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Nerve & Tendon MCQs

Practice Set 3 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 41

Topic: Nerve & Tendon

A 5-year-old child presents with an extension-type supracondylar humerus fracture. Examination reveals an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?

. Median nerve
. Anterior interosseous nerve
. Ulnar nerve
. Radial nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Median nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar fractures. It is a motor branch of the median nerve innervating the flexor pollicis longus and the flexor digitorum profundus to the index and middle fingers.

Question 42

Topic: Nerve & Tendon

A 5-year-old child sustains a displaced extension-type supracondylar humerus fracture. Examination reveals weakness in flexing the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Musculocutaneous nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. It innervates the flexor pollicis longus and flexor digitorum profundus to the index finger.

Question 43

Topic: Nerve & Tendon

A radiograph

of a 10-year-old girl who sustained a lateral condyle fracture of the humerus 5 years ago shows an established nonunion. She now complains of clumsiness in her hand and numbness in her little finger. This complication is most directly related to:

. Progressive cubitus varus deformity
. Ischemia of the anterior interosseous nerve
. Cubitus valgus deformity causing ulnar nerve stretching
. Direct ulnar nerve injury sustained at the time of the initial fracture
. Overgrowth of the lateral condyle compressing the median nerve

Correct Answer & Explanation

. Cubitus valgus deformity causing ulnar nerve stretching

Explanation

Nonunion of a lateral condyle fracture typically results in a progressive cubitus valgus deformity. Over time, this valgus angulation stretches the ulnar nerve, leading to tardy ulnar nerve palsy.

Question 44

Topic: Nerve & Tendon

A 6-year-old boy sustains an extension-type supracondylar humerus fracture. He is unable to flex the interphalangeal joint of his thumb. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. It innervates the FPL, responsible for thumb IP joint flexion.

Question 45

Topic: Nerve & Tendon

The most common neural injury after a supracondylar fracture of the distal humerus is:

. Anterior interosseous nerve
. Median nerve
. Posterior interosseous nerve
. Radial nerve
. Ulnar nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The most commonly injured nerve after a supracondylar fracture of the distal humerus is the anterior interosseous nerve. An injury to this nerve results in the inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger.

Question 46

Topic: Nerve & Tendon

Which of the following is the most proximal potential site of ulnar nerve compression in cubital tunnel syndrome?

. Arcade of Struthers
. Medial intermuscular septum
. Osborne's ligament
. Aponeurosis of the flexor carpi ulnaris
. Deep flexor pronator aponeurosis

Correct Answer & Explanation

. Arcade of Struthers

Explanation

The Arcade of Struthers is a fascial band located about 8 cm proximal to the medial epicondyle and represents the most proximal potential site for ulnar nerve compression. Other sites include the medial intermuscular septum, Osborne's ligament, and the FCU aponeurosis.

Question 47

Topic: Nerve & Tendon

In radial tunnel syndrome, compression of the posterior interosseous nerve most frequently occurs at which of the following structures?

. Fibrous bands anterior to the radiocapitellar joint
. Vascular leash of Henry
. Leading edge of the extensor carpi radialis brevis
. Arcade of Frohse
. Distal edge of the supinator

Correct Answer & Explanation

. Arcade of Frohse

Explanation

While compression can occur at multiple sites within the radial tunnel, the most common site of compression for the posterior interosseous nerve is the Arcade of Frohse. This is the thickened proximal aponeurotic edge of the superficial supinator muscle.

Question 48

Topic: Nerve & Tendon

During a single-incision anterior approach for repairing an acute distal biceps tendon rupture, which nerve is most frequently injured or irritated due to its superficial location and proximity to the cephalic vein?

. Lateral antebrachial cutaneous nerve (LABCN)
. Posterior interosseous nerve (PIN)
. Superficial radial nerve
. Ulnar nerve
. Median nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) runs closely with the cephalic vein and the distal biceps tendon, making it the most commonly injured nerve during a single-incision anterior approach. Injury results in lateral forearm paresthesias.

Question 49

Topic: Nerve & Tendon

A zone II flexor tendon laceration involves both the flexor digitorum profundus (FDP) and superficialis (FDS). Repairing both tendons, rather than the FDP alone, specifically helps prevent which of the following postoperative deformities?

. Boutonniere deformity
. Swan neck deformity
. Lumbrical plus deformity
. Quadriga syndrome
. Mallet finger

Correct Answer & Explanation

. Swan neck deformity

Explanation

The FDS acts as a primary dynamic stabilizer of the PIP joint against hyperextension. Failing to repair the FDS can lead to PIP joint hyperextension and a subsequent swan neck deformity.

Question 50

Topic: Nerve & Tendon

A 2-year-old child presents with an interphalangeal joint flexion deformity of the right thumb. A nodule is palpable at the volar MCP joint, and passive extension is impossible. What is the recommended treatment at this age if nonoperative measures have failed?

. A1 pulley release
. FPL tendon lengthening
. A2 pulley release
. Excision of the nodule
. Z-plasty of the volar skin

Correct Answer & Explanation

. A1 pulley release

Explanation

Pediatric trigger thumb is caused by a size mismatch between the FPL tendon (Notta's nodule) and the A1 pulley. Surgical release of the A1 pulley is the definitive treatment if stretching and observation fail.

Question 51

Topic: Nerve & Tendon

A 6-year-old boy sustains an extension-type supracondylar fracture of the humerus. Which nerve is most commonly injured in this specific type of fracture overall?

. Anterior interosseous nerve
. Posterior interosseous nerve
. Radial nerve
. Ulnar nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar humerus fractures. It is a motor branch of the median nerve that controls the flexor pollicis longus and the flexor digitorum profundus to the index finger.

Question 52

Topic: Nerve & Tendon

A 40-year-old typist complains of numbness in the small and ring fingers of her right hand, along with weakness in pinch strength. Froment's sign is positive. Which nerve is most likely compressed, and at what anatomical site?

. Median nerve at the carpal tunnel
. Ulnar nerve at the cubital tunnel
. Radial nerve at the spiral groove
. Median nerve at the pronator teres
. Ulnar nerve at Guyon's canal

Correct Answer & Explanation

. Ulnar nerve at the cubital tunnel

Explanation

Numbness in the ulnar digits and weak pinch (a positive Froment's sign due to adductor pollicis weakness) strongly indicate ulnar neuropathy. The cubital tunnel at the elbow is the most common site of ulnar nerve compression.

Question 53

Topic: Nerve & Tendon
A 28-year-old rugby player is unable to flex the distal interphalangeal (DIP) joint of his right ring finger after aggressively grabbing an opponent's jersey. Radiographs reveal a bony avulsion fragment retracted to the level of the A2 pulley. According to the Leddy and Packer classification, what type of injury is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Leddy and Packer Type II jersey finger involves retraction of the flexor digitorum profundus (FDP) tendon to the level of the PIP joint or A2 pulley. A small avulsion fracture often catches at the chiasm of the FDS, preserving some regional blood supply.

Question 54

Topic: Nerve & Tendon
A 25-year-old chef sustains a knife laceration over the volar proximal phalanx of his index finger. He is unable to flex the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. This injury corresponds to which flexor tendon zone?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Flexor tendon Zone II, historically called "no man's land", extends from the proximal aspect of the A1 pulley to the insertion of the flexor digitorum superficialis tendon.

Question 55

Topic: Nerve & Tendon

A 40-year-old secretary complains of numbness in her ring and small fingers, and weakness with pinch. Examination shows a positive Froment's sign. Which muscle is compensating for the weakened adductor pollicis during this test?

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

Correct Answer & Explanation

. Flexor pollicis longus

Explanation

Froment's sign indicates ulnar nerve palsy leading to weakness of the adductor pollicis. The patient compensates by using the flexor pollicis longus (innervated by the anterior interosseous nerve) to hyperflex the thumb interphalangeal joint during key pinch.

Question 56

Topic: Nerve & Tendon
A 30-year-old carpenter sustains a deep laceration to the volar aspect of his index finger precisely at the level of the A1 pulley, resulting in loss of active flexion. This injury corresponds to which flexor tendon zone?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Zone II of the flexor tendon system, historically known as "no man's land", extends from the level of the A1 pulley to the insertion of the flexor digitorum superficialis. Injuries here are notoriously difficult to treat due to the tight fibro-osseous tunnel.

Question 57

Topic: Nerve & Tendon

A 45-year-old cyclist presents with numbness and tingling in his small and ring fingers. He has weakness of finger abduction but normal sensation over the dorso-ulnar aspect of his hand. Where is the most likely site of nerve compression?

. Cubital tunnel
. Arcade of Struthers
. Guyon's canal (Zone 1)
. Guyon's canal (Zone 2)
. Guyon's canal (Zone 3)

Correct Answer & Explanation

. Guyon's canal (Zone 1)

Explanation

Normal dorso-ulnar sensation indicates the compression is distal to the dorsal ulnar cutaneous nerve branch (sparing the cubital tunnel). Involvement of both volar sensation (ring/small fingers) and intrinsic motor function localizes the lesion to Zone 1 of Guyon's canal.

Question 58

Topic: Nerve & Tendon
A 6-year-old boy who is treated for a type III supracondylar fracture has no neurovascular deficit on initial examination. His fracture is treated by anatomic closed reduction and percutaneous fixation with medial and lateral pins. A partial deficit in ulnar motor and sensory function is noted after surgery. The next step in treatment should be:
. Make sure the elbow is flexed to no more than 90° and observe.
. Remove the lateral pin.
. Remove both pins and place the patient in traction.
. Explore the ulnar nerve.
. Transpose the ulnar nerve anteriorly.

Correct Answer & Explanation

. Make sure the elbow is flexed to no more than 90° and observe.

Explanation

The use of medial pins in treatment of supracondylar fractures of the humerus has been associated with a risk of ulnar nerve injury. However, in the largest reported series, 16 of 17 palsies resolved spontaneously and completely with observation after a mean of 18 weeks. There is no evidence that pin removal, exploration, or transposition is necessary at this stage. Hyperflexion in a splint may cause the nerve to be apposed to the pin and can be decreased.

Question 59

Topic: Nerve & Tendon

A positive Finkelstein's test in a patient with De Quervain's tenosynovitis is caused by irritation of which of the following tendon groups as they pass through the first dorsal compartment?

. Extensor pollicis longus and extensor pollicis brevis
. Abductor pollicis longus and extensor pollicis brevis
. Abductor pollicis longus and extensor pollicis longus
. Flexor pollicis longus and abductor pollicis brevis
. Extensor carpi radialis longus and brevis

Correct Answer & Explanation

. Abductor pollicis longus and extensor pollicis brevis

Explanation

De Quervain's tenosynovitis involves stenosing inflammation of the first dorsal compartment of the wrist. This compartment contains the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).

Question 60

Topic: Nerve & Tendon
A 30-year-old carpenter lacerates the volar aspect of his index finger between the distal palmar crease and the proximal interphalangeal joint, transecting the FDS and FDP tendons. This injury is located in which flexor tendon zone?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Flexor tendon Zone II, historically known as "no man's land," extends from the A1 pulley at the distal palmar crease to the FDS insertion on the middle phalanx. Injuries here involve both flexor tendons within the tight fibro-osseous sheath.

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