Upper Extremity Orthotics Flashcards
Which muscle group is largely responsible for changing the shape of the working hand for grasping objects?
a. Supinators
b. Intrinsic muscles
c. Lumbricals
d. Extrinsic muscles
d. Extrinsic muscles
A patient presents with an injury to root C7. What nerve(s) would be unaffected?
a. Musculocutaneous, Ulnar
b. Axillary, Ulnar
c. Musculocutaneous, Median
d. Radial, Median
b. Axillary, Ulnar
What is the most common mechanism of injury for the Ulnar Collateral Ligament
Injury?
a. Valgus force
b. Extension force
c. Thumb spica
d. Flexion force
a. Valgus force
What position would you maintain the hand/wrist for a dorsal burn?
a. Functional hand
b. Intrinsic minus
c. Intrinsic plus
d. Full extension
c. Intrinsic plus
What motions make up a functional hand position?
a. Wrist extension, MCP flexion, PIP & DIP flexion, Ulnar deviation
b. Wrist extension, MCP flexion, PIP & DIP extension, Radial deviation
c. Wrist flexion, MCP flexion, PIP & DIP extension, Radial deviation
d. Wrist extension, MCP extension, PIP & DIP extension, Ulnar deviation
a. Wrist extension, MCP flexion, PIP & DIP flexion, Ulnar deviation
What does a “Boxers fracture” refer to?
5th metacarpal fracture
Which of the following describes the action of a WDWHO?
a. Converts wrist extension motion into finger flexion
b. Immobilization of the wrist and fingers
c. Elbow flexion and extension
d. Wrist flexion for grasping
a. Converts wrist extension motion into finger flexion
Which of the following clinical presentations is not found in an individual with
Rheumatoid Arthritis?
a. MCP Ulnar Deviation
b. DIP Radial Deviation
c. Carpal Tunnel
d. Joint Swelling
c. Carpal Tunnel
Erb’s palsy is caused by nerve damage at what level?
C5, C6
The medial cord of the brachial plexus has been injured. What presentation would
you expect to see and how would you treat this orthotically?
a. Claw hand; MCP extension stop
b. Glenohumeral subluxation; shoulder sling
c. Ape hand; short opponens
d. Wrist drop; static WHO
a. Claw hand; MCP extension stop
What is the most common precision grip?
a. Palmar
b. Tip
c. Lateral Pinch
d. Hook
a. Palmar
What wrist position allows for maximum hand grip strength?
a. 10-20degrees of wrist flexion
b. 20-30 degrees of wrist extension
c. 10-20 degrees of wrist extension
d. 0 degrees of wrist extension
b. 20-30 degrees of wrist extension
The extensor carpi ulnaris works synergistically with the ____________ to provide wrist extension.
a. Palmaris brevis
b. Palmaris longus
c. Flexor carpi ulnaris
d. Extensor digitorum
d. Extensor digitorum
An injury to the ulnar nerve can result in
a. Claw hand deformity
b. Klumpke’s Palsy
c. Bell’s palsy- facial paralysis
d. Saturday night palsy –radial nerve
a. Claw hand deformity
Carpal tunnel syndrome is commonly due to a lesion of what nerve?
a. Radial
b. Ulnar
c. Median
d. Musculocutaneous
c. Median
A patient presents with a stable olecranon fracture. Which of the following
orthoses would be the most appropriate treatment option?
a. ROM Elbow Orthosis (locked)
b. Dynamic De-contracture Orthosis
c. Myopro
d. Static WHO
a. ROM Elbow Orthosis (locked)
At what point would you cross the elbow joint and brace the forearm for a
humeral fracture?
a. Distal 1/4
b. Distal 1/3
c. Distal ½
d. Distal 2/3
b. Distal 1/3
Wrist drop is commonly due to a lesion of what nerve?
Radial
Which test is used to determine adductor pollicis weakness?
a. Tinels Sign
b. Froments Sign
c. Wartenbergs sign
d. Phalens test
b. Froments Sign
Which ASIA grade classifies a SCI with sensory intact, but motor function affected
below the level of injury?
a. Grade B
b. Grade A
c. Grade C
d. Grade D
a. Grade B
How can you clinically test a patient to see if they have de Quervain’s
Tenosynovitis?
a. Thomas test
b. Lateral pinch test
c. Froment’s Test
d. Finkelstein’s maneuver
d. Finkelstein’s maneuver
Which nerve runs thru the cubital tunnel?
Ulnar
Which is a contraindication for the addition of a thumb post on an upper
extremity orthosis?
a. Absence of active opposition
b. Thumb contracture
c. “Flail Thumb”
d. Loss of thumb flexion
b. Thumb contracture
Swan neck deformity presents with:
a. Flexion of PIP joint and flexion of the DIP joint
b. Hyperextension of the PIP joint and flexion of DIP joint
c. Hyperextension of the PIP joint and extension of the DIP joint
d. Flexion of the PIP joint and hyperextension of the DIP joint
b. Hyperextension of the PIP joint and flexion of DIP joint
A neuropraxia of a nerve within the brachial plexus is defined as?
a. The nerve is damaged (stretched) but not torn
b. A nerve root tried to heal on its own, and scar tissue formed that grows
around and decreases the signal strength
c. The nerve is torn, but not at the spinal attachment
d. The nerve root is torn where it exits the vertebral foramen
a. The nerve is damaged (stretched) but not torn
What muscle is the prime mover for elbow flexion?
Brachialis
Which metacarpal is the most mobile?
a. 2nd
b. 3rd
c. 4th
d. 5th
d. 5th
When performing the Finkelstein’s Maneuver, what motion is performed?
a. Ulnar deviation
b. Radial deviation
c. Wrist flexion
d. Wrist extension
a. Ulnar deviation
What deformity has this presentation: Flexion of the DIP joint?
a. Boutonniere deformity
b. Mallet finger
c. Swan neck deformity
d. Trigger finger
b. Mallet finger
Which of the following is commonly referred to as the “Spring Swivel Thumb”?
a. MP extension stop
b. Thumb adduction stop
c. Thumb abduction stop
d. IP extension assist
c. Thumb abduction stop
What muscle is is inflamed with lateral epicondylitis?
a. Extensor Carpi Radialis Brevis
b. Brachioradialis
c. Anconeus
d. Biceps
a. Extensor Carpi Radialis Brevis
To maintain the web space in a WDWHO in a patient with quadriplegia:
a. Add a wrist strap and IP extension assist
b. Add a thumb adduction stop
c. Add a C-bar and MP stop
d. Add an MP stop
b. Add a thumb adduction stop
“Short” fracture orthosis is appropriate for fracture treatment of:
a. Proximal 2/3 Humerus
b. Proximal 2/3 Radius
c. Distal 1/3 Radius
d. Distal 1/3 Humerus
a. Proximal 2/3 Humerus
Which of the following Radial fractures is classically caused by a fall on an
outstretched hand?
a. Colles Fracture
b. Smith’s Fracture
c. Barton’s Fracture
d. Hutchinson’s Fracture
a. Colles Fracture
In a patient that presents with lumbrical weakness and hyperextension of the
MCP joints on the left hand. Which of the following orthoses would be the most
appropriate choice for orthotic management?
a. WDWHO
b. Hand orthosis with IP flexion assist
c. WHO with spring swivel thumb
d. IP extension assist with MP extension stop
d. IP extension assist with MP extension stop
Forearm extensors are innovated by the _________ nerve.
Radial
Which of the following is true of hypertrophic scars?
a. Flatten spontaneously in time
b. Extends beyond border of original wound
c. Commonly occurs on sternum, arms, cheeks, earlobes
d. Thick collagen
a. Flatten spontaneously in time
The dorsal interossei perform what motion?
a. Adduct the fingers
b. Abduct the fingers
c. IP extension
d. MCP flexion
b. Abduct the fingers
What deformity has this presentation: Flexion of PIP and extension of the DIP?
a. Boutonniere deformity
b. Mallet finger
c. Swan neck deformity
d. Trigger finger
a. Boutonniere deformity
The most important sensory distribution in the hand is along the:
a. Ulnar nerve
b. Median nerve
c. Radial nerve
d. Axillary nerve
b. Median nerve
Which nerve provides motor supply to the posterior arm, forearm and thumb
abductor muscles?
a. Musculocutaneous nerve
b. Median nerve
c. Ulnar nerve
d. Radial nerve
d. Radial nerve
Which position should the hand be placed in for a palmar burn?
a. Wrist extension, MCP Extension, IP extension, thumb abduction and
extension
b. Functional hand position
c. Wrist flexion, 70⁰ MCP flexion, IP extension, thumb adduction
d. 15-30⁰ wrist extension, 70⁰ MCP flexion, IP extension, thumb abduction
a. Wrist extension, MCP Extension, IP extension, thumb abduction and
extension
Why are the creases of the hand important to O&P?
Provides helpful landmarks during orthotic fabrication
_______ Palsy is an injury to the lower brachial plexus, while ______ Palsy is an
injury to the upper brachial plexus.
a. Erb’s; Klumpke’s
b. Dupuytren’s; Erb’s
c. Klumpke’s; Erb’s
d. Cerebral; Dupuytren’s
c. Klumpke’s; Erb’s
A “partial thickness” burn is considered which classification?
2nd degree
An injury to the median and/or ulnar nerve can result in
a. Claw hand deformity
b. Klumpke’s Palsy
c. Bell’s Palsy
d. Trigger Finger
a. Claw hand deformity
Where does the palmar section of a HO and WHO terminate?
a. proximal to the MP crease of the hand
b. distal to the MCP crease of the hand
c. at the MCP joint
d. at the ulnar styloid
a. proximal to the MP crease of the hand
Which is not a biomechanical principle when treating an upper extremity involved
patient?
a. To prevent deformity
b. Cosmesis
c. To correct deformity
d. To position the limb to obtain maximal function
b. Cosmesis
A “full thickness” burn is considered which classification?
3rd degree
Hyperextension of the PIP joint and flexion of the DIP joint constitutes a
__________ deformity.
a. Mallet
b. Swan neck
c. Osteoarthritis
d. Boutonnière
b. Swan neck
Which of the following is considered a condyloid joint?
a. CMC joint of the thumb
b. IP joints
c. Glenohumeral joint
d. MCP joints
d. MCP joints
When would a thumb post be necessary on an orthotic device?
a. If there is an absence of thumb extension
b. If there is an absence of active opposition and thumb flexion
c. If the patient presents with spasticity
d. If the patient presents with contracture
b. If there is an absence of active opposition and thumb flexion
__________ is the location within the hand that abduction and adduction occurs.
a. Carpophalangeal joints
b. Interphalangeal joints
c. Radioulnar joint
d. Metacarpophalangeal joint
d. Metacarpophalangeal joint
Which is NOT true about Colles Fracture?
a. Fracture of the distal radius
b. Usually occurs during fall on extended wrist
c. Fracture of the lateral carpal
d. Usually occurs in patients >50 years
c. Fracture of the lateral carpal
What does not necessitate addition of a thumb post on an upper extremity
orthosis?
a. Absence of active opposition
b. Thumb contracture
c. “Flail Thumb”
d. Loss of thumb flexion
b. Thumb contracture
An MP Stop is also known as a:
a. C-bar
b. Extension Assist
c. Lumbrical Bar
d. Dynamic lever
c. Lumbrical Bar
Which nerve begins from the nerve roots C6-T1?
Median
An intrinsic minus hand is commonly due to a lesion of what nerve?
a. Ulnar
b. Radial
c. Median
d. Musculocutaneous
a. Ulnar
Which nerve provides the sensory distribution to the shoulder?
Axillary nerve
One advantage of a dorsal style WHO is
a. Improved suspension
b. Allows tactile sensation
c. Higher insurance reimbursement
d. Cosmetically appealing
b. Allows tactile sensation
What level of injury would most likely require use of a Mobile Arm Support?
a. C4-C5
b. C2-C4
c. C4-C6
d. C1-C2
a. C4-C5
Klumpke’s Palsy will have what presentation?
Claw hand
Commonly referred to as the “Spring Swivel Thumb”
a. MP extension stop
b. Thumb adduction stop
c. Thumb abduction stop
d. IP extension assist
c. Thumb abduction stop
A patient presents with an injury to root C5. What nerve would NOT be affected?
a. Median
b. Musculocutaneous
c. Axillary
d. Radial
a. Median
What is the presentation of Mallet finger?
a. Flexion of the DIP joint
b. Flexion of PIP and extension if the DIP
c. Hyperextension of PIP joint and flexion of the DIP joint
d. Extension of the DIP
a. Flexion of the DIP joint
Klumpke’s Palsy presents with weakness and/or paralysis of the:
a. Shoulder girdle and long flexor muscles of the arm
b. Complete brachial plexus and lumbar plexus involvement
c. Intrinsic hand muscles and long flexor muscles of the forearm
d. Biceps and Triceps muscles
c. Intrinsic hand muscles and long flexor muscles of the forearm
Using the Wrist Driven Tenodesis Orthosis:
a. Extension causes MP flexion of digits 2-5
b. Flexion causes MP extension of digits 2-5
c. Flexion causes MP flexion of digits 2-5
d. Extension causes MP extension of digits 2-5
a. Extension causes MP flexion of digits 2-5
A boutonniere deformity presents with:
a. PIP flexion and hyperextension of DIP
b. PIP extension and flexion of MCP
c. DIP flexion and MCP flexion
d. PIP hyperextension and flexion of DIP
a. PIP flexion and hyperextension of DIP
What muscles must remain active for the WDWHO to be an appropriate orthotic
treatment?
a. Extensor Carpi Radialis Longus (ECRL), Extensor Carpi Radialis Brevis
(ECRB), & Extensor Carpi Ulnaris (ECU)
b. Extensor Digitorum (ED), Extensor Carpi Ulnaris (ECU) & Palmaris Longus
(PL)
c. Lumbricals & Interossei
a. Extensor Carpi Radialis Longus (ECRL), Extensor Carpi Radialis Brevis
(ECRB), & Extensor Carpi Ulnaris (ECU)
Which motion would be affected if the Musculocutaneous nerve were injured?
a. Shoulder abduction
b. Pronation
c. Elbow flexion
d. Wrist extension
c. Elbow flexion
When should compression be applied to control edema, developed from a burn
injury?
72 hours
The palmar interossei are responsible for which motion?
Finger adduction
What is the presentation of Boutonniere Deformity?
a. Flexion of PIP and extension if the DIP
b. Flexion of the DIP joint
c. Hyperextension of PIP joint and flexion of the DIP joint
d. Extension of the DIP
a. Flexion of PIP and extension if the DIP
A positive Froment’s sign is presented by
a. Adduction of the thumb
b. Hyperextension of the thumb
c. Flexion of the MCP joint at the thumb
d. A flexed of the thumb IP joint
d. A flexed of the thumb IP joint
What clinical presentation is expected to develop following a dorsal burn to the
hand?
a. Intrinsic minus
b. MCP’s and IP’s in full extension
c. Intrinsic plus
d. MCP’s in 45 ⁰ of flexion with the wrist in neutral
a. Intrinsic minus
Of the following, which is a contraindication for a Mobile Arm Support (MAS)?
a. PNS injuries
b. Duchenne muscular dystrophy
c.Tetraplegia of C4 or higher
c.Tetraplegia of C4 or higher
If an individual’s BSA of a burn is greater than _____% (adult) the patient will
require hospitalization for IV fluid resuscitation.
a. 5%
b. 15%
c. 30%
d. 20%
b. 15%
Which arch of the hand is located at the MCP joint level?
a. Distal transverse arch
b. Proximal transverse arch
c. Longitudinal arch
d. Thenar arch
a. Distal transverse arch
A Colles fracture and a Smith’s fracture are variations of fracture for which bone:
a. Radius
b. Ulna
c. Humerus
d. Metacarpal
a. Radius
A patient presents with an injury at lateral cord. What nerve(s) may be affected?
Musculocutaneous, Median
The Statue of Liberty Orthosis is commonly used to treat:
Erb’s Palsy
A patient presents with no volitional strength to the thumb. What component will
you recommend?
a. Thumb post
b. Thumb abduction stop
c. Thumb extension assist
d. Thumb abduction assist
a. Thumb post
You have a patient that is 5’1” and 275lbs. She has cubital tunnel syndrome and
is here for a night time elbow orthosis. The circumference of her arm measures a
size large orthosis but the length measures as a small. You go a head and fit her
with the large orthosis, mark the length trimlines and cut the length of the
orthosis to fit her arm length. You then have to remove the straps and re-attach them appropriately due to the new trimlines. You fit her with this device and it
fits perfectly. This device would be classified as:
Custom Fit
What pathology is a “cock-up” orthosis commonly used to treat?
Carpal Tunnel Syndrome
Which orthosis would NOT be appropriate following a surgical repair to the
rotator cuff?
a. Airplane Orthosis
b. Gunslinger Orthosis
c. Shoulder Abduction Orthosis
d. GivMohr Sling Orthosis
d. GivMohr Sling Orthosis
What is the name of the position that places the wrist/hand/fingers in this
alignment:
30-40⁰ Wrist Extension
60-90⁰ MCP Flexion
PIP and DIPs in Extension
Thumb in palmar abduction
Antideformity Position
What is the normal ROM for wrist extension?
a. 0-70 degrees
b. 0-50 degrees
c. 0-120 degrees
d. 0-150 degree
a. 0-70 degrees
