7. Hand and Wrist MCQs

In the classification of flexor tendon injuries of the hand, Zone II (often referred to historically as "no man's land") extends anatomically from:

Stenosing tenosynovitis (trigger finger) most commonly results from thickening and nodule formation associated with which of the following pulleys?

When performing a surgical release for De Quervain's tenosynovitis, the surgeon must ensure complete decompression of the first dorsal compartment. Which two tendons run within this compartment?

A patient presents with paresthesias in the median nerve distribution of the hand. Which of the following clinical findings most reliably differentiates Pronator Syndrome from Carpal Tunnel Syndrome (CTS)?

During a single-incision anterior approach for the repair of an acute distal biceps tendon rupture, which of the following nerves is at the highest risk of iatrogenic injury?

A patient is diagnosed with an acute complete rupture of the ulnar collateral ligament (UCL) of the thumb (Skier's thumb). A Stener lesion is suspected, which mandates surgical intervention. A Stener lesion occurs when the torn UCL displaces superficial to the:

A 24-year-old male sustains a proximal pole scaphoid fracture. The high risk of avascular necrosis in this fracture pattern is primarily due to the retrograde blood supply derived from which of the following arteries?

A 6-year-old boy falls on an outstretched hand and sustains a fracture. Radiographs and clinical presentation are consistent with a posterolaterally displaced extension-type supracondylar humerus fracture.

Which of the following nerve injuries is most commonly associated with this specific direction of displacement?

In Zone II flexor tendon injuries of the hand, the blood supply to the flexor tendons within the digital synovial sheath is primarily provided by which of the following structures?

Which of the following clinical provocative tests has the highest reported sensitivity for diagnosing carpal tunnel syndrome?

A 45-year-old carpenter with chronic medial elbow pain that worsens with resisted forearm pronation and wrist flexion has failed 6 months of conservative treatment. During surgical debridement of the common flexor origin, which of the following nerves is most at risk of iatrogenic injury?

A patient with long-standing cubital tunnel syndrome presents with weakness in their pinch grip. During evaluation, the patient forcefully flexes the interphalangeal joint of the thumb when attempting to hold a piece of paper between the thumb and index finger. What is the name of this clinical sign?

An adult patient undergoes rigid plate fixation of the radial shaft for a Galeazzi fracture. Intraoperatively, following radius fixation, the distal radioulnar joint (DRUJ) is tested and found to be grossly unstable in all forearm positions (pronation, neutral, and supination). What is the most appropriate next step in management?

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. Diagnosis of this condition is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. The level of the lesion in this patient is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patients right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horners syndrome and the grasp reflex is absent. Appropriate surgical management in this case is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. Reconstructive surgery includes all of the following except:

Which mechanism and long-term deformity is most often associated with a dorsal avulsion fracture at the base of the middle phalanx:

A 28-year-old man fell off his bike and sustained a fall onto his outstretched hand. He experiences thumb and index finger numbness. Attempts at reduction of his grade I open extra-articular distal radius fracture are unsuccessful. The next appropriate step of management is:

Which of the following is the most common carpal coalition in the hand: