Hand Therapy Certification Examination cheat sheet

Goniometric ROM norms (AAOS): shoulder flexion 180°, abduction 180°, external rotation 90°, internal rotation 70°; elbow flexion 150°, extension 0°; forearm pronation/supination 80° each; wrist flexion 80°, extension 70°.

Total active motion (TAM) of a digit = sum of MCP + PIP + DIP active flexion minus sum of extension deficits; compare with contralateral side and express as % of normal TAM.

Strickland and modified Strickland formulas grade flexor tendon repair outcomes using PIP + DIP active flexion minus extension lag.

Manual muscle testing uses the 0-5 scale; grade 3 = antigravity full ROM, grade 4 = holds against moderate resistance, grade 5 = normal against maximal resistance.

Two-point discrimination: static normal ≤6 mm on fingertip; moving normal ≤4 mm; values >10 mm indicate poor sensory reinnervation.

Semmes-Weinstein monofilament testing uses logarithmic forces; the 2.83 filament (0.07 g) is the threshold for normal light touch.

Grip strength measured with a Jamar dynamometer at handle position 2; average of three trials; compare to age- and sex-matched norms; 20% or greater side-to-side difference is clinically meaningful.

Pinch types: lateral (key) 6-8 kg, tip-to-tip 4-6 kg, three-jaw chuck 6-8 kg in healthy adults; document the pinch type used.

Tissue healing phases guide intervention: hemostasis/inflammation (days 0-5), proliferation/fibroplasia (days 5-21), remodeling/maturation (day 21 to 1+ year).

Early controlled motion after flexor tendon repair (Kleinert or Duran protocols) reduces adhesions; place-and-hold and active extension with passive flexion are core techniques.

Edema management hierarchy: elevation, compression, retrograde massage, and active exercise; persistent edema impairs tendon glide and joint mobility.

Tendon gliding exercises (hook fist, full fist, straight fist, tabletop, straight fist) are sequenced to promote differential tendon excursion.

Orthosis principles: three-point pressure for deformity correction, low-load prolonged stretch for contracture, and static progressive or dynamic designs for stiff joints.

Neuromuscular re-education after nerve injury progresses from sensory re-education (discrimination) to motor re-education (mirror therapy, biofeedback, E-stim as indicated).

Activity modification and joint protection techniques (respect pain, avoid sustained grip, use larger joints) are indicated in osteoarthritis and inflammatory arthritis.

CIMT (constraint-induced movement therapy) uses massed practice of the affected limb with restraint of the less affected limb; indicated for selected post-stroke upper limb deficits.

Brachial plexus: C5-C6 musculocutaneous, C5-C7 axillary, C5-T1 radial, C8-T1 ulnar, C5-T1 median; roots, trunks, divisions, cords, branches.

Rotator cuff: supraspinatus (abduction initiation), infraspinatus and teres minor (external rotation), subscapularis (internal rotation); all insert on the humeral head.

Median nerve entrapment at the wrist = carpal tunnel syndrome; at the elbow = pronator teres syndrome; anterior interosseous nerve = no sensory loss, weak FPL and FDP to index.

Ulnar nerve at the elbow (cubital tunnel) causes clawing of the 4th and 5th digits (ulnar claw); at the wrist (Guyon canal) causes intrinsic wasting without clawing.

De Quervain tenosynovitis involves the first dorsal compartment (APL and EPB); Finkelstein test is positive.

Lateral epicondylalgia (tennis elbow) involves the ECRB origin; medial epicondylalgia (golfer's elbow) involves the pronator teres and FCR origin.

Dupuytren contracture is a fibroproliferative disorder of the palmar fascia; most commonly affects the 4th and 5th digits; Hueston tabletop test indicates surgical referral.

Scaphoid fracture is the most common carpal fracture; risk of avascular necrosis of the proximal pole; tenderness in the anatomic snuffbox.

Scar maturation takes 12-18 months; hypertrophic scars remain within the wound boundary; keloids extend beyond it.

Pressure therapy (15-25 mmHg) is applied 23 hours per day for 6-12 months to reduce hypertrophic scarring; custom-fit garments are required.

Silicone gel sheeting or ointment is first-line noninvasive treatment for hypertrophic and keloid scars; apply for 12-24 hours daily.

Scar massage techniques: circular, longitudinal, and perpendicular strokes; begin after wound closure and physician clearance.

Wound assessment uses the TIME framework: Tissue, Infection/Inflammation, Moisture balance, Edge advancement.

Moist wound healing is preferred over dry healing; select dressings by exudate level (hydrocolloid for low, foam/alginate for moderate-high, hydrocolloid or film for protection).

Signs of infection: increasing pain, erythema, warmth, purulent drainage, fever; refer for medical evaluation.

Edema control after hand surgery includes elevation above heart level, compression wrapping from distal to proximal, and active ROM.

Evidence hierarchy: systematic reviews/meta-analyses > randomized controlled trials > cohort > case-control > case series > expert opinion.

Levels of evidence and grades of recommendation: Level I (RCTs) to Level V (expert opinion); GRADE separates quality of evidence from strength of recommendation.

Informed consent requires disclosure of risks, benefits, alternatives, and the right to refuse; document the process.

Outcome measures should be reliable, valid, and responsive; examples include DASH, QuickDASH, PRWE, and the Michigan Hand Outcomes Questionnaire.

Standardized documentation includes SOAP format (Subjective, Objective, Assessment, Plan) and objective measurements with units and side.

Confidentiality and HIPAA: minimum necessary disclosure, secure storage, and patient authorization for release of records.

Scope of practice is defined by state licensure and professional standards; delegation and supervision requirements vary by jurisdiction.

Continuing competence and evidence-based practice require appraisal of current literature, application to patient care, and reflection on outcomes.