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7. Hand and Wrist MCQs

Practice Set 233 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 4641

Topic: Hand Trauma & Infection

A 42-year-old diabetic patient presents with a swollen, erythematous index finger. Of Kanavel's four cardinal signs for infectious pyogenic flexor tenosynovitis, which is considered the earliest and most sensitive clinical indicator?

. Symmetrical enlargement of the entire digit (fusiform swelling)
. Flexed resting posture of the digit
. Exquisite pain with passive extension of the digit
. Tenderness along the entire course of the flexor tendon sheath
. Fluctuant mass at the proximal interphalangeal joint

Correct Answer & Explanation

. Exquisite pain with passive extension of the digit

Explanation

Pain with passive extension is the earliest and most sensitive of Kanavel's signs for pyogenic flexor tenosynovitis. This stretch places direct tension on the inflamed synovial sheath, eliciting severe pain before the other localized signs fully manifest.

Question 4642

Topic: 7. Hand and Wrist

Which intrinsic ligament of the wrist is the primary stabilizer of the scapholunate articulation, and what is its strongest component?

. Scapholunate interosseous ligament; volar component
. Scapholunate interosseous ligament; dorsal component
. Lunotriquetral interosseous ligament; volar component
. Lunotriquetral interosseous ligament; dorsal component
. Radioscaphocapitate ligament; central component

Correct Answer & Explanation

. Scapholunate interosseous ligament; dorsal component

Explanation

The primary stabilizer of the scapholunate joint is the scapholunate interosseous ligament (SLIL). The dorsal component of the SLIL is the thickest and strongest, providing the most mechanical stability against dissociation.

Question 4643

Topic: 7. Hand and Wrist

A 45-year-old manual laborer presents with chronic wrist pain. X-rays show Scapholunate Advanced Collapse (SLAC) stage II. Which articulation is classically spared in SLAC arthritis?

. Radioscaphoid
. Capitolunate
. Radiolunate
. Scaphocapitate
. Scaphotrapezial

Correct Answer & Explanation

. Radiolunate

Explanation

In SLAC wrist, the radiolunate joint is characteristically spared due to the concentric shape of the lunate fossa and the absence of cartilage-shearing forces. Degeneration sequentially progresses from the radial styloid to the entire radioscaphoid joint, and then to the capitolunate joint.

Question 4644

Topic: 7. Hand and Wrist

In a patient with isolated palsy of the anterior interosseous nerve (AIN), which of the following clinical findings is expected?

. Inability to cross the fingers
. Numbness over the thenar eminence
. Inability to flex the distal interphalangeal joint of the index finger
. Weakness in wrist extension
. Loss of sensation over the dorsal first web space

Correct Answer & Explanation

. Inability to cross the fingers

Explanation

The AIN is a pure motor branch of the median nerve innervating the flexor pollicis longus, the flexor digitorum profundus to the index and middle fingers, and the pronator quadratus. An AIN palsy results in the inability to make an "OK" sign due to loss of index FDP and thumb FPL function.

Question 4645

Topic: 7. Hand and Wrist

Which of the following defines the "Camper chiasm" in flexor tendon anatomy of the hand?

. The insertion of the FDS on the middle phalanx
. The decussation of the FDS tendon allowing the FDP tendon to pass through
. The crossing of the FPL and FCR tendons in the carpal tunnel
. The bifurcation of the median nerve at the distal carpal tunnel
. The intersection of the extensor pollicis brevis and abductor pollicis longus

Correct Answer & Explanation

. The decussation of the FDS tendon allowing the FDP tendon to pass through

Explanation

Camper's chiasm is the structural decussation of the flexor digitorum superficialis (FDS) tendon slips. It allows the deeper flexor digitorum profundus (FDP) tendon to pass through and become superficial before inserting on the distal phalanx.

Question 4646

Topic: Hand Trauma & Infection

A 28-year-old male presents with a painful, swollen index finger held in slight flexion. There is tenderness along the entire flexor tendon sheath and severe pain with passive extension. What is the most common causative organism for this condition if acquired via a penetrating injury?

. Streptococcus pyogenes
. Staphylococcus aureus
. Pasteurella multocida
. Eikenella corrodens
. Neisseria gonorrhoeae

Correct Answer & Explanation

. Staphylococcus aureus

Explanation

The patient exhibits Kanavel's signs, indicating acute pyogenic flexor tenosynovitis. The most common causative organism overall, particularly following a penetrating injury, is Staphylococcus aureus.

Question 4647

Topic: 7. Hand and Wrist

A 60-year-old female presents with a progressively worsening "crossover toe" deformity of her second toe. Clinical examination demonstrates dorsal subluxation of the second metatarsophalangeal (MTP) joint and a positive positive Lachman test of the joint. In the context of a plantar plate tear leading to this deformity, which anatomical location of the plantar plate is most frequently torn?

. Proximal origin at the metatarsal neck
. Mid-substance of the plantar plate
. Distal insertion at the base of the proximal phalanx
. Medial collateral ligament junction
. Lateral collateral ligament junction

Correct Answer & Explanation

. Distal insertion at the base of the proximal phalanx

Explanation

A crossover toe deformity is typically the result of an insufficiency or rupture of the plantar plate and lateral collateral ligament of the MTP joint, most commonly affecting the second toe. The plantar plate is the primary static stabilizer against dorsal subluxation of the MTP joint. Anatomically, tears of the plantar plate most frequently occur at its distal insertion onto the plantar base of the proximal phalanx, rather than at its proximal origin on the metatarsal neck or in its mid-substance.

Question 4648

Topic: Nerve & Tendon

During an ulnar collateral ligament (UCL) reconstruction in a professional throwing athlete, the surgeon elects to use the docking technique rather than the traditional figure-of-eight (Jobe) technique. What is the primary anatomic and biomechanical advantage of the docking technique?

. It allows for an earlier return to competitive throwing
. It completely avoids the need for ulnar nerve handling or transposition
. It requires a significantly shorter graft harvest, allowing use of the palmaris longus
. It minimizes the size and number of drill holes in the medial epicondyle
. It provides a stiffer initial construct than native UCL anatomy

Correct Answer & Explanation

. It minimizes the size and number of drill holes in the medial epicondyle

Explanation

The docking technique utilizes a single larger socket in the medial epicondyle with smaller exit holes for sutures, rather than large intersecting tunnels. This minimizes bone loss in the medial epicondyle, thereby reducing the risk of iatrogenic epicondylar fracture.

Question 4649

Topic: 7. Hand and Wrist

A 22-year-old male sustains a proximal pole scaphoid fracture. The risk of avascular necrosis is high due to the retrograde blood supply. Which artery provides the primary blood supply to the proximal pole of the scaphoid?

. Ulnar artery
. Anterior interosseous artery
. Superficial palmar arch
. Dorsal carpal branch of the radial artery
. Volar carpal branch of the radial artery

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The primary blood supply to the scaphoid enters distally and flows retrograde. It is derived mostly from the dorsal carpal branch of the radial artery, making proximal pole fractures highly susceptible to nonunion and avascular necrosis.

Question 4650

Topic: 7. Hand and Wrist

A 50-year-old female sustains a volar Barton fracture of the distal radius. ORIF with a volar locking plate is planned. If the plate is placed excessively distal to the watershed line, which structure is at the highest risk of iatrogenic rupture?

. Extensor pollicis longus tendon
. Flexor carpi radialis tendon
. Flexor pollicis longus tendon
. Median nerve
. Extensor carpi ulnaris tendon

Correct Answer & Explanation

. Flexor pollicis longus tendon

Explanation

Placement of a volar plate distal to the watershed line of the distal radius causes prominence that impinges on the flexor tendons. The Flexor Pollicis Longus (FPL) tendon is the most commonly injured or ruptured structure due to volar hardware prominence.

Question 4651

Topic: Nerve & Tendon

A 45-year-old male undergoes a single-incision anterior approach for a distal biceps tendon rupture repair. Postoperatively, he complains of numbness and paresthesia along the radial aspect of his forearm. Which of the following nerves is most commonly at risk and likely injured due to superficial retraction during this specific surgical approach?

. Median nerve
. Ulnar nerve
. Posterior interosseous nerve (PIN)
. Lateral antebrachial cutaneous nerve (LABCN)
. Superficial radial nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN)

Explanation

In a single-incision anterior approach for distal biceps repair, the lateral antebrachial cutaneous nerve (LABCN) is the most frequently injured nerve (typically via neurapraxia from retraction). It runs superficially in the subcutaneous tissue on the lateral aspect of the antecubital fossa. While the posterior interosseous nerve (PIN) is at risk during drilling of the radial tuberosity, LABCN injury is the most common sensory complication of the anterior approach.

Question 4652

Topic: Nerve & Tendon

A 35-year-old weightlifter undergoes an acute distal biceps tendon repair using a single-incision anterior approach. Which nerve is at the highest risk of iatrogenic injury due to lateral retraction during this exposure?

. Median nerve
. Ulnar nerve
. Lateral antebrachial cutaneous nerve (LABCN)
. Posterior interosseous nerve (PIN)
. Superficial radial nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve in a single-incision anterior approach to the distal biceps. The PIN is at higher risk during a two-incision approach or if dissection strays lateral to the bicipital tuberosity.

Question 4653

Topic: Nerve & Tendon

During an ulnar collateral ligament (UCL) reconstruction utilizing a docking technique, what is the primary biomechanical rationale for precise graft placement on the medial ulna?

. To reconstruct the transverse band of the UCL
. To anatomically recreate the broad ulnar footprint on the sublime tubercle
. To avoid transposition of the ulnar nerve
. To provide rigid fixation without requiring bone tunnels
. To intentionally over-tension the graft to compensate for stretching

Correct Answer & Explanation

. To anatomically recreate the broad ulnar footprint on the sublime tubercle

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress and attaches to the sublime tubercle of the ulna. Modern reconstruction techniques emphasize anatomic recreation of this broad footprint to optimize graft tension throughout the elbow's arc of motion.

Question 4654

Topic: 7. Hand and Wrist

In the digital flexor pulley system, which two pulleys are considered the most biomechanically critical for preventing bowstringing of the flexor tendons?

. A1 and A3
. A2 and A4
. A3 and A5
. A1 and A5
. C1 and C3

Correct Answer & Explanation

. A2 and A4

Explanation

The A2 and A4 pulleys are the major annular pulleys. The A2 pulley is located over the proximal phalanx, and the A4 pulley is located over the middle phalanx. Preserving or reconstructing these pulleys is critical to prevent flexor tendon bowstringing and subsequent loss of active flexion and mechanical disadvantage.

Question 4655

Topic: Nerve & Tendon

A patient requires a first dorsal compartment release for De Quervain's tenosynovitis. The surgeon must be aware of anatomical variants. Which of the following is true regarding the first dorsal compartment?

. It contains the Extensor Pollicis Longus and Extensor Pollicis Brevis tendons.
. Multiple slips of the Abductor Pollicis Longus tendon are exceptionally rare.
. A subcompartmental septum separating the APL and EPB is found in 30-60% of patients.
. The superficial branch of the ulnar nerve is at high risk during the incision.
. It is located deep to the extensor retinaculum and palmar to the scaphoid.

Correct Answer & Explanation

. A subcompartmental septum separating the APL and EPB is found in 30-60% of patients.

Explanation

The first dorsal compartment contains the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) tendons. Multiple slips of the APL are very common. A subcompartmental septum separating the APL and EPB is found in up to 30-60% of cases, and failure to release both subcompartments is a common cause of recurrent/persistent symptoms. The superficial branch of the radial nerve (not ulnar) is at risk.

Question 4656

Topic: Nerve & Tendon

The ulnar nerve passes through several potential compression sites in the arm and elbow. The Arcade of Struthers is a potential site of entrapment located:

. Between the medial epicondyle and olecranon
. At the two heads of the flexor carpi ulnaris
. Approximately 8 cm proximal to the medial epicondyle
. Deep to the pronator teres
. At the level of Guyon's canal

Correct Answer & Explanation

. Approximately 8 cm proximal to the medial epicondyle

Explanation

The Arcade of Struthers is a fascial band or thickening of the medial intermuscular septum located approximately 8 cm proximal to the medial epicondyle. It extends from the medial intermuscular septum to the medial head of the triceps and is a known site of ulnar nerve compression, especially after anterior transposition.

Question 4657

Topic: 7. Hand and Wrist
During a digital fasciectomy for Dupuytren's contracture, the neurovascular bundle is identified. Which of the following normal anatomical ligaments of the digit passes dorsal to the neurovascular bundle and is typically spared from involvement in Dupuytren's disease?
. Grayson's ligament
. Cleland's ligament
. Natatory ligament
. Spiral band
. Pretendinous band

Correct Answer & Explanation

. Cleland's ligament

Explanation

Cleland's ligaments are strong fascial structures located dorsal to the digital neurovascular bundles and are rarely involved in Dupuytren's disease. Grayson's ligaments are volar (palmar) to the neurovascular bundle and are commonly involved, contributing to the pathological cords.

Question 4658

Topic: 7. Hand and Wrist
During endoscopic carpal tunnel release, precise knowledge of cross-sectional anatomy is paramount. Which of the following structures is anatomically positioned as the most radial component within the carpal tunnel?
. Median nerve
. Flexor pollicis longus (FPL) tendon
. Flexor carpi radialis (FCR) tendon
. Flexor digitorum superficialis (FDS) to the index finger
. Palmaris longus tendon

Correct Answer & Explanation

. Flexor pollicis longus (FPL) tendon

Explanation

Within the confines of the carpal tunnel (deep to the transverse carpal ligament), the FPL tendon is the most radial structure. The FCR is enclosed in its own separate fibro-osseous tunnel within the split of the transverse carpal ligament and is not considered a content of the main carpal tunnel.

Question 4659

Topic: 7. Hand and Wrist

Perilunate dislocations commonly propagate through an area of relative weakness in the volar wrist capsule known as the Space of Poirier. Between which two palmar carpal ligaments does this vulnerable space lie?

. Radioscaphocapitate (RSC) and Long radiolunate (LRL)
. Long radiolunate (LRL) and Short radiolunate (SRL)
. Radioscapholunate (RSL) and Ulnolunate
. Radioscaphocapitate (RSC) and Palmar lunotriquetral
. Dorsal radiocarpal and Dorsal intercarpal

Correct Answer & Explanation

. Radioscaphocapitate (RSC) and Long radiolunate (LRL)

Explanation

The Space of Poirier is a weakness in the volar radiocarpal capsule lying exactly between the radioscaphocapitate (RSC) ligament and the long radiolunate (LRL) ligament. In perilunate dislocations, the capitate typically dislocates dorsally through this interval or the lunate is extruded volarly through it.

Question 4660

Topic: Nerve & Tendon

The Martin-Gruber anastomosis is an important anatomical variant to consider during nerve conduction studies and hand surgery. What is the most common direction of nerve fiber crossover in this anomaly?

. Median nerve (or AIN) to the ulnar nerve in the forearm
. Ulnar nerve to the median nerve in the forearm
. Radial nerve to the median nerve in the forearm
. Ulnar nerve to the median nerve in the palm (Riche-Cannieu)
. Anterior interosseous nerve to the posterior interosseous nerve

Correct Answer & Explanation

. Median nerve (or AIN) to the ulnar nerve in the forearm

Explanation

A Martin-Gruber anastomosis is an anomalous connection in the forearm where motor fibers cross from the median nerve (or its anterior interosseous branch) to the ulnar nerve. It occurs in about 15% of individuals. A Riche-Cannieu anastomosis is a connection between the deep branch of the ulnar nerve and the recurrent branch of the median nerve in the hand.

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