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7. Hand and Wrist MCQs

Practice Set 143 of 266

This practice set contains high-yield board review questions covering key concepts in 7. Hand and Wrist. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2841

Topic: 7. Hand and Wrist

A 70-year-old male with pre-existing cervical spondylosis sustains a hyperextension injury, resulting in Central Cord Syndrome. As the patient undergoes rehabilitation, which of the following neurologic functions notoriously has the poorest prognosis for meaningful recovery?

. Bowel and bladder control
. Lower extremity proximal muscle strength
. Sensory recovery in the lower extremities
. Fine motor control of the hands
. Upper extremity gross motor pushing strength

Correct Answer & Explanation

. Bowel and bladder control

Explanation

In Central Cord Syndrome, the upper extremities are more severely affected than the lower extremities. Recovery typically follows a predictable pattern, with lower extremities recovering first, followed by bowel/bladder, then proximal arms, with fine motor control of the hands recovering last and least completely.

Question 2842

Topic: 7. Hand and Wrist

A patient with severe right hip osteoarthritis uses a cane to reduce joint pain. To most effectively minimize the joint reaction force across the right hip, how should the cane be utilized?

. In the right hand to increase the abductor moment arm
. In the left hand to decrease the abductor muscle force required
. In the right hand to shift the center of gravity laterally
. In the left hand to increase the body weight moment arm
. In either hand as long as it supports 50% of body weight

Correct Answer & Explanation

. In the right hand to increase the abductor moment arm

Explanation

Using a cane in the contralateral (left) hand reduces the joint reaction force on the right hip by counteracting the body weight moment. This significantly decreases the force required by the right hip abductor muscles, which are the primary contributors to hip joint reaction forces.

Question 2843

Topic: 7. Hand and Wrist

A patient presents with an inability to actively cross the index and middle fingers following a penetrating injury to the proximal forearm that isolated the median nerve. Testing shows normal sensation over the ulnar digits. Which anatomic variant best explains this intrinsic hand weakness?

. Riche-Cannieu anastomosis
. Marinacci communication
. Berrettini anastomosis
. Martin-Gruber anastomosis
. Struthers arcade compression

Correct Answer & Explanation

. Riche-Cannieu anastomosis

Explanation

The Martin-Gruber anastomosis involves motor fibers crossing from the median nerve to the ulnar nerve in the forearm. A proximal median nerve injury could therefore cause weakness of ulnar-innervated intrinsic hand muscles if these crossover fibers are involved.

Question 2844

Topic: 7. Hand and Wrist

A patient with severe right hip osteoarthritis is advised to use a cane for ambulation. To most effectively reduce the joint reactive forces across the right hip, how should the cane be used?

. Held in the right hand to increase the lever arm of the body weight
. Held in the right hand to decrease the abductor muscle force required
. Held in the left hand to decrease the abductor muscle force required
. Held in the left hand to shift the center of gravity laterally
. Held in either hand, as it primarily serves to improve proprioception

Correct Answer & Explanation

. Held in the right hand to increase the lever arm of the body weight

Explanation

A cane should be held in the hand contralateral to the affected hip (left hand for right hip arthritis). This provides a counter-moment that significantly decreases the force required by the abductor muscles, thereby reducing the overall joint reactive force.

Question 2845

Topic: 7. Hand and Wrist

Which of the following accurately describes the anatomy and function of Cleland's ligaments in the hand?

. They pass volar to the neurovascular bundles and contribute heavily to Dupuytren contracture
. They pass dorsal to the neurovascular bundles and prevent volar skin slippage during digital flexion
. They connect the flexor tendon sheath to the skin directly volar to the neurovascular bundle
. They act as the primary stabilizers of the proximal interphalangeal joint against lateral stress
. They are frequently involved in the pathogenesis of trigger finger

Correct Answer & Explanation

. They pass volar to the neurovascular bundles and contribute heavily to Dupuytren contracture

Explanation

Cleland's ligaments are strong fascial bands that pass dorsal to the digital neurovascular bundles. They stabilize the digital skin during flexion and are uniquely spared in Dupuytren's disease, unlike Grayson's ligaments.

Question 2846

Topic: 7. Hand and Wrist

The dart-throwing motion of the wrist is clinically significant for rehabilitation after specific carpal injuries. Biomechanically, this functional motion occurs primarily at which of the following articulations?

. Radiocarpal joint
. Midcarpal joint
. Distal radioulnar joint
. Scaphotrapezial joint
. Pisotriquetral joint

Correct Answer & Explanation

. Radiocarpal joint

Explanation

The dart-throwing motion, which couples radial deviation/extension with ulnar deviation/flexion, occurs predominantly at the midcarpal joint. This unique kinematic pattern minimizes movement and shear forces across the scaphoid and lunate.

Question 2847

Topic: Wrist & Carpus

A pediatric patient sustains a distal radius fracture with apex volar angulation. Over a year, the bone straightens as formation occurs on the concave side and resorption on the convex side. This biomechanical response is described by:

. Hueter-Volkmann Law
. Wolff's Law
. Heuter's Law
. Frank-Starling Law
. Hilton's Law

Correct Answer & Explanation

. Hueter-Volkmann Law

Explanation

Wolff's Law states that bone in a healthy person or animal will adapt to the loads under which it is placed. Remodeling restores the axis by depositing bone on the compressive (concave) side and resorbing it on the tensile (convex) side.

Question 2848

Topic: 7. Hand and Wrist

A 34-year-old carpenter presents with wrist pain. Evaluation of his wrist kinematics reveals normal synchronous carpal motion. During active radial deviation of the wrist from a neutral position, what is the normal kinematic behavior of the scaphoid?

. It extends and translates dorsally
. It flexes and translates ulnarly
. It flexes and its distal pole moves palmarly
. It extends and its proximal pole moves palmarly
. It remains stationary while the distal row rotates

Correct Answer & Explanation

. It extends and translates dorsally

Explanation

During radial deviation, the scaphoid normally flexes (palmarflexes) to allow the distal carpal row to move radially without impinging on the radial styloid. Conversely, the scaphoid extends during ulnar deviation.

Question 2849

Topic: 7. Hand and Wrist

A 40-year-old man falls on an outstretched hand and develops radial-sided wrist pain. MRI reveals a complete rupture of the scapholunate interosseous ligament (SLIL). The SLIL has three distinct anatomic regions. Which region is the thickest, strongest, and primary restraint to abnormal scapholunate translation?

. Volar
. Proximal membranous
. Dorsal
. Radioscaphocapitate
. Scaphotrapezial

Correct Answer & Explanation

. Volar

Explanation

The dorsal region of the scapholunate interosseous ligament is composed of thick, transversely oriented collagen fibers. It is biomechanically the strongest component and the most critical restraint to scapholunate dissociation.

Question 2850

Topic: 7. Hand and Wrist

During rehabilitation of a scapholunate ligament repair, the therapist utilizes the 'dart thrower's motion' to minimize strain on the healing ligament. This motion primarily restricts movement at the midcarpal joint by linking which of the following coupled wrist positions?

. Radial deviation with flexion to ulnar deviation with extension
. Radial deviation with extension to ulnar deviation with flexion
. Pure radial deviation to pure ulnar deviation
. Pure flexion to pure extension
. Pronation with flexion to supination with extension

Correct Answer & Explanation

. Radial deviation with flexion to ulnar deviation with extension

Explanation

The 'dart thrower's motion' couples radial extension with ulnar flexion. It is beneficial during early scapholunate rehabilitation because it occurs almost entirely at the radiocarpal joint, thereby minimizing midcarpal (scapholunate) motion.

Question 2851

Topic: 7. Hand and Wrist

A 30-year-old mechanic falls onto an outstretched hand. Examination reveals tenderness over the dorsal wrist and a positive Watson scaphoid shift test. A complete tear of the scapholunate interosseous ligament (SLIL) is suspected. Which portion of this ligament is the most critical for maintaining carpal stability?

. Volar portion
. Dorsal portion
. Proximal membranous portion
. Radioscaphocapitate ligament
. Long radiolunate ligament

Correct Answer & Explanation

. Volar portion

Explanation

The dorsal portion of the scapholunate interosseous ligament (SLIL) is the thickest and biomechanically strongest region. It serves as the primary stabilizer of the scapholunate articulation, and its rupture leads to significant dorsal intercalated segment instability (DISI).

Question 2852

Topic: 7. Hand and Wrist

A patient is undergoing rehabilitation following a partial scapholunate ligament injury. The therapist emphasizes the "dart-thrower's motion" to allow functional wrist movement while minimizing stress on the healing scapholunate interval. Which of the following best describes the coupled motion and primary articulation of this kinematic pathway?

. Radial extension to ulnar flexion occurring primarily at the midcarpal joint
. Radial flexion to ulnar extension occurring primarily at the radiocarpal joint
. Pure flexion and extension occurring equally at both radiocarpal and midcarpal joints
. Ulnar extension to radial flexion occurring primarily at the distal radioulnar joint
. Radial extension to ulnar flexion occurring primarily at the radiocarpal joint

Correct Answer & Explanation

. Radial extension to ulnar flexion occurring primarily at the midcarpal joint

Explanation

The dart-thrower's motion couples radial deviation with wrist extension, and ulnar deviation with wrist flexion. This unique oblique planar motion occurs primarily at the midcarpal joint, significantly reducing rotation and stress at the radiocarpal joint and scapholunate interval.

Question 2853

Topic: Nerve & Tendon

A patient presents with the inability to form an "OK" sign, demonstrating a loss of flexion at the thumb interphalangeal joint and index finger distal interphalangeal joint. The affected nerve normally travels distally in the forearm in the interval between which two muscles?

. Flexor carpi radialis and pronator teres
. Flexor digitorum superficialis and flexor digitorum profundus
. Flexor digitorum profundus and flexor pollicis longus
. Brachioradialis and extensor carpi radialis longus
. Extensor digitorum communis and extensor indicis proprius

Correct Answer & Explanation

. Flexor carpi radialis and pronator teres

Explanation

The anterior interosseous nerve (AIN) is a pure motor branch of the median nerve that innervates the FPL, FDP to the index/middle fingers, and pronator quadratus. It travels distally in the forearm strictly in the interval between the FDP and FPL muscle bellies.

Question 2854

Topic: 7. Hand and Wrist

A professional cyclist presents with severe intrinsic muscle weakness of the hand but normal sensation on the palmar aspect of the small finger. The ulnar nerve is diagnosed as compressed selectively in Zone 2 of Guyon's canal. Which of the following structures forms the floor of this specific zone?

. Palmar carpal ligament
. Transverse carpal ligament
. Volar radiocarpal ligament
. Pisohamate and pisometacarpal ligaments
. Triangular fibrocartilage complex

Correct Answer & Explanation

. Palmar carpal ligament

Explanation

Zone 2 of Guyon's canal contains only the deep motor branch of the ulnar nerve. Its floor is strictly formed by the pisohamate and pisometacarpal ligaments, while the roof is formed by the palmaris brevis and fibrous connective tissue.

Question 2855

Topic: 7. Hand and Wrist

A 25-year-old male receives a stab wound to the volar wrist, lacerating the median nerve 2 cm proximal to the carpal tunnel. Assuming no other injuries, which of the following clinical deficits is expected?

. Loss of adduction of the thumb
. Inability to flex the distal interphalangeal joint of the index finger
. Loss of opposition of the thumb
. Sensory loss over the dorsal web space of the thumb
. Weakness in spreading the fingers

Correct Answer & Explanation

. Loss of adduction of the thumb

Explanation

A median nerve injury at the wrist spares the anterior interosseous nerve (which innervates FDP to the index) but denervates the thenar muscles, resulting in loss of thumb opposition.

Question 2856

Topic: Nerve & Tendon

During surgical release of the first dorsal compartment for de Quervain's tenosynovitis, care must be taken to ensure all tendon slips are decompressed. Which of the following best describes the anatomy of this compartment?

. The extensor pollicis brevis (EPB) commonly has multiple tendon slips.
. The abductor pollicis longus (APL) commonly has multiple tendon slips.
. Both the APL and EPB typically have multiple slips.
. Neither the APL nor the EPB typically has multiple slips.
. The extensor pollicis longus (EPL) is frequently found within this compartment.

Correct Answer & Explanation

. The extensor pollicis brevis (EPB) commonly has multiple tendon slips.

Explanation

The APL tendon frequently consists of two to four slips, while the EPB usually has only one slip. Additionally, the EPB may be contained within its own separate subsheath.

Question 2857

Topic: 7. Hand and Wrist

A distal radius fracture is approached via the standard volar flexor carpi radialis (FCR) approach. After incising the FCR sheath and retracting the FCR tendon ulnarly, what is the immediate deep structure that must be identified and mobilized to expose the pronator quadratus?

. Median nerve
. Flexor pollicis longus
. Radial artery
. Flexor digitorum superficialis
. Brachioradialis

Correct Answer & Explanation

. Median nerve

Explanation

Once the FCR sheath is incised and the tendon is retracted, the flexor pollicis longus (FPL) tendon is encountered deep to it. The FPL is retracted ulnarly to expose the underlying pronator quadratus.

Question 2858

Topic: Wrist & Carpus

The triangular fibrocartilage complex (TFCC) acts as the primary stabilizer of the distal radioulnar joint (DRUJ). The TFCC takes its origin from the ulnar styloid and inserts primarily into which of the following structures?

. Base of the triquetrum
. Volar radiocarpal ligaments
. Hyaline cartilage of the sigmoid notch of the radius
. Lunate facet of the radius
. Pisiform bone

Correct Answer & Explanation

. Base of the triquetrum

Explanation

The TFCC originates from the base and fovea of the ulnar styloid and inserts radially into the hyaline cartilage of the sigmoid notch. Tears at its radial insertion (Palmer 1D) frequently cause DRUJ instability.

Question 2859

Topic: 7. Hand and Wrist

During surgical release of a trigger finger, maximum preservation of the digital flexor sheath is required to prevent tendon bowstringing. Which two annular pulleys are biomechanically the most critical to preserve?

. A1 and A3
. A2 and A4
. A1 and A5
. A3 and A5
. A2 and A5

Correct Answer & Explanation

. A1 and A3

Explanation

The A2 pulley (over the proximal phalanx) and the A4 pulley (over the middle phalanx) are the most critical annular pulleys for preventing bowstringing. Trigger finger release involves dividing the A1 pulley, which resides over the MCP joint.

Question 2860

Topic: 7. Hand and Wrist

A patient sustains a laceration to the deep motor branch of the ulnar nerve at the wrist. Which of the following deficits is expected regarding the lumbrical muscles?

. Loss of flexion at the MCP joints of the index and long fingers
. Loss of extension at the IP joints of the ring and small fingers
. Loss of extension at the MCP joints of the ring and small fingers
. Loss of flexion at the IP joints of all four digits
. No lumbrical deficit as they are exclusively innervated by the median nerve

Correct Answer & Explanation

. Loss of flexion at the MCP joints of the index and long fingers

Explanation

The ulnar nerve innervates the 3rd and 4th lumbricals, which function to flex the metacarpophalangeal (MCP) joints and extend the interphalangeal (IP) joints of the ring and small fingers. Loss of this motor branch results in a claw hand deformity due to unopposed IP flexion and MCP extension.

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