Menu

Nerve & Tendon MCQs

Practice Set 20 of 53

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

Question 381

Topic: Nerve & Tendon

During a Zone II flexor tendon repair, which of the following technical factors is most important for minimizing tendon gliding resistance and allowing for early active mobilization?

. Addition of a running epitendinous suture
. Increasing the number of core suture strands from 2 to 6
. Using a thicker caliber core suture (e.g., 3-0 instead of 4-0)
. Complete venting of the A2 pulley
. Immobilization for 3 weeks prior to movement

Correct Answer & Explanation

. Addition of a running epitendinous suture

Explanation

The addition of a running epitendinous suture significantly decreases gliding resistance by smoothing the repair site. It also increases the overall tensile strength of the repair by up to 30%.

Question 382

Topic: Nerve & Tendon

A 70-year-old male is being evaluated for cervical spondylotic myelopathy. Which of the following physical examination findings is an upper motor neuron sign highly specific to cervical cord compression?

. Absent brachioradialis reflex
. Positive Tinel's sign at the cubital tunnel
. Inverted brachioradialis reflex
. Weakness in intrinsic hand muscle abduction
. Decreased sensation in the C6 dermatome

Correct Answer & Explanation

. Inverted brachioradialis reflex

Explanation

An inverted brachioradialis reflex (spontaneous finger flexion upon striking the brachioradialis tendon) is a classic upper motor neuron sign. It indicates cord compression at the C5-C6 level with simultaneous lower motor neuron loss at C6 and upper motor neuron hyperreflexia below that level.

Question 383

Topic: Nerve & Tendon

A candidate is asked about clinical tests for ulnar nerve compression (cubital tunnel syndrome). The examiner asks what muscle weakness produces a positive Froment's sign. Which muscle is primarily affected?

. Flexor pollicis longus
. Adductor pollicis
. Abductor pollicis brevis
. First dorsal interosseous
. Opponens pollicis

Correct Answer & Explanation

. Adductor pollicis

Explanation

A positive Froment's sign occurs due to weakness of the adductor pollicis (innervated by the ulnar nerve). The patient compensates by using the flexor pollicis longus (median nerve) to pinch, resulting in hyperflexion of the thumb interphalangeal joint.

Question 384

Topic: Nerve & Tendon

A paediatric orthopaedic viva scenario involves a 6-year-old boy with a heavily displaced, extension-type supracondylar fracture of the humerus. On examination, he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. Which specific nerve branch is injured, and what is the typical prognosis?

. Ulnar nerve; requires immediate open exploration.
. Posterior interosseous nerve; expected to recover spontaneously within 3 months.
. Anterior interosseous nerve; expected to recover spontaneously within 3 to 6 months.
. Recurrent motor branch of the median nerve; high risk of permanent thenar atrophy.
. Musculocutaneous nerve; requires early nerve grafting if no recovery by 6 weeks.

Correct Answer & Explanation

. Anterior interosseous nerve; expected to recover spontaneously within 3 to 6 months.

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar fractures. It presents with the inability to make an "OK" sign, and the vast majority resolve spontaneously within 3 to 6 months without surgical exploration.

Question 385

Topic: Nerve & Tendon

A 35-year-old female presents with an inability to make an 'OK' sign with her thumb and index finger, demonstrating flattening of the distal interphalangeal joint of the index finger and interphalangeal joint of the thumb. She has no sensory deficits. Which nerve is compressed, and what is the most common anatomic site of entrapment?

. Ulnar nerve at Guyon's canal
. Median nerve at the carpal tunnel
. Anterior interosseous nerve at the pronator teres or FDS arcade
. Posterior interosseous nerve at the arcade of Frohse
. Radial nerve at the spiral groove

Correct Answer & Explanation

. Anterior interosseous nerve at the pronator teres or FDS arcade

Explanation

The patient has Anterior Interosseous Nerve (AIN) syndrome, evidenced by weakness in the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger. The AIN is a purely motor branch of the median nerve. Compression most commonly occurs at the deep head of the pronator teres or the fibrous arcade of the flexor digitorum superficialis (FDS).

Question 386

Topic: Nerve & Tendon

A 6-year-old boy falls from monkey bars and sustains a widely displaced, extension-type supracondylar humerus fracture. After closed reduction and percutaneous pinning, the patient demonstrates an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is injured?

. Main trunk of the median nerve
. Anterior interosseous nerve
. Radial nerve
. Ulnar nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The Anterior Interosseous Nerve (AIN) is the most frequently injured nerve in extension-type supracondylar humerus fractures (often contused by the proximal fragment). It innervates the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index and long fingers. The radial nerve is the second most common, particularly in posteromedial displacement.

Question 387

Topic: Nerve & Tendon

A 30-year-old male sustains a complete laceration of the median nerve at the wrist joint level. Despite the complete transection, physical examination reveals partially preserved function of the thenar musculature. This clinical finding is most likely explained by the presence of which of the following anomalous neural interconnections?

. Martin-Gruber anastomosis
. Riche-Cannieu anastomosis
. Marinacci communication
. Berrettini anastomosis
. Bouvier's anomaly

Correct Answer & Explanation

. Riche-Cannieu anastomosis

Explanation

The Riche-Cannieu anastomosis is an anomalous connection between the deep motor branch of the ulnar nerve and the recurrent motor branch of the median nerve in the palm. When present, it allows the ulnar nerve to supply innervation to some or all of the thenar muscles, preserving function even if the median nerve is lacerated at the wrist. Martin-Gruber is in the forearm.

Question 388

Topic: Nerve & Tendon

A cyclist complains of isolated weakness in the interosseous muscles of the hand and a claw deformity of the ring and small fingers. He has completely normal sensation in the small finger and the ulnar half of the ring finger. Compression of the ulnar nerve is most likely occurring in which zone of Guyon's canal?

. Zone 1
. Zone 2
. Zone 3
. Cubital tunnel
. Arcade of Struthers

Correct Answer & Explanation

. Zone 2

Explanation

Guyon's canal is divided into 3 zones. Zone 1 is proximal to the nerve bifurcation; compression here causes mixed motor and sensory deficits. Zone 2 surrounds the deep motor branch; compression here causes isolated motor deficits (interosseous weakness, clawing) with spared sensation. Zone 3 surrounds the superficial sensory branch; compression causes isolated sensory deficits.

Question 389

Topic: Nerve & Tendon

A 24-year-old avid golfer presents with weakness of the intrinsic muscles of the hand. Sensation is perfectly normal over the entire volar and dorsal aspect of the hand and digits. A fracture of the hook of the hamate is identified. In which zone of Guyon's canal is the ulnar nerve compression most likely occurring?

. Zone 1
. Zone 2
. Zone 3
. Zone 4
. Zone 5

Correct Answer & Explanation

. Zone 3

Explanation

Guyon's canal is divided into 3 zones. Zone 1 is proximal to the bifurcation and contains both motor and sensory fibers. Zone 2 surrounds the deep motor branch of the ulnar nerve after it bifurcates and passes adjacent to the hook of the hamate; compression here causes isolated motor weakness of the ulnar-innervated intrinsics. Zone 3 encompasses the superficial sensory branch; compression here causes isolated sensory deficits. Hook of the hamate fractures typically compress Zone 2.

Question 390

Topic: Nerve & Tendon

A 25-year-old rugby player presents with an inability to actively flex the distal interphalangeal (DIP) joint of his ring finger after grabbing an opponent's jersey. Radiographs are normal. Examination reveals a mass in the palm. According to the Leddy and Packer classification, this is a Type 1 injury. What is the recommended timeline for surgical repair?

. Within 7 to 10 days
. Within 24 hours
. Within 3 to 4 weeks
. After 6 weeks to allow inflammation to subside
. Staged tendon reconstruction is required immediately

Correct Answer & Explanation

. Within 7 to 10 days

Explanation

A Leddy and Packer Type 1 jersey finger involves avulsion of the FDP tendon with retraction all the way into the palm. This completely disrupts the vincula, compromising the blood supply to the tendon. Early surgical repair (within 7-10 days) is required before the tendon undergoes myostatic contracture and necrosis, making primary repair impossible.

Question 391

Topic: Nerve & Tendon

A 6-year-old boy presents with a displaced lateral condyle fracture of the humerus. Which of the following describes the most likely long-term complication if this fracture goes on to nonunion?

. Cubitus varus and tardy radial nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Cubitus valgus and median nerve palsy
. Cubitus varus and tardy ulnar nerve palsy
. Premature physeal closure with limb length discrepancy

Correct Answer & Explanation

. Cubitus valgus and tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle humerus fracture often leads to progressive cubitus valgus deformity. Over time, the stretching of the ulnar nerve behind the medial epicondyle can cause a tardy ulnar nerve palsy. Cubitus varus is classically associated with supracondylar humerus malunions.

Question 392

Topic: Nerve & Tendon

A patient with rheumatoid arthritis presents with a swan neck deformity of the ring finger. What is the primary pathophysiological event that typically initiates this specific deformity in the rheumatoid hand?

. Rupture of the extensor tendon central slip
. Volar plate laxity or attenuation at the PIP joint
. Subluxation of the lateral bands volar to the PIP joint axis
. Intrinsic muscle tightness and MCP joint subluxation
. Rupture of the flexor digitorum profundus (FDP) tendon

Correct Answer & Explanation

. Volar plate laxity or attenuation at the PIP joint

Explanation

In rheumatoid arthritis, the swan neck deformity typically initiates with synovitis at the proximal interphalangeal (PIP) joint, leading to stretching and attenuation of the volar plate. This causes PIP joint hyperextension, followed secondarily by dorsal subluxation of the lateral bands and compensatory flexion at the DIP joint. Central slip rupture causes a boutonniere deformity.

Question 393

Topic: Nerve & Tendon
A rugby player sustains a flexor digitorum profundus (FDP) avulsion of the ring finger (Jersey finger). Intraoperatively, the surgeon finds the tendon stump blocked at the level of the A4 pulley due to a large bony avulsion fragment. How is this injury classified according to the Leddy-Packer classification?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

The Leddy-Packer classification for FDP avulsion: Type I involves retraction to the palm (loss of all blood supply, repair within 7-10 days). Type II involves retraction to the PIP joint level (caught at chiasm of Camper, blood supply intact via vincula longa). Type III involves a large bony avulsion that gets caught at the A4 pulley, preventing further proximal retraction.

Question 394

Topic: Nerve & Tendon

A 35-year-old new mother presents with severe pain over the radial styloid. Finkelstein's test is markedly positive. After failing conservative management, she is scheduled for surgical release of the first dorsal compartment (De Quervain's tenosynovitis). Which of the following nerve branches is at the highest risk of iatrogenic injury during the superficial surgical dissection of this procedure?

. Palmar cutaneous branch of the median nerve
. Superficial branch of the radial nerve
. Dorsal cutaneous branch of the ulnar nerve
. Posterior interosseous nerve
. Lateral antebrachial cutaneous nerve

Correct Answer & Explanation

. Superficial branch of the radial nerve

Explanation

The superficial branch of the radial nerve (SBRN) runs in extremely close proximity to the first dorsal compartment. It typically crosses over the extensor retinaculum just superficial to the compartment. Iatrogenic injury to this nerve during De Quervain's release is a well-known complication that can lead to a highly debilitating and painful neuroma.

Question 395

Topic: Nerve & Tendon
A 22-year-old rugby player presents with an inability to actively flex the distal interphalangeal (DIP) joint of his ring finger after grabbing an opponent's jersey. Ultrasound confirms avulsion of the flexor digitorum profundus (FDP) tendon with retraction of the tendon end into the palm (Zone II). Based on the Leddy and Packer classification, what type of injury is this and what is the optimal surgical timeframe?
. Type I - requires repair within 7-10 days
. Type II - requires repair within 7-10 days
. Type I - can be safely repaired up to 6 weeks post-injury
. Type II - can be safely repaired up to 6 weeks post-injury
. Type III - requires immediate DIP arthrodesis

Correct Answer & Explanation

. Type I - requires repair within 7-10 days

Explanation

This is a classic 'Jersey finger' injury. According to the Leddy and Packer classification: Type I involves retraction of the FDP tendon into the palm, which ruptures both the vincula longa and brevia. The tendon loses its blood supply and must be repaired within 7 to 10 days before irreversible tendon retraction and necrosis occur. Type II retracts to the level of the PIP joint (held by the intact vinculum longum) and can be repaired later. Type III involves a large bony avulsion that catches at the A4 pulley.

Question 396

Topic: Nerve & Tendon

During a complex trigger finger release in a 55-year-old diabetic patient, the surgeon inadvertently excises the entire A2 pulley of the ring finger. What is the most likely biomechanical consequence of this isolated injury?

. Decreased excursion of the flexor digitorum profundus (FDP)
. Increased work of flexion and bowstringing
. Inability to initiate distal interphalangeal joint flexion
. Swan neck deformity
. Boutonniere deformity

Correct Answer & Explanation

. Increased work of flexion and bowstringing

Explanation

The A2 and A4 pulleys are the most critical mechanically for maintaining the flexor tendons close to the bone. Loss of the A2 pulley leads to volar displacement of the flexor tendons (bowstringing). While bowstringing increases the moment arm (torque) at the joint, it significantly decreases the mechanical efficiency of the tendon, leading to an increased work of flexion and requiring increased tendon excursion to achieve the same arc of motion.

Question 397

Topic: Nerve & Tendon
A patient presents with profound intrinsic muscle weakness in the right hand. Neurological examination reveals marked atrophy of the first dorsal interosseous and hypothenar muscles. However, sensation is completely preserved over both the volar and dorsal aspects of the small finger and the ulnar half of the ring finger. The compressive pathology is most likely located in which anatomical region?
. Guyon's canal Zone I
. Guyon's canal Zone II
. Guyon's canal Zone III
. The cubital tunnel
. The arcade of Struthers

Correct Answer & Explanation

. Guyon's canal Zone II

Explanation

Guyon's canal is divided into three zones. Zone I contains the mixed ulnar nerve proximal to its bifurcation. Compression here causes mixed motor and sensory deficits. Zone II surrounds the deep motor branch only; compression here results in isolated motor weakness of the ulnar-innervated intrinsic muscles with spared sensation. Zone III surrounds the superficial sensory branch; compression here causes isolated volar sensory deficits. The dorsal sensory branch leaves the main nerve proximal to Guyon's canal, so its sensation is spared in all Guyon's canal lesions.

Question 398

Topic: Nerve & Tendon

A 50-year-old woman complains of numbness in her ring and small fingers, and weakness in her hand. Examination shows a positive Froment's sign when she is asked to hold a piece of paper between her thumb and index finger. Which muscle is compensating to produce the positive Froment's sign?

. Flexor pollicis longus
. Adductor pollicis
. Abductor pollicis brevis
. First dorsal interosseous
. Extensor pollicis longus

Correct Answer & Explanation

. Adductor pollicis

Explanation

Froment's sign occurs in ulnar nerve palsy. The paralyzed adductor pollicis (ulnar nerve) is compensated for by the flexor pollicis longus (innervated by the Anterior Interosseous Nerve branch of the median nerve), causing hyperflexion of the thumb interphalangeal joint during pinch.

Question 399

Topic: Nerve & Tendon
According to the modified Verdan classification of flexor tendon zones in the hand, which zone is historically referred to as 'no man's land' due to the high propensity for adhesion formation and poor surgical outcomes?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Zone II extends from the proximal edge of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS). Historically, it was termed 'no man's land' by Sterling Bunnell because both the FDS and FDP tendons run tightly together within the narrow fibro-osseous sheath, making primary repair technically demanding and highly prone to restrictive adhesions.

Question 400

Topic: Nerve & Tendon

During an in situ ulnar nerve decompression at the elbow, the surgeon must divide several structures to fully release the cubital tunnel. Which of the following structures forms the roof of the cubital tunnel?

. The medial intermuscular septum
. Osborne's ligament
. The Arcade of Struthers
. The deep flexor pronator aponeurosis
. The medial collateral ligament of the elbow

Correct Answer & Explanation

. Osborne's ligament

Explanation

The cubital tunnel is bounded by the medial epicondyle anteriorly, the olecranon laterally, and the elbow joint capsule and medial collateral ligament (MCL) as the floor. The roof is formed by Osborne's ligament (the cubital tunnel retinaculum), which spans from the medial epicondyle to the olecranon and blends with the fascia of the two heads of the flexor carpi ulnaris (FCU).

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page