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Nerve & Tendon MCQs

Practice Set 39 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 761

Topic: Nerve & Tendon

A patient presents with a painful trigger finger, where the finger catches or locks in flexion and then snaps straight. Which anatomical structure is primarily involved in this condition?

. Flexor digitorum profundus tendon
. Extensor digitorum communis tendon
. A1 pulley
. A2 pulley
. Lumbrical muscle

Correct Answer & Explanation

. A1 pulley

Explanation

Trigger finger (stenosing tenosynovitis) is caused by inflammation and thickening of the flexor tendon sheath and/or the flexor tendons themselves, specifically at the A1 pulley. This creates a disparity between the size of the tendon and the pulley, causing the tendon to catch as it attempts to glide through. The A1 pulley is located at the metacarpal head. Other pulleys (A2, etc.) are further distal, and the tendons and muscles listed are involved in finger movement but the A1 pulley is the site of pathology.

Question 762

Topic: Nerve & Tendon

What is the primary anatomical structure involved in De Quervain's tenosynovitis?

. Extensor Carpi Ulnaris tendon
. Extensor Pollicis Longus tendon
. Abductor Pollicis Longus and Extensor Pollicis Brevis tendons in the first dorsal compartment
. Flexor Carpi Radialis tendon
. Flexor Pollicis Longus tendon

Correct Answer & Explanation

. Abductor Pollicis Longus and Extensor Pollicis Brevis tendons in the first dorsal compartment

Explanation

De Quervain's tenosynovitis is an inflammatory condition affecting the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) as they pass through the first dorsal compartment of the wrist. It causes pain on the radial side of the wrist, exacerbated by gripping or thumb movements, and a positive Finkelstein's test.

Question 763

Topic: Nerve & Tendon

Which of the following statements regarding the treatment of mallet finger is true?

. Surgical repair of the extensor tendon is always indicated.
. The DIP joint should be immobilized in flexion for 6 weeks.
. Conservative treatment involves continuous splinting of the DIP joint in extension for 6-8 weeks.
. It is caused by rupture of the flexor digitorum profundus tendon.
. Buddy taping to an adjacent finger is the most effective treatment.

Correct Answer & Explanation

. Conservative treatment involves continuous splinting of the DIP joint in extension for 6-8 weeks.

Explanation

Mallet finger is an injury to the extensor tendon at the distal interphalangeal (DIP) joint, resulting in an inability to fully extend the DIP joint. The standard conservative treatment involves continuous splinting of the DIP joint in full extension for 6-8 weeks (or longer), while allowing full PIP joint motion. Surgical repair is rarely indicated for closed injuries. Immobilizing in flexion would worsen the deformity. It's an extensor tendon injury, not flexor. Buddy taping is insufficient for effective immobilization of the DIP joint.

Question 764

Topic: Nerve & Tendon

What is the primary anatomical structure involved in De Quervain's tenosynovitis?

. Extensor carpi ulnaris.
. Flexor pollicis longus.
. Extensor pollicis brevis and abductor pollicis longus.
. Flexor digitorum profundus.
. Extensor digitorum communis.

Correct Answer & Explanation

. Extensor pollicis brevis and abductor pollicis longus.

Explanation

De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, specifically involving stenosing tenosynovitis of the first dorsal compartment. This compartment contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Finkelstein's test is typically positive. The other tendons are located in different compartments or have different functions.

Question 765

Topic: Nerve & Tendon

Which clinical sign would raise immediate concern for potential median nerve compression following closed reduction and casting of a Colles fracture?

. Pain with passive finger flexion
. Inability to actively extend the thumb IP joint
. Numbness and tingling in the little finger
. Paresthesia in the thumb, index, and middle fingers with pain radiating proximally
. Warm, dry, red skin of the affected hand

Correct Answer & Explanation

. Paresthesia in the thumb, index, and middle fingers with pain radiating proximally

Explanation

Paresthesia (numbness and tingling) in the median nerve distribution (thumb, index, middle fingers, radial half of ring finger) combined with pain radiating proximally are classic signs of median nerve compression. While pain with passive finger flexion can be a sign of compartment syndrome, the specific nerve distribution points to median nerve. Inability to extend the thumb IP joint suggests EPL rupture. Numbness in the little finger points to ulnar nerve. Warm, dry, red skin might be seen in CRPS, but not typically in acute median nerve compression.

Question 766

Topic: Nerve & Tendon

A 50-year-old male presents with chronic insidious onset numbness and tingling in his ulnar two fingers and medial forearm. He describes worsening symptoms with prolonged elbow flexion. Physical examination reveals a positive Tinel's sign at the cubital tunnel and weakness in intrinsic hand muscles. What is the most appropriate initial management?

. Immediate cubital tunnel release.
. Oral corticosteroids.
. Elbow extension splinting, activity modification, and nerve gliding exercises.
. Observation with serial neurological exams.
. NSAIDs and heat therapy.

Correct Answer & Explanation

. Elbow extension splinting, activity modification, and nerve gliding exercises.

Explanation

This patient presents with cubital tunnel syndrome (ulnar nerve compression at the elbow). Initial management is always conservative for mild to moderate symptoms. This includes elbow extension splinting, activity modification (avoiding prolonged elbow flexion, leaning on the elbow), and nerve gliding exercises. Surgical decompression (cubital tunnel release) is reserved for failed conservative management, severe nerve compression, or progressive neurological deficits. Oral corticosteroids and NSAIDs may offer temporary symptomatic relief but do not address the underlying compression. Observation alone is insufficient if symptoms are significant.

Question 767

Topic: Nerve & Tendon

During closed reduction and percutaneous pinning of a pediatric supracondylar humerus fracture, placement of a medial pin carries the highest risk of iatrogenic injury to which of the following structures?

. Median nerve
. Ulnar nerve
. Radial nerve
. Brachial artery
. Anterior interosseous nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

The ulnar nerve runs posterior to the medial epicondyle and is at significant risk of iatrogenic injury during the placement of a medial pin. To mitigate this risk, the elbow is often extended slightly from hyperflexion, and a mini-open technique is recommended.

Question 768

Topic: Nerve & Tendon

A patient presents with an inability to form an 'OK' sign with their thumb and index finger. Examination reveals weakness in flexing the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which of the following muscles is additionally denervated in this syndrome?

. Flexor carpi radialis
. Flexor digitorum superficialis
. Pronator teres
. Pronator quadratus
. Abductor pollicis brevis

Correct Answer & Explanation

. Pronator quadratus

Explanation

The patient has Anterior Interosseous Nerve (AIN) syndrome. The AIN is a pure motor branch of the median nerve that innervates the flexor pollicis longus (FPL), the radial half of the flexor digitorum profundus (FDP to the index and middle fingers), and the pronator quadratus.

Question 769

Topic: Nerve & Tendon

During an in-situ decompression of the ulnar nerve for cubital tunnel syndrome, the surgeon releases the fascial band spanning the two heads of the flexor carpi ulnaris muscle. What is the eponym for this anatomic structure?

. Ligament of Struthers
. Arcade of Frohse
. Osborne ligament
. Lacertus fibrosus
. Arcade of Struthers

Correct Answer & Explanation

. Osborne ligament

Explanation

Osborne's ligament forms the roof of the cubital tunnel and connects the olecranon and medial epicondylar heads of the flexor carpi ulnaris. It is a primary site of ulnar nerve compression.

Question 770

Topic: Nerve & Tendon

A cyclist presents with numbness in the volar aspect of his small finger and the ulnar half of his ring finger, alongside profound weakness of the interosseous muscles. Sensation on the dorsal ulnar aspect of the hand is completely preserved. According to the zoning of Guyon's canal, which zone is most likely the site of ulnar nerve compression?

. Zone 1
. Zone 2
. Zone 3
. The cubital tunnel
. The Arcade of Struthers

Correct Answer & Explanation

. Zone 1

Explanation

Guyon's canal is divided into 3 zones. Zone 1 is proximal to the nerve's bifurcation and contains both motor and sensory fascicles; compression here causes mixed motor and sensory deficits in the volar digits. Zone 2 contains only the deep motor branch, and Zone 3 contains only the superficial sensory branch. Dorsal sensation is spared because the dorsal sensory branch of the ulnar nerve branches off roughly 5-8 cm proximal to the wrist crease, completely bypassing Guyon's canal. Thus, volar sensory loss plus motor loss indicates Zone 1 compression.

Question 771

Topic: Nerve & Tendon

A 50-year-old female presents with triggering and pain at the base of her right ring finger. She complains that her finger locks in flexion. The primary site of pathology in typical primary stenosing tenosynovitis (trigger finger) is stenosis at the level of which pulley?

. A1 pulley
. A2 pulley
. A3 pulley
. A4 pulley
. C1 pulley

Correct Answer & Explanation

. A1 pulley

Explanation

Trigger finger (stenosing tenosynovitis) is characterized by catching or locking of the flexor tendon. The pathology primarily involves nodular thickening of the tendon and hypertrophy/stenosis of the first annular (A1) pulley at the level of the metacarpophalangeal (MCP) joint. Surgical release or corticosteroid injection typically targets the A1 pulley.

Question 772

Topic: Nerve & Tendon

A 40-year-old cyclist complains of numbness and tingling in the small and ulnar half of the ring finger. He also has weakness in finger abduction and adduction. Examination reveals normal sensation on the dorsum of the ulnar hand.

This clinical presentation is most consistent with compression of the ulnar nerve in Guyon's canal at which specific zone?

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

Correct Answer & Explanation

. Zone 1

Explanation

Compression in Guyon's canal Zone 1 involves the main ulnar nerve before it bifurcates, causing both motor (intrinsic weakness) and sensory (volar small/ring finger) deficits. Importantly, the dorsal ulnar cutaneous nerve branches off approximately 5 cm proximal to the wrist, so dorsal sensation is spared in Guyon's canal lesions. If it were Zone 2 (deep motor branch), there would be no sensory deficit. If Zone 3 (superficial sensory), there would be no motor deficit.

Question 773

Topic: Nerve & Tendon

A 35-year-old carpenter presents with a sudden inability to perform a tip-to-tip pinch with his thumb and index finger. When attempting an 'OK' sign, he forms a flat pinch due to an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Sensation over the hand is completely normal. Which muscle group is affected, and what nerve is implicated?

. Adductor pollicis and first dorsal interosseous; Ulnar nerve
. Flexor pollicis longus and flexor digitorum profundus to the index finger; Anterior interosseous nerve
. Abductor pollicis brevis and opponens pollicis; Recurrent motor branch of the median nerve
. Extensor pollicis longus and extensor indicis proprius; Posterior interosseous nerve
. Flexor digitorum superficialis and flexor carpi radialis; Median nerve

Correct Answer & Explanation

. Flexor pollicis longus and flexor digitorum profundus to the index finger; Anterior interosseous nerve

Explanation

The patient exhibits a classic anterior interosseous nerve (AIN) palsy. The AIN is a pure motor branch of the median nerve that innervates the flexor pollicis longus (FPL), the flexor digitorum profundus (FDP) to the index and long fingers, and the pronator quadratus. Weakness of the FPL and index FDP leads to the characteristic flat pinch, with no sensory deficit.

Question 774

Topic: Nerve & Tendon

A 40-year-old male with a chronic low ulnar nerve palsy demonstrates severe clawing of his ring and small fingers. During the physical exam, the examiner stabilizes his MCP joints in flexion, and the patient is subsequently able to actively extend the proximal interphalangeal (PIP) joints of those digits. What is this clinical test, and what does a positive result indicate regarding surgical planning?

. Froment's sign; indicates a need for adductor pollicis reconstruction
. Wartenberg's test; indicates intact third palmar interosseous muscle
. Bouvier test; indicates intact extrinsic extensor mechanism to the PIP joints, requiring only an MCP stabilization procedure
. Jeanne's sign; indicates FDP weakness requiring tendon transfer
. Elson test; indicates central slip integrity

Correct Answer & Explanation

. Bouvier test; indicates intact extrinsic extensor mechanism to the PIP joints, requiring only an MCP stabilization procedure

Explanation

The Bouvier test evaluates a claw hand deformity by passively blocking the MCP joints in flexion. If the patient can actively extend the PIP joints, the test is positive, indicating that the extrinsic extensor mechanism (central slip) is competent. This suggests that a simple MCP stabilization procedure (e.g., Zancolli lasso) will successfully correct the claw deformity without the need for a complex PIP extension transfer.

Question 775

Topic: Nerve & Tendon

A patient presents with an abducted posture of the small finger at rest and is unable to actively adduct it to the ring finger. This condition (Wartenberg's sign) is caused by the unopposed action of which muscle, due to weakness of which other muscle?

. Unopposed extensor digiti minimi; weakness of the third palmar interosseous
. Unopposed abductor digiti minimi; weakness of the fourth dorsal interosseous
. Unopposed flexor digiti minimi; weakness of the lumbrical
. Unopposed extensor digitorum communis; weakness of the abductor digiti minimi
. Unopposed fourth dorsal interosseous; weakness of the third palmar interosseous

Correct Answer & Explanation

. Unopposed extensor digiti minimi; weakness of the third palmar interosseous

Explanation

Wartenberg's sign is an abducted resting posture of the small finger typically seen in ulnar neuropathy. It results from weakness of the ulnar-innervated third palmar interosseous muscle, which normally adducts the finger, leaving the radial-innervated extensor digiti minimi (EDM) unopposed to exert an abducting force.

Question 776

Topic: Nerve & Tendon

A 28-year-old basketball player jams his finger and presents with a swollen proximal interphalangeal (PIP) joint. Over the next 3 weeks, he develops a characteristic Boutonniere deformity. What is the primary pathoanatomy leading to the progressive hyperextension of the distal interphalangeal (DIP) joint in this deformity?

. Volar subluxation of the lateral bands
. Rupture of the terminal extensor tendon
. Attenuation of the triangular ligament and dorsal subluxation of lateral bands
. Rupture of the sagittal band at the metacarpophalangeal joint
. Contracture of the oblique retinacular ligament (ORL)

Correct Answer & Explanation

. Attenuation of the triangular ligament and dorsal subluxation of lateral bands

Explanation

A Boutonniere deformity is initiated by a disruption of the central slip. As the central slip fails, the triangular ligament stretches, allowing the lateral bands to subluxate volar to the axis of rotation of the PIP joint. They then act as flexors of the PIP joint, and their increased proximal pull on the terminal tendon causes secondary hyperextension of the DIP joint.

Question 777

Topic: Nerve & Tendon

During the surgical release of a trigger thumb, the A1 pulley is divided to relieve triggering. Which adjacent structure is at greatest risk of iatrogenic injury if the surgical approach and dissection are placed too far radially?

. Radial proper digital nerve of the thumb
. Ulnar proper digital nerve of the thumb
. Recurrent motor branch of the median nerve
. Flexor pollicis longus tendon
. Superficial branch of the radial nerve

Correct Answer & Explanation

. Radial proper digital nerve of the thumb

Explanation

The radial proper digital nerve of the thumb crosses obliquely over the flexor tendon sheath at the level of the metacarpophalangeal flexion crease near the A1 pulley. It is highly susceptible to iatrogenic injury if the incision or deep dissection for a trigger thumb release extends too far radially.

Question 778

Topic: Nerve & Tendon

A patient with severe carpal tunnel syndrome exhibits profound thenar atrophy but normal sensation over the dorsum of the hand. Electromyography reveals normal motor function of the first dorsal interosseous muscle, but paradoxically normal thenar function on proximal nerve stimulation due to a Martin-Gruber anastomosis. Where does this specific neural connection occur anatomically?

. In the forearm between the median nerve and the ulnar nerve
. In the palm between the recurrent motor branch of the median nerve and deep ulnar nerve
. In the upper arm between the musculocutaneous and median nerves
. In the wrist, as a sensory connection between ulnar and median nerves
. In the digital web spaces between common digital nerves

Correct Answer & Explanation

. In the forearm between the median nerve and the ulnar nerve

Explanation

The Martin-Gruber anastomosis is an anomalous crossing of nerve fibers from the median nerve (or its anterior interosseous branch) to the ulnar nerve in the proximal forearm. It typically carries motor fibers. In contrast, the Riche-Cannieu anastomosis occurs in the palm between the recurrent branch of the median nerve and the deep motor branch of the ulnar nerve.

Question 779

Topic: Nerve & Tendon

A cyclist presents with isolated weakness in finger abduction and adduction. Sensation is perfectly intact in the ring and small fingers, and over the hypothenar eminence. Compression of the ulnar nerve in Guyon's canal is diagnosed. In which anatomical zone of Guyon's canal is the compression located?

. Zone 1
. Zone 2
. Zone 3
. Proximal to the canal entirely
. Distal to the hook of the hamate

Correct Answer & Explanation

. Zone 3

Explanation

Guyon's canal is divided into three zones. Zone 1 is proximal to the nerve bifurcation and contains mixed motor and sensory fibers. Zone 2 contains only the deep motor branch, which innervates the interossei and lumbricals (abduction/adduction). Zone 3 contains the superficial sensory branch. Isolated motor deficit indicates Zone 2 compression.

Question 780

Topic: Nerve & Tendon

A patient presents with atrophy of the dorsal interossei and weakness of finger abduction. Sensation over the volar ulnar aspect of the small finger and the hypothenar eminence is completely preserved. The flexor digitorum profundus to the small finger has normal strength. Where is the most likely site of ulnar nerve compression?

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

Correct Answer & Explanation

. Zone 2 of Guyon's canal

Explanation

Zone 2 of Guyon's canal contains only the deep motor branch of the ulnar nerve. Compression here (e.g., from a hook of hamate fracture) causes isolated intrinsic muscle weakness with preserved sensation.

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