7. Hand and Wrist MCQs

A 55-year-old woman returns to the clinic 1 year after volar locking plate fixation of a distal radius fracture. She reports suddenly losing the ability to flex the interphalangeal (IP) joint of her thumb while lifting a moderately heavy pan. Radiographs demonstrate a well-healed distal radius fracture with the volar plate positioned palmar to the watershed line. Assuming the distal segment of the ruptured tendon is not amenable to primary repair, which of the following is the most appropriate surgical management?

A 35-year-old manual laborer presents with chronic, progressive, dorsal wrist pain. Radiographs demonstrate significant sclerosis and early fragmentation of the lunate, confirming Kienbock's disease. Measurements reveal a negative ulnar variance of 3 mm. There is no fixed scaphoid rotary subluxation and no evidence of radiocarpal or midcarpal arthritis (Lichtman Stage IIIA). Which of the following is the most appropriate surgical treatment?

A 52-year-old man presents with chronic, progressive wrist pain and stiffness. He sustained a fall onto his outstretched hand 15 years ago but never sought medical treatment. Current radiographs reveal a chronic scaphoid waist nonunion with advanced degenerative changes involving both the radioscaphoid and capitolunate joints. The radiolunate articulation is entirely spared. What stage of Scaphoid Nonunion Advanced Collapse (SNAC) does this represent, and what is the preferred surgical salvage procedure?

A 24-year-old man presents with chronic wrist pain after a fall 2 years ago. He is diagnosed with a scaphoid nonunion. Radiographs reveal a humpback deformity with a radiolunate angle of 20 degrees. MRI shows avascular necrosis of the proximal pole without radioscaphoid arthritis. What is the most appropriate surgical treatment?

A 55-year-old woman is seen 8 weeks after a nondisplaced distal radius fracture treated with cast immobilization. She reports a sudden inability to extend her thumb at the interphalangeal joint, which occurred while lifting a light pan. Examination reveals full passive extension of the thumb IP joint but a complete lack of active extension. Radiographs show a healed distal radius fracture. What is the most appropriate management?

A 48-year-old carpenter complains of numbness and tingling in his small and ring fingers of the right hand. He also notes weakness in grip strength. Examination reveals a positive Froment's sign and intrinsic muscle wasting. Electrodiagnostic studies confirm severe ulnar neuropathy at the elbow. Which of the following clinical or anatomic findings is an absolute indication for an anterior transposition of the ulnar nerve rather than a simple in situ decompression?

A 32-year-old carpenter presents with an 8-month history of dorsal wrist pain and decreased grip strength. Radiographs show sclerosis and early collapse of the lunate with a negative ulnar variance of 3 mm. There is no evidence of radiocarpal osteoarthritis. MRI confirms avascular necrosis of the lunate. Based on the Lichtman classification (Stage IIIA), what is the most appropriate surgical intervention?

A 60-year-old man of Northern European descent presents with progressive flexion contractures of his ring and small fingers. He is diagnosed with Dupuytren's disease. Which of the following normal anatomic fascial structures is the primary precursor to the pseudo-cord responsible for contracture at the proximal interphalangeal (PIP) joint?

A 38-year-old male manual laborer complains of right wrist pain 5 years after a fall. Radiographs demonstrate a scaphoid nonunion with radioscaphoid joint space narrowing and capitolunate arthritis. The radiolunate joint space is preserved. What is the most appropriate surgical treatment?

A 40-year-old male felt a pop in his antecubital fossa while lifting a heavy box. An MRI confirms a complete avulsion of the distal biceps tendon from the radial tuberosity. He elects to undergo surgical repair using a single-incision anterior approach. Which of the following neurological complications is most frequently encountered with this specific surgical approach?

A 58-year-old female sustains a nondisplaced distal radius fracture treated with cast immobilization. Six weeks later, the cast is removed, and radiographs confirm a healed fracture. Two weeks following cast removal, she reports a sudden inability to actively extend the interphalangeal joint of her thumb. She is unable to lift her thumb off the table when the hand is placed flat. Which of the following is the most appropriate surgical management?

A 62-year-old woman undergoes open reduction and internal fixation of a distal radius fracture with a volar locking plate. Four months postoperatively, she presents with volar wrist pain and a new-onset inability to actively flex the interphalangeal joint of her thumb. Radiographs demonstrate fracture union, but the volar plate is positioned distal to the watershed line. Which of the following is the most likely etiology of her condition?

A 50-year-old male carpenter presents with a 6-month history of numbness and tingling in his ring and small fingers, accompanied by grip weakness. Nerve conduction studies confirm compression of the ulnar nerve across the elbow. During a surgical in situ decompression, the nerve is traced from proximal to distal. Which of the following structures is the most common site of ulnar nerve compression in this region?

A 55-year-old female presents with persistent numbness, tingling, and pain in her thumb, index, and long fingers, waking her up at night. She underwent an open carpal tunnel release 6 months ago by an outside surgeon. Nerve conduction studies confirm severe median neuropathy across the carpal tunnel. Exploration of the carpal tunnel is performed. What is the most common intraoperative finding responsible for recurrent or persistent carpal tunnel syndrome?

A 55-year-old manual laborer presents with chronic right wrist pain. Radiographs demonstrate advanced joint space narrowing of the radioscaphoid and capitolunate joints, while the radiolunate joint is well preserved. Based on these findings, which of the following is the most appropriate surgical treatment?

A 62-year-old woman is 6 months status post volar locked plating of a comminuted distal radius fracture. She reports a sudden inability to flex her thumb interphalangeal joint. Radiographs show a well-healed fracture, but the distal margin of the plate is positioned directly on the watershed line. Which tendon is most likely ruptured?

A 30-year-old mechanic presents with a swollen, painful index finger 3 days after sustaining a minor puncture wound. Which of the following is NOT one of Kanavel's cardinal signs of pyogenic flexor tenosynovitis?

A 45-year-old avid cyclist presents with a 3-month history of numbness and tingling in his right ring and small fingers. He also notes weakness in spreading his fingers apart. Tinel's sign is positive over the ulnar aspect of the wrist, but negative at the elbow. Sensation over the dorsoulnar aspect of the hand is completely normal. Where is the most likely site of nerve compression?

A 45-year-old man presents with chronic, progressive wrist pain and limited range of motion. He recalls falling on his outstretched hand several years ago but did not seek medical attention at the time. Radiographs reveal a scaphoid nonunion with advanced arthritic changes at the radioscaphoid and capitolunate joints, while the radiolunate joint is entirely preserved. Based on these findings, which of the following is the most appropriate surgical treatment?

A 32-year-old manual laborer presents with an insidious onset of dorsal wrist pain and weakened grip strength. Radiographs reveal sclerosis, cystic changes, and early fragmentation of the lunate, consistent with Lichtman Stage IIIA Kienböck disease. Wrist films also demonstrate a negative ulnar variance of 3 mm. There are no signs of carpal collapse or secondary osteoarthritis. Which of the following is the most appropriate management?