7. Hand and Wrist MCQs

A 60-year-old carpenter presents with progressive right wrist pain over the past two years. Radiographs reveal advanced joint space narrowing, sclerosis, and osteophyte formation of the entire radioscaphoid articulation. The radiolunate and midcarpal (capitolunate) joints appear completely preserved with no evidence of arthritis. What is the most appropriate surgical treatment for this patient?

A 55-year-old woman presents with sudden loss of active thumb interphalangeal joint flexion 9 months after volar plate fixation of a distal radius fracture. Radiographs show the plate is positioned volar to the watershed line. Which of the following describes the most likely pathogenesis of her current condition?

A 42-year-old man undergoes a single-incision anterior approach for repair of an acute distal biceps tendon rupture. Postoperatively, he notes numbness along the lateral aspect of his forearm. Which nerve is most likely injured?

A 40-year-old female undergoes volar locking plate fixation for a distal radius fracture. Six months postoperatively, she suddenly loses the ability to actively flex the interphalangeal joint of her thumb. Which of the following is the most likely cause?

A 38-year-old bodybuilder undergoes a single-incision anterior approach repair for a distal biceps tendon rupture. Postoperatively, he complains of numbness and tingling along the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

A 50-year-old male presents with weakness of pinch grip and numbness in the small finger, extending to the dorsal ulnar aspect of the hand. Examination reveals weakness of the first dorsal interosseous muscle and a positive Froment sign. What is the most likely diagnosis?

A 30-year-old construction worker presents with chronic wrist pain and decreased grip strength. Radiographs reveal sclerosis of the lunate with negative ulnar variance, but no carpal collapse. What is the most appropriate surgical treatment?

A 28-year-old carpenter lacerates his index finger at the level of the proximal phalanx, completely severing both the FDS and FDP tendons (Zone II). Which of the following factors has the most direct correlation with the tensile strength of the primary flexor tendon repair, allowing for an early active motion protocol?

A 45-year-old typist complains of numbness in his ring and small fingers, and weakness in his hand. Examination reveals a positive Froment's sign when attempting to pinch a piece of paper. Which muscle is compensating for the primary motor deficit during this maneuver?

A 28-year-old construction worker complains of dorsal central wrist pain. Radiographs reveal ulnar negative variance and sclerosis of the lunate without collapse. MRI confirms diffuse avascular necrosis of the lunate. What is the most appropriate initial surgical intervention to offload the radiolunate joint?

A 30-year-old male sustains a severe high-energy wrist hyperextension injury. Lateral radiograph demonstrates the capitate resting dorsally to the lunate, while the lunate maintains its normal alignment with the distal radius. The patient exhibits acute numbness in the thumb, index, and middle fingers. What is the most appropriate initial step in management?

A 62-year-old female with advanced basal joint arthritis undergoes a ligament reconstruction and tendon interposition (LRTI) procedure using the flexor carpi radialis (FCR) tendon. This procedure is specifically designed to reconstruct which primary stabilizing ligament of the trapeziometacarpal joint to prevent proximal metacarpal subsidence?

A 40-year-old mechanic presents with a swollen, erythematous index finger held in slight flexion. He reports severe pain when the examiner passively extends the digit. He has exquisite tenderness along the volar aspect of the digit. If left untreated, what is the most significant consequence of the increased pressure within the flexor tendon sheath?

A 60-year-old woman requires open reduction and internal fixation for a volar Barton's fracture of the distal radius. The surgeon utilizes a standard volar Henry approach. During distal dissection, which structure must be carefully retracted ulnarly to protect the median nerve while maintaining the plane between the FCR and radial artery?

A 24-year-old gymnast presents with persistent ulnar-sided wrist pain and clicking upon pronation and supination. Examination reveals gross instability of the distal radioulnar joint (DRUJ) and a positive foveal sign. MRI confirms a complete avulsion of the triangular fibrocartilage complex (TFCC). Which specific fibers must be reattached to restore DRUJ stability?

A 45-year-old carpenter presents with persistent numbness in his small and ring fingers, accompanied by intrinsic hand muscle weakness. He is diagnosed with severe cubital tunnel syndrome. During surgical decompression, which structure represents the most common site of ulnar nerve compression at the elbow?

A 29-year-old man falls backward onto his extended wrist and complains of severe dorsal radial wrist pain. Radiographs demonstrate a widened scapholunate interval of 5 mm and a "cortical ring sign" of the scaphoid. The patient is scheduled for surgical repair of the scapholunate ligament. Which portion of the scapholunate interosseous ligament is the strongest and most critical to repair for carpal stability?