CERTIFIED HAND THERAPIST EXAM
reciprocal wrist extension/finger flexion grip pattern - Answer- scar adhesions
proximal to extensor retinaculum w/ extrinsic extensor tightness and active fingers
flexion cause wrist ext and further wrist ext allows full digit flexion
Innervation Density - Answer- 2 point discrimination tests this
1.65 - 2.83 - Answer- Semmes Weinstein - normal
3.22 - 3.61 - Answer- Semmes Weinstein - diminished light touch
3.84 - 4.31 - Answer- Semmes Weinstein - diminished protective sensation
4.56 - Answer- Semmes Weinstein - loss of protective sensation
6.65 - Answer- Semmes Weinstein - los of depp pressure
Figure 8 edema method - Answer- ulnar styloid, cross volar to radial styloid, diagonal
over dorsal hand to 5th MP joint, radial over volar MP joints, return to ulnar styloid
Kapandji Scale - Answer- Thumb Opposition: 0 IF MP -- 1 IF PIP -- 2 IF DIP -- 3 IF
P3 -- 4 MF P3 -- 5 RF P3 -- 6 SF P3 -- 7 SF DIP -- 8 SF PIP -- 9 SF MP -- 10 DPC
Neutrophils - Answer- predominant cell first 2 days (to phagocytize debris/bacteria)
Macrophages - Answer- 2 days after injury (to phagocytize & induce angiogenesis &
create granulation tissue)
Wound maturation (sutured wound) - Answer- week 3: 15-25%, 3 months: 50%,
reorganized collagen maximum strength 70-80%
Angiogenesis & neovascularization - Answer- new capillaries are forming causing
local erythema (this stage provides the fibroblasts and endothelial cells oxygen &
nutrients)
Hemostasis - Answer- Hemostasis lasts 24 hours
Pseudomonas - Answer- present in a yellow wound and give color and odor
Autolytic debridement dressing - Answer- Hydrogel dressings & hydrocolloid
dressings
ECU resting position - Answer- in supination ECU takes a 30 degree turn and is less
stable (ECU is more stable/better resting position in pronation)
Unopposed adductor pollicis - Answer- deforming muscle force in a thumb RCL
injury
,Unopposed FPB and APB - Answer- deforming muscle force in a thumb UCL injury
IF PIP joint collateral ligament injury - Answer- RCL of IF PIP joint more often injured
than UCL of IF PIP Joint
PIP joints more susceptible to injury than DIP/MP joint - Answer- PIP joints are more
often injured in extension rather than flexion
Middle finger sagittal band - Answer- more injured than other fingers
Maximum differential tendon gliding - Answer- hook fist for FDS/FDP; straight fist for
FDS; composite flexion for FDP
Passive protected extension - Answer- allows for most distal tendon excursion (3-
8mm)
Most ideal time to start early active mobilization protocol - Answer- 3-5 days post-op
to let inflammation decrease, but adhesions can start limiting at 1 week post-op
Zone 3 flexor tendon repair = distal end of carpal tunnel to the A1 pulley - Answer-
scarring to intrinsics can occur & tightness, so MPs in splint at 30-40 degrees flexion
Swan-neck deformity - Answer- can occur with absent FDS
Normal finger active flexion - Answer- PIP joint flexes first
Extensor tendons proximal to juncturae tendinum - Answer- ruptures of these can be
missed due to extension through adjacent tendons
Evans' Short Arc Motion extensor tendons - Answer- Wrist placed in 30 degrees
flexion, then templates for 30 degrees flexion PIP and 25 degrees flexion DIP, then
advance as no extensor lag present
Extensor tendon repair proximal to JT - Answer- all fingers placed in orthosis in
extension
Extensor tendon repair distal to JT - Answer- affected digit in full extension, adjacent
digits in 30 degrees MP flexion
Yoke splint - Answer- for RF {RF+MF}; for MF {MF}; for SF {SF+IF}; for IF {IF+SF}
Boutonniere deformity - Answer- lateral bands sublux volarly due to attenuation of
Triangular Ligament (and tightening of Transverse Retinacular Ligaments) - ORL
gets tight with a Boutonniere
Address PIP extension lags with reverse blocking - Answer- MP in hyper flexion and
work on PIP extension
,Central slip initiates extension at PIP joint - Answer- Elson's test assesses central
slip integrity at edge of table
Pseudo-boutonniere - Answer- dorsal dislocation/hyperextension/volar plate
injury/contracture - no DIP hyperextension or ORL tightness
CID - Answer- carpal instability dissociative - same row
CIND - Answer- carpal instability non-dissociative - between rows
CIC (carpal instability combined) - Answer- combination of CID and CIND
adaptive carpus - Answer- instability d/t extrinsic cause like a malunited distal radius
fx
DISI - Answer- SL injury - scaphoid flexes and lunate/triquetrum extend
VISI - Answer- LT injury - scaphoid/lunate flex and triquetrum extends
Palmar midcarpal instability (MCI) - Answer- CIND - presents volar sag at ulnar side
of wrist w/ clunk when moving into ulnar deviation and decreased grip strength
ECU and FCU and hypothenars - Answer- start strengthening these in supination for
MCI
SL friendly muscles - Answer- FCU, APL, ECRL (dart thrower's motion)
proximal row carpectomy - Answer- procedure for SLAC wrist, Kienbock's, Prieser's
(not for capitolunate arthritis)
Proximal Row Carpectomy - Answer- painfree motion is goal for this procedure
Dorsal wrist is less supported by ligaments - Answer- volar wrist has more
ligamentous stability
Proximal carpal row flexes (and UD) with radial deviation - Answer- Proximal carpal
row extends (and RD) with ulnar deviation
with progressive perilunate instability - Answer- lunate dislocates into carpal tunnel
Space of Poirier - Answer- ligament free area at Capitolunate space
TFCC - Answer- primary soft tissue stabilizer for DRUJ and ulnocarpal joints
Ulnocarpal stress test - Answer- axial load on the wrist in UD then passively perform
pronation/supination
TFCC type I injuries - Answer- traumatic injuries - Type A: central --- Type B: ulnar --
Type C: distal -- Type D: radial
, TFCC type 2 injuries - Answer- degenerative injuries - chondromalacia in ulna and
lunate; LT tear; arthritis present
Suave Kapandji - Answer- maintains contact between distal radius and ulna with a
pseudo-arthrosis (appropriate for high demand patient)
GRIT test - Answer- utilized for ulnocarpal abutment; supination/pronation grip ratio
greater than 1 indicates positive abutment
Kienbock's disease - Answer- AVN of the lunate through radius load (negative ulnar
variance)
Piano Key Sign - Answer- DRUJ instability
TFCC - Answer- central tears are debrided; peripheral tears are repaired due to
blood flow
OA most common in the DIP Joint - Answer- then 2nd most common in basal CMC
joint
STT arthritis - Answer- associated with CMC OA
anterior oblique ligament ("beak ligament") - Answer- most often degenerated with
CMC OA
compressive force at CMC Joint - Answer- 12x force than thumb/index pinch (1#
pinch = 12# compressive force at CMC)
arthrodesis (fusion) for DIP arthritis - Answer- arthroplasty for PIP arthritis
pyrolytic carbon implant lasts longer/higher demand activities - Answer- compared to
a silicone joint implant
PIP volar plate laxity - Answer- can lead to swan-neck deformity
stretching of ulnar intrinsics - Answer- can reduce ulnar drift
avoid passive elbow flexion s/p olecranon fx - Answer- to avoid strain on triceps
tendon (and to avoid displacement of fx)
external fixation - Answer- utilizes ligamentotaxis
tuft fx - Answer- nailbed or pulp comminuted fx
intraarticular PIP fx can be treated with this - Answer- hemihamate arthroplasty
moist heat - Answer- conduction
fluidotherapy/whirlpool - Answer- convection
reciprocal wrist extension/finger flexion grip pattern - Answer- scar adhesions
proximal to extensor retinaculum w/ extrinsic extensor tightness and active fingers
flexion cause wrist ext and further wrist ext allows full digit flexion
Innervation Density - Answer- 2 point discrimination tests this
1.65 - 2.83 - Answer- Semmes Weinstein - normal
3.22 - 3.61 - Answer- Semmes Weinstein - diminished light touch
3.84 - 4.31 - Answer- Semmes Weinstein - diminished protective sensation
4.56 - Answer- Semmes Weinstein - loss of protective sensation
6.65 - Answer- Semmes Weinstein - los of depp pressure
Figure 8 edema method - Answer- ulnar styloid, cross volar to radial styloid, diagonal
over dorsal hand to 5th MP joint, radial over volar MP joints, return to ulnar styloid
Kapandji Scale - Answer- Thumb Opposition: 0 IF MP -- 1 IF PIP -- 2 IF DIP -- 3 IF
P3 -- 4 MF P3 -- 5 RF P3 -- 6 SF P3 -- 7 SF DIP -- 8 SF PIP -- 9 SF MP -- 10 DPC
Neutrophils - Answer- predominant cell first 2 days (to phagocytize debris/bacteria)
Macrophages - Answer- 2 days after injury (to phagocytize & induce angiogenesis &
create granulation tissue)
Wound maturation (sutured wound) - Answer- week 3: 15-25%, 3 months: 50%,
reorganized collagen maximum strength 70-80%
Angiogenesis & neovascularization - Answer- new capillaries are forming causing
local erythema (this stage provides the fibroblasts and endothelial cells oxygen &
nutrients)
Hemostasis - Answer- Hemostasis lasts 24 hours
Pseudomonas - Answer- present in a yellow wound and give color and odor
Autolytic debridement dressing - Answer- Hydrogel dressings & hydrocolloid
dressings
ECU resting position - Answer- in supination ECU takes a 30 degree turn and is less
stable (ECU is more stable/better resting position in pronation)
Unopposed adductor pollicis - Answer- deforming muscle force in a thumb RCL
injury
,Unopposed FPB and APB - Answer- deforming muscle force in a thumb UCL injury
IF PIP joint collateral ligament injury - Answer- RCL of IF PIP joint more often injured
than UCL of IF PIP Joint
PIP joints more susceptible to injury than DIP/MP joint - Answer- PIP joints are more
often injured in extension rather than flexion
Middle finger sagittal band - Answer- more injured than other fingers
Maximum differential tendon gliding - Answer- hook fist for FDS/FDP; straight fist for
FDS; composite flexion for FDP
Passive protected extension - Answer- allows for most distal tendon excursion (3-
8mm)
Most ideal time to start early active mobilization protocol - Answer- 3-5 days post-op
to let inflammation decrease, but adhesions can start limiting at 1 week post-op
Zone 3 flexor tendon repair = distal end of carpal tunnel to the A1 pulley - Answer-
scarring to intrinsics can occur & tightness, so MPs in splint at 30-40 degrees flexion
Swan-neck deformity - Answer- can occur with absent FDS
Normal finger active flexion - Answer- PIP joint flexes first
Extensor tendons proximal to juncturae tendinum - Answer- ruptures of these can be
missed due to extension through adjacent tendons
Evans' Short Arc Motion extensor tendons - Answer- Wrist placed in 30 degrees
flexion, then templates for 30 degrees flexion PIP and 25 degrees flexion DIP, then
advance as no extensor lag present
Extensor tendon repair proximal to JT - Answer- all fingers placed in orthosis in
extension
Extensor tendon repair distal to JT - Answer- affected digit in full extension, adjacent
digits in 30 degrees MP flexion
Yoke splint - Answer- for RF {RF+MF}; for MF {MF}; for SF {SF+IF}; for IF {IF+SF}
Boutonniere deformity - Answer- lateral bands sublux volarly due to attenuation of
Triangular Ligament (and tightening of Transverse Retinacular Ligaments) - ORL
gets tight with a Boutonniere
Address PIP extension lags with reverse blocking - Answer- MP in hyper flexion and
work on PIP extension
,Central slip initiates extension at PIP joint - Answer- Elson's test assesses central
slip integrity at edge of table
Pseudo-boutonniere - Answer- dorsal dislocation/hyperextension/volar plate
injury/contracture - no DIP hyperextension or ORL tightness
CID - Answer- carpal instability dissociative - same row
CIND - Answer- carpal instability non-dissociative - between rows
CIC (carpal instability combined) - Answer- combination of CID and CIND
adaptive carpus - Answer- instability d/t extrinsic cause like a malunited distal radius
fx
DISI - Answer- SL injury - scaphoid flexes and lunate/triquetrum extend
VISI - Answer- LT injury - scaphoid/lunate flex and triquetrum extends
Palmar midcarpal instability (MCI) - Answer- CIND - presents volar sag at ulnar side
of wrist w/ clunk when moving into ulnar deviation and decreased grip strength
ECU and FCU and hypothenars - Answer- start strengthening these in supination for
MCI
SL friendly muscles - Answer- FCU, APL, ECRL (dart thrower's motion)
proximal row carpectomy - Answer- procedure for SLAC wrist, Kienbock's, Prieser's
(not for capitolunate arthritis)
Proximal Row Carpectomy - Answer- painfree motion is goal for this procedure
Dorsal wrist is less supported by ligaments - Answer- volar wrist has more
ligamentous stability
Proximal carpal row flexes (and UD) with radial deviation - Answer- Proximal carpal
row extends (and RD) with ulnar deviation
with progressive perilunate instability - Answer- lunate dislocates into carpal tunnel
Space of Poirier - Answer- ligament free area at Capitolunate space
TFCC - Answer- primary soft tissue stabilizer for DRUJ and ulnocarpal joints
Ulnocarpal stress test - Answer- axial load on the wrist in UD then passively perform
pronation/supination
TFCC type I injuries - Answer- traumatic injuries - Type A: central --- Type B: ulnar --
Type C: distal -- Type D: radial
, TFCC type 2 injuries - Answer- degenerative injuries - chondromalacia in ulna and
lunate; LT tear; arthritis present
Suave Kapandji - Answer- maintains contact between distal radius and ulna with a
pseudo-arthrosis (appropriate for high demand patient)
GRIT test - Answer- utilized for ulnocarpal abutment; supination/pronation grip ratio
greater than 1 indicates positive abutment
Kienbock's disease - Answer- AVN of the lunate through radius load (negative ulnar
variance)
Piano Key Sign - Answer- DRUJ instability
TFCC - Answer- central tears are debrided; peripheral tears are repaired due to
blood flow
OA most common in the DIP Joint - Answer- then 2nd most common in basal CMC
joint
STT arthritis - Answer- associated with CMC OA
anterior oblique ligament ("beak ligament") - Answer- most often degenerated with
CMC OA
compressive force at CMC Joint - Answer- 12x force than thumb/index pinch (1#
pinch = 12# compressive force at CMC)
arthrodesis (fusion) for DIP arthritis - Answer- arthroplasty for PIP arthritis
pyrolytic carbon implant lasts longer/higher demand activities - Answer- compared to
a silicone joint implant
PIP volar plate laxity - Answer- can lead to swan-neck deformity
stretching of ulnar intrinsics - Answer- can reduce ulnar drift
avoid passive elbow flexion s/p olecranon fx - Answer- to avoid strain on triceps
tendon (and to avoid displacement of fx)
external fixation - Answer- utilizes ligamentotaxis
tuft fx - Answer- nailbed or pulp comminuted fx
intraarticular PIP fx can be treated with this - Answer- hemihamate arthroplasty
moist heat - Answer- conduction
fluidotherapy/whirlpool - Answer- convection
