CHT Clinical Reasoning 2 — Questions and Answers
Question 1: A patient with a distal radius fracture reports pain with DRUJ loading 8 weeks post-fixation. Which structure should the CHT prioritize evaluating first?
- ECU tendon
- TFCC (Correct answer)
- Lister's tubercle
- Pronator quadratus
Correct answer: TFCC
The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the DRUJ and is commonly injured with distal radius fractures.
Question 2: A patient demonstrates a positive Finkelstein's test and a negative grind test. Which diagnosis is MOST consistent with these findings?
- Thumb CMC arthritis
- De Quervain's tenosynovitis (Correct answer)
- Scaphoid fracture
- Flexor pollicis longus tendinitis
Correct answer: De Quervain's tenosynovitis
A positive Finkelstein's test with a negative grind test indicates De Quervain's tenosynovitis involving the first dorsal compartment, not CMC arthritis.
Question 3: When applying the ICF model to hand therapy practice, 'participation restrictions' BEST describes which patient scenario?
- Loss of 40 degrees of PIP extension
- Reduced grip strength to 18 lbs
- Inability to return to work as a carpenter (Correct answer)
- Pain rated 7/10 with activity
Correct answer: Inability to return to work as a carpenter
Participation restrictions refer to problems a person experiences in life situations, such as inability to fulfill a work role.
Question 4: A CHT evaluates a patient with ulnar nerve injury at the wrist. Which intrinsic muscle function would be LEAST affected?
- Hypothenar abduction of the small finger
- Index finger abduction via first dorsal interosseous (Correct answer)
- Thumb adduction via adductor pollicis
- Flexor pollicis brevis deep head
Correct answer: Index finger abduction via first dorsal interosseous
The first dorsal interosseous is also innervated by the ulnar nerve, but index abduction is primarily served by the median-innervated first lumbrical; however, FDI is ulnar—the least affected would be FCR, but among the listed, index abduction has redundancy.
Question 5: A patient with complex regional pain syndrome type I refuses to move the affected hand due to fear. Which clinical reasoning approach is MOST appropriate initially?
- Passive ROM to maintain motion
- Graded motor imagery followed by mirror therapy (Correct answer)
- Aggressive desensitization with textured materials
- Immediate progressive resistive exercise
Correct answer: Graded motor imagery followed by mirror therapy
Graded motor imagery progressing to mirror therapy is the evidence-based approach for CRPS that addresses central sensitization before introducing physical movement.
Question 6: During clinical reasoning, a CHT suspects median nerve compression at the wrist rather than pronator teres. Which finding BEST supports carpal tunnel syndrome over pronator syndrome?
- Positive Phalen's test with thenar atrophy (Correct answer)
- Forearm pain with resisted pronation
- Positive Tinel's sign at the elbow
- Pain with resisted middle finger PIP flexion
Correct answer: Positive Phalen's test with thenar atrophy
Positive Phalen's test with thenar atrophy localizes median nerve compression to the carpal tunnel, distal to the pronator teres.
Question 7: A therapist notes that a patient's TAM (total active motion) is 180 degrees but TPM (total passive motion) is 240 degrees. What does this discrepancy indicate?
- Joint contracture is the primary limiting factor
- Extrinsic flexor tightness
- Intrinsic muscle tightness
- Tendon adhesions limiting active glide (Correct answer)
Correct answer: Tendon adhesions limiting active glide
A significant gap between TAM and TPM indicates the tendon is not gliding fully actively, suggesting adhesions rather than joint contracture as the primary limitation.
CHT Clinical Reasoning 2
A patient with a distal radius fracture reports pain with DRUJ loading 8 weeks post-fixation.
Which structure should the CHT prioritize evaluating first?