CHT Clinical Reasoning 4 — Questions and Answers
Question 1: A patient's intrinsic tightness test is positive. This means PIP flexion is more restricted when the MP joint is:
- Flexed
- Extended (Correct answer)
- In radial deviation
- In ulnar deviation
Correct answer: Extended
Intrinsic tightness causes greater restriction of PIP flexion when the MP is extended because the tight intrinsics are placed on maximum stretch.
Question 2: A CHT treating a patient with Dupuytren's contracture post-fasciectomy should FIRST address which goal in early rehabilitation?
- Strengthening the flexors to prevent re-rupture
- Edema management and wound healing to allow early motion (Correct answer)
- Passive stretching into full MP and PIP extension immediately
- Scar massage starting day one post-surgery
Correct answer: Edema management and wound healing to allow early motion
Early post-fasciectomy rehabilitation prioritizes edema control and wound healing before aggressive motion to prevent wound dehiscence.
Question 3: When performing clinical reasoning for a patient with lateral epicondylalgia, which neural tissue provocation would implicate cervical radiculopathy as a contributing factor?
- Positive Maudsley's test
- Upper Limb Tension Test (ULTT) positive for radial nerve bias (Correct answer)
- Positive Cozen's test
- Positive Mill's test
Correct answer: Upper Limb Tension Test (ULTT) positive for radial nerve bias
A positive ULTT with radial nerve bias implicates neural tension from the cervical spine contributing to lateral elbow symptoms.
Question 4: A patient with a scaphoid nonunion presents with persistent wrist pain after cast treatment. The CHT's clinical reasoning should MOST prioritize:
- Initiating aggressive wrist mobilization
- Fabricating a wrist immobilization splint and referring back to physician (Correct answer)
- Beginning grip strengthening immediately
- Applying ultrasound to promote healing
Correct answer: Fabricating a wrist immobilization splint and referring back to physician
Scaphoid nonunion requires surgical evaluation, and the CHT should immobilize the wrist and refer the patient back to the physician.
Question 5: Which factor is MOST important when selecting a functional outcome measure for a CHT research study on tendon repair?
- The measure's responsiveness to change in the target population (Correct answer)
- The cost of the measurement tool
- The time it takes to administer the measure
- Whether the measure is free to access
Correct answer: The measure's responsiveness to change in the target population
Responsiveness (sensitivity to change) is the most critical psychometric property when selecting an outcome measure for a clinical research study.
Question 6: A patient reports that pain is worse with cold weather and after inactivity but improves with movement. This pain pattern is MOST consistent with:
- Acute inflammatory arthritis flare
- Neuropathic pain from median nerve compression
- Osteoarthritis of the hand joints (Correct answer)
- Tendon rupture
Correct answer: Osteoarthritis of the hand joints
Pain worse with inactivity and cold that improves with movement is a classic pattern of osteoarthritis, reflecting mechanical joint changes.
Question 7: A CHT notes that a patient with trigger finger has failed corticosteroid injections twice. Which clinical reasoning step is MOST appropriate?
- Provide a static extension splint and re-evaluate in 6 weeks
- Initiate progressive flexor tendon gliding exercises
- Discuss surgical referral with the patient and physician (Correct answer)
- Apply iontophoresis as the next conservative option
Correct answer: Discuss surgical referral with the patient and physician
After two failed corticosteroid injections, clinical practice guidelines support referral for surgical release (A1 pulley release).
CHT Clinical Reasoning 4
A patient's intrinsic tightness test is positive.
This means PIP flexion is more restricted when the MP joint is: