COF Upper Extremity Orthotics 2 — Questions and Answers
Question 1: A patient with radial nerve palsy presents with wrist drop. Which orthosis is MOST appropriate to restore functional hand use?
- Resting hand splint
- Wrist-driven flexor hinge orthosis
- Dynamic wrist extension orthosis (Correct answer)
- Ulnar deviation splint
Correct answer: Dynamic wrist extension orthosis
A dynamic wrist extension orthosis (cock-up splint with outrigger) positions the wrist in extension, restoring tenodesis grip function lost due to radial nerve palsy.
Question 2: When fabricating a thumb spica orthosis for de Quervain's tenosynovitis, the thumb IP joint should be:
- Included and immobilized in flexion
- Included and immobilized in extension
- Left free to allow active motion (Correct answer)
- Immobilized at 45° of opposition
Correct answer: Left free to allow active motion
The IP joint is typically left free in a thumb spica for de Quervain's because the extensor pollicis longus does not pass through the first dorsal compartment.
Question 3: The 'safe position' for immobilizing an injured hand to prevent collateral ligament shortening is characterized by:
- MCP extension with IP flexion
- MCP flexion 70–90° with IP extension (Correct answer)
- Full fist position with wrist neutral
- Intrinsic minus position
Correct answer: MCP flexion 70–90° with IP extension
The intrinsic-plus (safe) position — MCP 70–90° flexion with IPs extended — keeps collateral ligaments at maximum length, preventing contracture.
Question 4: A patient recovering from carpal tunnel release complains of hypersensitivity at the scar. Which orthotic intervention is MOST indicated?
- Rigid wrist immobilization orthosis worn 24 hours
- Compression glove combined with desensitization program (Correct answer)
- Dynamic finger flexion orthosis
- Resting pan splint in intrinsic-plus position
Correct answer: Compression glove combined with desensitization program
A compression glove reduces edema and scar adherence while tactile desensitization addresses hypersensitivity following carpal tunnel release.
Question 5: Which forearm-based orthosis design is MOST appropriate for a patient with a proximal ulna fracture repaired with ORIF who requires controlled elbow motion?
- Sugar-tong splint
- Hinged elbow orthosis with range-of-motion stops (Correct answer)
- Resting hand splint
- Munster-style elbow orthosis
Correct answer: Hinged elbow orthosis with range-of-motion stops
A hinged elbow orthosis with adjustable ROM stops allows controlled, protected motion after ORIF while restricting extremes of flexion and extension.
Question 6: When fitting a prefabricated wrist orthosis, which anatomical landmark is used to verify proper proximal border placement to avoid restricting elbow motion?
- Olecranon process
- Two-thirds of the forearm length proximal to the wrist crease (Correct answer)
- Antecubital fossa
- Radial head
Correct answer: Two-thirds of the forearm length proximal to the wrist crease
The proximal border of a forearm-based wrist orthosis should end at no more than two-thirds of the forearm length to avoid impinging the elbow and ensure full motion.
Question 7: A patient with cubital tunnel syndrome presents with intrinsic muscle weakness and clawing of the ring and small fingers. Which nerve is affected?
- Median nerve at the wrist
- Radial nerve at the radial groove
- Ulnar nerve at the elbow (Correct answer)
- Anterior interosseous nerve
Correct answer: Ulnar nerve at the elbow
Cubital tunnel syndrome compresses the ulnar nerve at the elbow, causing intrinsic weakness and clawing of the ring and small (4th and 5th) digits.
COF Upper Extremity Orthotics 2
A patient with radial nerve palsy presents with wrist drop.
Which orthosis is MOST appropriate to restore functional hand use?