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 41
Topic: 7. Hand and Wrist
The "Turf Toe" injury, commonly seen in football players on artificial surfaces, is defined as:
Correct Answer & Explanation
. A hyperextension injury causing sprain or tear of the plantar plate complex of the first MTP joint
Explanation
Turf toe is a forced hyperextension injury of the first metatarsophalangeal (MTP) joint. This mechanism stretches or tears the plantar plate and capsuloligamentous complex, compromising MTP joint stability.
Question 42
Topic: Wrist & Carpus
The primary stabilizer of the distal radioulnar joint (DRUJ) during forearm supination is the:
Correct Answer & Explanation
. Volar radioulnar ligament
Explanation
During supination, the volar radioulnar ligament becomes taut and serves as the primary stabilizer of the DRUJ. In contrast, the dorsal radioulnar ligament is the primary restraint during pronation.
Question 43
Topic: 7. Hand and Wrist
The scapholunate interosseous ligament is a C-shaped structure essential for proximal carpal row stability. Which portion of this ligament is the strongest and acts as the primary restraint to dorsal translation and diastasis?
Correct Answer & Explanation
. Dorsal portion
Explanation
The scapholunate ligament is anatomically divided into volar, dorsal, and proximal membranous regions. The dorsal portion is the thickest and strongest component, acting as the primary restraint against scapholunate diastasis.
Question 44
Topic: Nerve & Tendon
A 16-year-old male high school football player was making a tackle when he felt sudden pain in his right long finger. He has swelling and tenderness along the volar aspect of the injured digit. He is unable to actively flex the distal interphalangeal joint of the injured digit. Radiographs are negative for fracture. Recommended treatment should include:
Correct Answer & Explanation
. Observation
Explanation
Avulsion of the flexor digitorum profundus, or "jersey finger," is a common injury in football. Appropriate treatment includes surgical repair.
Question 45
Topic: Nerve & Tendon
A 50-year-old woman presents with numbness in her ring and small fingers. Examination reveals a positive Froment sign when asked to pinch a piece of paper. Which of the following muscles is actively compensating to cause the typical interphalangeal flexion seen in a positive Froment sign?
Correct Answer & Explanation
. Flexor pollicis longus
Explanation
A positive Froment sign indicates ulnar nerve palsy affecting the adductor pollicis. To maintain pinch grip, the patient compensates by firing the anterior interosseous nerve (AIN)-innervated flexor pollicis longus (FPL), resulting in hyperflexion of the thumb interphalangeal joint.
Question 46
Topic: 7. Hand and Wrist
A surgeon uses fluoroscopy to place percutaneous screws
. Which strategy is most effective at reducing radiation exposure specifically to the surgeon's hands?
Correct Answer & Explanation
. Using hand-away techniques and radiolucent instruments
Explanation
Hand-away techniques (using long instruments) and keeping hands out of the primary beam are the most effective ways to reduce extremity exposure. Standing on the side of the detector (not the tube) also reduces scatter.
Question 47
Topic: 7. Hand and Wrist
An 82-year-old man with cervical spondylosis sustains a hyperextension injury resulting in central cord syndrome. What is the typical sequence of neurological recovery for this patient?
Correct Answer & Explanation
. Lower extremities recover first, followed by bladder and upper extremities
Explanation
In central cord syndrome, the lower extremities and sacral tracts (located more peripherally in the cord) tend to recover first. Fine motor function of the upper extremities and hands (located more centrally) is typically the last to recover and often remains permanently impaired.
Question 48
Topic: 7. Hand and Wrist
Which of the following sensory areas is affected by compression of the C 6 nerve root:
Correct Answer & Explanation
. Lateral forearm into the radial side of the hand
Explanation
It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput C4 Base of neck, medial shoulder C5 Base of neck to shoulder and upper arm C6 Lateral forearm into the radial side of the hand C7 Posterolateral forearm into the middle finger of the hand C8 Ulnar side of the forearm and hand
Question 49
Topic: 7. Hand and Wrist
Which of the following sensory areas is affected by compression of the C 7 nerve root:
Correct Answer & Explanation
. Posterolateral forearm into the middle finger of the hand
Explanation
It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput C4 Base of neck, medial shoulder C5 Base of neck to shoulder and upper arm C6 Lateral forearm into the radial side of the hand C7 Posterolateral forearm into the middle finger of the hand C8 Ulnar side of the forearm and hand
Question 50
Topic: 7. Hand and Wrist
A patient comes into your office with neck and arm pain. The patient's plain radiograph is shown (Slide). Which of the following signs is most likely to be found on physical examination?
Correct Answer & Explanation
. Numbness on the lateral forearm into the radial side of the hand
Explanation
The lateral radiograph shows narrowing of the C5-C6 intervertebral disk space with osteophytes arising anteriorly and posteriorly. This degenerative process results in facet joint hypertrophy, osteophytes in the uncovertebral joints, and hypertrophy of the ligamentum flavum. The C6 nerve root is compressed resulting in numbness on the lateral forearm into the radial side of the hand. Elbow and wrist extension may be affected, and the biceps tendon reflex may be diminished or absent. It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput; C4 Base of neck, medial shoulder; C5 Base of neck to shoulder and upper arm; C6 Lateral forearm into the radial side of the hand; C7 Posterolateral forearm into the middle finger of the hand; C8 Ulnar side of the forearm and hand.
Question 51
Topic: 7. Hand and Wrist
A 55-year-old male presents with clumsiness in his hands and frequent dropping of objects. On examination, he is unable to keep his small finger fully adducted (Wartenberg's sign positive) but his grip strength is intact. He exhibits hyperreflexia in the lower extremities. Which of the following is the most likely diagnosis?
Correct Answer & Explanation
. Cervical spondylotic myelopathy
Explanation
Cervical spondylotic myelopathy often presents with upper extremity clumsiness, myelopathy hand findings (like finger escape sign or Wartenberg's sign due to intrinsic weakness), and upper motor neuron signs (hyperreflexia) in the lower extremities.
Question 52
Topic: Nerve & Tendon
Which of the following nerve roots supplies motor innervation to the flexor digitorum superficialis (FDS):
Correct Answer & Explanation
. C 8
Explanation
The FDS flexes the proximal interphalangeal joint and is innervated by the C 8 cervical spine nerve root. The FDS is innervated peripherally by the median nerve. The flexor digitorum profundus flexes the distal interphalangeal joint and is also innervated by the C 8 cervical spine nerve root. The middle and index fingers are supplied by the median nerve, and the ring and little fingers are supplied by the ulnar nerve.
Question 53
Topic: 7. Hand and Wrist
During a posterior cervical foraminotomy at C7-T1, the C8 nerve root is inadvertently injured. Sensation is most likely lost over which of the following areas?
Correct Answer & Explanation
. Ulnar aspect of the forearm and small finger
Explanation
The C8 nerve root supplies sensation to the ulnar side of the hand, ring, and small fingers, as well as the ulnar aspect of the distal forearm.
Question 54
Topic: 7. Hand and Wrist
A 45-year-old man presents with severe neck pain radiating to his left arm. Physical examination reveals weakness in elbow extension and wrist flexion, along with an absent triceps reflex. Which nerve root is most likely affected?
Correct Answer & Explanation
. C7
Explanation
The C7 nerve root provides motor innervation for elbow extension (triceps) and wrist flexion (flexor carpi radialis). It also mediates the triceps reflex.
Question 55
Topic: 7. Hand and Wrist
A Pancoast tumor in the lung apex invades the lower brachial plexus, directly compressing the T1 nerve root. Which of the following motor deficits is most characteristic?
Correct Answer & Explanation
. Weakness of finger abduction and adduction
Explanation
The T1 nerve root heavily innervates the intrinsic muscles of the hand (dorsal and palmar interossei) via the ulnar nerve. Compression results in profound weakness of finger abduction and adduction.
Question 56
Topic: 7. Hand and Wrist
A 28-year-old female presents with pain, numbness, and tingling in the ulnar distribution of her hand. Symptoms are exacerbated by overhead activities. Examination shows a positive Roos test but normal cervical MRI. Compression of which structure is most likely responsible?
Correct Answer & Explanation
. Upper trunk of the brachial plexus
Explanation
Neurogenic thoracic outlet syndrome most commonly involves compression of the lower trunk of the brachial plexus (C8 and T1 nerve fibers). This leads to symptoms in the ulnar nerve distribution and intrinsic hand muscle weakness.
Question 57
Topic: 7. Hand and Wrist
If the T1 spinal nerve root is injured during surgery at the cervicothoracic junction, the patient will present with sensory loss in which primary distribution?
Correct Answer & Explanation
. Medial aspect of the forearm
Explanation
The T1 dermatome covers the medial aspect of the forearm. The C8 nerve root supplies the medial hand, while the T2 dermatome supplies the medial upper arm and axilla.
Question 58
Topic: 7. Hand and Wrist
A patient sustains a traction injury to the lower brachial plexus resulting in an isolated T1 nerve root deficit. Which of the following physical examination findings will be most prominent?
Correct Answer & Explanation
. Weakness of finger abduction
Explanation
The T1 nerve root primarily innervates the intrinsic muscles of the hand, including the dorsal interossei, which are responsible for finger abduction. The lateral forearm and wrist extension are predominantly C6.
Question 59
Topic: 7. Hand and Wrist
If the T1 spinal nerve root is injured during an extensive surgical approach to the cervicothoracic junction, motor weakness would be most pronounced in which of the following actions?
Correct Answer & Explanation
. Wrist flexion
Explanation
The T1 nerve root predominantly innervates the intrinsic muscles of the hand via the ulnar and median nerves. Injury to T1 leads to weakness in finger abduction (dorsal interossei) and adduction (palmar interossei).
Question 60
Topic: 7. Hand and Wrist
A 45-year-old male presents with severe neck pain radiating down his left arm. Physical exam reveals weakness in wrist flexion and finger extension, with diminished triceps reflex. Sensation is decreased in the middle finger. Which nerve root is most likely compressed?
Correct Answer & Explanation
. C7
Explanation
Compression of the C7 nerve root classically causes weakness in the triceps, wrist flexors, and finger extensors. It also results in a diminished triceps reflex and numbness primarily affecting the middle finger.
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