Nerve & Tendon MCQs

A 25-year-old male complains of progressive weakness in his forearm flexors (excluding the flexor carpi ulnaris and ulnar half of the FDP) and numbness in his thumb, index, middle, and radial ring fingers. Examination reveals tenderness along the medial aspect of the distal humerus, just proximal to the medial epicondyle. Radiographs reveal a supracondylar spur (ligament of Struthers). What is the MOST likely diagnosis?

A 35-year-old carpenter presents with a painful mass in the palm of his hand, at the base of his ring finger. The finger locks in flexion and requires passive extension with an audible 'click'. Examination reveals a tender nodule at the A1 pulley level. What is the MOST appropriate initial management?

A 40-year-old patient undergoes an open carpal tunnel release. Post-operatively, he complains of persistent numbness in the median nerve distribution and new weakness of his intrinsic hand muscles. On examination, he has a positive Froment's sign and Wartenberg's sign. What is the MOST likely iatrogenic injury?

A 15-year-old competitive gymnast presents with chronic posteromedial elbow pain. She complains of pain with elbow extension, especially during overhead activities. Radiographs show hypertrophy of the posteromedial olecranon and loose bodies within the olecranon fossa. What is the MOST appropriate surgical intervention?

A 55-year-old woman develops progressive bilateral numbness and tingling in her ring and small fingers after undergoing cervical spine fusion for myelopathy. She has no new neck pain. Examination reveals decreased sensation in the ulnar nerve distribution and weakness of intrinsic hand muscles. Nerve conduction studies confirm bilateral ulnar neuropathy at the elbow. What is the MOST likely cause of her symptoms?

A 35-year-old male sustains a complete, confirmed sharp laceration of the ulnar nerve at the level of the medial epicondyle. Upon physical examination 6 months later, the patient unexpectedly demonstrates intact active function of the first dorsal interosseous and adductor pollicis muscles, despite a profound sensory deficit in the little finger. Which of the following anatomical anomalies best explains this clinical finding?

A 50-year-old man presents with a 4-month history of numbness in his ring and small fingers, accompanied by weakness in his hand grip. Examination reveals a positive Froment's sign. Which of the following physical examination findings would best differentiate the site of ulnar nerve compression as being at the cubital tunnel rather than Guyon's canal?

A 45-year-old carpenter presents with numbness and tingling in the small and ring fingers of his right hand, along with weakness in grip strength. On examination, when asked to hold a piece of paper between his thumb and radial side of his index finger against resistance, the interphalangeal joint of his thumb hyperflexes (positive Froment sign). Which muscle is the patient substituting with to maintain hold of the paper?

A 48-year-old male with severe cubital tunnel syndrome is undergoing an anterior transposition of the ulnar nerve. To prevent secondary compression post-transposition, the surgeon must systematically release all potential sites of ulnar nerve entrapment around the elbow. Which of the following structures represents the most proximal potential site of compression for the ulnar nerve in this region?

A 50-year-old man presents with chronic numbness in his small and ring fingers, accompanied by intrinsic muscle wasting and a positive Froment's sign. Electromyography confirms severe compression of the ulnar nerve at the elbow. During an in situ ulnar nerve decompression, the surgeon must ensure all potential sites of compression are released. Which of the following is the most common anatomical site of ulnar nerve compression in this region?

A 28-year-old carpenter presents with an inability to make an 'OK' sign with his right hand. On examination, his thumb interphalangeal joint and index finger distal interphalangeal joint remain extended when attempting to pinch. He has no sensory deficits. Which of the following anatomical variants is a well-known cause of this specific nerve compression syndrome?

During surgical decompression and anterior transposition of the ulnar nerve for severe cubital tunnel syndrome, the surgeon meticulously releases all potential sites of compression. From proximal to distal, which of the following structures represents the most proximal potential site of ulnar nerve compression in the arm?

A 45-year-old woman undergoes surgical decompression of the ulnar nerve for severe cubital tunnel syndrome. During the approach, the primary structure causing compression between the olecranon and the medial epicondyle is identified and released. Which of the following anatomical structures forms the true roof of the cubital tunnel in this region?

During the repair of an acute distal biceps tendon rupture using a single-incision anterior approach, the surgeon must be particularly careful to protect a specific nerve during the deep dissection and placement of retractors on the radial side of the radial tuberosity. Injury to this nerve leads to an inability to extend the digits. Which nerve is at greatest risk?

A 45-year-old male laborer undergoes a two-incision approach (modified Boyd-Anderson) for the repair of an acute distal biceps tendon rupture. During the posterolateral approach (second incision) to expose the radial tuberosity, excessive retraction or improper splitting of the supinator muscle places which of the following neurovascular structures at highest risk of iatrogenic injury?

A 55-year-old male undergoes an in situ decompression of the ulnar nerve for severe cubital tunnel syndrome. During the release of Osborne's fascia, the surgeon identifies and meticulously protects the first motor branch of the ulnar nerve in the forearm. Which of the following muscles is innervated by this specific branch?

During an in situ ulnar nerve decompression for cubital tunnel syndrome, the surgeon releases the nerve from the cubital tunnel. To prevent proximal entrapment, the surgeon explores the medial arm. Which fascial structure represents a potential site of ulnar nerve compression up to 8 cm proximal to the medial epicondyle?

A 45-year-old male presents with persistent medial elbow pain, constant numbness in the ring and small fingers, and intrinsic muscle weakness 12 months after an in situ ulnar nerve decompression at the cubital tunnel. Postoperative EMG/NCS confirms persistent, severe ulnar neuropathy localized to the elbow. Which of the following revision procedures is most appropriate?

During surgical decompression of the ulnar nerve for cubital tunnel syndrome, multiple potential sites of compression must be evaluated. Which of the following anatomical structures represents the most common site of ulnar nerve entrapment in this region?

A 52-year-old man with severe, electromyographically confirmed cubital tunnel syndrome is undergoing an anterior subcutaneous transposition of the ulnar nerve. During the transposition, a specific structural band extending from the medial epicondyle to the medial humerus must be resected to prevent secondary kinking of the nerve as it is moved anteriorly. What is this structure?