CHT Therapeutic Interventions 5 — Questions and Answers
Question 1: A patient with de Quervain's tenosynovitis is fitted with a thumb spica splint. Which wrist and thumb position is MOST appropriate?
- Wrist neutral, thumb CMC and MP in palmar abduction and extension (Correct answer)
- Wrist in 20° flexion, thumb in full opposition
- Wrist in 30° extension, thumb MP in 30° flexion
- Wrist in 15° ulnar deviation, thumb in radial abduction
Correct answer: Wrist neutral, thumb CMC and MP in palmar abduction and extension
The thumb spica splint for de Quervain's positions the wrist in neutral and the thumb in palmar abduction/extension to rest the APL and EPB tendons.
Question 2: A CHT performs joint mobilization to the hamate-triquetrum joint for a patient with ulnar-sided wrist pain. The mobilization technique for restricted dorsal glide would include:
- Stabilizing the hamate and gliding the triquetrum dorsally (Correct answer)
- Stabilizing the triquetrum and gliding the hamate volarly
- Traction only without glide
- Posterior-anterior pressure on the pisiform
Correct answer: Stabilizing the hamate and gliding the triquetrum dorsally
To restore dorsal glide, the distal bone (triquetrum) is mobilized dorsally relative to the stabilized proximal bone (hamate).
Question 3: In the early phase of rehabilitation after extensor tendon repair in zone VI (dorsal hand), the therapist should avoid:
- Wrist extension exercises
- Composite wrist flexion with simultaneous MCP flexion (Correct answer)
- Isolated MCP extension with the wrist in extension
- Light retrograde massage to the dorsal hand
Correct answer: Composite wrist flexion with simultaneous MCP flexion
Simultaneous wrist and MCP flexion creates maximum extensor tendon tension, risking rupture in the early healing phase.
Question 4: When treating a patient with a replanted finger, which modality is CONTRAINDICATED in the early postoperative period?
- Gentle active ROM at 3–5 days per protocol
- Cold (cryotherapy) application over the replanted digit (Correct answer)
- Elevation above heart level
- Light edema massage proximal to the digit
Correct answer: Cold (cryotherapy) application over the replanted digit
Cold application is contraindicated after replantation because vasoconstriction threatens the already tenuous vascular supply to the replanted digit.
Question 5: A patient recovering from a radial nerve injury (posterior interosseous nerve) demonstrates wrist drop. The appropriate splint to provide function is:
- Wrist cock-up splint only, fingers unsupported
- Dynamic wrist and finger extension splint (outrigger with rubber band assist) (Correct answer)
- Intrinsic-plus resting splint in full wrist and finger flexion
- Ulnar gutter splint immobilizing the wrist in flexion
Correct answer: Dynamic wrist and finger extension splint (outrigger with rubber band assist)
A dynamic extension splint with outrigger and rubber band assist replaces lost wrist and finger extension from radial/PIN nerve injury, enabling functional grasp and release.
Question 6: Which exercise is MOST appropriate to specifically isolate flexor digitorum superficialis (FDS) gliding independently from FDP?
- Full composite fist closing all joints simultaneously
- Blocking the DIP in extension while actively flexing the PIP joint (Correct answer)
- Tenodesis grasp using wrist extension to close fingers passively
- Hook fist with MCP extended and IP joints flexed
Correct answer: Blocking the DIP in extension while actively flexing the PIP joint
Blocking the DIP in extension prevents FDP from contributing to PIP flexion, isolating FDS glide.
Question 7: A CHT is performing nerve gliding exercises for a patient with pronator syndrome. Which sequence correctly describes a median nerve glide progression?
- Wrist flexion → elbow extension → shoulder abduction → cervical lateral flexion away
- Wrist extension → elbow extension → shoulder depression → cervical lateral flexion away (Correct answer)
- Wrist neutral → elbow flexion → shoulder internal rotation → cervical rotation toward
- Wrist ulnar deviation → elbow extension → shoulder elevation → cervical extension
Correct answer: Wrist extension → elbow extension → shoulder depression → cervical lateral flexion away
The upper limb neurodynamic test 1 (ULNT1) for median nerve tensioning progresses through wrist extension, elbow extension, shoulder depression, and contralateral cervical lateral flexion.
CHT Therapeutic Interventions 5
A patient with de Quervain's tenosynovitis is fitted with a thumb spica splint.
Which wrist and thumb position is MOST appropriate?