Hand Therapy Practice Exam Questions 6-10 ANSWERS



6.


Correct Answer: C. Elbow extension/flexion 30/130; forearm supination/pronation 50/50


 A biomechanical study of functional elbow motion has concluded that 30/130 of elbow ROM and 50/50 of forearm ROM are required to complete most activities of daily living (ADLs).  Answer A. lists typical ROM found in someone with an uninjured elbow or forearm.  ROM listed in answer B. may permit completion of some upperbody ADLs but is insufficient for completion of lower body ADLs due to limitation in elbow extension and forearm rotation.  ROM in answer D. may allow completion of lower body ADLs but not upper body ADLs due to lack of sufficient elbow flexion.

     Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition. Chapter 3; location 2478. 



7.  

Correct Answer: B. Extensor zones III-IV

The SAM protocol was developed to help patients overcome problems related to adhesions due to: "The broad tendon–bone interface in zone IV and the intimacy of periosteum and extensor tendon [that] yield functional gliding problems in the zone III injury." 

Howell and associates’ Immediate Controlled Active Motion (ICAM) protocol is appropriate for extensor tendon repairs in zones IV through VII.  Extensor tendons in zones I-II, as well as thumb extensor zones T1 and T2, do not tolerate early controlled active motion.

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition. Chapter 39 



8.

Correct Answer: B. Stay with the current exercises as the patient’s excellent range of motion puts him at risk for tendon rupture.

According to Gail Groth, this patient is at risk for tendon rupture due to lack of scar formation as evidenced by the patient being able to easily make a full fist. The therapist should proceed with caution.  

References: Rehabilitation of the Hand and Upper Extremity, 6th edition.  Chapter 36

Pyramid of progressive force exercises to the injured flexor tendon, Gail N Groth, Journal of Hand Therapy, Vol. 17, Issue 1, p31-42, January 2004



9. 

Correct Answer:  B. Elbow flexion contracture 

Elbow flexion contracture is the most common complication after an elbow fracture or dislocation.   The etiology of an elbow flexion contracture is not entirely known.  Prolonged immobilization, soft tissue trauma, intra-articular trauma, and heterotrophic ossification (HO) formation can all contribute. The brachialis muscle, which lies anterior to the elbow capsule, can also become adherent to the capsule after traumatic injury. 

Posterior lateral rotational instability (PLRI) is usually the result of a traumatic disruption of the medial collateral ligament (MCL) from a fall. With PLRI, the radial head lies in a posterior position to the capitellum and the lateral aspect of the ulnohumeral articulation is widened.

Heterotopic ossification and nonunion can also occur after elbow trauma but are not as common. 

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition. Chapter 79



10. 

Correct Answer: C. Brachioradialis
  
Brachioradialis assists in elbow flexion and is innervated by the radial nerve. Biceps brachii and brachialis are both innervated by the musculocutaneous nerve.  Anconeus is an accessory elbow extensor innervated by the radial nerve. 

Reference: Hand Secrets, 3rd edition, p. 11

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