Upper limb rehabilitation clinical skills and theory
This domain tests your ability to turn upper limb anatomy, biomechanics, and tissue-healing science into safe, measurable hand therapy. Questions cluster around evaluation, orthotic design, tendon and nerve rehabilitation, joint mobilization, and clinical decision-making across the healing continuum. The exam rewards precise terminology and defensible reasoning rather than memorized protocols.
Evaluation anchors
- Measure active and passive ROM with a consistent goniometric method; record the joint, digit, and whether motion is limited by pain, edema, or contracture.
- Manual muscle testing uses the 0–5 scale, but it is valid only when the healing structure can tolerate the load; use observation or dynamometry when resistance is contraindicated.
- Semmes–Weinstein monofilaments test light touch threshold; static and moving two-point discrimination test innervation density. Document the method and the digit.
- Quantify edema with volumetry or circumference and relate it to functional limitation.
Tissue and intervention rules
- The healing phase dictates load: protection during inflammation, controlled stress during proliferation, and progressive loading during remodeling.
- Splints use three-point fixation and distribute pressure. The safe position is wrist 20–30° extension, MCP joints 70–90° flexion, IP joints extended, and the thumb abducted.
- Flexor tendon rehabilitation uses early controlled motion and differential gliding; place-and-hold selectively recruits FDS and FDP.
- Nerve care moves from protection to sensory and motor re-education; orthoses prevent deformity while reinnervation proceeds.
Worked example
Four weeks after a zone II FDS/FDP repair, a patient has PIP flexion of 30°, DIP flexion of 55°, and full passive PIP extension. Reasoning: FDP is gliding because DIP flexion is present, but the PIP lag suggests an FDS adhesion or PIP joint stiffness. Full passive PIP motion points to an FDS glide deficit, so use differential gliding and place-and-hold; limited passive motion instead calls for joint mobilization and splint reassessment. Do not force passive flexion at this stage.
Traps that cost marks
- Treating manual muscle testing as valid on a healing tendon.
- Missing a more proximal nerve lesion or a double crush.
- Applying an over-tight splint without checking skin and neurovascular status.
- Confusing two-point discrimination with light touch threshold.