Certified Hand Therapist Exam
reciprocal wrist extension/finger flexion grip pattern - correct answers s car 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 - correct answers 2 point discrimination tests this
1.65 - 2.83 - correct answers s emmes Weinstein - normal
3.22 - 3.61 - correct answers s emmes Weinstein - diminished light touch
3.84 - 4.31 - correct answers s emmes Weinstein - diminished protective sensation
4.56 - correct answers s emmes Weinstein - loss of protective sensation
6.65 - correct answers s emmes Weinstein - los of depp pressure
Figure 8 edema method - correct answers 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 - correct answers 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 - correct answers predominant cell first 2 days (to phagocytize debris/bacteria)
Macrophages - correct answers 2 days after injury (to phagocytize & induce angiogenesis &
create granulation tissue)
Wound maturation (sutured wound) - correct answers week 3: 15-25%, 3 months: 50%,
reorganized collagen maximum strength 70-80%
Angiogenesis & neovascularization - correct answers new capillaries are forming causing local
erythema (this stage provides the fibroblasts and endothelial cells oxygen & nutrients)
Hemostasis - correct answers Hemostasis lasts 24 hours
Pseudomonas - correct answers present in a yellow wound and give color and odor
Autolytic debridement dressing - correct answers Hydrogel dressings & hydrocolloid dressings
ECU resting position - correct answers in supination ECU takes a 30 degree turn and is less
stable (ECU is more stable/better resting position in pronation)
Unopposed adductor pollicis - correct answers deforming muscle force in a thumb RCL injury
Unopposed FPB and APB - correct answers deforming muscle force in a thumb UCL injury
,IF PIP joint collateral ligament injury - correct answers RCL of IF PIP joint more often injured
than UCL of IF PIP Joint
PIP joints more susceptible to injury than DIP/MP joint - correct answers PIP joints are more
often injured in extension rather than flexion
Middle finger sagittal band - correct answers more injured than other fingers
Maximum differential tendon gliding - correct answers hook fist for FDS/FDP; straight fist for
FDS; composite flexion for FDP
Passive protected extension - correct answers allows for most distal tendon excursion (3-8mm)
Most ideal time to start early active mobilization protocol - correct answers 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 - correct answers s
carring to intrinsics can occur & tightness, so MPs in splint at 30-40 degrees flexion
Swan-neck deformity - correct answers can occur with absent FDS
Normal finger active flexion - correct answers PIP joint flexes first
Extensor tendons proximal to juncturae tendinum - correct answers ruptures of these can be
missed due to extension through adjacent tendons
Evans' Short Arc Motion extensor tendons - correct answers 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 - correct answers all fingers placed in orthosis in
extension
Extensor tendon repair distal to JT - correct answers affected digit in full extension, adjacent
digits in 30 degrees MP flexion
Yoke splint - correct answers for RF {RF+MF}; for MF {MF}; for SF {SF+IF}; for IF {IF+SF}
Boutonniere deformity - correct answers 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 - correct answers MP in hyper flexion and
work on PIP extension
Central slip initiates extension at PIP joint - correct answers Elson's test assesses central slip
integrity at edge of table
,Pseudo-boutonniere - correct answers dorsal dislocation/hyperextension/volar plate
injury/contracture - no DIP hyperextension or ORL tightness
CID - correct answers carpal instability dissociative - same row
CIND - correct answers carpal instability non-dissociative - between rows
CIC (carpal instability combined) - correct answers combination of CID and CIND
adaptive carpus - correct answers instability d/t extrinsic cause like a malunited distal radius fx
DISI - correct answers s L injury - scaphoid flexes and lunate/triquetrum extend
VISI - correct answers LT injury - scaphoid/lunate flex and triquetrum extends
Palmar midcarpal instability (MCI) - correct answers 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 - correct answers s tart strengthening these in supination for
MCI
SL friendly muscles - correct answers FCU, APL, ECRL (dart thrower's motion)
proximal row carpectomy - correct answers procedure for SLAC wrist, Kienbock's, Prieser's (not
for capitolunate arthritis)
Proximal Row Carpectomy - correct answers painfree motion is goal for this procedure
Dorsal wrist is less supported by ligaments - correct answers volar wrist has more ligamentous
stability
Proximal carpal row flexes (and UD) with radial deviation - correct answers Proximal carpal row
extends (and RD) with ulnar deviation
with progressive perilunate instability - correct answers lunate dislocates into carpal tunnel
Space of Poirier - correct answers ligament free area at Capitolunate space
TFCC - correct answers primary soft tissue stabilizer for DRUJ and ulnocarpal joints
Ulnocarpal stress test - correct answers axial load on the wrist in UD then passively perform
pronation/supination
TFCC type I injuries - correct answers traumatic injuries - Type A: central --- Type B: ulnar --
Type C: distal -- Type D: radial
TFCC type 2 injuries - correct answers degenerative injuries - chondromalacia in ulna and
lunate; LT tear; arthritis present
, Suave Kapandji - correct answers maintains contact between distal radius and ulna with a
pseudo-arthrosis (appropriate for high demand patient)
GRIT test - correct answers utilized for ulnocarpal abutment; supination/pronation grip ratio
greater than 1 indicates positive abutment
Kienbock's disease - correct answers AVN of the lunate through radius load (negative ulnar
variance)
Piano Key Sign - correct answers DRUJ instability
TFCC - correct answers central tears are debrided; peripheral tears are repaired due to blood
flow
OA most common in the DIP Joint - correct answers then 2nd most common in basal CMC joint
STT arthritis - correct answers associated with CMC OA
anterior oblique ligament ("beak ligament") - correct answers most often degenerated with
CMC OA
compressive force at CMC Joint - correct answers 12x force than thumb/index pinch (1# pinch =
12# compressive force at CMC)
arthrodesis (fusion) for DIP arthritis - correct answers arthroplasty for PIP arthritis
pyrolytic carbon implant lasts longer/higher demand activities - correct answers compared to a
silicone joint implant
PIP volar plate laxity - correct answers can lead to swan-neck deformity
stretching of ulnar intrinsics - correct answers can reduce ulnar drift
avoid passive elbow flexion s/p olecranon fx - correct answers to avoid strain on triceps tendon
(and to avoid displacement of fx)
external fixation - correct answers utilizes ligamentotaxis
tuft fx - correct answers nailbed or pulp comminuted fx
intraarticular PIP fx can be treated with this - correct answers hemihamate arthroplasty
moist heat - correct answers conduction
fluidotherapy/whirlpool - correct answers convection
ultrasound - correct answers conversion
target temperature of tissue for superficial heat - correct answers 104-113 F
reciprocal wrist extension/finger flexion grip pattern - correct answers s car 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 - correct answers 2 point discrimination tests this
1.65 - 2.83 - correct answers s emmes Weinstein - normal
3.22 - 3.61 - correct answers s emmes Weinstein - diminished light touch
3.84 - 4.31 - correct answers s emmes Weinstein - diminished protective sensation
4.56 - correct answers s emmes Weinstein - loss of protective sensation
6.65 - correct answers s emmes Weinstein - los of depp pressure
Figure 8 edema method - correct answers 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 - correct answers 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 - correct answers predominant cell first 2 days (to phagocytize debris/bacteria)
Macrophages - correct answers 2 days after injury (to phagocytize & induce angiogenesis &
create granulation tissue)
Wound maturation (sutured wound) - correct answers week 3: 15-25%, 3 months: 50%,
reorganized collagen maximum strength 70-80%
Angiogenesis & neovascularization - correct answers new capillaries are forming causing local
erythema (this stage provides the fibroblasts and endothelial cells oxygen & nutrients)
Hemostasis - correct answers Hemostasis lasts 24 hours
Pseudomonas - correct answers present in a yellow wound and give color and odor
Autolytic debridement dressing - correct answers Hydrogel dressings & hydrocolloid dressings
ECU resting position - correct answers in supination ECU takes a 30 degree turn and is less
stable (ECU is more stable/better resting position in pronation)
Unopposed adductor pollicis - correct answers deforming muscle force in a thumb RCL injury
Unopposed FPB and APB - correct answers deforming muscle force in a thumb UCL injury
,IF PIP joint collateral ligament injury - correct answers RCL of IF PIP joint more often injured
than UCL of IF PIP Joint
PIP joints more susceptible to injury than DIP/MP joint - correct answers PIP joints are more
often injured in extension rather than flexion
Middle finger sagittal band - correct answers more injured than other fingers
Maximum differential tendon gliding - correct answers hook fist for FDS/FDP; straight fist for
FDS; composite flexion for FDP
Passive protected extension - correct answers allows for most distal tendon excursion (3-8mm)
Most ideal time to start early active mobilization protocol - correct answers 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 - correct answers s
carring to intrinsics can occur & tightness, so MPs in splint at 30-40 degrees flexion
Swan-neck deformity - correct answers can occur with absent FDS
Normal finger active flexion - correct answers PIP joint flexes first
Extensor tendons proximal to juncturae tendinum - correct answers ruptures of these can be
missed due to extension through adjacent tendons
Evans' Short Arc Motion extensor tendons - correct answers 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 - correct answers all fingers placed in orthosis in
extension
Extensor tendon repair distal to JT - correct answers affected digit in full extension, adjacent
digits in 30 degrees MP flexion
Yoke splint - correct answers for RF {RF+MF}; for MF {MF}; for SF {SF+IF}; for IF {IF+SF}
Boutonniere deformity - correct answers 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 - correct answers MP in hyper flexion and
work on PIP extension
Central slip initiates extension at PIP joint - correct answers Elson's test assesses central slip
integrity at edge of table
,Pseudo-boutonniere - correct answers dorsal dislocation/hyperextension/volar plate
injury/contracture - no DIP hyperextension or ORL tightness
CID - correct answers carpal instability dissociative - same row
CIND - correct answers carpal instability non-dissociative - between rows
CIC (carpal instability combined) - correct answers combination of CID and CIND
adaptive carpus - correct answers instability d/t extrinsic cause like a malunited distal radius fx
DISI - correct answers s L injury - scaphoid flexes and lunate/triquetrum extend
VISI - correct answers LT injury - scaphoid/lunate flex and triquetrum extends
Palmar midcarpal instability (MCI) - correct answers 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 - correct answers s tart strengthening these in supination for
MCI
SL friendly muscles - correct answers FCU, APL, ECRL (dart thrower's motion)
proximal row carpectomy - correct answers procedure for SLAC wrist, Kienbock's, Prieser's (not
for capitolunate arthritis)
Proximal Row Carpectomy - correct answers painfree motion is goal for this procedure
Dorsal wrist is less supported by ligaments - correct answers volar wrist has more ligamentous
stability
Proximal carpal row flexes (and UD) with radial deviation - correct answers Proximal carpal row
extends (and RD) with ulnar deviation
with progressive perilunate instability - correct answers lunate dislocates into carpal tunnel
Space of Poirier - correct answers ligament free area at Capitolunate space
TFCC - correct answers primary soft tissue stabilizer for DRUJ and ulnocarpal joints
Ulnocarpal stress test - correct answers axial load on the wrist in UD then passively perform
pronation/supination
TFCC type I injuries - correct answers traumatic injuries - Type A: central --- Type B: ulnar --
Type C: distal -- Type D: radial
TFCC type 2 injuries - correct answers degenerative injuries - chondromalacia in ulna and
lunate; LT tear; arthritis present
, Suave Kapandji - correct answers maintains contact between distal radius and ulna with a
pseudo-arthrosis (appropriate for high demand patient)
GRIT test - correct answers utilized for ulnocarpal abutment; supination/pronation grip ratio
greater than 1 indicates positive abutment
Kienbock's disease - correct answers AVN of the lunate through radius load (negative ulnar
variance)
Piano Key Sign - correct answers DRUJ instability
TFCC - correct answers central tears are debrided; peripheral tears are repaired due to blood
flow
OA most common in the DIP Joint - correct answers then 2nd most common in basal CMC joint
STT arthritis - correct answers associated with CMC OA
anterior oblique ligament ("beak ligament") - correct answers most often degenerated with
CMC OA
compressive force at CMC Joint - correct answers 12x force than thumb/index pinch (1# pinch =
12# compressive force at CMC)
arthrodesis (fusion) for DIP arthritis - correct answers arthroplasty for PIP arthritis
pyrolytic carbon implant lasts longer/higher demand activities - correct answers compared to a
silicone joint implant
PIP volar plate laxity - correct answers can lead to swan-neck deformity
stretching of ulnar intrinsics - correct answers can reduce ulnar drift
avoid passive elbow flexion s/p olecranon fx - correct answers to avoid strain on triceps tendon
(and to avoid displacement of fx)
external fixation - correct answers utilizes ligamentotaxis
tuft fx - correct answers nailbed or pulp comminuted fx
intraarticular PIP fx can be treated with this - correct answers hemihamate arthroplasty
moist heat - correct answers conduction
fluidotherapy/whirlpool - correct answers convection
ultrasound - correct answers conversion
target temperature of tissue for superficial heat - correct answers 104-113 F
