Nerve & Tendon MCQs

A 45-year-old female presents with a 6-month history of a symptomatic chronic soft-tissue mallet finger of her left index finger. She has developed a swan neck deformity with a 35-degree extensor lag at the DIP joint and PIP joint hyperextension. Both joints remain fully passively correctable, and there is no radiographic evidence of osteoarthritis. Which of the following surgical interventions is most appropriate?

A 50-year-old male presents to your clinic 5 weeks after sustaining a closed soft-tissue mallet injury to his right small finger. He has not sought prior medical attention and currently has a 40-degree extensor lag at the DIP joint. Radiographs are negative for fractures. What is the recommended initial management for this delayed presentation?

A 62-year-old male presents with a chronic mallet finger of his right index finger sustained 5 years ago. He complains of significant pain, difficulty with pinch grip, and a 45-degree extensor lag. Radiographs reveal complete loss of joint space, subchondral sclerosis, and osteophytes at the DIP joint. What is the definitive treatment of choice?

In the pathogenesis of a swan neck deformity resulting from an untreated mallet finger, the initial flexed posture of the DIP joint leads to a biomechanical cascade. Which of the following best describes the primary anatomic change at the PIP joint?

A 48-year-old carpenter presents with a painful locking sensation in his right middle finger. He points to the base of his finger in the palm as the site of discomfort. During surgical planning for an A1 pulley release, the surgeon must accurately identify the anatomical location of the A1 pulley. For the middle finger, where is the A1 pulley consistently situated relative to the palmar creases?

A 60-year-old woman reports a 'catching' and 'snapping' sensation in her left ring finger when she tries to extend it after making a fist. This has progressed to the point where she sometimes needs to use her other hand to straighten the finger. The underlying biomechanical pathology responsible for this 'triggering' phenomenon, as described in the case, primarily involves:

During an open A1 pulley release for a trigger index finger, a surgeon is meticulously dissecting through the subcutaneous tissue and palmar fascia. The proper digital nerves and arteries are identified and retracted. According to the case, which specific digital nerve is particularly vulnerable during this procedure for the index finger?

A 35-year-old mother presents with a 9-month history of painful locking of her right thumb, which she describes as interfering significantly with her ability to care for her infant. She has a palpable nodule at the base of her thumb and a fixed flexion deformity of the MCP joint, requiring passive manipulation to extend. She has undergone two corticosteroid injections, with only temporary relief lasting less than 2 weeks each time. Based on the provided indications, what is the most appropriate next step in her management?

A 68-year-old male undergoes an open A1 pulley release for a trigger middle finger. Two weeks post-operatively, he reports that while the pain has improved, he still experiences a 'catching' sensation when actively flexing and extending his finger, similar to his pre-operative symptoms, though perhaps less severe. On examination, a subtle click is still palpable at the base of the finger. Based on the case, what is the most likely cause of his persistent symptoms?

During an open A1 pulley release, after identifying and retracting the neurovascular bundles, the surgeon exposes the glistening white flexor tendon sheath. To ensure safe and complete release of the A1 pulley, which critical step should be performed immediately before incising the pulley?

A surgeon is performing an A1 pulley release. During the procedure, there is concern about inadvertently damaging adjacent pulleys. The case highlights the importance of preserving specific pulleys to prevent bowstringing and maintain the mechanical advantage of the flexor tendons. Which of the following pulleys is considered critical to preserve during an A1 pulley release to avoid bowstringing?

During an open trigger finger release of the middle finger, the surgeon incises the A1 pulley. Which adjacent annular pulley is most critical to preserve to prevent bowstringing of the flexor tendons?

A 2-year-old child presents with a fixed flexion deformity of the right thumb interphalangeal joint. The parents state the thumb has been "stuck" for a month. A palpable Nott's node is present at the volar metacarpophalangeal joint. What is the most appropriate initial management?

A 55-year-old patient with poorly controlled type 2 diabetes mellitus presents with a locked trigger ring finger. How does the patient's diabetic status affect the expected outcome of a local corticosteroid injection compared to a non-diabetic patient?

During an open surgical release of the A1 pulley for a trigger thumb, which nerve is at greatest risk of iatrogenic injury due to its oblique anatomical course crossing the flexor pollicis longus sheath?

During an open surgical release of the A1 pulley for a trigger thumb, which neurovascular structure is at the greatest risk of iatrogenic injury due to its anatomical course?

Which of the following describes the primary histological finding in the A1 pulley of a patient with chronic trigger finger?

During surgical release of a pediatric trigger thumb, which neurological structure is at highest risk of iatrogenic injury due to its anatomical course?

A 58-year-old patient with long-standing type 1 diabetes mellitus presents with a locking ring finger. What is the most accurate information regarding the expected outcome of a single corticosteroid injection for her trigger finger compared to a non-diabetic patient?