Ultimate CHT

You are measuring wrist proprioception following a distal radius fracture. With the patient’s vision occluded you passively move the wrist to 25 degree wrist extension, reset to neutral, then ask the patient to reproduce the movement. After measuring the difference between your placement and the patient's reproduced placement, how many degrees difference would imply a problem with wrist proprioception? a) 3 degree or greater b) 7 degrees or greater c) 15 degrees or greater d) 20 degrees or greater

b) 7 degrees or greater | Rationale: >7° error indicates impaired joint position sense.

You are treating a patient who recently underwent a flexor digitorum superficialis transfer to extensor digitorum communis for finger extension. During what time frame would you start performing active retraining? a) 3 days post operative b) 3.5-6 weeks post operative c) 6.5 -9 weeks postoperative d) 12 weeks postoperative

b) 3.5-6 weeks post operative | Rationale: Early activation risks tendon stretch; this window protects healing while restoring function.

You are seeing a patient who sustained a gunshot wound proximal to the elbow joint in the upper arm transecting the ulnar nerve. The patient would present with which of the following? a) Positive Froment’s with clawing of the ring and small finger b) Positive Froment’s without clawing of the ring and small finger c) Negative Froment’s with clawing of the ring and small finger d) Negative Froment’s without clawing of ring and small finger

b) Positive Froment’s without clawing of the ring and small finger | Rationale: High ulnar injury prevents FDP function, so no clawing.

If a magnetic resonance image (MRI) correctly identifies 87.5% of patients as positive for triangular fibrocartilage tear, then the MRI is? a) Sensitive b) Specific c) Significant d) Stable

a) Sensitive | Rationale: Sensitivity = ability to correctly identify those with the condition.

The Common Digital Arteries provide blood supply to the ulnar sided digits. They arise most directly from which of the following arteries? a) Superficial palmar arch b) Deep palmar arch c) Radial artery d) Ulnar artery

a) Superficial palmar arch | Rationale: Superficial arch supplies common digital arteries.

Serial casting is sometimes used for zone 3 extensor tendon injuries or for proximal interphalangeal (PIP) joint flexion contractures. When using this method for joint immobilization, how often should the cast be removed and replaced during the plan of care? a) Daily b) Every 4 days c) Every 7 days d) Every 14 days

c) Every 7 days | Rationale: Maintains fit and prevents breakdown.

The frequency of ultrasound determines the depth of penetration within the target tissue. You are wanting to reach a tissue depth of 2 to 5cm. What frequency is most appropriate? a) 1-MHz b) 2-MHz c) 3-MHz d) 5-MHz

a) 1-MHz | Rationale: Lower frequency penetrates deeper tissues.

Your patient suffered a compression to the posterior interosseous nerve (PIN)… what motion returns next? a) Thumb IP extension b) Index finger extension only c) Palmar abduction of thumb d) Extension ability of Index through small finger

d) Extension ability of Index through small finger | Rationale: EDC returns after wrist extensors.

A patient suffered a crush injury… claw hand deformity ring and small fingers. Which nerve injury? a) PIN b) Low median c) Low ulnar d) High ulnar

c) Low ulnar nerve injury | Rationale: Intrinsic loss causes clawing in low ulnar injuries.

Your patient fell… wound healing with granulation and epithelialization. Which type? a) Primary b) Secondary c) Tertiary d) Maturation

b) Secondary | Rationale: Open wound healing via granulation = secondary intention.

Exudate yellow, thick, foul odor → how document? a) Serosanguinous b) Purulent c) Serous d) Sanguineous

b) Purulent | Rationale: Thick yellow drainage = infection.

Zone 3 extensor SAM protocol wrist position? a) 45° ext b) 15° ext c) 0° d) 30° flex

d) 30° flexion | Rationale: Flexion reduces tension on repair.

After total wrist arthrodesis, discontinue orthosis? a) 4 wks b) 6 wks c) 8 wks d) 12 wks

b) 6 weeks | Rationale: Healing sufficient for support removal.

Fracture proximal phalanx small finger orthosis? a) resting hand b) radial gutter c) ulnar gutter d) volar gutter

c) Hand-based ulnar gutter | Rationale: Stabilizes ulnar digits + adjacent finger.

Radial nerve palsy return sequence next muscle? a) EDC b) EPB c) ECRB d) EI

b) Extensor pollicis brevis | Rationale: Follows innervation pattern.

Median nerve injury—why thenar sensation spared? a) Martin-Gruber b) Reverse c) Cutaneous branch outside tunnel d) Riche-Cannieu

c) Cutaneous branch travels outside carpal tunnel | Rationale: Not compressed in tunnel.

Camitz transfer involves? a) FDP transfer b) ECRB→AP c) ADM→APB d) Palmaris longus→APB

d) Palmaris longus to APB | Rationale: Restores thumb opposition.

Lumbrical plus finger next step? a) Return to surgeon b) MCP block c) NMES d) dorsal block

a) Return to surgeon | Rationale: Surgical correction required.

Graded motor imagery—identify L/R hands = ? a) Mirror therapy b) Laterality training c) Imagery d) Desensitization

b) Laterality training | Rationale: First stage of GMI.

Scapulohumeral rhythm first 30°? a) GH motion b) 1:2 ratio c) scapular d) 1:3

a) Primarily glenohumeral | Rationale: Scapula engages later.

Unable to initiate abduction but can continue after assist—nerve? a) Axillary b) Musculocutaneous c) Long thoracic d) Suprascapular

d) Suprascapular nerve | Rationale: Supraspinatus initiates abduction.

Test for long head biceps pathology? a) Hawkins b) Fowler c) Speed’s d) Empty can

c) Speed’s | Rationale: High specificity.

Wallerian degeneration sensory terminal gone by? a) 6 mo b) 9 mo c) 12 mo d) 15 mo

b) 9 months | Rationale: Terminal degeneration complete by ~9 months.

Child finger flexion deformity congenital? a) Clinodactyly b) Syndactyly c) Camptodactyly d) Macrodactyly

c) Camptodactyly | Rationale: Fixed PIP flexion.

Blood vessel repair protection time? a) 1–2 wks b) 2–3 c) 3–4 d) 4–5

a) 1–2 weeks | Rationale: Early protection critical.

Test for lunotriquetral instability? a) Watson b) Fovea c) Derby d) Midcarpal

c) Derby maneuver | Rationale: Stabilizes triquetrum during test.

Mallet injury—when start PROM DIP? a) 6–8 b) 8–10 c) 10–12 d) 12–14

b) 8–10 weeks | Rationale: Prevent tendon disruption.

Epiphyseal plate closure? a) 8–10 yrs b) onset puberty c) end puberty d) 18–22

c) End of puberty | Rationale: Growth plate fusion occurs then.

TFCC repair orthosis? a) Muenster b) Clamshell c) Gauntlet d) Posterior elbow

a) Muenster | Rationale: Limits rotation + wrist motion.

Lateral deltoid numbness + ER weakness? a) Axillary b) Long thoracic c) Musculocutaneous d) Dorsal scapular

a) Axillary nerve | Rationale: Innervates deltoid + teres minor.

Cadaver graft classification? a) Isograft b) Allograft c) Autograft d) Xenograft

b) Allograft | Rationale: Same species, different individual.

Greater tubercle insertions? a) IS, SS, TM b) IS, SS, Subscap c) SS, Subscap, TM d) Subscap, TM, pec minor

a) Infraspinatus, supraspinatus, teres minor | Rationale: Rotator cuff insertions.

Lateral elbow pain proximal—likely muscle? a) Brachioradialis b) Flexor tendon c) ECRB d) EDC

a) Brachioradialis | Rationale: Proximal origin matches symptoms.

Primary contracture greatest in? a) Xenograft b) Allograft c) STSG d) FTSG

d) FTSG | Rationale: More dermis → more recoil.

Sesamoid bone? a) Lunate b) Hamate c) Pisiform d) Capitate

c) Pisiform | Rationale: Located in tendon.

Jersey finger orthosis? a) Mallet b) volar gutter c) DIP splint d) dorsal blocking

d) Dorsal blocking | Rationale: Protect FDP.

EDC 2/5 MMT—what motion? a) full ext pronation b) full ext neutral c) MCP ext + IP flex pronation d) MCP ext + IP flex neutral

d) MCP extension with IP flexion in neutral | Rationale: Gravity eliminated.

A patient presents with decreased thumb opposition following severe carpal tunnel syndrome and undergoes tendon transfer. Which muscle is most commonly transferred in a Camitz procedure? a) Flexor digitorum superficialis b) Palmaris longus c) Extensor carpi radialis brevis d) Abductor digiti minimi

b) Palmaris longus | Rationale: Standard tendon used to restore opposition in Camitz transfer.

A patient demonstrates inability to extend the wrist and fingers after midshaft humerus fracture. Which nerve is most likely injured? a) Median b) Ulnar c) Radial d) Musculocutaneous

c) Radial nerve | Rationale: Radial nerve injury causes wrist drop.

Which structure forms the roof of the carpal tunnel? a) Flexor retinaculum b) Transverse carpal ligament c) Palmar fascia d) Thenar muscles

b) Transverse carpal ligament | Rationale: Same structure commonly referred to as flexor retinaculum.

A patient presents with numbness in the small finger and ulnar half of the ring finger. Which nerve is involved? a) Median b) Ulnar c) Radial d) Musculocutaneous

b) Ulnar nerve | Rationale: Ulnar nerve supplies these digits.

Which tendon is responsible for flexion of the distal interphalangeal joint? a) FDS b) FDP c) EDC d) Lumbricals

b) FDP | Rationale: FDP flexes DIP joint.

Which structure stabilizes the distal radioulnar joint? a) TFCC b) Scapholunate ligament c) Lunotriquetral ligament d) Radial collateral ligament

a) TFCC | Rationale: Primary stabilizer of DRUJ.

Which nerve innervates the thenar muscles? a) Ulnar b) Radial c) Median d) Axillary

c) Median nerve | Rationale: Recurrent branch supplies thenar eminence.

Which muscle initiates shoulder abduction? a) Deltoid b) Supraspinatus c) Infraspinatus d) Teres minor

b) Supraspinatus | Rationale: First ~15° of abduction.

Which condition is characterized by inflammation of the tendon sheath causing triggering? a) DeQuervain’s b) Trigger finger c) Mallet finger d) Boutonniere

b) Trigger finger | Rationale: Flexor tendon sheath inflammation.

Which ligament prevents hyperextension at the MCP joint? a) Collateral ligament b) Volar plate c) Dorsal capsule d) Annular pulley

b) Volar plate | Rationale: Prevents hyperextension injury.

Which pulley system is most important for preventing bowstringing in fingers? a) A1 b) A2 c) A3 d) C1

b) A2 pulley | Rationale: Primary restraint to bowstringing.

Which nerve injury leads to “ape hand” deformity? a) Radial b) Ulnar c) Median d) Axillary

c) Median nerve | Rationale: Loss of thenar function.

Which test is used to identify DeQuervain’s tenosynovitis? a) Phalen’s b) Finkelstein’s c) Tinel’s d) Allen’s

b) Finkelstein’s | Rationale: Pain with thumb ulnar deviation.

Which structure is damaged in a mallet finger injury? a) FDP b) FDS c) Terminal extensor tendon d) Lumbricals

c) Terminal extensor tendon | Rationale: Leads to DIP flexion deformity.

Which condition results from compression of the median nerve at the wrist? a) Cubital tunnel b) Carpal tunnel c) Guyon’s canal d) Thoracic outlet

b) Carpal tunnel | Rationale: Median nerve compression.