7. Hand and Wrist MCQs

A 45-year-old woman is undergoing conservative treatment for a soft tissue mallet finger of her index finger. She was instructed to wear an extension splint continuously for 8 weeks. At her 4-week follow-up, she admits she removed the splint for 5 minutes to wash her hand, during which her fingertip dropped into flexion. What is the most appropriate next step in her management?

A 62-year-old farmer presents with chronic instability and pain in his right thumb MCP joint, sustained from an injury 10 years ago. He has a positive pinch grip test with significant weakness. Radiographs demonstrate severe joint space narrowing, subchondral sclerosis, and osteophyte formation at the MCP joint. What is the most appropriate surgical treatment?

A 35-year-old musician presents with a soft-tissue mallet finger of the little finger. You decide to treat him conservatively with a custom thermoplastic splint. To optimize healing and prevent complications, what is the ideal position for splinting the affected digit?

A 29-year-old professional athlete is diagnosed with an acute thumb UCL tear. An MRI is obtained to evaluate for a Stener lesion. What classic MRI appearance is highly specific for the presence of a Stener lesion?

When performing an open repair of an acute ulnar collateral ligament tear of the thumb with a suture anchor, exact anatomic placement of the anchor is critical. Where is the normal anatomic insertion site of the proper UCL on the proximal phalanx?

A 30-year-old construction worker presents with a bony mallet finger of his middle finger involving 40% of the articular surface. Lateral radiographs show the fracture is slightly displaced, but the distal phalanx remains perfectly congruous with the head of the middle phalanx without any volar subluxation. What is the most appropriate management?

A surgeon is utilizing the Ishiguro technique (extension block pinning) for a displaced bony mallet finger with volar subluxation. Which of the following describes the correct sequence and placement of the pins?

A 50-year-old woman presents with a chronic soft tissue mallet deformity of her ring finger of 6 months duration. She has a 40-degree extensor lag at the DIP joint and a 20-degree hyperextension deformity at the PIP joint. Which of the following describes the fundamental pathophysiology of the secondary PIP joint deformity seen in this patient?

What is the most frequently encountered complication of conservative management (continuous extension splinting) for soft tissue mallet finger injuries?

A patient is undergoing surgical repair of an acute UCL tear of the thumb. During the procedure, the surgeon inadvertently places the suture anchor at the insertion site too dorsally on the base of the proximal phalanx. What specific postoperative biomechanical deficit is most likely to occur as a result of this technical error?

A 55-year-old patient presents with a 5-week-old soft tissue mallet injury to the small finger. He has not received any prior treatment and has a 40-degree extensor lag. According to current literature, what is the most appropriate initial management for this delayed presentation?

In a patient presenting with an acute thumb injury, differentiating between a Skier's thumb (UCL injury) and a radial collateral ligament (RCL) injury is important. Which of the following clinical presentations or mechanisms is highly characteristic of an RCL injury rather than a UCL injury?

A 25-year-old skier falls while holding his ski pole and presents with ulnar-sided thumb pain. On examination, there is lack of a firm endpoint when a valgus stress is applied to the thumb metacarpophalangeal (MCP) joint in 30 degrees of flexion. Which of the following anatomical structures must be interposed to create a Stener lesion?

A 45-year-old male sustains a soft tissue mallet finger injury to his right index finger. He is treated with a strict continuous DIP joint extension splint. During his 4-week follow-up, he admits the splint slipped off for 10 minutes while showering, causing the finger to flex. What is the most appropriate next step in management?

Which of the following is considered an absolute indication for operative intervention in a bony mallet finger injury?

A patient with an untreated chronic mallet finger presents with a new secondary deformity consisting of PIP joint hyperextension and DIP joint flexion. What is the primary biomechanical cause of this secondary PIP hyperextension?

During surgical repair of an acute Skier's thumb, the surgeon utilizes a dorsal-ulnar approach to the thumb MCP joint. Which of the following neurologic structures is at the highest risk of iatrogenic injury during this approach?

A 30-year-old laborer presents with an 8-week-old soft tissue mallet finger of the ring finger. He has had no previous treatment. What is the recommended initial management?

A patient presents with a thumb UCL injury. MRI confirms a Stener lesion. During surgical exploration and repair, where will the distal stump of the torn UCL be found?

A 28-year-old patient presents with pain and a supination deformity of the thumb following a fall onto an outstretched hand. Stress testing of the thumb MCP joint demonstrates laxity with radial stress. Which ligament is injured?