Certified Hand Therapist (CHT) Examination cheat sheet

Semmes-Weinstein monofilament thresholds: 2.83 normal light touch; 3.61 diminished light touch; 4.31 diminished protective sensation; 4.56 loss of protective sensation; 6.65 deep pressure only.

Static two-point discrimination: normal fingertip value is 5 mm or less; 6 mm or more indicates impaired innervation density.

Phalen test: wrists held in maximal flexion for about 60 seconds; median-distribution tingling is a positive finding.

Durkan carpal compression test: direct pressure over the carpal tunnel for 30 seconds; reproduction of symptoms is positive.

Tinel sign: percussion over a nerve producing distal tingling indicates nerve irritation or regenerating axons.

Watson scaphoid shift: scaphoid tubercle pressure during ulnar-to-radial wrist motion; pain or clunk suggests scapholunate instability.

Moberg pick-up test: timed retrieval of small objects with eyes occluded; assesses median nerve functional sensibility.

Grip dynamometry standard position: shoulder adducted, elbow 90 degrees, forearm neutral, wrist 0-30 degrees extension; average three trials and compare with the uninvolved side.

After flexor tendon repair, early controlled motion usually begins within 3-5 days; a dorsal blocking splint holds the wrist in 20-30 degrees extension and MCP joints in 50-70 degrees flexion.

Kleinert protocol: passive digital flexion via rubber-band traction with active extension within a dorsal blocking splint.

Duran protocol: controlled passive flexion and extension of repaired flexor tendons within a dorsal block, repeated frequently each day.

Safe position (intrinsic plus) splint: wrist 20-30 degrees extension, MCP joints 70-90 degrees flexion, IP joints extended.

Edema management includes elevation, compression, retrograde massage, and active exercise.

Scar management includes silicone gel or sheeting, pressure, and massage applied over several months.

Nerve gliding uses gentle sequential tensioning movements; tension at the repair site is avoided early after repair.

Graded desensitization progresses through textures, tapping, vibration, and pressure as tolerance improves.

Relative motion splinting positions adjacent joints to reduce tension on a specific tendon, enabling early active motion.

Carpal tunnel contents: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus (nine tendons total) plus the median nerve.

Guyon canal contents: ulnar nerve and ulnar artery; it contains no flexor tendons.

Flexor tendon zones: I distal to FDS insertion; II from FDS insertion to distal palmar crease; III palm; IV carpal tunnel; V forearm.

Pulleys: A1, A3, and A5 lie over joints; A2 and A4 lie over phalangeal shafts and are most critical for preventing bowstringing.

Scaphoid blood supply is retrograde from the dorsal branch of the radial artery; proximal pole fractures carry high risk of avascular necrosis.

Median nerve thenar branch innervates abductor pollicis brevis, opponens pollicis, and the superficial head of flexor pollicis brevis.

Ulnar nerve innervates adductor pollicis; weakness produces a positive Froment sign with thumb IP flexion during pinch.

Dart-throwing motion combines radial deviation with extension and ulnar deviation with flexion; it occurs primarily at the midcarpal joint.

Lateral epicondylitis is degenerative tendinopathy most commonly at the origin of the extensor carpi radialis brevis.

Evidence hierarchy: Level I systematic review or meta-analysis of RCTs; Level II RCT; Level III cohort; Level IV case-control; Level V case series or expert opinion.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).

Positive predictive value = TP/(TP+FP); negative predictive value = TN/(TN+FN); both depend on prevalence.

SEM = SD x square root of (1 - ICC); MDC95 = 1.96 x SEM x square root of 2.

ICC above 0.75 indicates good reliability; above 0.90 indicates excellent reliability.

MCID is the smallest change patients perceive as beneficial and is not identical to statistical significance.

A p value below 0.05 indicates statistical significance but does not establish clinical importance.

A 95% confidence interval gives the range of plausible values for a parameter; precision increases with sample size.

Research designs: RCTs best control bias; cohort studies follow exposed and unexposed groups; case-control studies compare past exposures.