Certified Hand Therapist CHT Exam 2026: Latest
Comprehensive Study Guide with Practice Questions,
Hand Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Assess Upper Limb and Relevant Patient Characteristics
(Exam Weight: 26% | 26 Questions)
Domain 1 Tasks Covered: History review (medical, surgical, pharmacologic,
imaging, neurodiagnostics) • Patient/caregiver interviews • Upper limb screen and
systems review • Assessment of accessory motions, ADL/IADL function,
dexterity, edema, functional capacity, muscle function, pain, posture, ROM,
sensibility, special tests, strength, sympathetic status, tightness, vascular status, and
wounds • Differential diagnosis • Orthotic/prosthetic need assessment •
Complication identification
Question 1. A patient presents with pain over the radial styloid that is exacerbated
by ulnar deviation of the wrist with the thumb flexed into the palm. Which
structure is MOST likely involved?
A) Extensor pollicis longus tendon
B) Abductor pollicis longus and extensor pollicis brevis tendons
C) Flexor carpi radialis tendon
D) Triangular fibrocartilage complex
Rationale: De Quervain's tenosynovitis involves the first dorsal compartment,
which contains the abductor pollicis longus (APL) and extensor pollicis brevis
(EPB) tendons. The Finkelstein test (ulnar deviation with thumb flexed) stretches
these tendons and provokes pain. The extensor pollicis longus (A) is in the third
dorsal compartment. The flexor carpi radialis (C) is a volar wrist flexor. The TFCC
(D) stabilizes the distal radioulnar joint and is not assessed by the Finkelstein test.
Question 2. When evaluating a patient using Semmes-Weinstein monofilaments,
which filament size is considered the threshold for normal light touch sensation?
A) 2.83
B) 3.22
,C) 3.61
D) 4.31
Rationale: A monofilament size of 2.83 (representing 0.07 grams of force) is
classified as the upper limit of normal light touch. Filament sizes 3.22–3.61
indicate diminished light touch, 3.84–4.31 indicate diminished protective
sensation, and 4.56–6.65 indicate loss of protective sensation. These thresholds are
critical for determining sensory re-education candidacy and safety precautions.
Question 3. Which nerve is MOST commonly compressed in carpal tunnel
syndrome?
A) Ulnar nerve
B) Radial nerve
C) Median nerve
D) Musculocutaneous nerve
Rationale: The carpal tunnel houses the median nerve along with the flexor
tendons, making it vulnerable to compression between the flexor tendons and the
transverse carpal ligament. The ulnar nerve (A) passes through Guyon's canal. The
radial nerve (B) is not associated with the carpal tunnel. The musculocutaneous
nerve (D) innervates the anterior arm and is not involved in carpal tunnel
syndrome.
Question 4. A patient reports numbness in the small finger and ulnar half of the
ring finger. Which condition should the therapist suspect?
A) Carpal tunnel syndrome
B) Cubital tunnel syndrome
C) Pronator teres syndrome
D) Radial tunnel syndrome
Rationale: Cubital tunnel syndrome involves compression of the ulnar nerve at the
elbow, causing numbness and tingling in the small finger and ulnar half of the ring
finger. Carpal tunnel syndrome (A) affects the median nerve distribution (thumb,
index, middle, and radial half of ring finger). Pronator teres syndrome (C) is a
proximal median nerve compression. Radial tunnel syndrome (D) affects the radial
nerve distribution.
Question 5. Which test is used to assess for lateral epicondylitis?
,A) Cozen's test
B) Phalen's test
C) Tinel's sign at the wrist
D) Finkelstein test
Rationale: Cozen's test (resisted wrist extension with the elbow extended and
forearm pronated) is used to assess lateral epicondylitis (tennis elbow). Phalen's
test (B) assesses carpal tunnel syndrome. Tinel's sign at the wrist (C) assesses
median nerve regeneration or compression. Finkelstein test (D) assesses De
Quervain's tenosynovitis.
Question 6. A patient presents with a swollen, painful hand following a crush
injury. The therapist notes excessive sweating, cool skin, and limited ROM. Which
condition should the therapist suspect?
A) Infection
B) Complex regional pain syndrome (CRPS)
C) Dupuytren's contracture
D) Carpal tunnel syndrome
Rationale: CRPS (also known as reflex sympathetic dystrophy) presents with pain,
edema, vasomotor changes (temperature and color changes), sudomotor changes
(excessive sweating), and motor dysfunction. Infection (A) would present with
fever, redness, and purulent drainage. Dupuytren's contracture (C) presents with
palmar nodules and cords. Carpal tunnel syndrome (D) presents with median nerve
symptoms.
Question 7. Which structure provides primary stability to the distal radioulnar
joint (DRUJ)?
A) Volar plate
B) Annular ligament
C) Triangular fibrocartilage complex (TFCC)
D) Interosseous membrane
Rationale: The TFCC stabilizes the DRUJ during forearm rotation and absorbs
axial load across the ulna. The volar plate (A) stabilizes the PIP joints. The annular
ligament (B) stabilizes the proximal radioulnar joint. The interosseous membrane
(D) provides secondary stability but is not the primary stabilizer of the DRUJ.
, Question 8. What is the standard positioning for measuring grip strength with a
Jamar hydraulic dynamometer?
A) Forearm pronated, wrist in neutral
B) Forearm neutral, wrist in 0° to 30° of extension
C) Forearm supinated, wrist in 15° of flexion
D) Forearm neutral, wrist in 45° of extension
Rationale: The ASHT standardized testing protocol dictates that the patient sits
with the shoulder adducted, elbow flexed to 90°, forearm in neutral, and the wrist
positioned between 0° and 30° of extension with slight ulnar deviation. This
position optimizes grip strength and ensures reliable measurements.
Question 9. A patient presents with a positive Froment's sign. This finding is
MOST consistent with:
A) Median nerve compression
B) Ulnar nerve palsy
C) Radial nerve injury
D) Posterior interosseous nerve syndrome
Rationale: Froment's sign tests for ulnar nerve palsy. When the patient is asked to
hold a piece of paper between the thumb and index finger, the thumb IP joint
flexes due to weakness of the adductor pollicis and first dorsal interosseous
muscles (ulnar nerve innervated). Median nerve compression (A) would present
with thenar atrophy and a positive Phalen's test.
Question 10. Which imaging modality is MOST appropriate for evaluating
suspected scaphoid fracture when initial radiographs are negative?
A) CT scan
B) MRI
C) Ultrasound
D) Bone scan
Rationale: MRI is the most sensitive imaging modality for detecting occult
scaphoid fractures. It can identify bone marrow edema and fracture lines that may
not be visible on initial radiographs. CT scan (A) is useful for assessing fracture
displacement and healing. Ultrasound (C) is not appropriate for bone assessment.
Bone scan (D) is sensitive but lacks specificity.
Comprehensive Study Guide with Practice Questions,
Hand Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Assess Upper Limb and Relevant Patient Characteristics
(Exam Weight: 26% | 26 Questions)
Domain 1 Tasks Covered: History review (medical, surgical, pharmacologic,
imaging, neurodiagnostics) • Patient/caregiver interviews • Upper limb screen and
systems review • Assessment of accessory motions, ADL/IADL function,
dexterity, edema, functional capacity, muscle function, pain, posture, ROM,
sensibility, special tests, strength, sympathetic status, tightness, vascular status, and
wounds • Differential diagnosis • Orthotic/prosthetic need assessment •
Complication identification
Question 1. A patient presents with pain over the radial styloid that is exacerbated
by ulnar deviation of the wrist with the thumb flexed into the palm. Which
structure is MOST likely involved?
A) Extensor pollicis longus tendon
B) Abductor pollicis longus and extensor pollicis brevis tendons
C) Flexor carpi radialis tendon
D) Triangular fibrocartilage complex
Rationale: De Quervain's tenosynovitis involves the first dorsal compartment,
which contains the abductor pollicis longus (APL) and extensor pollicis brevis
(EPB) tendons. The Finkelstein test (ulnar deviation with thumb flexed) stretches
these tendons and provokes pain. The extensor pollicis longus (A) is in the third
dorsal compartment. The flexor carpi radialis (C) is a volar wrist flexor. The TFCC
(D) stabilizes the distal radioulnar joint and is not assessed by the Finkelstein test.
Question 2. When evaluating a patient using Semmes-Weinstein monofilaments,
which filament size is considered the threshold for normal light touch sensation?
A) 2.83
B) 3.22
,C) 3.61
D) 4.31
Rationale: A monofilament size of 2.83 (representing 0.07 grams of force) is
classified as the upper limit of normal light touch. Filament sizes 3.22–3.61
indicate diminished light touch, 3.84–4.31 indicate diminished protective
sensation, and 4.56–6.65 indicate loss of protective sensation. These thresholds are
critical for determining sensory re-education candidacy and safety precautions.
Question 3. Which nerve is MOST commonly compressed in carpal tunnel
syndrome?
A) Ulnar nerve
B) Radial nerve
C) Median nerve
D) Musculocutaneous nerve
Rationale: The carpal tunnel houses the median nerve along with the flexor
tendons, making it vulnerable to compression between the flexor tendons and the
transverse carpal ligament. The ulnar nerve (A) passes through Guyon's canal. The
radial nerve (B) is not associated with the carpal tunnel. The musculocutaneous
nerve (D) innervates the anterior arm and is not involved in carpal tunnel
syndrome.
Question 4. A patient reports numbness in the small finger and ulnar half of the
ring finger. Which condition should the therapist suspect?
A) Carpal tunnel syndrome
B) Cubital tunnel syndrome
C) Pronator teres syndrome
D) Radial tunnel syndrome
Rationale: Cubital tunnel syndrome involves compression of the ulnar nerve at the
elbow, causing numbness and tingling in the small finger and ulnar half of the ring
finger. Carpal tunnel syndrome (A) affects the median nerve distribution (thumb,
index, middle, and radial half of ring finger). Pronator teres syndrome (C) is a
proximal median nerve compression. Radial tunnel syndrome (D) affects the radial
nerve distribution.
Question 5. Which test is used to assess for lateral epicondylitis?
,A) Cozen's test
B) Phalen's test
C) Tinel's sign at the wrist
D) Finkelstein test
Rationale: Cozen's test (resisted wrist extension with the elbow extended and
forearm pronated) is used to assess lateral epicondylitis (tennis elbow). Phalen's
test (B) assesses carpal tunnel syndrome. Tinel's sign at the wrist (C) assesses
median nerve regeneration or compression. Finkelstein test (D) assesses De
Quervain's tenosynovitis.
Question 6. A patient presents with a swollen, painful hand following a crush
injury. The therapist notes excessive sweating, cool skin, and limited ROM. Which
condition should the therapist suspect?
A) Infection
B) Complex regional pain syndrome (CRPS)
C) Dupuytren's contracture
D) Carpal tunnel syndrome
Rationale: CRPS (also known as reflex sympathetic dystrophy) presents with pain,
edema, vasomotor changes (temperature and color changes), sudomotor changes
(excessive sweating), and motor dysfunction. Infection (A) would present with
fever, redness, and purulent drainage. Dupuytren's contracture (C) presents with
palmar nodules and cords. Carpal tunnel syndrome (D) presents with median nerve
symptoms.
Question 7. Which structure provides primary stability to the distal radioulnar
joint (DRUJ)?
A) Volar plate
B) Annular ligament
C) Triangular fibrocartilage complex (TFCC)
D) Interosseous membrane
Rationale: The TFCC stabilizes the DRUJ during forearm rotation and absorbs
axial load across the ulna. The volar plate (A) stabilizes the PIP joints. The annular
ligament (B) stabilizes the proximal radioulnar joint. The interosseous membrane
(D) provides secondary stability but is not the primary stabilizer of the DRUJ.
, Question 8. What is the standard positioning for measuring grip strength with a
Jamar hydraulic dynamometer?
A) Forearm pronated, wrist in neutral
B) Forearm neutral, wrist in 0° to 30° of extension
C) Forearm supinated, wrist in 15° of flexion
D) Forearm neutral, wrist in 45° of extension
Rationale: The ASHT standardized testing protocol dictates that the patient sits
with the shoulder adducted, elbow flexed to 90°, forearm in neutral, and the wrist
positioned between 0° and 30° of extension with slight ulnar deviation. This
position optimizes grip strength and ensures reliable measurements.
Question 9. A patient presents with a positive Froment's sign. This finding is
MOST consistent with:
A) Median nerve compression
B) Ulnar nerve palsy
C) Radial nerve injury
D) Posterior interosseous nerve syndrome
Rationale: Froment's sign tests for ulnar nerve palsy. When the patient is asked to
hold a piece of paper between the thumb and index finger, the thumb IP joint
flexes due to weakness of the adductor pollicis and first dorsal interosseous
muscles (ulnar nerve innervated). Median nerve compression (A) would present
with thenar atrophy and a positive Phalen's test.
Question 10. Which imaging modality is MOST appropriate for evaluating
suspected scaphoid fracture when initial radiographs are negative?
A) CT scan
B) MRI
C) Ultrasound
D) Bone scan
Rationale: MRI is the most sensitive imaging modality for detecting occult
scaphoid fractures. It can identify bone marrow edema and fracture lines that may
not be visible on initial radiographs. CT scan (A) is useful for assessing fracture
displacement and healing. Ultrasound (C) is not appropriate for bone assessment.
Bone scan (D) is sensitive but lacks specificity.
