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Hand Trauma & Infection MCQs

Practice Set 9 of 10

This practice set contains high-yield board review questions covering key concepts in Hand Trauma & Infection. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 161

Topic: Hand Trauma & Infection
A patient presents to the emergency department with a swollen, acutely painful index finger after a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs of pyogenic flexor tenosynovitis?
. Fusiform swelling of the digit
. Pain on active extension of the digit
. Tenderness along the course of the flexor tendon sheath
. Digit held in a flexed resting posture
. Pain on passive extension of the digit

Correct Answer & Explanation

. Pain on active extension of the digit

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis are: 1) fusiform (sausage-like) swelling, 2) tenderness along the flexor sheath, 3) posture of the digit in slight flexion, and 4) severe pain on PASSIVE (not active) extension. Active motion is generally painful, but exquisite pain on passive extension is the hallmark sign.

Question 162

Topic: Hand Trauma & Infection

A skier presents with a traumatic abduction injury to the thumb metacarpophalangeal (MCP) joint. MRI confirms a complete rupture of the ulnar collateral ligament (UCL) with a Stener lesion. Which anatomic structure is interposed between the torn UCL ends in a Stener lesion?

. Extensor pollicis longus tendon
. Adductor pollicis aponeurosis
. Abductor pollicis brevis aponeurosis
. Flexor pollicis longus tendon
. Volar plate

Correct Answer & Explanation

. Extensor pollicis longus tendon

Explanation

A Stener lesion occurs when the completely avulsed distal end of the ulnar collateral ligament of the thumb MCP joint displaces superficial to the adductor pollicis aponeurosis. This interposition mechanically blocks the UCL from returning to its anatomic insertion, preventing healing and establishing an absolute indication for surgical repair.

Question 163

Topic: Hand Trauma & Infection

Which of the following is NOT one of the four classic Kanavel signs indicating pyogenic flexor tenosynovitis?

. Fusiform swelling of the digit
. Severe pain with passive extension of the digit
. Erythema extending proximal to the metacarpophalangeal joint
. Flexed resting posture of the digit
. Tenderness along the course of the flexor tendon sheath

Correct Answer & Explanation

. Fusiform swelling of the digit

Explanation

Kanavel's four cardinal signs of pyogenic flexor tenosynovitis are: 1) Fusiform (sausage-like) swelling of the digit, 2) Flexed resting posture of the digit, 3) Tenderness to palpation along the course of the flexor tendon sheath, and 4) Severe pain elicited by passive extension of the digit (most sensitive sign). Erythema extending proximal to the MCP joint is not a classic Kanavel sign and may indicate a deeper space infection or diffuse cellulitis.

Question 164

Topic: Hand Trauma & Infection

A skier falls while holding a ski pole, sustaining a hyperabduction injury to the thumb. An MRI reveals an ulnar collateral ligament (UCL) tear with the torn end displaced superficial to the adductor pollicis aponeurosis. What is the most appropriate management?

. Thumb spica cast for 6 weeks
. Buddy taping for 3 weeks
. Corticosteroid injection into the first MCP joint
. Surgical repair of the UCL
. First carpometacarpal arthrodesis

Correct Answer & Explanation

. Thumb spica cast for 6 weeks

Explanation

This describes a Stener lesion, where the adductor aponeurosis interposes between the torn UCL and its anatomic insertion. This interposition prevents spontaneous healing, making surgical repair the definitive indication.

Question 165

Topic: Hand Trauma & Infection

In the context of a thumb ulnar collateral ligament (UCL) rupture (Skier's thumb), a Stener lesion is anatomically defined as the interposition of which structure between the torn ends of the UCL?

. Abductor pollicis brevis aponeurosis
. Adductor pollicis aponeurosis
. Extensor pollicis longus tendon
. Extensor pollicis brevis tendon
. Flexor pollicis longus tendon

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the torn ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint flips proximally and comes to rest superficial to the adductor pollicis aponeurosis. This interposition prevents primary ligamentous healing and is a strong indication for surgical repair.

Question 166

Topic: Hand Trauma & Infection

A 42-year-old diabetic patient presents with a swollen, erythematous index finger. Of Kanavel's four cardinal signs for infectious pyogenic flexor tenosynovitis, which is considered the earliest and most sensitive clinical indicator?

. Symmetrical enlargement of the entire digit (fusiform swelling)
. Flexed resting posture of the digit
. Exquisite pain with passive extension of the digit
. Tenderness along the entire course of the flexor tendon sheath
. Fluctuant mass at the proximal interphalangeal joint

Correct Answer & Explanation

. Exquisite pain with passive extension of the digit

Explanation

Pain with passive extension is the earliest and most sensitive of Kanavel's signs for pyogenic flexor tenosynovitis. This stretch places direct tension on the inflamed synovial sheath, eliciting severe pain before the other localized signs fully manifest.

Question 167

Topic: Hand Trauma & Infection

A 28-year-old male presents with a painful, swollen index finger held in slight flexion. There is tenderness along the entire flexor tendon sheath and severe pain with passive extension. What is the most common causative organism for this condition if acquired via a penetrating injury?

. Streptococcus pyogenes
. Staphylococcus aureus
. Pasteurella multocida
. Eikenella corrodens
. Neisseria gonorrhoeae

Correct Answer & Explanation

. Staphylococcus aureus

Explanation

The patient exhibits Kanavel's signs, indicating acute pyogenic flexor tenosynovitis. The most common causative organism overall, particularly following a penetrating injury, is Staphylococcus aureus.

Question 168

Topic: Hand Trauma & Infection

A 40-year-old diabetic patient presents to the emergency department with a swollen, painful index finger 3 days after sustaining a puncture wound. You suspect pyogenic flexor tenosynovitis. Of Kanavel's four cardinal signs, which is generally considered the earliest and most sensitive indicator of this infection?

. Symmetric, fusiform swelling of the entire digit
. Tenderness along the anatomic course of the flexor tendon sheath
. Resting posture of the digit in slight flexion
. Exquisite pain with passive extension of the digit
. Erythema tracking up the volar forearm

Correct Answer & Explanation

. Exquisite pain with passive extension of the digit

Explanation

Kanavel's four cardinal signs for pyogenic flexor tenosynovitis are: 1) flexed resting posture, 2) symmetric fusiform swelling, 3) tenderness along the flexor tendon sheath, and 4) exquisite pain with passive extension. Pain with passive extension is widely regarded as the most sensitive and often the earliest clinical sign of flexor tendon sheath infection, as it actively stretches the inflamed synovial sheath.

Question 169

Topic: Hand Trauma & Infection

A 35-year-old mechanic sustains a puncture wound to the volar index finger. Two days later, he presents with a suspected pyogenic flexor tenosynovitis. Which of Kanavel's four cardinal signs is generally considered the most sensitive and earliest indicator of this infection?

. Fusiform (sausage-like) swelling of the digit
. Flexed resting posture of the digit
. Tenderness along the entire course of the flexor tendon sheath
. Severe pain with passive extension of the digit
. Erythema extending past the metacarpophalangeal joint

Correct Answer & Explanation

. Severe pain with passive extension of the digit

Explanation

Of Kanavel's four cardinal signs, severe pain on passive extension is considered the most sensitive and earliest clinical finding of pyogenic flexor tenosynovitis, occurring before frank fusiform swelling or marked resting flexion are fully established.

Question 170

Topic: Hand Trauma & Infection

A 25-year-old skier falls while holding a pole, forcibly hyperabducting his thumb. MRI confirms a complete tear of the ulnar collateral ligament (UCL) of the thumb MCP joint with a Stener lesion. Which structure is interposed between the torn UCL and its anatomic insertion?

. Abductor pollicis longus aponeurosis
. Adductor pollicis aponeurosis
. Extensor pollicis brevis tendon
. Flexor pollicis brevis tendon
. Sagittal band

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the distally torn UCL of the thumb flips and rests superficial to the adductor pollicis aponeurosis. This interposition prevents anatomic healing and necessitates surgical repair.

Question 171

Topic: Hand Trauma & Infection

A 40-year-old diabetic patient presents with a swollen, painful index finger. Which of the following is NOT one of Kanavel's cardinal signs of pyogenic flexor tenosynovitis?

. Fusiform swelling of the digit
. Pain on active extension
. Tenderness along the flexor tendon sheath
. Digit held in a flexed posture
. Pain on passive extension

Correct Answer & Explanation

. Pain on passive extension

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis include fusiform swelling, the digit resting in flexion, tenderness along the tendon sheath, and severe pain on passive (not active) extension. Pain on passive extension is usually the earliest and most reliable sign.

Question 172

Topic: Hand Trauma & Infection

A 30-year-old diabetic patient presents to the emergency department with a swollen, painful index finger three days after sustaining a minor puncture wound. Which of Kanavel's four cardinal signs is generally considered the earliest and most sensitive indicator of pyogenic flexor tenosynovitis?

. Fusiform swelling of the digit
. Flexed resting posture of the digit
. Pain elicited by passive extension of the digit
. Tenderness to palpation along the flexor tendon sheath
. Erythema extending proximal to the metacarpophalangeal joint

Correct Answer & Explanation

. Pain elicited by passive extension of the digit

Explanation

Kanavel's signs for pyogenic flexor tenosynovitis are: 1) flexed resting posture, 2) fusiform (sausage-like) swelling, 3) tenderness strictly along the tendon sheath, and 4) pain with passive extension. Pain on passive extension is widely regarded as the earliest and most sensitive clinical sign, as it stretches the inflamed visceral and parietal synovium.

Question 173

Topic: Hand Trauma & Infection

In a complete rupture of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (Stener lesion), healing is prevented due to the interposition of which structure between the torn ends of the ligament?

. Adductor pollicis aponeurosis
. Abductor pollicis brevis tendon
. Extensor pollicis brevis tendon
. Flexor pollicis longus tendon
. Volar plate

Correct Answer & Explanation

. Adductor pollicis aponeurosis

Explanation

A Stener lesion occurs when the distal attachment of the thumb UCL avulses and gets trapped superficial to the adductor aponeurosis. The adductor aponeurosis acts as a mechanical barrier between the torn ligament and its insertion site, preventing spontaneous healing and necessitating surgical repair.

Question 174

Topic: Hand Trauma & Infection

A 30-year-old mechanic presents with an exquisitely painful, swollen index finger following a puncture wound. Which of the following clinical signs (Kanavel's signs) is considered the latest and most reliable indicator of pyogenic flexor tenosynovitis?

. Symmetric uniform swelling of the entire digit
. Flexed resting posture of the digit
. Tenderness isolated to the dorsal distal interphalangeal joint
. Severe pain with passive extension of the digit
. Erythema extending proximally to the palmar crease

Correct Answer & Explanation

. Severe pain with passive extension of the digit

Explanation

Pain with passive extension is typically the most reliable and exquisitely sensitive sign of pyogenic flexor tenosynovitis. The four Kanavel signs are fusiform swelling, flexed posture, tenderness along the flexor sheath, and pain on passive extension.

Question 175

Topic: Hand Trauma & Infection

A 29-year-old presents with a severely swollen, erythematous, and throbbing volar distal pad of the index finger, consistent with a felon. If surgical drainage is performed, which anatomical consideration is crucial regarding the fibrous septa of the retinaculum cutis?

. They must be completely preserved to maintain pulp contour
. They should be sharply divided to decompress the individual pulp spaces
. They only exist in the proximal phalanx and do not affect fingertip incisions
. They transmit the primary venous drainage and bleeding is excessive if cut
. They are contiguous with the flexor tendon sheath, increasing the risk of pyogenic flexor tenosynovitis

Correct Answer & Explanation

. They should be sharply divided to decompress the individual pulp spaces

Explanation

A felon is a closed-space infection of the volar fingertip pulp. The pulp is divided into multiple small, discrete compartments by vertical fibrous septa; adequate surgical drainage requires disrupting these septa to fully decompress the purulent material.

Question 176

Topic: Hand Trauma & Infection

A 27-year-old carpenter presents with a swollen, painful index finger 3 days after a puncture wound. Upon examination, he exhibits all four of Kanavel's cardinal signs for suppurative flexor tenosynovitis. Which of these four signs is considered the earliest and most sensitive indicator of this condition?

. Fusiform swelling of the digit
. Flexed resting posture of the digit
. Tenderness along the flexor tendon sheath
. Pain with passive extension of the digit
. Erythema extending to the palmar crease

Correct Answer & Explanation

. Pain with passive extension of the digit

Explanation

Kanavel's four cardinal signs of purulent flexor tenosynovitis are: 1) fusiform (sausage-like) swelling, 2) flexed resting posture of the digit, 3) exquisite tenderness along the entire course of the flexor tendon sheath, and 4) excruciating pain with passive extension of the digit. Pain with passive extension is historically and clinically considered the earliest and most sensitive sign of the condition.

Question 177

Topic: Hand Trauma & Infection

A 28-year-old nurse presents with a painful, erythematous, and swollen index finger pulp. Exam shows multiple coalescing vesicles filled with clear fluid on the volar pad. The pulp is tense, but no focal fluctuance is felt. What is the most appropriate initial management?

. Urgent bedside incision and drainage followed by oral antibiotics
. Formal surgical debridement in the operating room
. Oral acyclovir and application of a dry dressing
. Local corticosteroid injection to reduce inflammation
. Partial nail plate removal and eponychial marsupialization

Correct Answer & Explanation

. Oral acyclovir and application of a dry dressing

Explanation

The patient has a herpetic whitlow, a viral infection of the distal finger caused by Herpes Simplex Virus (HSV 1 or 2). It classically presents with coalescing vesicles. It is typically self-limiting but can be treated with oral acyclovir. Incision and drainage is strictly contraindicated as it provides no benefit, delays healing, and carries a high risk of secondary bacterial superinfection.

Question 178

Topic: Hand Trauma & Infection

A 35-year-old carpenter presents with a swollen, painful index finger 3 days after a puncture wound. Which of the following Kanavel's signs is typically the earliest and most reliable indicator of acute suppurative flexor tenosynovitis?

. Symmetric, uniform swelling of the entire digit
. Flexed resting posture of the digit
. Tenderness along the course of the flexor tendon sheath
. Exquisite pain with passive extension of the digit
. Erythema extending to the palmar crease

Correct Answer & Explanation

. Exquisite pain with passive extension of the digit

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis are: 1) flexed resting posture, 2) fusiform swelling (sausage digit), 3) tenderness along the flexor sheath, and 4) pain with passive extension. Exquisite pain with passive extension of the affected digit is widely considered the earliest, most sensitive, and most reliable clinical sign.

Question 179

Topic: Hand Trauma & Infection

A 40-year-old carpenter presents with a swollen, erythematous, and painful index finger after sustaining a puncture wound 2 days ago. Which of the following is NOT one of Kanavel's cardinal signs of acute suppurative flexor tenosynovitis?

. Fusiform swelling of the digit
. Tenderness along the flexor tendon sheath
. Pain with active finger flexion
. Pain with passive finger extension
. Finger held in a resting posture of slight flexion

Correct Answer & Explanation

. Pain with active finger flexion

Explanation

Kanavel's four cardinal signs include fusiform swelling, tenderness along the tendon sheath, resting flexion posture, and pain with passive extension. Pain with active flexion is not one of the specific classic signs, as pain on passive extension is the most sensitive early indicator.

Question 180

Topic: Hand Trauma & Infection

A 35-year-old carpenter sustains a puncture wound to his right index finger. Two days later, he presents with severe pain and swelling. Which of the following is NOT one of Kanavel's cardinal signs of flexor tenosynovitis?

. Flexed posture of the digit
. Fusiform swelling of the digit
. Erythema extending to the forearm
. Tenderness along the flexor tendon sheath
. Pain with passive extension of the digit

Correct Answer & Explanation

. Erythema extending to the forearm

Explanation

Kanavel's four cardinal signs of flexor tenosynovitis include flexed resting posture, fusiform swelling, tenderness along the flexor sheath, and severe pain on passive extension. Erythema extending to the forearm indicates spreading cellulitis or lymphangitis.

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