7. Hand and Wrist MCQs

A 55-year-old female undergoes volar plating for a displaced distal radius fracture. Postoperatively, she develops the inability to actively flex the interphalangeal joint of her thumb. She reports no pain but a sudden loss of movement. What is the most likely cause?

Following a primary flexor tendon repair in zone II of the hand, what is the predominant type of collagen produced by fibroblasts during the proliferative phase (days 7-21) of tendon healing?

Which of the following is the primary source of nutrition for flexor tendons within Zone II of the hand (the 'no man's land')?

In evaluating a patient with a traumatic nerve injury to the forearm, the electrodiagnostic study reveals innervation of the intrinsic hand muscles (such as the first dorsal interosseous) despite a complete transection of the ulnar nerve at the elbow. Which of the following anatomical variants is responsible for this finding?

A 35-year-old carpenter presents with a swollen, painful index finger 3 days after a puncture wound. Which of the following Kanavel's signs is typically the earliest and most reliable indicator of acute suppurative flexor tenosynovitis?

During a nerve conduction study for suspected carpal tunnel syndrome, the neurologist identifies a Martin-Gruber anastomosis. This anatomic variant involves a neural communication in the forearm transferring fibers from the:

A patient sustains a laceration to the volar aspect of the hand, resulting in an inability to flex both the PIP and DIP joints of the index finger. The injury is located between the distal palmar crease and the middle of the middle phalanx. What zone of flexor tendon injury is this?

A 45-year-old pregnant woman in her third trimester presents with severe numbness and tingling in the radial three and a half digits of her right hand, awakening her at night. Nerve conduction studies confirm severe carpal tunnel syndrome. What is the most appropriate initial management?

A 65-year-old woman sustains a volar-angulated extra-articular distal radius fracture (Smith's fracture). Following closed reduction and volar locked plating, the patient develops an inability to flex the interphalangeal joint of her thumb. Which tendon is most likely ruptured?

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. Diagnosis of this condition is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. The level of the lesion in this patient is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as a clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to the fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. Appropriate surgical management in this case is:

An 18-month-old boy presents with a clawing deformity of the right hand. He was born full term after a difficult delivery complicated by shoulder dystocia. He weighed 9.5 lbs at birth. The patient had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. A tender bump was noted on the patient's right clavicle, which was diagnosed as a clavicle fracture. A week later, the patient could not flex the fingers of his right hand. The neonatologist informed the parents that the fracture was managed conservatively and the absence of finger flexion was due to the fracture and would recover. However, recovery can be prolonged and may take up to two years. The patient has grown and his immunization is complete. His right hand has extension at all the metacarpal joints of the fingers while the proximal interphalangeal and distal interphalangeal joints are flexed. The thumb is in an adducted position, and it is difficult to passively bring the thumb to full abduction. There is obvious wasting of the hand and forearm. The patient moves the arm well with no abnormalities noticed at the shoulder, elbow, and wrist. Radiograph of the chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner's syndrome and the grasp reflex is absent. Reconstructive surgery includes all of the following except:

A patient presents with hand weakness. On examination, she has no sensory deficit, decreased strength with pronation, and her elbow is at 90° of flexion and pulp-to-pulp contact on key pinch. The most likely diagnosis is:

Operative indications for Dupuytren's contracture include:

A 24-year-old man presents with a short forearm and a hand deformity. The patient is otherwise healthy with no other congenital defects. The potential complications of lengthening are discussed, and the patient is advised against it. However, the elbow flexion contracture is corrected by gradual distraction. One year postoperatively, the patient has attained a 30° correction of the flexion deformity, which remains mobile. Now, he desires that his wrist deformity be corrected. The procedure of choice is:

A 15-day-old boy presents with deformity of the right hand. The boy was delivered prematurely and underwent an urgent arterial switch for transposition of great vessels. The patient is in stable condition. He has a radial club hand, and because the radial head cannot be palpated, total absence of radius is suspected. The thumb is absent and the index finger has camptodactyly. The forearm is short compared to the left side, and the patient flexes his elbow upon stimulation. Spontaneous finger motion is also present. A thorough physical examination is performed and a set of investigations is ordered. The results are as follows: complete blood count 10,000 mcu/L; platelet 254×10^3 mcu/L; neutrophils 50%; Hb 14.2 mg/dL; lymphocytes 40%; Hct 45; and monocytes 10%. No renal abnormalities were noted on ultrasonogram of the abdomen. A radiograph of the spine is normal. Centralization will be performed on the patient. All of the following statements are true about centralization except:

A 45-year-old carpenter complains of numbness in his ring and small fingers, and progressive hand weakness. Examination shows intrinsic muscle wasting, a positive Froment's sign, and a positive Tinel's sign at the elbow. Which of the following anatomical structures is the most common site of compression for this pathology?

A 30-year-old manual laborer presents with dorsal wrist pain. Radiographs demonstrate sclerosis of the lunate with negative ulnar variance, but no carpal collapse (Lichtman Stage II Kienböck disease). What is the most appropriate initial surgical management?

A 65-year-old male presents with deteriorating hand dexterity and difficulty buttoning his shirt. Physical exam reveals a positive Hoffmann's sign and an inverted supinator reflex. These findings are most indicative of which underlying pathology?