HTCC CCE common mistakes
HTCC CCE · Understand the traps and how to avoid them.
When asked to describe a tendon-gliding or nerve-gliding home programme, the candidate lists exercises in a fixed order without stating the repetitions, frequency, or the point at which the patient should stop (onset of tingling or pain).
Candidates memorise exercise names from textbooks but never learned the dosing and symptom-monitoring parameters that make a home programme safe, so they recite a menu rather than a prescription.
What to do instead
Structure every programme answer as: exercise, sets/reps, frequency per day, position/progression, and stopping rule (e.g., stop at first onset of paraesthesia, resume after symptoms settle). Practise writing three full programmes (median nerve glide, flexor tendon block, shoulder active-assisted range) with all five elements before exam day.
The candidate assesses shoulder flexion range of motion by asking the patient to lift the arm actively and records the number, without distinguishing active from passive range or noting scapular substitution such as shrugging or trunk side-flexion.
In a busy clinical setting active range is quicker to measure, and candidates carry that shortcut into the exam, forgetting that the examiner is testing whether they can separate joint restriction from muscle weakness and from compensatory movement.
What to do instead
Always state the mode measured (active, passive, active-assisted), the starting position, and the observation of scapulohumeral rhythm. Use a consistent phrase: 'Active flexion 90 degrees with early scapular elevation; passive flexion 130 degrees, suggesting capsular restriction plus weak deltoid.' Rehearse this on a partner with a goniometer.
When interpreting a case of lateral elbow pain, the candidate labels it 'tennis elbow' and prescribes eccentric wrist extensor loading without performing or reporting provocative tests (Cozen's, Mill's, Maudsley's) or screening the cervical spine and radial nerve.
Pattern recognition feels efficient, and lateral epicondylalgia is common, so candidates skip the differential. They also under-test the cervical spine because they view elbow pain as a purely local problem.
What to do instead
For every regional pain case, verbalise a three-part screen: cervical spine (active range, Spurling's), peripheral nerve (radial nerve bias, Tinel's at the elbow), and local tissue (resisted wrist extension, palpation). State which findings support and which argue against the working diagnosis before proposing treatment.
The candidate designs a post-stroke upper limb plan consisting only of passive range of motion and 'facilitation' handling, with no functional task practice, no measurement of baseline impairment (e.g., Fugl-Meyer upper extremity or Action Research Arm Test), and no stated intensity or progression.
Hands-on facilitation is emphasised in early training and feels skilled, whereas task-specific practice and outcome measurement feel administrative, so candidates under-represent them in written answers.
What to do instead
Build a standard template: baseline measure, impairment-focused component, task-specific practice with actual objects, dose (repetitions or minutes per session, sessions per week), progression rule, and re-measurement interval. Name at least one validated measure and one functional task per answer.
Asked about a patient with a repaired flexor tendon, the candidate recommends immediate resisted gripping and full active flexion 'to prevent adhesions', without referencing the surgeon's protocol, the repair zone, or the tenodesis/place-and-hold distinction.
The candidate knows adhesions are a risk and over-generalises the principle 'early motion prevents adhesions' without knowing that the safe motion type depends on repair zone and surgical technique.
What to do instead
Anchor answers to the protocol: state that timing and exercise type follow the surgeon's specified regimen, name the zone (e.g., zone II), and distinguish passive flexion with active extension, place-and-hold, and resisted work as stages. State the signs of rupture (sudden loss of active flexion, altered resting posture) that mandate urgent review.
The candidate describes a complex regional pain syndrome or frozen shoulder plan using only stretching and strengthening, omitting pain science education, graded exposure, sleep and autonomic considerations, and the criterion for referring on.
Biomedical framing dominates revision, and psychosocial and autonomic features are treated as background rather than as treatment targets, so candidates default to tissue-based interventions.
What to do instead
For each chronic upper limb pain case, include one paragraph on education and pacing, one on graded motor imagery or desensitisation where relevant, one on functional goals, and an explicit referral trigger (e.g., worsening allodynia, unexplained swelling, no progress after six weeks).
When asked to measure grip strength, the candidate reports a single squeeze value without specifying the dynamometer setting, elbow and shoulder position, number of trials, rest between trials, or which hand was tested first.
Grip strength seems self-evident, so the standardisation details that determine reliability are never practised and are omitted under time pressure.
What to do instead
Memorise and always state the protocol: seated, shoulder adducted and neutrally rotated, elbow at 90 degrees, forearm neutral, wrist 0 to 30 degrees extension; second handle position; three trials each hand, alternating, with rest; report the mean and compare to the uninvolved side and to normative data.
The candidate answers a question about upper limb neurodynamic testing by describing the 'upper limb tension test' as one procedure, without naming the specific bias (median, radial, ulnar), the sequence of movements, the sensitising manoeuvres, and what constitutes a positive response.
Neurodynamic testing is taught as a family of similar tests and the distinctions blur in recall; candidates also confuse a positive test with reproduction of any stretch sensation.
What to do instead
Learn one base sequence and its biases explicitly: shoulder depression and abduction, elbow extension, forearm supination, wrist and finger extension, then cervical side-flexion as sensitiser. State that a positive finding requires reproduction of the patient's symptoms plus a difference from the other side, and that structural differentiation (moving the neck or wrist) must change the response.
The candidate writes goals such as 'improve range of motion and strength' without a measurable target, timeframe, or link to a patient-valued activity, and without identifying who is responsible for each part of the plan.
Goal writing is treated as paperwork rather than clinical reasoning, so candidates reproduce vague textbook phrasing instead of converting assessment findings into specific targets.
What to do instead
Use a fixed format for every goal: activity, measurable criterion, conditions, timeframe. Example: 'Patient will bring a cup to mouth with the affected hand, without compensation, in 4 weeks.' Add one impairment-level and one participation-level goal, and state the patient's own priority in their words.
Faced with a case of sudden shoulder pain with fever, or new weakness and sensory loss after recent shoulder manipulation, the candidate proceeds to a rehabilitation plan rather than flagging red flags and the need for medical review.
The exam rewards treatment planning, so candidates rush to demonstrate intervention knowledge and treat safety screening as a preamble they can skip.
What to do instead
Make a red-flag screen the first sentence of every case answer: infection (fever, erythema, systemically unwell), fracture or dislocation (deformity, inability to weight-bear through the arm), neurological deterioration (new weakness, progressive sensory loss), and vascular compromise. State the action (urgent medical referral, withhold treatment) before any plan.