louis: C.V. Mosby Co., 2002, 521-554.Evidence Based Hand and Upper Extremity Protocols: a Practical Guide for Therapists and Physicians. Elizabeth De Herder. 2015. Page 71-72.

The lateral antebrachial cutaneous nerve is the terminal sensory branch of which nerve? (0/1) a) Radial b) Musculocutaneous c) Ulnar d) Median

Correct Answer: b Feedback: Adams JE, Steinmann SP: Anatomy and kinesiology of the elbow. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 34, Elsevier, 2011, Mosby.The lateral antebrachial cutaneous nerve supplies sensation to the radial forearm.

Arc II of Gilula's lines includes: (0/1) a) Proximal convex outline of scaphoid, lunate and triquetrum b) Distal concave outline of scaphoid, lunate and triquetrum c) Convex curve of capitate and hamate. d) Concave proximal curve of capitate and hamate.

Correct Answer: b Feedback: Arc I is described as the proximal convex outline of the scaphoid, lunate and triquetrum. Arc II is the distal concave outline of scaphoid, lunate and triquetrum. Arc III is the convex curve of capitate and hamate.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 14 pg 7-8).

A patient's injury to the forearm has been described as causalgia as it has continued to worsen and become more complex. It has a clearly defined injury to a nerve and is the result of trauma with significant reports of pain. What could be the developing condition? a) CRPS type 1 b) CRPS type 2 c) Systemic sclerosis d) Systemic lupus

Correct Answer: b Feedback: CRPS type 2 involves clear injury to a nerve and includes other symptoms of CRPS type 1. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 260

Perception of touch in the fingertips is mediated by which of the following? (0/1) a) Non-myelinated C fibers b) Large, myelinated group A-beta fibers c) Small, myelinated free nerve endings d) Myelinated C fibers

Correct Answer: b Feedback: Callahan AD: Sensibility assessment for nerve lesions-in-continuity and nerve lacerations. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, pp. 619-620, Elsevier, 2011, Mosby.Group A fibers have a large diameter and high velocity.

According to Gelberman, which amount of tendon glide is needed to stimulate intrinsic healing at the repair site without creating significant gap formation? (1/1) a) 1 to 2mm b) 3 to 4mm c) 4 to 6mm d) 6 to 8mm

Correct Answer: b Feedback: Evans RB: Clinical management of extensor tendon injuries: the therapist's perspective. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 525, Elsevier, 2011, Mosby.The amount of tendon glide is proportional to joint motion. An understanding of this relationship is one component to safely moving a tendon after repair.

When initiating the short arc motion protocol for a zone III or IV extensor tendon repair, what position do you place the wrist and MCP joint in during the exercises? (0/1) a) It doesn't matter, as these zones are distal to the juncturae tendonum b) Wrist in 30 degrees of flexion, MP joint in full extension c) Wrist and MP joint in full extension d) Wrist at 45 degrees of extension, MP joint in slight flexion

Correct Answer: b Feedback: In the short arc motion protocol, the PIP is immobilized in full extension except for exercises. The DIP may be left free for AROM unless there was a lateral band injury. There are conflicting opinions in the literature about whether or not to include the MP joint in the immobilization orthosis, but it is Roslyn Evans' opinion that this is unnecessary except for proximal zone IV injuries that are almost in the zone V range.Due to a broad tendon-bone interface in zones III and IV, tendon injury in this zone are at high risk for adhesions. To minimize this risk short arc motion exercises may be initiated within 3-5 days post repair. When initiating these exercises, the PIP should only be allowed AROM from 0-30, the wrist should be positioned in 30 degrees of flexion, and the MCP joint should be placed in full extension.Reference:Evans RB. Early Active Short Arc Motion for the Repaired Central Slip. J Hand Surg 1994;19A:991-7.Evans RB. Immediate active short arc motion following extensor tendon repair. Hand Clinics 2:3: 483-512, 1995.Evans RB. Clinical Management of Extensor tendon Injuries. In: Mackin EJ, Callahan AD, Skirven TM, Schneider LH, Osterman AL, eds: Rehabilitation of the Hand and Upper Extremity, ed 5. St Louis: C.V. Mosby Co., 2002, 542-579.Evans RB, Thompson DE. An Analysis of Factors That Support Early Active Short Arc Motion of the Repaired Central Slip. J Hand Ther. 1992;5:187-201.Evans RB, Thompson DE. Immediate active short arc motion following tendon repair. In: Hunter JM, Schneider LH, Mackin EJ. Ed. Tendon and Nerve Surgery in the Hand: a third decade. St. Louis: C.V. Mosby Co. 1997: 362-398.Evans RB. Rehabilitation Techniques for Applying Immediate Active Tension to the Repaired Extensor System. Techniques in Hand and Upper Extremity Surgery. Vol 3:2, 1999.

A therapist is treating a patient after replantation. Venous outflow appears to be a problem. What should the therapist do? (1/1) a) Lower the limb b) Elevate the limb c) Tighten the dressing d) Make the limb colder

Correct Answer: b Feedback: Jones NF, Kashani P: The surgical and rehabilitative aspects of replantation and revascularization of the hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1260, Elsevier, 2011, Mosby.Swollen digits with a bluish tint indicate venous congestion.

An elbow with posterolateral rotatory instability is optimally placed in which position? a) Elbow in 90° flexion, forearm in full supination b) Elbow in 120° flexion, forearm in full pronation c) Elbow in 30° flexion, forearm neutral d) Elbow in 40° flexion, forearm in full pronation

Correct Answer: b Feedback: Journal of Hand Therapy, April/June 2006, page 240 To promote stability in the elbow with posterolateral instability, the arm should be positioned with the elbow in 120 degrees flexion and the forearm in full pronation.

If a patient's upper extremity symptoms do not follow a dermatomal or peripheral nerve distribution this could be a clue that: (0/1) a) The patient has a cervical level herniated disc b) The brachial plexus is involved c) The patient has a shoulder impingement d) The patient is a malingerer

Correct Answer: b Feedback: Kang L, Wolfe S: Traumatic brachial plexus injuries. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 752, Elsevier, 2011, Mosby.Anatomic variations combined with an associated injury to the cervical spine can cloud the presentation of symptoms in a traumatic brachial plexus injury.

Your patient has a scrape on her forearm after a fall. It is healing well with no sign of infection or discharge and granulation tissue is present and developing. The patient's skin is fighting off infection. Which structure in the epidermis is responsible for this? (0/1) a) Merkel cells b) Langerhans cells c) Lamellar granules d) Stratum granulosum

Correct Answer: b Feedback: Langerhans cells are in the deep epidermal layers and function to fight off infection.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 3 pf 65).

The sequence of loss of pinch in scleroderma are: (1/1) a) Lateral pinch, tip to tip pinch, palmar pinch b) Tip to tip pinch, palmar pinch, lateral pinch c) Palmar pinch, Lateral pinch, tip to tip pinch d) There is no sequence of loss of pinch

Correct Answer: b Feedback: Melvin JL: Scleroderma (systemic sclerosis): treatment of the hand.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1437, Elsevier, 2011, Mosby.The progressive skin abnormalities and joint contractures seen with scleroderma can lead to permanent loss of hand function. Every effort should be taken to preserve lateral pinch, as it is the most powerful.

When treating scleroderma, which is NOT the priority to maintain? (0/1) a) MCP flexion b) PIP Extension c) Thumb Abduction d) Lateral Pinch

Correct Answer: b Feedback: Melvin JL: Scleroderma (systemic sclerosis): treatment of the hand.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, pp. 1440-1441, Elsevier, 2011, Mosby.Although preferred to maintain PIP extension, the progressive nature of scleroderma often makes it very difficult. Focusing on MCP flexion, thumb abduction and lateral pinch can preserve function for these patients.

At which level does the brachial plexus become enclosed in sheath of fascia? a) Costoclavicular interval b) Coracoid/pectoralis minor loop c) Quadrangular space d) The axilla

Correct Answer: b Feedback: Neil Pratt, JHT, April/June 2005, page 218 The brachial plexus becomes encased in a sheath of fascia as it progresses in the area of the coracoid process and pectoralis minor loop.

Entrapment of which nerve causes not only muscular weakness, but also deep shoulder capsule pain with motion that can lead to the development of capsulitis? a) Axillary b) Suprascapular c) Dorsal scapular d) Radial

Correct Answer: b Feedback: Neil Pratt, JHT, April/June 2005, page 219 Entrapment of the suprascapular nerve can result in muscle weakness of the rotator cuff as well as cause deep capsular pain in the shoulder.

Which of the following is NOT a risk factors for developing MSDs: (0/1) a) Obesity b) Level of education c) Non-work activities (ie: leisure) d) Advanced age

Correct Answer: b Feedback: Obesity, having a history of prior injury or disease of the musculoskeletalsystem, advanced age, lifestyle factors (non-work activities), and even the female genderin some industries, will put an individual at a greater risk of developing MSDs. Thesefactors are considered non-workplace factors, while repetition, force, awkward/extreme/fixed postures, cold temperatures, vibration, and job related psychosocial factors are considered workplace risk factors. Level of education is not considered a risk factor for developing MSDs.Kietrys, D., Barr, A., Barbe, M., In Skirven, TM., Osterman, AL., Fedorczyk, JM., Amadio PC., 6th ed, pp.1769

A quick threshold screening test for median nerve function in the hand that includes the minimum number of critical points is: a) Moving Two-point discrimination testing of the index, middle, and thumb tips b) Monofilament testing of the thumb and index fingertips and the proximal index c) Moving Two-point discrimination testing of the index and thumb tips d) Monofilament testing of the thumb and index fingertips and ring finger

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 139. To test the median nerve, monofilaments are used testing the thumb and index fingertips along with the proximal index. The sites are the ulnar nerve are the distal small finger, proximal phalanx, and the ulnar base of the palm.

What is the earliest that an MCP arthroplasty is considered clinically stable, allowing exercise out of the orthosis? a) 1 week b) 3 weeks c) 6 weeks d) 8 weeks

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1390. The implant for MP joint arthroplasty is considered stable at 21 days (3 weeks) so out-of-orthosis exercises may be initiated as long as alignment of the MP joint is controlled during motion.

At which level do the flexor tendons of the fingers enter the flexor sheath? a) The FDP at midmetacarpal level; the FDS at the MP joint level b) FDP and FDS at MP joint level c) FDS as it emerges from the carpal tunnel; FDP at MP joint level d) FDP and FDS at midmetacarpal level

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 14. The flexor tendons enter the tendon sheath at the MP joint level. This is zone II.

The "critical corner" needs to be intact in order to maintain IP joint stability. Which structures is it comprised of? a) Lateral bands, central slip, triangular ligament b) ACL, PCL, volar plate c) Volar plate, ACL, PCL, FDP d) FDS, FDP, volar plate

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 404. The critical corner is the area where all 3 structures converge on the middle phalanx to provide joint stability anatomically.

The ______ opposes the powerful FCU, and has the most endurance of the wrist extensors. a) ECRB b) ECRL c) ECU d) BR

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 491. The ECRL has the longest fibers and the largest mass, thus it has the greatest capacity for sustained work. * ECRB is the strongest and most efficient wrist extensor. * ECRL has the greatest capacity for sustained work. * ECU is most effective as an ulnar deviator with the forearm in pronation.

The main mechanism for MP joint extension is: a) Central tendon b) Sagittal bands c) Transverse metacarpal ligament d) Vertical and oblique fibers of the interosseous muscles

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 495-496. Extension of the MP joint is achieved through the sagittal bands, vertically oriented fibers that shroud the capsule and collateral ligaments, connecting the extensor tendons with the volar plate and proximal phalanx on both sides of the joint.

A patient 8 weeks after extensor tendon repair presents with ROM limitations. His repair was in the distal forearm. Adhesions here can lead to: a) Restricted wrist flexion and extension b) Restricted composite wrist and finger flexion and involuntary tenodesis effect causing passive wrist extension with active grip c) Extensor-plus phenomenon d) A & C

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 515. When there is scar formation or tendon adhesion in the distal forearm both finger and wrist motion are affected. There can be restricted composite finger flexion or a resulting tenodesis effect during grip. In addition, wrist flexion and extension can also be limited.

When is the postoperative dressing typically removed? a) Day 1 b) Day 2-3 c) Day 4-7 d) After 10 days or more

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 646. The postoperative dressing is typically not removed until 48 hours in order for hemostasis and stabilization of the edema from the inflammatory process.

Last month a 38 year old woman had a dorsal ganglion excised from her right wrist. Her progress with range of motion has been good, and her wrist motion (flexion/extension) is now 65/45 with discomfort on flexion, and flexion decreased to 38 when her fingers are fisted. In addition to her pain at available end range motion, she continues to be markedly tender over her dorsal central wrist, and has not yet been able to return to her job as an administrative assistant. What could be causing her symptoms? a) Secondary gain b) PIN neuritis c) Extensor tenosynovitis d) Wartenberg's syndrome

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 79. The PIN, which is mainly a motor nerve to the finger extensors, ends in the dorsal capsule of the wrist. This nerve may be a source of pain when a ganglion develops and distends the wrist capsule. Neuromas of the PIN after wrist surgery performed from a dorsal approach can be a reason for persistent postoperative pain.

Edema in the infracondylar recess may be the first sign of effusion in the elbow. The borders of this triangle are: a) Lateral epicondyle, medial epicondyle, triceps muscle belly b) Lateral epicondyle, radial head, tip of olecranon c) Medial epicondyle, medial triceps tendon, tip of olecranon d) Lateral epicondyle, medial epicondyle, olecranon

Correct Answer: b Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 86 figure 8-31. The infracondylar recess, located in the triangular area bounded by the lateral epicondyle, the radial head, and the tip of the olecranon, contains the most superficial and easily palpable extent of the elbow joint capsule.

You would like to test the stability of a patient's inferior ligament of the glenohumeral joint. Which shoulder position is ideal for testing the strength of this ligament? (0/1) a) Shoulder at 70 deg abduction with external rotation b) Shoulder at 90 deg abduction with external rotation c) Shoulder at 90 deg flexion with external rotation d) Shoulder at 90 deg abduction with internal rotation

Correct Answer: b Feedback: Shoulder at 90 deg abduction with external rotation forces the head of the humerus into a position to test the inferior ligament.Iannotti, J. P., & Parker, R. D. (2013). The Netter Collection of Medical Illustrations Musculoskeletal System: Part I: Upper Limb (2nd ed., Vol. 6). Elsevier. Pg 27.

An open wound at the epidermis with involvement of dermis, subcutaneous fat, and discontinuity of skin is classified as: (0/1) a) Stage I b) Stage II c) Stage III d) Stage IV

Correct Answer: b Feedback: Stage I: epidermis involvement and edema/erythema present. Stage II: epidermis with involvement of dermis, subcutaneous fat, and discontinuity of skin. Stage III: Full thickness involving fascia only. Stage IV: Full thickness involving fascia with possible bone/muscle involvement.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 3 pg 74).

A pathologic process similar to Dupuytren's disease occurs in which of the following? (1/1) a) Albright's disease b) Ledderhose's disease c) Dercum's disease d) Paschen's disease

Correct Answer: b Feedback: Sweet S, Kroonen L, Weiss L: Soft tissue tumors of the forearm and hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 298, Elsevier, 2011, Mosby.Ledderhose disease is also called plantar fibromatosis. Similar connective tissue proliferation as Dupuytens occurs in the soles of the feet.

What is the most common carpal coalition? (1/1) a) Scaphoid-triquetrum b) Lunate-triquetrum c) Hamate-triquetrum d) Scaphoid-hamate

Correct Answer: b Feedback: Taras JS, D'Addesi LL: Diagnostic imaging of the upper extremity.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 170, Elsevier, 2011, Mosby.There are three types of carpal coalition: congenital, post-traumatic and inflammatory.

The short head of the bicep originates at the ______; the long head of the biceps originates on the ______. (0/1) a) Supra-glenoid tubercle; coracoid process of scapula b) Coracoid process of scapula; supra-glenoid tubercle c) Coronoid process of scapula; supra-glenoid tubercle d) Coracoid process of scapula; acromion

Correct Answer: b Feedback: The short head of the biceps attaches to the coracoid process of the scapula. The long head of the biceps attaches to the supra-glenoid tubercle. The coronoid process is the proximal, anterior projection of the ulna in the elbow.Iannotti, J. P., & Parker, R. D. (2013). The Netter Collection of Medical Illustrations Musculoskeletal System: Part I: Upper Limb (2nd ed., Vol. 6). Elsevier. Pg 12.

The Frykman classification system categorizes fractures of which of the following? (0/1) a) Elbow b) Distal Radiu c) Proximal interphalangeal (PIP) joint d) Thumb

Correct Answer: b Feedback: Trumble, T., Rayan, G., Budoff, J., Baratz, M. 2010. Principles of Hand Surgery, 2nd Ed., Elsevier, p. 137.Frykman's classification describes classifications of distal radius fractures. There are several others commonly used, including the AO system.

The following is not a tool for evaluating a scar? (1/1) a) Oximeter b) Odometer c) Tonometer d) Elastometer

Correct Answer: b Feedback: Tufaro PA, Bondoc SL: Therapist's management of the burned hand.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 325, Elsevier, 2011, Mosby.An oximeter measures oxygen tension of the scar, a tonometer measures pliability and an elastometer measures elastic properties.

During the initial stage of a burn (first 24 to 72 hours), the hand should be elevated to what level? (0/1) a) Above the heart b) To heart level but not above c) Below the heart d) All of the above are appropriate

Correct Answer: b Feedback: Tufaro, P.A. & Bondoc, S: Therapist's management of the burned hand. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 320, Elsevier, 2011, Mosby.In a burn injury, elevation above the heart level can limit blood supply to the hand.

Following a traumatic injury, patients must process the injury and work through psychological adjustment in addition to the physical aspects of the injury. All of the following are considered cognitive phenomena EXCEPT which? a) Flashbacks b) Nightmares c) Anxiety d) Poor concentration

Correct Answer: c Feedback: Anxiety is an affective, not cognitive, phenomenon that affects an injured patient, not cognitive. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 480

Which structures pass through the quadrangular space? (1/1) a) Median nerve and brachial artery b) Ulnar nerve and brachial artery c) Axillary nerve and posterior circumflex artery d) Axillary nerve and anterior circumflex humeral artery

Correct Answer: c Feedback: Bednar JM, Wurapa RK: Common nerve injuries about the shoulder.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 766, Elsevier, 2011, Mosby.The Quadrangular space is bordered by the humerus, teres major, teres minor and the long head of the triceps.

A newborn baby was referred to his physician when it was noticed that the thumb on his left hand had 3 phalangeal segments vs. the normal 2. The physician diagnosed the baby with triphalangism. Which developmental type of deformity does this represent? a) Failure of formation b) Failure of differentiation c) Duplication d) Overgrowth

Correct Answer: c Feedback: Duplication is an extra segment or digit. Overgrowth is simply larger segments or digits. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 346

During a tip or key pinch, the compressive forces at the thumb CMC joint are noted to be approximately ____________ times of the applied force at the tips of thumb and index finger. (0/1) a) 1-2 b) 4-6 c) 12-14 d) 20-22

Correct Answer: c Feedback: In a person weighing 70 kg, power grasp is noted to generate up to 120kg force in the thumb CMC joint. During tip or key pinch, the compressive forces at the thumb CMC joint are noted to be 12-14 times the applied force at the tips of the thumb and index finger, and shear forces at the TMC joint are noted to be 2.5 times the applied force.Edmunds, J. O. (2011). Current concepts of the anatomy of the thumb trapeziometacarpal joint. The Journal of Hand Surgery, 36(1), 170-182. doi:10.1016/j.jhsa.2010.10.029Leversedge, F. J., Goldfarb, C. A., & Boyer, M. I. (2010). A pocketbook manual of hand and upper extremity anatomy: Primus manus. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

According to MacDermid and Michlovitz when documenting outcomes, the Visual Analog Scale score must change by_______ in order to be clinically significant. a) 1 point b) 2 points c) 3 points d) It is irrelevant a this test is not a sound test to use in clinical practice

Correct Answer: c Feedback: MacDermid JC, Michlovitz SL: Examination of the elbow: linking diagnosis, prognosis, and outcomes. J. Hand Ther 19(2):82-97. According to the VAS for pain, a score changing at least 3 point (positive or negative) is considered significant.

Which example of a prosthesis is an aesthetic prosthesis? (1/1) a) Myoelectric hand b) Above-elbow prosthesis c) Pillet d) All of the above are aesthetic prosthetics

Correct Answer: c Feedback: Pillet J, Didierjean-Pillet A, Holcombe LK: Aesthetic hand prosthesis: its psychological and functional potential. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1285, Elsevier, 2011, Mosby.Prosthesis can be categorized as functional or aesthetic. A Pillet prosthesis is an example of a passive device to restore the normal appearance of the hand.

Which is the correct sequence of events in the acute inflammation reaction? a) Vasodilation, edema formation, vasoconstriction b) Increase in cell permeability, vasodilation, edema formation c) Vasoconstriction, vasodilation, edema formation d) Edema formation, phagocytosis, coagulation cascade

Correct Answer: c Feedback: Reference: Modalities for Therapeutic Application Michlovitz, page 18. Initially, vasoconstriction occurs to provide hemostasis. After hemostasis is achieved, vasodilation occurs and there is increased cell permeability leading to edema formation.

Which TENS application is thought to result in the release of endorphins, therefore giving pain relief that may last for several hours? a) Noxious level b) Pulsed application c) Motor level d) Subsensory

Correct Answer: c Feedback: Reference: Modalities for therapeutic intervention, edited by S. Michlovitz, T. Nolan, page 111- 113. Rehabilitation of the Hand and Upper Extremity 6th edition Page 1467. Motor level TENS appears to stimulate the release of endorphins making it more effective for long-term pain relief. Pulsed application and subsensory levels do not effectively stimulate the release of endorphins resulting in less effective pain relief.

In general, after simple ligament repair for acute scapholunate dissociation, what is the expected AROM outcome? a) Full flexion, full extension, full radial/ulnar deviation b) Around 40° flexion, 40° extension, 10° combined radial/ulnar deviation c) Around 40° flexion, 40° extension, radial/ulnar deviation minimally restricted d) 40° combined flexion/extension, 10° combined radial/ulnar deviation

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1009. Expectations following acute repair of the SL ligament are for functional ROM of the wrist with some limitations of extension and flexion and minimal restriction of ulnar and radial deviation.

When should active motion begin after radial head prosthetic replacement? When should active motion begin during nonoperative management of a Type II fracture? a) 3 weeks; 2 weeks b) 3 weeks; 4 weeks c) During the first week for both d) 2 weeks; 3 weeks

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1058. Operative and nonoperative protocols initiate AROM immediately/within the first post-operative week.

Choose the most complete group of muscles in which trigger points may be present in the patient with tennis elbow. a) ECRL, ECRB b) ECRL, ECRB, ECU c) ECRL, ECRB, supinator, brachioradialis d) ECRB, supinator, brachioradialis, EDC

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1109-1112. Trigger points are commonly found in the ECRL and ECRB muscles with lateral epicondylitis. Trigger points can also be found in the supinator and brachioradialis. All of these trigger points can refer pain to the lateral epicondyle.

With what condition is the term angiofibroblastic hyperplasia associated? a) Hypertrophic scarring after surgery b) Acute inflammation of a tendon sheath c) Degenerative tendon changes d) SLE

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1111. Degenerative changes of a tendon have been described as tendinosis. Tendinosis is confirmed by the presence of aniofibroblastic hyperplasia.

The most common shoulder tendonitis involves the: a) Long biceps tendon b) Infraspinatus c) Supraspinatus d) Teres minor

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 118-119. Due to its position underneath the coracoacromial arch, the supraspinatus is most commonly involved in shoulder tendinitis.

A patient you are treating has pantrapezial OA and CMCJ OA. What is the best orthosis to use for her? a) A CMCJ orthosis that immobilized the CMC and MP b) A CMCJ orthosis that immobilized the CMC only c) A CMCJ orthosis that immobilized the CMC and include a wrist wrist immobilization d) A CMCJ orthosis that immobilized the CMC, MP, and IP, as well as wrist immobilization.

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1371. With STT and/or pantrapezial OA, treatment should include immobilization of the wrist and thumb in order to effectively slow the progression.

An upper limb tension test that places shoulder in depression and slight abduction; elbow in extension; forearm in supination; shoulder in lateral rotation, is intended to place tension most specifically on which nerve(s)? a) Median and anterior interosseous b) Ulnar and lower trunk of plexus c) Median, musculocutaneous and axillary d) Radial

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1522-1523. Orthopedic physical assessment, 4th edition, page 148. The ULTT for the median, musculocutaneous, and axillary nerves are test with shoulder depression, slight abduction, external rotation, forearm supination.

Just proximal to the wrist, the median nerve is located between which structures? a) Radial artery and scaphoid tubercle b) Tendons of palmaris longus and FPL c) Tendons of palmaris longus and FCR d) Tendon of ECU and FDS

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 16 Just proximal to the wrist the median nerve lies between the palmaris longus tendon and the FCR tendon then passes through the carpal tunnel as the most volar structure (hence its propensity for injury)

Which is NOT true regarding the anterior muscles of the forearm? a) All muscles of the first layer arise from the medial epicondyle b) The 2nd and 4th layers each consist of only one muscle c) All are innervated by the median nerve d) The median nerve passes directly beneath and is adherent to the FDS

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 24. The muscles of the anterior forearm are not all median nerve innervation. For example, the ulnar 2 slips of the FDP are innervated by the ulnar nerve.

Statistical evidence supports the association of which diseases with Dupuytren's disease? a) RA, heart disease, alcoholism, diabetes b) OA, diabetes, tuberculosis, smoking c) Epilepsy, alcoholism, diabetes d) Carpal tunnel syndrome, trigger finger, diabetes

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 269. Dupuytrens in commonly seen in patients with diabetes. Patient with both idiopathic and acquired epilepsy have high incidence of dupuytrens suggesting possible correlation with barbiturate use. In terms of alcoholism the correlation appears to be with the volume of alcohol rather than association with liver disease.

In cases of frostbite, deeper tissues may sustain severe damage but the extent of nonviable tissue may not be visible until: a) 2 weeks later b) Blisters appear c) 22-45 days later d) 70-90 days later

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 345. The degree of cold injury is difficult to determine initially, even after thawing of the frozen extremity. Demarcation between viable and nonviable tissue usually occurs 22-45 days after injury.

Your referring hand surgeon is chatting with you, and tells you that the lady he is sending for therapy is an interesting example of the extensor-plus phenomenon. You ask him to explain what he is seeing in this patient. What does he tell you? a) Finger flexion is painful due to bulky scar preventing gliding of the tendons b) Abnormal extension pattern at the MP joint occurs because of scarring about the deep transverse metacarpal ligament, causing involuntary PIP flexion with MP extension, and limiting composite extension c) MP flexion passively extends the IP joints, and IP flexion passively extends the MP joints, and composite MP/IP flexion is lacking, due to scar adhesions between the EDC tendons and fascia d) When the patient attempts composite flexion of the involved fingers, the DIP joints instead extend because of advancement of the lumbricals

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 515. An extensor plus deformity is seen when a patient attempts IP joint flexion which results in hyperextension of the MP joint. This occurs most often due to scar tissue adhesions.

Your patient is a 35 year old hair stylist who reports 'catching' of her long finger and thumb after gripping and holding implements at work and at home. She describes having to use her other hand to straighten those digits after they catch. It is April now, and she reports this has been happening since before Christmas. She is very busy and has tried to manage on her own, massaging and soaking her hand in warm water. What stage of trigger finger does she present with? a) Stage 1 b) Stage 2 c) Stage 3a d) Stage 3b e) Stage 4

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 575. 3a is described as Passive with demonstrable catching and the a. indicates passive extension is required and b. would indicate an inability to flex

The least resistance to electrical flow; therefore, the most susceptible tissue to electrical injury is: a) Skin b) Bone c) Nerve d) Fat

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 605. Electrical current follows the path of least resistance. Resistance to flow increases in various tissues in the following order: nerve, blood vessels, muscle, skin, tendon, fat, and bone.

Generally speaking, repaired nerves are immobilized for: a) 2-3 days b) 1 week c) 3-4 weeks d) 5-6 weeks

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 613. IN general, a repaired nerve is immobilized for 3-4 weeks in a dorsal block orthosis, at which time the nerve can withstand tensile stress.

The contents of the scalene triangle are: a) Rami or trunks of the brachial plexus; subclavian artery and vein b) Divisions of the brachial plexus; subclavian artery and vein c) Rami or trunks of the brachial plexus; subclavian artery d) Rami or trunks of the brachial plexus; axillary artery

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 735. Neil Pratt, JHT, April/June 2005, page 218. The scalene triangle in the neck consists of the rami or trunks of the brachial plexus along with the subclavian artery.

The shoulder position of abduction and external rotation can cause neurovascular compression involving: a) The pectoralis major tendon and the lesser tuberosity of the humerus b) The first rib and the clavicle c) The coracoid process, pectoralis minor, and the humeral head d) The quadrangular space, the triceps, and the humerus

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 741. Neil Pratt, JHT, April/June 2005, page 218-219 In abduction neurovascular structures are placed on tension. With external rotation there is compression involving the coracoid process, the pectoralis minor, and the humeral head.

During the acute response to injury, histamine and bradykinin are released to __________________. a) Dispose of injury byproducts b) Cause vasoconstriction, then vasodilation c) Increase capillary permeability d) Go and get help

Correct Answer: c Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 847 & 458. Histamine and bradykinin increase capillary permeability and allow for the inflammatory process to occur.

Your patient is recovering from a substantial burn to the left hand which required a skin graft at the thumb webspace. At which point after surgery can you begin to expose the hand and graft to water, assuming healing is occurring without complication? (0/1) a) 21 days b) 14 days c) 5 days d) day 1

Correct Answer: c Feedback: Skin graft is a harvested section of dermis and epidermis which has been applied to a wound bed with good vascularity and stability. A skin graft can be exposed to water by day 4-5 but modalities should not begin until day 7-10.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 3 pg 70).

Which of the following tendons does not originate off of the ulna? (0/1) a) EIP b) EPL c) FPL d) APL

Correct Answer: c Feedback: Taras, JS, Martyak, GG, Steelman,P: Primary care of flexore tendon injuries. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p.446, Elsevier, 2011, Mosby.The FPL originates off of the proximal radius and interosseous membrane.

Your next patient is recovering from a 2nd digit ray resection with first dorsal interosseous transfer. In the first post operative phase. (0/1) a) Immediate unrestricted AROM/PROM with NMES if needed to promote tendon glide. b) Immediate unrestricted PROM and begin unrestricted AROM 2 week post op. c) Fabricate hand based P1 block orthosis and begin AROM at 3-4 weeks post op. d) Fabricate hand based P1 block orthosis and begin AROM at 10-12 weeks post op.

Correct Answer: c Feedback: The P1 block orthosis is indicated to protect the FDI transfer. AROM at 3-4 weeks post op. Cannon, N. M., & Schnitz, G. (2001). Diagnosis and treatment manual for physicians and therapists. Indianapolis, IN: Hand Rehabilitation Center of Indiana.

Both the palmar and dorsal interossei are present in the deepest layer of the hand in addition to which muscle? (0/1) a) The lumbricals b) Flexor pollicis brevis c) Adductor pollicis d) Opponens digiti minimi

Correct Answer: c Feedback: The deepest layer of the hand includes the palmar interossei, dorsal interossei and the adductor pollicis Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., p. 28).

The flexor pollicis longus muscle is: (0/1) a) Pennate b) Fusiform c) Unipennate d) Bipennate

Correct Answer: c Feedback: The fibers of the FPL angle to side of the tendon and is described as a unipennate muscle.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 33 pg 4).

According to Maitland, what are the parameters of performing a grade II joint mobilization? a) A large amplitude motion from just before mid-range motion to end range motion b) A small amplitude motion focusing most motion in end range c) A large amplitude motion from beginning of range to just beyond mid-range d) A small amplitude motion focusing most motion in beginning range

Correct Answer: c Feedback: These all describe a grade of joint mobilization, this answer matches grade II. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 108

A patient presents to the clinic with numbness in the 4th and 5th digits with weakness of the intrinsic muscles following prolonged bike riding. What type of handlebar palsy would this be considered? a) Type 3 b) Type 2 c) Type 1 d) None of the Above

Correct Answer: c Feedback: Type 1 involves motor and sensory; types 2 and 3 involve one or the other. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 328 Type II = motor only, Type III = sensory only

According to Groth what is considered adequate displacement or excursion of the FDP tendon to prevent tethering or binding adhesions? (0/1) a) 2.5 mm b) 1.7 cm c) 2.5 cm d) 1.7 mm

Correct Answer: d Feedback: 1.7 mm is thought to be adequate displacement of the FDP tendon to prevent adhesion's.Groth, G. N. (2004). Pyramid of progressive force exercises to the injured flexor tendon. Journal of Hand Therapy, 17(1), 31-42.

A patient presents to your clinic with a stiff MCP joint of the left 3rd finger. In order to determine the most appropriate possible orthosis, a Modified Weeks test is performed. Following a thermal modality and sustained end range positioning, it is noticed that PROM has increased by 10 degrees. What is the most appropriate orthosis based on this information? a) No orthosis b) Static orthosis c) Static progressive orthosis d) Dynamic orthosis

Correct Answer: d Feedback: 20 degrees change is grounds for no orthosis, 15 for static, 10 for dynamic, and 0-5 for static progressive according to this test. Reference: Rehabilitation of the Hand and Upper Extremity, 6th Edition, Pg. 887

Which muscle inserts directly onto the proximal phalanx? (0/1) a) Extensor Indicis Proprius b) Opponens Pollicis c) Opponens Digiti Minimi d) Palmar Interosseous

Correct Answer: d Feedback: All palmar interossei originate along the shaft of the metacarpal bone of the digit on which they act. They are inserted into both the base of the proximal phalanx and the extensor expansion of the extensor digitorum of the same digit.The extensor indicis proprius originates on the dorsal ulnar and interosseous membrane. It inserts just ulnar to the extensor digitorum communis tendon insertion on the index finger, inserting into the extensor hood, and not directly onto the proximal phalanx.The opponens pollicis originates on the transverse carpal ligament and trapezium, and inserts on the shaft of the first metacarpal.The opponens digiti minimi originates from the hook of the hamate, and inserts along a line on the medial shaft of the fifth metacarpal.References:Palastanga, N; Soames, R (2012). Anatomy and Human Movement: Structure and Function (6th ed.). ISBN 978-0-7020-4053-5.Pratt, Neal. Chapter 1: Anatomy and Kinesiology of the Hand. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, ed. Rehabilitation of the Hand and Upper Extremity. 6th Edition. Philidelphia, PA: Elsevier Mosby; 2011: 10-15

According to the Hand Rehabilitation Center of Indiana, when can a sling be discontinued following a conservative anterior shoulder dislocation and initiation of AAROM? a) 8 weeks b) 6 weeks c) 10 weeks d) 2-3 weeks

Correct Answer: d Feedback: At 2-3 weeks post dislocation, the sling or immobilizer is removed in order to begin AAROM and light posterior capsule stretching to regain internal rotation. Diagnosis and Treatment Manual for Physicians and Therapists: Upper Extremity Rehabilitation, 4th Edition (Indiana), Pg. 55

Following a proximal row carpectomy in which the scaphoid, lunate, triquetrum, and tip of the radial styloid have been excised; patients can be expected to recover: (1/1) a) Less than 20% of the opposite side grip strength b) 20-40 % of the opposite side grip strength c) 100 % of the opposite side grip strength d) 50 - 80 % of opposite side grip strength

Correct Answer: d Feedback: Bednar JM, Feldscher SB, Seftchick J: Wrist reconstruction: salvage procedures. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1029, Elsevier, 2011, Mosby.Decreased bone length and muscle excursion after a PRC contribute to the loss of grip strength.

Which statement below is not true? a) Potential excursion of a muscle is related to muscle fiber length b) The cross section area of a muscle relates to its ability to generate tension c) The work capacity of a muscle is related to its bulk d) The strength of a muscle is related to its bulk

Correct Answer: d Feedback: Clinical mechanics of the hand, 2nd edition; eds. Brand PW, Hollister A; 1992, page 28 The strength of a muscle is not related to its bulk. The larger muscle mass often gives a muscle more potential for sustained work not strength.

A patient is receiving a EMG to explore the cause of abnormal neuromuscular symptoms. What exactly is being measured? (0/1) a) Nerve conduction velocity by measuring the speed that a electric signal travels along a stimulated peripheral nerve b) It compares the amplitude of neural signals between the affected limb and unaffected limb c) It measures the latency between the stimulated sensory nerves and the reflex muscle response to determine if the pathology is more proximal or involving the CNS d) Detecting electrical activity within the muscle by detecting activity of motor units close to the needle

Correct Answer: d Feedback: Electromyography is defined as "the use of hypodermic needle electrodes to record electrical activity within the muscle, by detecting the voltages generated by motor units close to the needle " (Sabbahi and Costello). Answers A-C apply to nerve conduction studies, not electromyography.Reference:Test Prep for the CHT Exam, 3rd Edition. American Society of Hand Therapists. Electromyographic Testing. Mohamed Sabbahi and Charles Costello. Chapter 31, pages 1-38.Mackin, GA. Clinical Interpretation of Nerve Conduction Studies and Electromyography of the Upper Extremity. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, ed. Rehabilitation of the Hand and Upper Extremity. 6th Edition. Philidelphia, PA: Elsevier Mosby; 2011: pages 187-193.

Ultrasound at 3 MHz affects tissues up to what depth? (1/1) a) 6 cm b) 5 cm c) 4 cm d) 2 cm

Correct Answer: d Feedback: Fedorczyk JM: The use of physical agents in hand rehabilitation.In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 1497, Elsevier, 2011, Mosby.Ultrasound units have 1 and 3 MHz frequencies. The greater the frequency, the less penetration depth 1 MHZ= 5cm 3 MHZ = 2cm

A patient with significant injury to posterosuperior rotator cuff consults his surgeon when noticeable loss in external rotation is noticed. The surgeon reports significant, irreparable damage to the rotator cuff but possible ability to transfer latissimus dorsi and teres major muscles in order to regain ability to externally rotate his shoulder. To what transfer does this refer? a) Boyes transfer b) Bunnel transfer c) Huber transfer d) L'Episcipo transfer

Correct Answer: d Feedback: L'Episcipo transfer is most often performed as a result of a brachial plexus injury to regain external rotation, though is an option for irreparable cuff tears as well. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 299-300

What treatment can be initiated at post-OP week 4 of a patient who has undergone surgical release for Dupuytren's disease? (0/1) a) Gentle tendon glides to maintain ROM b) Progress flexion and maintain extension c) Dynamic and passive flexion while monitoring for extensor lag d) Strengthening

Correct Answer: d Feedback: Light resistance exercises can begin at week 4 and progress as tolerated. Gentle tendon glides may be initiated at post OP days 3-10. More aggressive PROM in both flexion and extension, as well as dynamic splinting, can be initiated if needed at post OP week 3, taking care to monitor for an extension lag.References:Evidence Based Hand and Upper Extremity Protocols: a Practical Guide for Therapists and Physicians. Elizabeth De Herder. 2015. Page 29.Evans, Roslyn. Therapeutic Management of Dupuytren's Contracture. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, ed. Rehabilitation of the Hand and Upper Extremity. 6th Edition. Philidelphia, PA: Elsevier Mosby; 2011: 2781-288

An electrician is referred to have an FCE performed to determine ability to return to work and meet job requirements. The job classification is heavy. The patient demonstrates ability to occasionally lift 65 lbs., frequently lift 20 lbs., and constantly lift 10 lbs. Does he meet the physical requirements of the job and what category does he fall in? a) Yes, he falls in the heavy classification b) No, he falls in the sedentary classification c) No, he falls in the light classification d) No, he falls in the medium classification

Correct Answer: d Feedback: Occasional and constant lifts meet heavy criteria, however frequent meets medium demand level. Therefore, the patient falls in the medium demand level and does not meet job requirements. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 475 light work: 20# of force occasionally, 10# frequently, may require walking/standing to significant degree or maintaining a production rate pace Medium work: 20-50# of force occasionally, 10-25# frequently, 10# constantly heavy work: 50# occasionally, 25-50# frequently, 10-20# constantly to move objects Very heavy work: >100# occasionally, >50# frequently, >20# constantly to move objects

With strong suspicion of TOS as described above, what test(s) would be most appropriate to validate suspicion of TOS? a) Adson's test b) Wright's test c) Halsted's test d) All of the above

Correct Answer: d Feedback: One test is a good start for diagnosis of TOS, however, with an increase in the number of positive tests, increases the sensitivity of a positive diagnosis. Reference: Rehabilitation of the Hand and Upper Extremity, 6th Edition, Pg. 727

Pain in the anterior shoulder , lateral arm, lateral forearm, and radial hand can be referred from a trigger point in which muscle? a) Levator scapula b) Subscapularis c) Pectoralis d) Infraspinatus

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 104. Trigger points in the pectoralis and subscapularis often refer pain medially. The levator scapula usually refers pain along the superior shoulder or medial border of the scapula.

Which type of dressing is not appropriate for the wound described? a) Surgical suture line: dry dressing b) Dirty wound: wet wide mesh dressing c) Clean open wound with moderate drainage: Telfa d) Infected open wound in digit: Thin hydrocolloid

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 228-229. The hydrocolloid is not the best choice of dressing on infected, open wounds of the digit. Hydrocolloid can be used on a yellow wound but is not the best selection for an infected wound.

All of the following infections of the hand may require surgical drainage except: a) Felon b) Paronychia c) Fascial space infection d) Lymphangitis

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 237. Due to the aggressive progression of lymphangitis through the channels of the lymphatics, surgical drainage is only reserved for cases in which there is evidence of localized pus and abscess formation or tissue necrosis.

A full thickness skin graft: a) Maintains its size when applied early b) Has a great amount of primary contracture c) Can prevent the contracture of the wound d) All of the above

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 246. FTSG demonstrates the greatest amount of primary contracture and the least amount of secondary wound contracture. If it is applied early, a FTSG will maintain its size and completely stop the contracture of the wound.

In cases where both the FDP and FDS are lacerated, the benefit of repairing both include all but which of the following? a) Presence of the FDS supplies more blood to FDP b) FDS provides a gliding surface for FDP c) PIP hyperextension deformities can be avoided d) All of the above e) a and b

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 449. Maintaining and repairing the FDS includes maintaining a blood supply to the FDP through the vincula, providing a smooth gliding surface for the FDP, independent motion of the digit with stronger flexion power, and decreased possibility of hyperextension deformities.

A patient with a mallet finger has been in a DIP extension splint for 7 weeks. He is now referred to you to begin flexion exercises. You heard Roz Evans lecture recently, and want to follow her guidelines. How much flexion will you prescribe during his first week of therapy and as part of his home program? a) Flexion to tolerance, within pain free limits b) Full flexion is permitted with no restrictions, as long as he continues to have full extension c) Flexion to 35°-45° in an exercise template d) Flexion to 20°-25° in an exercise template

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 530-532. According to Evans, the initial flexion of the DIP is 20-25 degrees using an exercise template. If no lag develops, the flexion is increased the second week to 35 degrees.

You are doing a systematic evaluation on a patient who was referred by her PCP, with a general diagnosis of 'wrist sprain'. Which finding below would not be associated with the radial dorsal zone of the wrist? a) Clamp sign b) Drummer's palsy c) Wartenberg's syndrome d) + Linscheid test

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 76. The Linscheid test is performed in the central dorsal zone of the wrist to detect ligament injury and instability of the 2nd and 3rd CMC joints.

Procedures that restore thumb opposition may include all but which of the following? a) EIP b) Ring FDS c) ADQ d) Index FDS

Correct Answer: d Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 776. Clinical mechanics of the hand, 2nd edition; eds. Brand PW, Hollister A; 1992, page 206. The index finger FDS is not used to restore thumb opposition as it would sacrifice independent motion and function of the index finger

At 4 weeks post-OP for a peripheral TFCC repair, what AROM exercise is contraindicated? (0/1) a) Forearm Rotation b) Wrist flexion and extension c) Wrist ulnar and radial deviation d) There are no AROM contraindications at 4 weeks post-OP. All of the above exercises should be initiated to decrease stiffness.

Correct Answer: d Feedback: Reference:Evidence Based Hand and Upper Extremity Protocols: a Practical Guide for Therapists and Physicians. Elizabeth De Herder. 2015. Page 135-136.Bednar JM, Feldscher SB, Seftchick J. Wrist Reconstruction: Salvage Procedures. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, ed. Rehabilitation of the Hand and Upper Extremity. 6th Edition. Philidelphia, PA: Elsevier Mosby; 2011: pages 963-973.

While climbing a mountain, one of the climbers sustained frostbite to one finger and frost nip to another. A year later some symptoms remain. All of the following are common long-term injuries except which? a) Cold sensitivity b) Muscle wasting c) Raynaud's phenomenon d) Swelling

Correct Answer: d Feedback: Swelling is an acute symptom upon rewarming, though is not common as a long-term deficit. Reference: Hand & Upper Extremity Rehabilitation: A Quick Reference Guide & Review, Pg. 159

What type of suture is used in the periphery of a flexor tendon repair? (0/1) a) Two-strand b) Four-strand c) Six-strand d) Epitendinous

Correct Answer: d Feedback: Taras JS, Martyak GG, Steelman PJ: Primary care of flexor tendon injuries. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 450, Elsevier, 2011, Mosby.An epitendinous suture is added to increase the strength of the tendon repair, improve gliding and prevent gapping.

When the forearm is pronated, the interosseous membrane is slack. What injury correlates with injury during a fall on the outstretched hand with the arm in a pronated position? (0/1) a) Distal radius fracture b) Elbow dislocation c) DRUJ dislocation d) Radial head fracture

Correct Answer: d Feedback: The relaxing of the interosseous membrane increases the risk of a radial head fracture during a fall on an outstretched hand.Cannon, N. M., & Schnitz, G. (2001). Diagnosis and treatment manual for physicians and therapists. Indianapolis, IN: Hand Rehabilitation Center of Indiana

Which epidermal layer is found in only the palms of the hands and soles of feet? (0/1) a) Stratum corneum b) Stratum spinosum c) Stratum granulosum d) Stratum lucidum

Correct Answer: d Feedback: The stratum lucidum is an epidermal layer only found in the palms of the hand and soles of the feet.Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., p. 65).

A "Meleney ulcer" is another name for: (0/1) a) Gangrene b) Lymphangitis c) A fungal infection d) Necrotizing fasciitis

Correct Answer: d Feedback: This is a severe manifestation of lymphangitis which progresses in a matter of hours.Iannotti, J. P., & Parker, R. D. (2013). The Netter Collection of Medical Illustrations Musculoskeletal System: Part I: Upper Limb (2nd ed., Vol. 6). Elsevier. Pg190

Which of the following is not a site of compression in radial tunnel syndrome? (0/1) a) Fibrous bands anterior to the radial head b) Recurrent radial vessels c) Tendinous margin of the ECRB d) The arcade of Frohse e) All of the above are sites of compression

Correct Answer: e Feedback: Abjug JM, Martyak G, Culp RW: Other nerve compression syndromes of the wrist and elbow. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 687, Elsevier, 2011, Mosby.Radial tunnel is a compressive neuropathy of the PIN.

Intermittent pneumatic compression (IPC)—or vasopneumatic compression—is often used to control postoperative edema. By what mechanism is it most likely that IPC reduces peripheral edema? (0/1) a) IPC causes forward propulsion of blood in the arterial system b) IPC elevates the pressure of fluid contained within the interstitial space. c) IPC causes forward propulsion of blood in the venous system. d) b and c e) All of the above

Correct Answer: e Feedback: It is hypothesized that the compression of soft tissue with IPC causes elevation of the pressure of interstitial fluid to be higher than that of blood and lymph vessels (venous pressure is typically about 30 mmHg). This change in the pressure gradient likely encourages the drainage of fluid out of the interstitial space and into the venous and lymphatic systems. Furthermore, it is proposed that soft tissue compression with IPC promotes forward propulsion of blood flow, optimizing peak flow velocity and preventing venous stasis.Answer: EBellew, JW, Michlovitz, SL, Nolan, TP, Pp. 239

Which statements regarding CRPS are true? a) Type I- No known nerve injury b) Type II- Is associated with a nerve injury c) Both types are sympathetically maintained d) There is some evidence that CRPS is hereditary e) a, b & d f) a, b & c

Correct Answer: e Feedback: Reference: Rehabilitation of the Hand and Upper Extremity 6th edition Page 1479. CRPS 1 and 2 can be sympathetically maintained or independent.

CRPS is the most common complication after open Dupuytren's contracture release. (1/1) True False

Correct Answer: f Feedback: Hurst L: Dupuytren's disease: surgical management. In Skirven TM, Osterman AL, Fedorczyk JM, et al, eds: Rehabilitation of the hand and upper extremity, ed 6, p. 279, Elsevier, 2011, Mosby.More common complications include tendon or nerve injury and soft tissue loss.

True/False. Muscle absorbs US energy faster than tendon. (0/1) True False

Correct Answer:f Feedback: False. Patellar tendon absorbed US energy 3.5 times faster than the calf muscle under identical treatment parameters.Chan AK, Myrer JW, Measom GJ, Draper DO. Temperature changes in human patellar tendon in response to therapeutic ultrasound. Journal of athletic training. Apr 1998;33(2):130-135.As cited inDuff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics

True/false. Surgical wounds are epithelialized within 12 hours. (0/1) True False

Correct Answer:f Feedback: False. Surgical wounds are epithelialized within 48 hours,Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch 3 pg 68).

True/False. The Load and Shift test a gold standard assessment to assess both anterior and posterior instability. (0/1) True False

Correct Answer:t Feedback: Duff, S., EdD, PT OTR/L, CHT, & Levy, T., MS, OTR/L, CBIST. (2017). Anatomy and biomechanics of the upper extremity. In Test prep for the CHT exam (3rd ed., Ch. 15 pg 8).

True/False. The Extrinsic ligaments of the wrist have no insertion on the proximal carpal row. (0/1) True False

Correct Answer:t Feedback: Kao, D., MD. (2018, April 5). Wrist Tendinopathy - Diagnosis and Treatment [UW Hand Course 2018]. University of Washington, Seattle.