Hand Therapy Practice Exam 16-20 ANSWERS

16. Correct Answer: B. Martin Gruber Anastomosis

A Martin Gruber Anastomosis is an anomalous, and primarily motor connection, of the median and ulnar nerves in the forearm.  A lesion to the ulnar nerve proximal to this connection will not result in typical signs and symptoms of ulnar nerve disruption because of median innervation to the ulnar innervated intrinsic muscles of the hand.

A Riche Canneau Anastomosis (Answer A.) is a connection between the deep branch of the ulnar nerve and the recurrent branch of the median nerve at the thenar eminence.

The Marinacci Anastomosis (Answer C.) occurs in the forearm, with the ulnar nerve connecting to the median nerve. (Just the opposite of the Martin Gruber Anastomosis.)

A Beretinni Anastomosis (Answer D.) is an anomalous communication between common digital nerves in the hand that arise from both the ulnar and median nerves

Reference: Neuroanatomy 2009; 8:15-19
Greens Operative Hand Surgery (chap. 30 Compression Neuropathies, location 50821)


17. Correct Answer: B. Boutonnière deformity

Boutonnière deformity is a possible complication following volar PIP dislocation. With a boutonnière deformity the lateral bands shift volarly, the PIP flexes, and the DIP hyperextends. The ORLs become contracted.  PIP extension splinting is necessary to correct central slip disruption and shift the lateral bands dorsally. Active DIP flexion exercises are necessary to stretch the ORLs.

Swan neck deformity (Answer A.) is a possible complication of a dorsal dislocation with figure 8 splinting and active flexion exercises being essential early interventions.

Mallet finger (Answer C.) and MCP flexion contracture (Answer D.) are not complications of a volar PIP dislocation.

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition (chap. 32, electronic location 19961)
www.wheelessonline.com/ortho/transverse_and_oblique_retincular_ligament



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

      It has been determined that 30/130 of elbow ROM and 50/50 of FA ROM
      are required to complete most ADLs.  Answer A. lists typical ROM of an uninjured
      elbow and FA.  ROM listed in answer B. may permit completion of some upper
      body ADLs but is insufficient for completion of lower body ADLs.  ROM in answer
      D. may allow completion of lower body ADLs but not upper body ADLs.

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition (chap. 3,    electronic location 2478) 

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19.  Correct Answer: B. The anterior oblique ligament (AOL)

The AOL is the most important band of the MCL in providing stability to valgus forces placed upon the elbow.  The AOL should be preserved or reconstructed during an MCL repair. The transverse and POL (Answers A. and C.) are both part of the MCL but are not as crucial to valgus stability. The annular ligament (Answer D.) is part of the lateral collateral ligament complex (LCL). The LCL provides varus stability to the elbow.

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition (chap. 3, electronic location 2571) 
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20.  Correct Answer: B. Elbow in flexion, FA in supination

Following repair of the MCL placing the elbow in flexion and the FA in supination keeps the MCL on only slight tension and prevents pronation and tightening the flexor origin which could cause attenuation or rupture of the repair. Exercises usually include active elbow flexion, keeping the FA supinated.  The therapist should always check with the surgeon to find out how much flexion is permitted, but typically 60 degrees of flexion to full flexion is permitted. Putting the elbow in flexion and FA pronation (Answer A.)  would protect a repair to the lateral collateral ligament complex (LCL). (If both MCL and LCL are repaired the FA is placed in neutral). Answers C. and D. both place the elbow in extension. Elbow extension is contraindicated following MCL or LCL repair because both the MCL and LCL become taught in extension.

Reference: Rehabilitation of the Hand and Upper Extremity, 6th edition (chap. 79,   electronic location 50505) 


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