7. Hand and Wrist MCQs

A 52-year-old man presents with chronic numbness and tingling in his small and ring fingers. Physical examination reveals a positive Tinel's sign over the cubital tunnel and weak interosseous muscles. Nerve conduction studies confirm severe ulnar neuropathy at the elbow. During surgical decompression, the surgeon must evaluate all potential sites of ulnar nerve entrapment. From proximal to distal, which of the following represents the most proximal potential site of compression?

A 32-year-old manual laborer presents with an 8-month history of central dorsal wrist pain. Radiographs demonstrate sclerosis and early fragmentation of the lunate, but the carpal height is maintained and there is no capitate migration. Radiographic measurements reveal a negative ulnar variance of 3 mm. Which of the following is the most appropriate surgical treatment?

A 42-year-old male bodybuilder sustains an acute distal biceps tendon rupture and undergoes surgical repair using a dual-incision (modified Boyd-Anderson) technique. Postoperatively, he reports difficulty extending his fingers and thumb. Examination reveals absent digit extension at the metacarpophalangeal joints, but wrist extension is preserved albeit with radial deviation. Sensation over the dorsum of the hand and lateral forearm is completely intact. Which of the following nerves was most likely injured during the procedure?

A 45-year-old man presents with chronic radial-sided wrist pain 10 years after a fall on his outstretched hand. Radiographs demonstrate a scaphoid waist fracture nonunion with sclerosis and cystic changes. There is joint space narrowing and osteophyte formation between the distal scaphoid fragment and the radial styloid. The radiolunate and midcarpal joints are well preserved. What is the diagnosis and the most appropriate surgical management?

A 55-year-old woman is seen in the clinic 6 weeks after sustaining a nondisplaced distal radius fracture treated conservatively in a short arm cast. The cast is removed, and radiographs show early healing with maintained alignment. Two weeks later, she returns reporting a sudden inability to actively extend her thumb at the interphalangeal joint. She denies any new trauma. What is the most appropriate management for this complication?

A 28-year-old mechanic presents with chronic wrist pain 2 years after falling onto an outstretched hand. Radiographs demonstrate a scaphoid waist nonunion with advanced osteoarthritis of the radioscaphoid and capitolunate joints. The radiolunate joint is well preserved. What is the most appropriate surgical treatment?

A 60-year-old woman undergoes volar locked plating for a comminuted distal radius fracture. Six months postoperatively, she presents to the clinic with an inability to actively flex the interphalangeal joint of her thumb. Which of the following technical errors during the index procedure is most likely responsible for this complication?

A 25-year-old man presents with chronic dorsal wrist pain. Radiographs reveal sclerosis and fragmentation of the lunate without fixed scaphoid rotation or carpal height collapse. Ulnar variance is measured at negative 3 mm. What is the most appropriate initial surgical management?

A 45-year-old male undergoes a single-incision anterior repair of a distal biceps tendon rupture. Postoperatively, he is noted to have profound weakness in finger and thumb extension, but his wrist extension is preserved with radial deviation. Sensation over the hand and forearm is entirely intact. Which nerve was most likely injured, and what is its anatomic path near the surgical site?

A 55-year-old male undergoes surgery for severe cubital tunnel syndrome. During the planned in situ decompression, the ulnar nerve is observed to subluxate completely anterior to the medial epicondyle during passive elbow flexion. What is the most appropriate next step in surgical management?

A 55-year-old woman is seen 6 weeks after sustaining a non-displaced distal radius fracture treated conservatively in a cast. The cast was removed 2 weeks ago, and she began physical therapy. She now reports a sudden, painless inability to actively extend her thumb interphalangeal joint. On examination, she has full passive thumb extension, but cannot actively lift the thumb off the table when the hand is placed flat. Radiographs show a healed distal radius fracture. What is the most appropriate surgical management for this patient's new deficit?

A 40-year-old male bodybuilder undergoes a single-incision anterior approach for repairing an acute distal biceps tendon rupture using cortical button fixation. Six weeks postoperatively, he complains of weakness in his hand and difficulty extending his fingers. On physical examination, he demonstrates a lack of active metacarpophalangeal (MCP) joint extension of all four fingers and thumb extension. Wrist extension is preserved but occurs with radial deviation. Sensation over the hand and forearm is normal. Which of the following nerves was most likely injured during the surgical procedure?

A 42-year-old avid cyclist presents with intrinsic muscle weakness and numbness in the small and ring fingers of his right hand. Examination shows clawing of the ring and small fingers, a positive Froment sign, and normal sensation over the dorsal ulnar aspect of the hand. Where is the most likely location of ulnar nerve compression?

During surgical decompression of the cubital tunnel for ulnar nerve entrapment, the surgeon must be aware of potential anatomical variations. Which structure is considered the primary static constraint forming the roof of the cubital tunnel?

A 30-year-old male presents with acute pain and swelling over the dorsal aspect of his wrist following a fall onto an outstretched hand. Radiographs confirm a scaphoid fracture. Which of the following carpal bones has the most consistent and predominant dorsal blood supply, making it susceptible to avascular necrosis when fractured at its waist?

A surgeon is decompressing the deep palmar space of the hand due to a severe infection. Which of the following anatomical structures forms the primary boundary between the thenar space and the midpalmar space?

A patient presents with chronic wrist pain and instability following a fall. Imaging suggests disruption of the distal radioulnar joint (DRUJ). Which component of the Triangular Fibrocartilage Complex (TFCC) is the most critical stabilizer of the DRUJ?

A patient develops a painful mass on the palmar aspect of the hand, particularly along the flexor tendon sheath of the ring finger. During surgical excision, the surgeon encounters a cyst arising from the synovial sheath of a flexor tendon within the fibro-osseous canal. Which type of ganglion cyst is most commonly found in this location, associated with the flexor tendon sheath?

During surgical exploration of the posteromedial elbow, the surgeon must identify the various components of the medial epicondyle's muscle attachment. Which muscle's tendon is the most posterior attachment to the medial epicondyle, making it vulnerable during posterior approaches?

In the hand, which group of muscles contributes to both flexion at the metacarpophalangeal (MCP) joints and extension at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints?