CHT Clinical Reasoning 3 — Questions and Answers
Question 1: A patient with a zone II flexor tendon repair at 6 weeks post-op shows good passive motion but limited active FDP glide. The MOST likely clinical reasoning is:
- Rupture of the repair
- Quadriga effect from adjacent digit
- Tendon adhesions at the repair site (Correct answer)
- Lumbrical plus deformity
Correct answer: Tendon adhesions at the repair site
Limited active FDP glide with preserved passive motion at 6 weeks post zone II repair strongly suggests peritendinous adhesion formation restricting tendon excursion.
Question 2: Which outcome measure is MOST appropriate for capturing a patient's self-reported hand function disability after carpal tunnel release?
- Disabilities of the Arm, Shoulder and Hand (DASH) (Correct answer)
- Visual Analog Scale
- Minnesota Rate of Manipulation Test
- Jamar dynamometer grip strength
Correct answer: Disabilities of the Arm, Shoulder and Hand (DASH)
The DASH is a validated patient-reported outcome measure specifically designed to capture upper extremity functional disability.
Question 3: A patient post-extensor tendon repair (zone VI) presents with an extensor lag at the MP joint. What clinical reasoning step should the CHT take NEXT?
- Immediately begin resistive extension exercises
- Assess for intrinsic versus extrinsic extensor tightness
- Fabricate a static progressive extension splint
- Rule out tendon rupture and assess repair integrity (Correct answer)
Correct answer: Rule out tendon rupture and assess repair integrity
An extensor lag after zone VI repair requires first ruling out repair rupture before initiating further exercise or splinting.
Question 4: When using clinical prediction rules for therapy, a CHT should PRIMARILY consider:
- The rule's sensitivity and specificity in the study population (Correct answer)
- The number of patients in the derivation study
- Whether the rule was published in a hand therapy journal
- How recently the rule was published
Correct answer: The rule's sensitivity and specificity in the study population
The diagnostic accuracy of a clinical prediction rule, expressed through sensitivity and specificity, is the primary indicator of its clinical applicability.
Question 5: A 55-year-old patient with rheumatoid arthritis has ulnar drift and swan-neck deformities. Which clinical reasoning principle guides splinting priority?
- Correct deformity first, then address function
- Prioritize function and prevention of further deformity progression (Correct answer)
- Focus on pain relief exclusively
- Maximize PROM before considering splinting
Correct answer: Prioritize function and prevention of further deformity progression
In RA management, splinting aims to optimize functional use and prevent deformity progression, balancing joint protection with maintaining independence.
Question 6: A CHT is treating a patient after replantation of the index finger. On day 3, the finger is cool and pale. The MOST critical clinical reasoning action is:
- Apply warm compresses and increase active motion
- Notify the surgeon immediately for possible vascular compromise (Correct answer)
- Begin sympathetic nervous system desensitization
- Apply compression wrapping to reduce edema
Correct answer: Notify the surgeon immediately for possible vascular compromise
Cool, pale appearance post-replantation signals arterial insufficiency, a surgical emergency requiring immediate physician notification.
Question 7: A patient develops hypersensitivity after digital nerve repair. Which clinical reasoning framework guides progression of desensitization treatment?
- Begin with the most irritating stimulus and work downward
- Progress from least to most irritating stimuli in a graded hierarchy (Correct answer)
- Use electrical stimulation before tactile desensitization
- Apply firm pressure only, avoiding light touch
Correct answer: Progress from least to most irritating stimuli in a graded hierarchy
Desensitization follows a graded hierarchy from least to most irritating stimuli to progressively decrease hypersensitivity through habituation.
CHT Clinical Reasoning 3
A patient with a zone II flexor tendon repair at 6 weeks post-op shows good passive motion but limited active FDP glide.
The MOST likely clinical reasoning is: