CHT Clinical Reasoning 2

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?

Accepted Answer

TFCC

Answer

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?

Accepted Answer

De Quervain's tenosynovitis

Answer

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?

Accepted Answer

Inability to return to work as a carpenter

Answer

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?

Accepted Answer

Index finger abduction via first dorsal interosseous

Answer

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?

Accepted Answer

Graded motor imagery followed by mirror therapy

Answer

Graded motor imagery progressing to mirror therapy is the evidence-based approach for CRPS that addresses central sensitization before introducing physical movement.

(CHT) Certified Hand Therapist Practice Test

(CHT) Certified Hand Therapist Practice Test

CHT Clinical Reasoning 2