THA/TKA
A client underwent a posterior total hip arthroplasty (THA). Which movement should be avoided to reduce the risk of hip dislocation?
A. Hip flexion greater than 90 degrees
B. Knee extension
C. Ankle dorsiflexion
D. Trunk extension
Correct Answer: A
Rationale: Clients with posterior THA precautions should avoid hip flexion greater than 90 degrees, adduction, and internal rotation to reduce the risk of dislocation.
A client falls on an outstretched hand and sustains a distal radius fracture with dorsal displacement. Which fracture is MOST likely?
A. Smith fracture
B. Colles fracture
C. Scaphoid fracture
D. Bennett fracture
Correct Answer: B. Colles fracture
Rationale: A Colles fracture is a distal radius fracture with dorsal displacement, commonly resulting from a fall onto an outstretched hand (FOOSH). It is one of the most common upper extremity fractures seen in adults.
A client is in the early postoperative phase following a flexor tendon repair. Which intervention is MOST appropriate?
A. Resistive grip strengthening
B. Protected motion using the prescribed protocol
C. Weight-bearing through the hand
D. Full active range of motion without a splint
Correct Answer: B
Rationale: Following flexor tendon repair, controlled protected motion is used to prevent adhesions while protecting the repair from rupture. Strengthening and unrestricted movement are contraindicated early in recovery.
Question:
A client with rheumatoid arthritis is experiencing an acute flare characterized by pain, swelling, and inflammation of the hand joints. Which splint is MOST appropriate?
A. Figure-8 splint
B. Thumb spica splint
C. Resting hand splint
D. Dynamic MCP flexion splint
Correct Answer: C
Rationale: During acute RA flares, a resting hand splint is used to reduce pain and inflammation while maintaining proper joint alignment.
A client reports numbness and tingling in the thumb, index, middle, and radial half of the ring finger that worsens at night. Which condition is MOST likely?
A. Cubital Tunnel Syndrome
B. Trigger Finger
C. Carpal Tunnel Syndrome
D. De Quervain's Tenosynovitis
Correct Answer: C
Rationale: Carpal tunnel syndrome results from compression of the median nerve at the wrist and commonly presents with numbness and tingling in the thumb, index, middle, and radial half of the ring finger, often worsening at night.
A client is recovering from a total knee arthroplasty (TKA). The occupational therapist notices the client resting in bed with a pillow placed directly under the knee. What is the therapist's PRIMARY concern?
A. Increased edema
B. Hip dislocation
C. Knee flexion contracture
D. Foot drop
Correct Answer: C
Rationale: Following TKA, prolonged positioning with a pillow under the knee promotes knee flexion and may lead to a knee flexion contracture. Clients should be encouraged to achieve full knee extension during recovery.
A client is unable to actively extend the DIP joint following a traumatic injury to the fingertip. Which deformity is MOST likely?
A. Boutonniere deformity
B. Swan neck deformity
C. Mallet finger
D. Ulnar drift
Correct Answer: C. Mallet finger
Rationale: Mallet finger occurs when the extensor tendon at the DIP joint is injured, resulting in an inability to actively extend the DIP joint. The fingertip rests in flexion.
A client is 3 days post-op following a flexor tendon repair in Zone II. Which splint is MOST commonly used as part of the rehabilitation protocol?
A. Resting hand splint
B. Dorsal blocking splint
C. Dynamic MCP extension splint
D. Thumb spica splint
Correct Answer: B. Dorsal blocking splint
Rationale: A dorsal blocking splint is commonly used following flexor tendon repair to protect the repaired tendon from excessive tension while allowing controlled motion according to the prescribed protocol. This helps reduce the risk of tendon rupture while minimizing adhesions.
A client with rheumatoid arthritis reports pain when opening jars and demonstrates a tight cylindrical grasp around the lid. Which technique BEST follows joint protection principles when opening a jar without adaptive equipment?
A. Use a C-grip and distribute force across multiple joints
B. Grip the lid tightly with the fingertips
C. Increase grip force and open the jar as quickly as possible
D. Use a lateral pinch to twist the lid
Correct Answer: A
Rationale: Joint protection principles emphasize avoiding forceful pinch patterns, distributing forces across larger joints, and reducing stress on painful joints. A C-grip allows force to be distributed more evenly and places less stress on the small joints of the hand than fingertip gripping or pinch patterns.
An occupational therapist suspects De Quervain's tenosynovitis. Which special test would MOST likely reproduce the client's symptoms?
A. Finkelstein's test
B. Tinel's sign
C. Phalen's test
D. Froment's sign
Rationale: Finkelstein's test is used to assess for De Quervain's tenosynovitis and reproduces pain over the radial wrist. Phalen's and Tinel's are commonly used for carpal tunnel syndrome, while Froment's sign is associated with ulnar nerve dysfunction.
A client is following posterior hip precautions after a total hip arthroplasty. Which piece of adaptive equipment is MOST appropriate for lower body dressing?
A. Long-handled shoehorn
B. Dressing stick
C. Reacher
D. Sock aid
Correct Answer: C. Reacher
Rationale: A reacher allows the client to don pants and retrieve clothing without bending forward past 90 degrees, helping maintain posterior hip precautions. While a sock aid and long-handled shoehorn may also be useful, the reacher is typically the most appropriate choice for lower body dressing when hip flexion must be avoided.
An occupational therapist observes a client resting with the PIP joint flexed and the DIP joint hyperextended following a finger injury. Which deformity is MOST likely?
A. Mallet finger
B. Swan neck deformity
C. Boutonniere deformity
D. Ulnar drift
Correct Answer: C. Boutonniere deformity
Rationale: A boutonniere deformity is characterized by PIP flexion and DIP hyperextension due to disruption of the central slip of the extensor tendon. It is commonly contrasted with a swan neck deformity, which presents with the opposite pattern.
A client is 1 week post-op following a flexor tendon repair. The rehabilitation protocol allows the therapist to passively flex the fingers while the client actively extends the fingers within the limits of a dorsal blocking splint. Which protocol is being followed?
A. Duran protocol
B. Kleinert protocol
C. Early active motion protocol
D. Immobilization protocol
Correct Answer: A. Duran protocol
Rationale: The Duran protocol utilizes passive flexion and active extension exercises performed within a dorsal blocking splint to promote tendon gliding while protecting the repair.
A client with rheumatoid arthritis is experiencing an acute flare with significant joint inflammation, redness, and swelling. Which physical agent modality is MOST appropriate?
A. Paraffin bath
B. Fluidotherapy
C. Moist heat pack
D. Cold pack
Correct Answer: D
Rationale: During an acute rheumatoid arthritis flare, cold modalities can help decrease inflammation, edema, and pain. Heat-based modalities such as paraffin, fluidotherapy, and moist heat are generally more appropriate for chronic stiffness rather than acute inflammation.
A client reports numbness and tingling in the ring and little fingers that worsens with prolonged elbow flexion. Which nerve is MOST likely involved?
A. Radial nerve
B. Median nerve
C. Ulnar nerve
D. Axillary nerve
Correct Answer: C
Rationale: Cubital tunnel syndrome involves compression of the ulnar nerve at the elbow. Symptoms commonly include numbness and tingling in the ring and little fingers, especially during activities involving prolonged elbow flexion.
A client is preparing for discharge following a posterior total hip arthroplasty. Which bathroom modification is MOST appropriate to help the client maintain hip precautions during toileting?
A. Grab bars installed next to the toilet
B. Raised toilet seat
C. Non-slip bath mat
D. Handheld showerhead
Correct Answer: B. Raised toilet seat
Rationale: A raised toilet seat reduces the amount of hip flexion required during sit-to-stand transfers and toileting, helping the client maintain posterior hip precautions. While grab bars may also be beneficial, the raised toilet seat most directly addresses the precaution of avoiding hip flexion greater than 90 degrees.
A client presents with trigger finger and reports that the finger catches and locks during flexion and extension. Which anatomical structure is MOST commonly involved?
A. A1 pulley
B. Central slip
C. Extensor hood
D. Triangular fibrocartilage complex (TFCC)
Correct Answer: A. A1 pulley
Rationale: Trigger finger occurs when inflammation or thickening of the flexor tendon and tendon sheath interferes with smooth gliding through the A1 pulley. This can result in catching, locking, or painful clicking during finger movement.
A client sustained a laceration to the flexor tendons at the level of the palm proximal to the carpal tunnel. According to the flexor tendon zone classification system, this injury is located in:
A. Zone I
B. Zone II
C. Zone III
D. Zone V
Correct Answer: D. Zone V
Rationale: Zone V extends from the musculotendinous junction in the forearm to the carpal tunnel. Injuries in this zone often involve multiple tendons as well as the median and ulnar nerves.
An occupational therapist observes a client with rheumatoid arthritis demonstrating MCP joint flexion and ulnar deviation of the fingers. Which intervention is MOST appropriate to help prevent further progression of this deformity?
A. Strengthening the intrinsic hand muscles with resistive putty exercises
B. Encouraging repetitive gripping activities to maintain ROM
C. Fabricating a resting hand or ulnar deviation splint and providing joint protection education
D. Restricting all hand use during daily activities
Correct Answer: C
Rationale: Ulnar drift is a common deformity associated with rheumatoid arthritis. OT intervention focuses on joint protection, proper alignment, splinting, and activity modification to reduce stress on the joints and help slow deformity progression. Resistive gripping may increase joint stress during active inflammation.
An occupational therapist evaluates a client who demonstrates progressive thickening of the palmar fascia and increasing flexion contractures of the fourth and fifth digits. Which condition is MOST likely?
A. Trigger finger
B. Carpal tunnel syndrome
C. De Quervain's tenosynovitis
D. Dupuytren's contracture
Correct Answer: D
Rationale: Dupuytren's contracture is characterized by progressive thickening and shortening of the palmar fascia, resulting in flexion contractures of the fingers, most commonly the ring and little fingers.
A client is 2 days post-op following a total knee arthroplasty (TKA). During a treatment session, the client reports significant pain and requests to remain in bed. What is the MOST appropriate OT response?
A. Allow the client to remain in bed until pain subsides
B. Encourage participation in functional mobility and ADLs within the client's tolerance
C. Focus exclusively on upper extremity exercises
D. Discontinue therapy and notify the surgeon
Correct Answer: B. Encourage participation in functional mobility and ADLs within the client's tolerance
Rationale: Early mobilization following TKA is essential to prevent complications, promote functional recovery, and improve outcomes. While pain management is important, participation in mobility and ADLs should be encouraged within the client's tolerance level. Prolonged bed rest can contribute to stiffness, weakness, and delayed recovery.
An occupational therapist observes a client with MCP hyperextension and IP flexion of the ring and little fingers. Which nerve is MOST likely involved?
A. Radial nerve
B. Median nerve
C. Ulnar nerve
D. Axillary nerve
Correct Answer: C. Ulnar nerve
Rationale: Ulnar nerve injury can result in a claw hand deformity characterized by MCP hyperextension and IP flexion, particularly of the fourth and fifth digits.
A client is 10 days post-op following a flexor tendon repair. During a treatment session, the client removes the dorsal blocking splint and attempts to actively make a full fist. What is the therapist's PRIMARY concern?
A. Development of edema
B. Joint contracture
C. Tendon rupture
D. Sensory loss
Correct Answer: C
Rationale: During the early postoperative period, excessive active flexion can place significant stress on the repaired tendon and increase the risk of rupture. Protection of the repair is the primary concern before strengthening or unrestricted motion is initiated.
A client with rheumatoid arthritis reports increasing hand pain while carrying groceries. Which joint protection principle is being applied when the client switches from carrying multiple bags with the fingers to carrying a reusable grocery bag over the forearm?
A. Avoid positions of deformity
B. Respect pain
C. Use larger, stronger joints
D. Balance rest and activity
Correct Answer: C
Rationale: Joint protection principles emphasize using larger, stronger joints whenever possible. Carrying a bag over the forearm decreases stress on the small joints of the hand and fingers.
An occupational therapist evaluates a client who reports nocturnal numbness and tingling in the thumb, index, and middle fingers. The therapist wants to reproduce symptoms by having the client maintain wrist flexion for 60 seconds. Which special test is being performed?
A. Finkelstein's test
B. Froment's sign
C. Tinel's sign
D. Phalen's test
Correct Answer: D
Rationale: Phalen's test is performed by maintaining wrist flexion to reproduce symptoms of carpal tunnel syndrome. Tinel's sign involves tapping over the nerve, Finkelstein's is used for De Quervain's tenosynovitis, and Froment's sign assesses ulnar nerve dysfunction.