CHT Certification Exam Prep 2026 Updated Practice
Questions, Comprehensive Hand Therapy Practice
Review, Detailed Explanations, Verified Answers,
Complete Success Workbook
• Domain 1: Assess Upper Limb and Relevant Patient Characteristics —
26% (52 questions)
• Domain 2: Determine Prognosis and Individualized Plan of Care —
20% (40 questions)
• Domain 3: Implement Plan of Care and Therapeutic Interventions —
32% (64 questions)
• Domain 4: Fundamental Knowledge and Basic Science — 22% (44
questions)
Domain 1: Assess Upper Limb and Relevant Patient Characteristics (26 items)
1. A 45-year-old female presents with pain at the radial aspect of the wrist
that worsens with thumb abduction and extension. The therapist performs a
test that involves ulnar deviation of the wrist while the thumb is flexed into
the palm. This test is known as:
A) Phalen's test
B) Finkelstein's test
C) Tinel's sign
D) Allen's test
Rationale: Finkelstein's test is the classic provocative maneuver for De Quervain's
tenosynovitis, which involves inflammation of the abductor pollicis longus and
extensor pollicis brevis tendons in the first dorsal compartment. The test is positive
when it reproduces pain over the radial styloid. Phalen's test assesses carpal tunnel
syndrome, Tinel's sign assesses nerve regeneration or irritation, and Allen's test
assesses radial and ulnar artery patency.
,2. 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. Compression of the median nerve within this confined space produces
carpal tunnel syndrome, characterized by numbness and tingling in the thumb,
index, middle, and radial half of the ring finger .
3. A therapist is evaluating a patient with a suspected scapholunate ligament
injury. Which special test is MOST appropriate?
A) Watson test
B) Watson test (scaphoid shift test)
C) TFCC load test
D) Ulnar grind test
Rationale: The Watson test (scaphoid shift test) assesses scapholunate ligament
instability by applying pressure to the scaphoid tubercle while moving the wrist
from radial to ulnar deviation. A positive test reproduces pain and a clunking
sensation as the scaphoid subluxes. The TFCC load test assesses triangular
fibrocartilage complex pathology, and the ulnar grind test assesses ulnar-sided
wrist pathology.
4. Which of the following is the MOST appropriate method to assess
sensibility in a patient with a peripheral nerve injury?
A) Goniometry
B) Semmes-Weinstein monofilament testing
C) Manual muscle testing
D) Dynamometry
Rationale: Semmes-Weinstein monofilament testing is the standard for assessing
light touch sensibility and detecting sensory deficits in peripheral nerve injuries.
,Goniometry measures ROM, manual muscle testing assesses strength, and
dynamometry measures grip and pinch strength.
5. A patient presents with a positive Tinel's sign at the elbow. This finding is
MOST consistent with:
A) Carpal tunnel syndrome
B) Cubital tunnel syndrome
C) Radial tunnel syndrome
D) Pronator teres syndrome
Rationale: A positive Tinel's sign at the cubital tunnel (medial elbow) is indicative
of cubital tunnel syndrome, which involves compression of the ulnar nerve. Carpal
tunnel syndrome produces a positive Tinel's at the wrist, radial tunnel syndrome at
the proximal forearm, and pronator teres syndrome at the proximal forearm.
6. Which of the following tests is used to assess for thoracic outlet syndrome?
A) Adson's test
B) Phalen's test
C) Finkelstein's test
D) McMurray's test
Rationale: Adson's test assesses for thoracic outlet syndrome by having the patient
take a deep breath and extend the neck while the therapist monitors the radial
pulse. A positive test reproduces symptoms and diminishes the pulse. Phalen's test
assesses carpal tunnel, Finkelstein's assesses De Quervain's, and McMurray's
assesses meniscal pathology (knee).
7. A therapist is assessing a patient with a suspected rotator cuff tear. Which
test is MOST specific for a supraspinatus tear?
A) Neer's test
B) Hawkins-Kennedy test
C) Drop arm test
D) Speed's test
, Rationale: The drop arm test is highly specific for a full-thickness supraspinatus
tear. The patient's arm is passively abducted to 90° and the therapist asks the
patient to slowly lower it; if the arm drops suddenly, the test is positive. Neer's and
Hawkins-Kennedy tests assess subacromial impingement, and Speed's test assesses
biceps tendinopathy.
8. Which of the following is the MOST appropriate assessment to measure
pinch strength?
A) Jamar dynamometer
B) Pinch gauge
C) Goniometer
D) Semmes-Weinstein monofilaments
Rationale: A pinch gauge is specifically designed to measure pinch strength (tip,
key, and three-point pinch). The Jamar dynamometer measures grip strength, the
goniometer measures ROM, and Semmes-Weinstein monofilaments assess
sensibility.
9. A patient with a distal radius fracture is being assessed for median nerve
compression. Which test is MOST appropriate?
A) Phalen's test
B) Finkelstein's test
C) Watson test
D) Cozen's test
Rationale: Phalen's test is used to assess for carpal tunnel syndrome (median nerve
compression) by having the patient hold the wrists in maximum flexion for 60
seconds. Finkelstein's assesses De Quervain's, Watson's assesses scapholunate
instability, and Cozen's assesses lateral epicondylitis.
10. Which of the following best describes the purpose of the nine-hole peg
test?
A) Assess grip strength
B) Assess fine motor dexterity
Questions, Comprehensive Hand Therapy Practice
Review, Detailed Explanations, Verified Answers,
Complete Success Workbook
• Domain 1: Assess Upper Limb and Relevant Patient Characteristics —
26% (52 questions)
• Domain 2: Determine Prognosis and Individualized Plan of Care —
20% (40 questions)
• Domain 3: Implement Plan of Care and Therapeutic Interventions —
32% (64 questions)
• Domain 4: Fundamental Knowledge and Basic Science — 22% (44
questions)
Domain 1: Assess Upper Limb and Relevant Patient Characteristics (26 items)
1. A 45-year-old female presents with pain at the radial aspect of the wrist
that worsens with thumb abduction and extension. The therapist performs a
test that involves ulnar deviation of the wrist while the thumb is flexed into
the palm. This test is known as:
A) Phalen's test
B) Finkelstein's test
C) Tinel's sign
D) Allen's test
Rationale: Finkelstein's test is the classic provocative maneuver for De Quervain's
tenosynovitis, which involves inflammation of the abductor pollicis longus and
extensor pollicis brevis tendons in the first dorsal compartment. The test is positive
when it reproduces pain over the radial styloid. Phalen's test assesses carpal tunnel
syndrome, Tinel's sign assesses nerve regeneration or irritation, and Allen's test
assesses radial and ulnar artery patency.
,2. 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. Compression of the median nerve within this confined space produces
carpal tunnel syndrome, characterized by numbness and tingling in the thumb,
index, middle, and radial half of the ring finger .
3. A therapist is evaluating a patient with a suspected scapholunate ligament
injury. Which special test is MOST appropriate?
A) Watson test
B) Watson test (scaphoid shift test)
C) TFCC load test
D) Ulnar grind test
Rationale: The Watson test (scaphoid shift test) assesses scapholunate ligament
instability by applying pressure to the scaphoid tubercle while moving the wrist
from radial to ulnar deviation. A positive test reproduces pain and a clunking
sensation as the scaphoid subluxes. The TFCC load test assesses triangular
fibrocartilage complex pathology, and the ulnar grind test assesses ulnar-sided
wrist pathology.
4. Which of the following is the MOST appropriate method to assess
sensibility in a patient with a peripheral nerve injury?
A) Goniometry
B) Semmes-Weinstein monofilament testing
C) Manual muscle testing
D) Dynamometry
Rationale: Semmes-Weinstein monofilament testing is the standard for assessing
light touch sensibility and detecting sensory deficits in peripheral nerve injuries.
,Goniometry measures ROM, manual muscle testing assesses strength, and
dynamometry measures grip and pinch strength.
5. A patient presents with a positive Tinel's sign at the elbow. This finding is
MOST consistent with:
A) Carpal tunnel syndrome
B) Cubital tunnel syndrome
C) Radial tunnel syndrome
D) Pronator teres syndrome
Rationale: A positive Tinel's sign at the cubital tunnel (medial elbow) is indicative
of cubital tunnel syndrome, which involves compression of the ulnar nerve. Carpal
tunnel syndrome produces a positive Tinel's at the wrist, radial tunnel syndrome at
the proximal forearm, and pronator teres syndrome at the proximal forearm.
6. Which of the following tests is used to assess for thoracic outlet syndrome?
A) Adson's test
B) Phalen's test
C) Finkelstein's test
D) McMurray's test
Rationale: Adson's test assesses for thoracic outlet syndrome by having the patient
take a deep breath and extend the neck while the therapist monitors the radial
pulse. A positive test reproduces symptoms and diminishes the pulse. Phalen's test
assesses carpal tunnel, Finkelstein's assesses De Quervain's, and McMurray's
assesses meniscal pathology (knee).
7. A therapist is assessing a patient with a suspected rotator cuff tear. Which
test is MOST specific for a supraspinatus tear?
A) Neer's test
B) Hawkins-Kennedy test
C) Drop arm test
D) Speed's test
, Rationale: The drop arm test is highly specific for a full-thickness supraspinatus
tear. The patient's arm is passively abducted to 90° and the therapist asks the
patient to slowly lower it; if the arm drops suddenly, the test is positive. Neer's and
Hawkins-Kennedy tests assess subacromial impingement, and Speed's test assesses
biceps tendinopathy.
8. Which of the following is the MOST appropriate assessment to measure
pinch strength?
A) Jamar dynamometer
B) Pinch gauge
C) Goniometer
D) Semmes-Weinstein monofilaments
Rationale: A pinch gauge is specifically designed to measure pinch strength (tip,
key, and three-point pinch). The Jamar dynamometer measures grip strength, the
goniometer measures ROM, and Semmes-Weinstein monofilaments assess
sensibility.
9. A patient with a distal radius fracture is being assessed for median nerve
compression. Which test is MOST appropriate?
A) Phalen's test
B) Finkelstein's test
C) Watson test
D) Cozen's test
Rationale: Phalen's test is used to assess for carpal tunnel syndrome (median nerve
compression) by having the patient hold the wrists in maximum flexion for 60
seconds. Finkelstein's assesses De Quervain's, Watson's assesses scapholunate
instability, and Cozen's assesses lateral epicondylitis.
10. Which of the following best describes the purpose of the nine-hole peg
test?
A) Assess grip strength
B) Assess fine motor dexterity
