7. Hand and Wrist MCQs

The transverse carpal ligament forms the volar roof of the carpal tunnel. Which of the following pairs of carpal bones serve as the radial attachments for this structure?

A 45-year-old woman undergoes volar locked plating for a distal radius fracture

. At 6 months post-op, she suddenly loses the ability to actively flex her thumb interphalangeal joint. What surgical technical error most likely caused this complication?

A 55-year-old woman with end-stage renal disease on hemodialysis presents with severe bone pain. Radiographs of her hands show subperiosteal resorption on the radial aspect of her middle phalanges. What is the primary driver of these osseous changes?

A 4-year-old girl with Hurler syndrome presents with bilateral stiffness and contractures of her fingers. On examination, she has multiple trigger digits. What is the primary pathophysiologic cause of the trigger digits in this patient population?

A 3-year-old child presents with coarse facies, corneal clouding, and a thoracolumbar kyphosis. Radiographs of the hands demonstrate proximal pointing of the metacarpals.

Which enzyme is most likely deficient in this patient?

A 40-year-old female undergoes a mini-open carpal tunnel release. Post-operatively, she complains of an inability to palmar abduct her thumb. Examination shows weakness of the abductor pollicis brevis, but normal sensation in the radial 3.5 digits. Which structure was most likely injured?

A 28-year-old chef sustains a knife wound to the volar proximal phalanx of his index finger (Zone II), lacerating both the FDP and FDS tendons. A primary repair is performed. Which postoperative rehabilitation protocol yields the best outcomes regarding tendon glide and strength?

A 55-year-old woman presents with severe bilateral nighttime hand numbness and thenar atrophy. Electromyography confirms severe median neuropathy at the wrist. During an open carpal tunnel release, which specific structure is sectioned to decompress the nerve?

A 60-year-old woman is treated for a dorsally angulated distal radius fracture with a volar locking plate. Six weeks postoperatively, she suddenly loses the ability to actively extend her thumb interphalangeal joint. What is the most likely cause of this complication?

A patient with Ellis-van Creveld (chondroectodermal dysplasia) syndrome presents for orthopedic evaluation of postaxial polydactyly and genu valgum. Which of the following systemic manifestations is most commonly associated with this syndrome and requires preoperative medical clearance?

A 5-year-old Amish child presents with disproportionate short stature, postaxial polydactyly of the hands, and a history of an atrial septal defect repair. Radiographs show hypoplastic distal phalanges. What is the most likely diagnosis?

A 45-year-old female is 8 weeks status post closed reduction and cast immobilization for a distal radius fracture. She complains of severe, burning pain that is disproportionate to the injury, along with skin color changes and stiffness.

Radiographs show patchy osteopenia. Which intervention has been shown to reduce the incidence of this condition when administered daily following a distal radius fracture?

A 55-year-old female presents 8 weeks after closed reduction and casting of a distal radius fracture. She reports intense, burning pain, swelling, and vasomotor changes in her hand. Radiographs show patchy periarticular osteopenia.

Which of the following prophylactic measures has been prospectively shown to reduce the incidence of this condition when administered at the time of injury?

A 45-year-old female is treated conservatively for a distal radius fracture. Eight weeks later, she develops severe burning pain out of proportion to the injury, along with skin changes and stiffness. Radiographs show patchy, periarticular osteopenia.

What is the best pharmacologic prophylaxis that could have been prescribed at the time of injury to reduce her risk of developing this condition?

A 35-year-old male develops chronic, severe burning pain and allodynia in his forearm following a recognized median nerve injury from a glass laceration. What feature distinguishes his diagnosis of CRPS Type II from CRPS Type I?

A 40-year-old woman develops CRPS Type I of the hand and wrist.

She is completely intolerant of physical therapy due to extreme allodynia, and she has failed NSAIDs, gabapentin, and oral steroids. Which intervention is most appropriate next to facilitate active range of motion therapy?

A 45-year-old female presents 8 weeks after ORIF of a distal radius fracture with severe burning pain, swelling, and shiny skin. Radiographs show patchy osteopenia. Which prophylactic medication given post-operatively could have significantly reduced her risk of developing this condition?

A 55-year-old female sustains a distal radius fracture. To prevent the complication shown in the radiograph

, what pharmacological prophylaxis has historically been recommended during the conservative management of this injury?

A 48-year-old female presents 12 weeks after a closed reduction of a distal radius fracture complaining of severe, burning hand pain. Examination reveals glossy, erythematous skin, profound stiffness, and hypersensitivity.

Which of the following criteria is the internationally accepted standard for diagnosing this condition?

A 50-year-old female presents 3 months after a conservatively treated distal radius fracture with a stiff, swollen, erythematous hand, and severe allodynia. Radiographs show periarticular osteopenia.

What is the primary autonomic nervous system dysfunction mediating her symptoms?