CHT Therapeutic Interventions 3 — Questions and Answers
Question 1: When using retrograde massage to manage hand edema, strokes should be performed:
- From proximal to distal along the dorsum of the hand
- From distal to proximal beginning at the fingertips (Correct answer)
- In circular motions over the dorsal wrist only
- Using deep pressure moving from palm to dorsum
Correct answer: From distal to proximal beginning at the fingertips
Retrograde massage moves from distal to proximal to mechanically assist fluid movement toward the lymphatic system.
Question 2: A patient with complex regional pain syndrome (CRPS) type I of the hand is most likely to benefit FIRST from which therapeutic approach?
- Progressive resistive strengthening beginning at 2 lbs
- Stress loading program including scrubbing and carrying activities (Correct answer)
- Passive range-of-motion exercises performed by the therapist
- Ultrasound to the affected joints for pain relief
Correct answer: Stress loading program including scrubbing and carrying activities
Stress loading (scrubbing and carrying) provides compressive and traction forces that normalize sympathetic nervous system activity without directly moving the painful joints.
Question 3: Which splint design best protects a repaired ulnar collateral ligament of the thumb (gamekeeper's thumb) while permitting IP joint motion for tendon gliding?
- Short opponens splint immobilizing the thumb CMC and MP joints with the IP free (Correct answer)
- Thumb spica extending to the IP joint
- Wrist splint with thumb post holding the thumb in palmar abduction
- Dynamic thumb MP abduction splint
Correct answer: Short opponens splint immobilizing the thumb CMC and MP joints with the IP free
A short opponens splint immobilizes the CMC and MP joints to protect the UCL repair while leaving the IP joint free to maintain FPL glide.
Question 4: During sensory re-education for a patient after median nerve repair, moving touch re-education should begin when the patient can reliably detect:
- 30 cps vibration and moving touch (Correct answer)
- 256 cps vibration only
- Static two-point discrimination of 10 mm
- Pinprick sensation throughout the palm
Correct answer: 30 cps vibration and moving touch
Moving touch re-education begins when the patient can perceive 30 cps vibration and moving touch, indicating early receptor recovery.
Question 5: A patient presents with dorsal wrist ganglion causing pain with wrist extension. Conservative management should include:
- Wrist splint in slight extension to decompress the ganglion
- Wrist splint in neutral to limit extension and reduce ganglion pressure (Correct answer)
- Resistive wrist exercises to strengthen extensors
- Ultrasound directly over the ganglion at 1.5 W/cm²
Correct answer: Wrist splint in neutral to limit extension and reduce ganglion pressure
A neutral wrist splint limits the extension movement that compresses the dorsal ganglion and reduces symptoms.
Question 6: When fabricating a dynamic MCP extension splint for a patient with ulnar nerve palsy (intrinsic minus hand), the outrigger should direct force in which direction?
- MCP flexion and IP extension simultaneously (Correct answer)
- MCP extension and IP flexion simultaneously
- MCP extension only, leaving IP joints free
- IP extension only, leaving MCP joints free
Correct answer: MCP flexion and IP extension simultaneously
The lumbrical substitute splint flexes the MCPs while extending the IPs to replicate the lost intrinsic muscle function in ulnar nerve palsy.
Question 7: Which clinical finding indicates a patient is ready to progress from phase I to phase II of the Duran passive motion protocol after flexor tendon repair?
- Full active flexion at the repaired digit
- Absence of infection and wound healing with passive ROM achieved (Correct answer)
- Grip strength equal to 50% of the uninvolved side
- Static two-point discrimination less than 6 mm
Correct answer: Absence of infection and wound healing with passive ROM achieved
Phase II progression requires wound healing, no infection, and full passive ROM being maintained to allow introduction of more active techniques.
CHT Therapeutic Interventions 3
When using retrograde massage to manage hand edema, strokes should be performed: