Nerve & Tendon MCQs

A 40-year-old avid cyclist presents with hand weakness. Examination shows isolated profound weakness of the adductor pollicis and dorsal interossei muscles of the right hand. Sensation in the small finger is completely normal, and the hypothenar muscles demonstrate normal bulk and strength. An ulnar nerve compression is most likely localized to which zone of Guyon's canal?

A 48-year-old carpenter presents with progressive numbness in his small and ring fingers, accompanied by intrinsic hand muscle weakness. Clinical evaluation suggests ulnar nerve entrapment at the elbow. Which of the following structures is the most common site of compression for this condition?

A 45-year-old male presents with progressive hand clumsiness, intrinsic muscle atrophy, and a positive Froment's sign. He reports a childhood elbow fracture that was treated non-operatively. Current elbow radiographs reveal a severe cubitus valgus deformity and a nonunion of the lateral humeral condyle. What is the pathomechanism of his current neurologic deficit?

When performing a single-incision anterior approach for the repair of a distal biceps tendon rupture, excessive traction on the lateral soft-tissue retractors most commonly places which of the following nerves at risk of injury?

A 21-year-old collegiate baseball pitcher is undergoing ulnar collateral ligament (UCL) reconstruction. Which of the following technical steps regarding the ulnar nerve is currently recommended for routine primary UCL reconstructions to minimize postoperative neuropathy?

An avid cyclist presents with a 3-month history of right hand weakness. Examination reveals marked atrophy of the dorsal interossei and a positive Froment sign. Sensation is completely intact over the volar and dorsal aspects of the small finger and the ulnar half of the ring finger. Hypothenar muscle bulk is normal. Where is the most likely site of ulnar nerve compression?

Which of the following physical examination findings is highly specific for distinguishing true neurogenic thoracic outlet syndrome (TOS) from a severe compressive ulnar neuropathy at the elbow (cubital tunnel syndrome)?

In the classic Oberlin transfer used to restore elbow flexion following an upper trunk (C5-C6) brachial plexus avulsion injury, which specific nerve fascicles are transferred to the motor branch of the biceps?

When performing an autogenous cable nerve graft to bridge a 4-cm defect in the median nerve, standard surgical technique involves reversing the orientation of the harvested nerve graft. What is the primary biological rationale for this step?

To restore elbow flexion in a patient with a traumatic C5-C6 brachial plexus root avulsion, an Oberlin transfer is planned. Which of the following describes the classic donor and recipient nerves in this procedure?

Vascularized nerve grafts (e.g., vascularized ulnar nerve graft) are considered theoretically superior to standard non-vascularized nerve autografts in which of the following specific clinical scenarios?

A 19-year-old rugby player sustains a closed jersey finger injury of the ring finger. Radiographs show no fracture, and the flexor digitorum profundus (FDP) tendon is palpable in the palm. To prevent irreversible contracture and tendon necrosis due to disrupted vincular blood supply, definitive repair should ideally be performed within what timeframe?

A patient is undergoing an Oberlin transfer for a C5-C6 brachial plexus root avulsion to restore elbow flexion. Which specific donor nerve fascicle is most commonly transferred to the motor branch of the biceps?

Six months after a Zone II flexor tendon repair of the middle finger, a patient complains that the affected digit paradoxically extends at the proximal interphalangeal (PIP) joint when attempting to make a tight fist. What is the most likely etiology of this phenomenon?

A patient presents with a Boutonniere deformity 4 weeks after sustaining a closed crush injury to the PIP joint. Which of the following describes the underlying pathomechanics of this deformity?

A 32-year-old woman presents with severe, excruciating pain in the tip of her left index finger, which is severely exacerbated by cold weather. On exam, there is pinpoint tenderness beneath the nail bed. Application of a tourniquet to the base of the finger completely relieves her pain during the examination. This specific physical exam finding is known as:

A 42-year-old woman complains of severe, paroxysmal pain at the tip of her left ring finger. The pain is exacerbated by cold weather. On examination, a subtle bluish discoloration is seen under the nail plate, and exquisite point tenderness is noted. Which of the following clinical tests is most specific for diagnosing this condition?

A patient with an isolated low ulnar nerve palsy exhibits a pronounced claw deformity of the ring and small fingers. A Bouvier test is performed and is positive (the patient is able to actively extend the PIP joints when the examiner blocks the MCP joints in slight flexion). Based on this finding, which of the following procedures is most appropriate to dynamically correct the deformity?