The Wrist

Question 1

Your patient complains of dropping objects, trouble gripping, and tingling in digits 1, 2, and 3. Which provocative test would you perform to confirm your suspicion?

A. Finkelstein’s
B. Phalen’s
C. Cozen’s
D. Reverse Mill’s

Answer 1

B. Phalen’s

Explanation:
(B) is the answer because it tests for carpal tunnel syndrome.

(A) Finkelstein’s tests for DeQuervaine’s
(C) Cozen’s tests extensors/lateral epicondylitis.
(D) Reverse Mill’s tests flexors/medial epicondylitis.

Question 2

How would you splint your patient with carpal tunnel?

A. Wrist in flexion; fingers in neutral
B. Wrist in neutral; fingers in flexion
C. Wrist in neutral; fingers in neutral
D. Wrist in extension; fingers in flexion

Answer 2

C. Wrist in neutral; fingers in neutral

Explanation:
(A) Wrist in flexion; fingers in neutral = wrist in flexion impunges median nerve.

B. Wrist in neutral; fingers in flexion = fingers in flexion draws lumbricals into carpal tunnel.

D. Wrist in extension; fingers in flexion = wrist extension impinges median nerve and fingers in flexion draws lumbricals into carpal tunnel.

Question 3

You are fabricating a splint for a distal radius fracture. To what distal landmark should your splint go?

A. DIPs
B. MCPs
C. CMCs
D. DPC

Answer 3

D. DPC

Explanation:
(A) DIPs and (B) MCPs you want these fingers free.
(C) CMCs you want the CMCs included.

Question 4

A distal radius fracture results in a volarly displaced fragment. This is known as what kind of fracture?

A. Barton’s
B. Colles
C. Chauffer’s
D. Smith’s

Answer 4

D. Smiths

Explanation:

(A) Barton’s; DRF on volar side with dislocation of radiocarpal joint.
(B) Colles; dorsally displaced fragment
(C) Chauffer’s; radial styloid fracture

Question 5

Which of the following is not a part of OT management for a distal radius fracture?

A. Strengthening
B. Forearm supination
C. MP blocking
D. Power gripping

Answer 5

A. Strengthening

Explanation:

(A) because this is not ideal, especially in the first 6 weeks.

Question 6

Avascular necrosis is common with which fracture?

A. Colles
B. Scaphoid
C. Distal humerus
D. PIP

Answer 6

B. Scaphoid

Explanation:
(B) because it only gets blood supply from one aspect of the bone, and it can die if quickly left untreated.

Question 7

Order the protocol for carpal fractures:

A. PROM
B. Orthosis
C. Edema management
D. Strength

Answer 7

1st = Edema management
2nd = PROM
3rd = Orthosis
4th = Strength

Question 8

In a perilunate wrist dislocation, its important to continually assess which nerve?

A. Ulnar
B. Radial
C. Median

Answer 8

C. Median

Explanation:
(C) In this injury the lunate can displace into the carpal tunnel, causing an impingement on the median nerve.

Question 9

Which of the following is not a top priority of OT management for most wrist injuries?

A. Rest (splinting)
B. Activity modification
C. Progressive resistive exercises
D. Avoidance of aggravating activities

Answer 9

C. Progressive resistive exercises

Explanation:
(C) because if anything, gentle PROM & AROM