7. Hand and Wrist MCQs

A 60-year-old female is 6 weeks post non-operative management of a minimally displaced distal radius fracture. She suddenly loses the ability to actively extend her thumb interphalangeal joint. Physical exam confirms loss of retropulsion but normal function of the abductor pollicis longus and extensor pollicis brevis. What is the MOST appropriate surgical treatment?

A 25-year-old male sustained a C5-C6 upper trunk brachial plexus injury 5 months ago. He has no active elbow flexion, but hand and wrist function are fully intact. He is scheduled for an Oberlin transfer. This procedure classically involves which of the following nerve transfers?

A 50-year-old patient with severe carpal tunnel syndrome exhibits paradoxical preservation of intrinsic hand muscle function that is normally innervated by the median nerve. Electromyography confirms an anomalous motor communication between the median and ulnar nerves in the proximal forearm. What is the eponymous name of this anatomical variant?

A 32-year-old manual laborer presents with progressive dorsal wrist pain. Imaging reveals lunate sclerosis and a coronal fracture line. Carpal height is preserved, and there is no fixed scaphoid rotation (Lichtman Stage IIIA Kienböck's disease). Radiographs demonstrate an ulnar variance of negative 3 mm. What is the MOST appropriate surgical intervention?

A 45-year-old manual laborer presents with chronic, progressive dorsal wrist pain and weakness in grip strength. He sustained a 'sprained wrist' 10 years ago that was never treated. Radiographs reveal a scaphoid nonunion with advanced joint space narrowing and sclerosis at the radioscaphoid and capitolunate joints; however, the radiolunate joint is remarkably preserved. Which of the following is the MOST appropriate surgical management for this patient?

A 45-year-old poorly-controlled diabetic male presents with acute pyogenic flexor tenosynovitis of the thumb following a minor puncture wound. He delays seeking medical attention for 72 hours. Upon presentation, his small finger is also markedly swollen, held in a flexed posture, and exquisitely tender along its volar aspect, while the index, middle, and ring fingers remain relatively unaffected. Which anatomical feature explains the direct contiguous spread of infection from the thumb to the small finger in this patient?

A 45-year-old male presents with chronic wrist pain. Radiographs demonstrate a scaphoid nonunion advanced collapse (SNAC) pattern with arthritic changes present at the radioscaphoid and capitolunate joints. The radiolunate joint is well preserved. What is the most appropriate definitive surgical treatment?

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 40-year-old man undergoes a single-incision anterior approach for a distal biceps tendon repair. Postoperatively, he notes weakness in extending his thumb and fingers. When asked to extend his wrist, his wrist deviates radially. Sensation in the hand and forearm is entirely intact. Which nerve was most likely injured during the procedure?

A 55-year-old woman is 6 months status post volar locking plate fixation for a comminuted distal radius fracture. She complains of a sudden inability to actively flex the interphalangeal joint of her thumb. Lateral radiographs demonstrate the distal edge of the volar plate is positioned prominently volar to the watershed line. What is the most likely cause of her current presentation?

A 30-year-old construction worker presents with chronic dorsal wrist pain and stiffness. Radiographs reveal sclerosis and early collapse of the lunate, consistent with Kienböck's disease. Measurement of ulnar variance shows ulnar minus 3 mm. The articular cartilage of the radiocarpal and midcarpal joints appears well-preserved on MRI. Which of the following is the most appropriate initial surgical intervention to decompress the lunate?

A 45-year-old manual laborer presents with chronic, progressive radial-sided wrist pain. He has a history of a fall on an outstretched hand 10 years ago. Radiographs demonstrate a scaphoid nonunion with advanced collapse (SNAC). There is significant joint space narrowing and sclerosis at the radioscaphoid and capitolunate joints, but the radiolunate articulation is well preserved. Which of the following is the most appropriate surgical treatment?

A 65-year-old woman is seen 9 months after undergoing open reduction and internal fixation of a distal radius fracture with a volar locking plate. She reports the sudden onset of an inability to actively flex the interphalangeal joint of her thumb. Passive motion is intact. What is the most likely etiology of this complication?

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 50-year-old woman presents with persistent ulnar-sided wrist pain that worsens with pronation and gripping, 1 year after non-operative management of a distal radius fracture.

Radiographs demonstrate a healed distal radius with 4 mm of radial shortening, resulting in positive ulnar variance. MRI reveals degenerative tearing of the triangular fibrocartilage complex (TFCC) and cystic changes in the lunate. The distal radioulnar joint (DRUJ) is congruous without advanced arthritis. What is the most appropriate definitive surgical management?

A 32-year-old man presents with chronic, progressive wrist pain. Radiographs reveal a scaphoid nonunion advanced collapse (SNAC). Imaging demonstrates moderate degenerative changes at the radioscaphoid joint and the scaphocapitate joint, while the radiolunate articulation is entirely spared. However, there is marked cartilage loss and degenerative cyst formation on the proximal head of the capitate. Which of the following is the most appropriate surgical treatment?

A 55-year-old woman sustained a nondisplaced fracture of the distal radius 6 weeks ago, which was managed conservatively in a short-arm cast. Two days after cast removal, she suddenly loses the ability to actively extend the interphalangeal joint of her thumb.

Radiographs show healing of the distal radius fracture with no displacement. What is the gold standard surgical intervention for this complication?

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 35-year-old mechanic presents to the emergency department complaining of a severely swollen, throbbing index finger 3 days after sustaining a minor puncture wound with a wire.

You suspect pyogenic flexor tenosynovitis. According to Kanavel's criteria, which of the following is considered the earliest and most sensitive clinical sign of this condition?

A 30-year-old manual laborer presents with progressive dorsal wrist pain and weakened grip strength over the past 6 months. Radiographs demonstrate increased sclerosis and early collapse of the lunate, without fixed scaphoid rotation or adjacent carpal arthritis. Ulnar variance is measured at -3 mm.

The patient is diagnosed with Lichtman Stage II Kienbock's disease. Which of the following surgical interventions is the most appropriate primary joint leveling procedure to unload the lunate in this patient?