7. Hand and Wrist MCQs

A 28-year-old male sustains a volar laceration to his proximal phalanx (Zone II) requiring primary flexor tendon repair. Which of the following rehabilitation protocols best promotes intrinsic tendon healing while minimizing adhesion formation?

During an open carpal tunnel release, the surgeon must identify and protect the recurrent motor branch of the median nerve. What is the most common anatomic variation of this motor branch?

A patient sustains a closed midshaft humerus fracture and presents with a complete radial nerve palsy. An EMG performed at 4 weeks shows fibrillation potentials in the brachioradialis and no voluntary motor unit action potentials. However, clinical recovery is noted at 12 weeks. According to the Seddon classification, what was the most likely initial nerve injury?

A 28-year-old carpenter presents with progressive right hand weakness and numbness over the past 6 months, primarily affecting the thumb, index, and middle fingers. He reports a constant dull ache in the forearm. Physical examination reveals thenar atrophy, weakness of thumb opposition and abduction, and positive Tinel's sign at the wrist. Nerve conduction studies show severe carpal tunnel syndrome. He has undergone two steroid injections with only transient relief. What is the most significant factor influencing the outcome of surgical release in this patient?

A 40-year-old carpenter presents with a swollen, erythematous, and painful index finger after sustaining a puncture wound 2 days ago. Which of the following is NOT one of Kanavel's cardinal signs of acute suppurative flexor tenosynovitis?

A 35-year-old carpenter sustains a puncture wound to his right index finger. Two days later, he presents with severe pain and swelling. Which of the following is NOT one of Kanavel's cardinal signs of flexor tenosynovitis?

A 45-year-old man presents with chronic wrist pain years after a FOOSH injury. Imaging reveals a scaphoid nonunion advanced collapse (SNAC). Which joint is classically spared in the typical progression of a SNAC wrist?

A 24-year-old male falls on an outstretched hand and sustains a fracture through the proximal pole of the scaphoid. He is at high risk for nonunion and avascular necrosis due to the retrograde nature of the scaphoid's blood supply. The primary vascular supply to the proximal pole is derived directly from the:

A 55-year-old female undergoes open reduction and internal fixation of a dorsally comminuted distal radius fracture with a volar locking plate. Six months postoperatively, she presents with an inability to extend her thumb interphalangeal joint. The attritional rupture of this tendon is most likely due to prominent screws penetrating the:

A 35-year-old male presents with chronic radial-sided wrist pain 2 years after an untreated fall on an outstretched hand. Radiographs demonstrate a scaphoid nonunion. In the progression of Scaphoid Nonunion Advanced Collapse (SNAC), which joint is characteristically the first to develop degenerative arthritic changes?

A 52-year-old female presents with night-time awakening due to numbness in her thumb, index, and long fingers. On nerve conduction studies (NCS), what is the earliest electrodiagnostic finding characteristic of carpal tunnel syndrome?

A 45-year-old female is 3 months post-operative following open reduction and internal fixation of a distal radius fracture. She complains of severe, burning pain in the hand, out of proportion to the injury. On examination, the hand is edematous, erythematous, and hypersensitive to light touch (allodynia). Which of the following is the most appropriate initial pharmacological treatment for this condition?

In the pathophysiology of Dupuytren's disease, contracture of the proximal interphalangeal (PIP) joint is primarily driven by the involvement of which fascial structure?

Stenosing tenosynovitis (Trigger Finger) is characterized by painful catching or locking of the digit during flexion and extension. The pathology is primarily caused by thickening and constriction at the level of which pulley?

A 35-year-old carpenter presents with swelling, erythema, and severe pain along the volar aspect of his index finger. According to Kanavel's criteria for pyogenic flexor tenosynovitis, which of the following is considered the most specific and earliest clinical sign?

A 45-year-old female sustains a displaced distal radius fracture. Following closed reduction and casting, she develops severe pain and stiffness in the fingers. Which of the following is a well-established iatrogenic risk factor for the development of Complex Regional Pain Syndrome (CRPS) or median neuropathy in this setting?

A 35-year-old carpenter complains of aching pain in the proximal forearm and numbness in the radial three-and-a-half digits. Sensation over the thenar eminence is diminished. Tinel's sign at the carpal tunnel is negative. Which structure is most likely compressing the median nerve?

A 28-year-old male is diagnosed with a scaphoid nonunion advanced collapse (SNAC). Which of the following carpal articulations is typically the LAST to degenerate in the SNAC wrist progression?