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7. Hand and Wrist MCQs

Practice Set 64 of 266

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 1261

Topic: 7. Hand and Wrist

A 28-year-old concert pianist develops a lumbrical plus deformity in her left index finger following a flexor tendon repair. She is concerned about the impact on her career. A thorough understanding of the lumbrical muscles is crucial for her surgeon. Which of the following statements accurately describes the anatomical and functional characteristics of the lumbrical muscles?

. All four lumbrical muscles are bipennate and are solely innervated by the median nerve.
. The lumbricals originate from the radial side of the flexor digitorum superficialis (FDS) tendons and insert into the central slip of the extensor mechanism.
. The first and second lumbricals are unipennate and innervated by the median nerve, while the third and fourth are bipennate and innervated by the ulnar nerve.
. The primary action of the lumbricals is to extend the metacarpophalangeal (MCP) joints and flex the interphalangeal (IP) joints.
. Lumbricals pass dorsal to the deep transverse metacarpal ligament before inserting into the lateral bands.

Correct Answer & Explanation

. The first and second lumbricals are unipennate and innervated by the median nerve, while the third and fourth are bipennate and innervated by the ulnar nerve.

Explanation

Correct Answer: CExplanation:The case provides a detailed description of lumbrical anatomy and action:Option C (Correct): The case states: 'The first and second lumbricals typically originate from the FDP tendons of the index and middle fingers, respectively, and are unipennate. The third and fourth lumbricals are bipennate, originating from adjacent FDP tendons... The first and second lumbricals are innervated by the median nerve. The third and fourth lumbricals are innervated by the ulnar nerve.' This option accurately combines these facts.Option A (Incorrect): Not all lumbricals are bipennate (1st and 2nd are unipennate), and they are not solely innervated by the median nerve (3rd and 4th by ulnar nerve).Option B (Incorrect): Lumbricals originate from the radial side of theFDPtendons, not FDS tendons. They insert into the radial lateral band of the extensor apparatus and the base of the proximal phalanx, not directly into the central slip.Option D (Incorrect): The primary actions of the lumbricals are 'Flexion of the Metacarpophalangeal (MCP) joints' and 'Extension of the Interphalangeal (IP) joints' (the "intrinsic plus" position), not the reverse.Option E (Incorrect): Lumbricals passvolarto the deep transverse metacarpal ligament, then extend dorsally to insert into the lateral bands.

Question 1262

Topic: 7. Hand and Wrist

A 55-year-old patient presents with a lumbrical plus deformity of the middle finger following a complex flexor tendon reconstruction. The surgeon explains that the deformity results from a disruption of normal force transmission. Which of the following statements best describes the biomechanical pathophysiology of this condition?

. The flexor digitorum profundus (FDP) tendon is over-lengthened, leading to insufficient pull on the lumbrical origin and subsequent IP joint extension.
. The lumbrical muscle becomes paralyzed, causing an imbalance where the extrinsic extensors overpower the intrinsic flexors at the IP joints.
. Excessive tension on the FDP tendon restricts its distal excursion, causing the contracting FDP to pull predominantly on the lumbrical origin, leading to paradoxical IP extension.
. The extensor digitorum communis (EDC) tendon becomes adherent to the central slip, preventing full PIP joint flexion.
. The deep transverse metacarpal ligament ruptures, allowing the lumbrical to migrate dorsally and exert an unopposed extensor force on the IP joints.

Correct Answer & Explanation

. Excessive tension on the FDP tendon restricts its distal excursion, causing the contracting FDP to pull predominantly on the lumbrical origin, leading to paradoxical IP extension.

Explanation

Correct Answer: CExplanation:The case provides a clear explanation of the biomechanics of lumbrical plus deformity:Option C (Correct): The case states: 'When the FDP tendon is abnormally taut... The primary FDP muscle belly contracts, but the excessive tension on the tendon restricts its distal excursion... Instead of transmitting force primarily to the distal phalanx, the contracting FDP tendon pulls predominantly on the origin of the lumbrical muscle. This effectively shortens the lumbrical and intensifies its pull... The now over-active lumbrical... flexes the MCP joint while simultaneously extending the PIP and DIP joints through its connection to the lateral bands and terminal tendon.' This perfectly matches the description.Option A (Incorrect): An over-lengthened FDP would result in weakness of DIP flexion, not paradoxical IP extension. The problem is FDP tightness, not looseness.Option B (Incorrect): The lumbrical muscle is overactive, not paralyzed, in lumbrical plus deformity.Option D (Incorrect): Adhesions of the EDC tendon would primarily affect MCP and PIP extension, not cause paradoxical IP extension during attempted flexion.Option E (Incorrect): Rupture of the deep transverse metacarpal ligament would lead to splaying of the fingers and potentially subluxation of the MCP joints, but it does not directly explain the paradoxical IP extension characteristic of lumbrical plus. The lumbrical passes volar to this ligament.

Question 1263

Topic: Nerve & Tendon
A 60-year-old patient is scheduled for surgical correction of a lumbrical plus deformity in the small finger. During pre-operative planning, the surgeon emphasizes the importance of a detailed history and physical examination. Which of the following findings on physical examination is considered the hallmark of lumbrical plus deformity?
. Fixed flexion contracture of the PIP joint with hyperextension of the DIP joint.
. Inability to actively extend the MCP joint while maintaining IP joint flexion.
. Paradoxical extension of the PIP and DIP joints during attempted active flexion of the digit.
. Isolated inability to flex the DIP joint, with normal PIP and MCP flexion.
. Pain and swelling localized to the A1 pulley region, exacerbated by gripping.

Correct Answer & Explanation

. Paradoxical extension of the PIP and DIP joints during attempted active flexion of the digit.

Explanation

The hallmark lumbrical plus deformity manifests as MCP flexion with paradoxical PIP and DIP extension during attempted active flexion of the involved digit.

Question 1264

Topic: 7. Hand and Wrist

A 48-year-old patient is undergoing surgical correction for a lumbrical plus deformity of the middle finger. The surgeon has made a Brunner zig-zag incision and meticulously protected the digital neurovascular bundles. After exposing the flexor sheath, the next critical step is to identify the lumbrical muscle. Which of the following accurately describes the typical anatomical location and appearance of the lumbrical muscle in relation to the flexor tendons?

. It originates from the ulnar side of the FDS tendon in the distal palm and appears as a thin, white tendinous structure.
. It originates from the radial side of the FDP tendon in the palm, distal to the carpometacarpal joint line, appearing as a reddish-brown muscle belly transitioning into a thin tendon.
. It originates from the central slip of the extensor mechanism and runs volar to the flexor tendons.
. It is located deep to the FDP tendon, originating from the interosseous membrane and inserting into the A2 pulley.
. It originates from the flexor retinaculum and inserts into the base of the middle phalanx.

Correct Answer & Explanation

. It originates from the radial side of the FDP tendon in the palm, distal to the carpometacarpal joint line, appearing as a reddish-brown muscle belly transitioning into a thin tendon.

Explanation

Correct Answer: BExplanation:The 'Detailed Surgical Approach / Technique' section provides specific guidance on identifying the lumbrical:Option B (Correct): The case states: 'Identify the lumbrical muscle. It typically originates from the radial side of the FDP tendon in the palm, distal to the carpometacarpal joint line, and runs distally along the radial side of the FDP tendon. It appears as a reddish-brown, often fusiform, muscle belly transitioning into a thin tendon that inserts into the extensor mechanism.' This option precisely matches the description.Option A (Incorrect): Lumbricals originate from the FDP, not FDS, and from the radial side, not ulnar. They are muscular proximally, not purely tendinous.Option C (Incorrect): Lumbricals are part of the intrinsic muscles, originating from the FDP, not the central slip. They run volar to the deep transverse metacarpal ligament, then dorsally to the extensor mechanism, not volar to the flexor tendons throughout.Option D (Incorrect): Lumbricals are not deep to the FDP tendon; they originate from its radial side. Their insertion is into the extensor mechanism, not the A2 pulley.Option E (Incorrect): Lumbricals do not originate from the flexor retinaculum; that is the origin for some thenar and hypothenar muscles. Their insertion is into the extensor mechanism, not directly into the base of the middle phalanx (that's the central slip).

Question 1265

Topic: 7. Hand and Wrist

A 35-year-old patient undergoes a lumbrical tenotomy for a lumbrical plus deformity of the ring finger. During the immediate post-operative period (Day 0-7), the hand therapist applies a dorsal blocking splint. Which of the following positions is typically maintained by this splint, and what is its primary purpose?

. Wrist in full extension, MCP joints in full extension, IP joints in slight flexion; to prevent adhesions of the FDP tendon.
. Wrist in slight flexion, MCP joints in moderate flexion (70-90 degrees), IP joints in full extension; to prevent MCP flexion contractures and facilitate IP flexion.
. Wrist in neutral, MCP joints in slight flexion (30 degrees), IP joints in full extension; to protect the lumbrical repair site.
. Wrist in full flexion, MCP joints in full extension, IP joints in full flexion; to maximize FDP excursion.
. Wrist in slight extension, MCP joints in full flexion, IP joints in slight flexion; to promote early strengthening of the lumbricals.

Correct Answer & Explanation

. Wrist in slight flexion, MCP joints in moderate flexion (70-90 degrees), IP joints in full extension; to prevent MCP flexion contractures and facilitate IP flexion.

Explanation

Correct Answer: BExplanation:The 'Post-Operative Rehabilitation Protocols' section details the immediate post-operative management:Option B (Correct): The case states: 'A dorsal blocking splint is typically applied. The wrist is positioned in slight flexion (e.g., 20-30 degrees), the MCP joints are in moderate flexion (e.g., 70-90 degrees), and the IP joints are in full extension. This "intrinsic plus" position helps to prevent flexion contractures of the MCPs and facilitates IP flexion once active motion begins.' This option accurately describes both the position and its purpose.Option A (Incorrect): Full wrist extension and MCP extension are not the typical positions for a dorsal blocking splint in this context. The goal is to prevent MCP extension contracture and facilitate IP flexion.Option C (Incorrect): While protection is a goal, the specific MCP flexion angle is typically greater (70-90 degrees), and the primary purpose is not just to protect the lumbrical repair (which is a tenotomy, not a repair needing protection from tension).Option D (Incorrect): Full wrist flexion would put excessive tension on the extensor tendons and is not a functional position. Full IP flexion is also not the initial splinting position.Option E (Incorrect): Slight wrist extension and IP flexion are not the typical initial splinting positions. Early strengthening of lumbricals is not a goal after a tenotomy.

Question 1266

Topic: 7. Hand and Wrist

A 22-year-old athlete undergoes surgical correction of a lumbrical plus deformity. Post-operatively, he develops persistent, disproportionate pain, swelling, skin color changes, and allodynia in the affected hand. These symptoms are suggestive of Complex Regional Pain Syndrome (CRPS). According to the case, what is the MOST appropriate initial management strategy for CRPS?

. Immediate surgical re-exploration to rule out nerve entrapment.
. Aggressive passive range of motion exercises to break up adhesions.
. Multimodal pain management, aggressive hand therapy focusing on desensitization, and psychological support.
. High-dose systemic corticosteroids for several weeks to reduce inflammation.
. Strict immobilization of the affected hand for an extended period to reduce pain.

Correct Answer & Explanation

. Multimodal pain management, aggressive hand therapy focusing on desensitization, and psychological support.

Explanation

Correct Answer: CExplanation:The 'Complications & Management' section addresses CRPS:Option C (Correct): The case states for CRPS: 'Early recognition is key. Multimodal pain management (medications, sympathetic blocks), aggressive hand therapy focusing on desensitization and active motion, psychological support.' This option accurately reflects the recommended approach.Option A (Incorrect): While nerve entrapment can cause pain, CRPS is a distinct syndrome. Immediate surgical re-exploration is not the initial management for CRPS, which is a diagnosis based on clinical criteria.Option B (Incorrect): Aggressive passive range of motion can exacerbate CRPS symptoms and is generally contraindicated in the early stages. Therapy should focus on gentle, active motion and desensitization.Option D (Incorrect): While corticosteroids might be used in some pain syndromes, they are not the primary or sole initial management for CRPS, which requires a broader, multimodal approach.Option E (Incorrect): Strict immobilization is generally detrimental in CRPS, as it can worsen stiffness and pain. Early, gentle active motion is preferred.

Question 1267

Topic: 7. Hand and Wrist
A 42-year-old patient is recovering from a lumbrical tenotomy for a lumbrical plus deformity. During Phase II (Weeks 1-3) of rehabilitation, the hand therapist initiates several interventions. Which of the following is a key component of rehabilitation during this early mobilization phase?
. Gradual introduction of heavy strengthening exercises using therapeutic putty and weights.
. Complete cessation of splinting to encourage full, unrestricted range of motion.
. Initiation of gentle, active flexion and extension exercises for the affected MCP, PIP, and DIP joints, focusing on isolated FDP and FDS gliding.
. Surgical capsulotomy for any developing fixed joint contractures.
. Strict immobilization of the hand in a position of rest to allow for maximal tissue healing.

Correct Answer & Explanation

. Initiation of gentle, active flexion and extension exercises for the affected MCP, PIP, and DIP joints, focusing on isolated FDP and FDS gliding.

Explanation

Phase II (Early Mobilization) involves initiating gentle, active flexion and extension exercises for the affected MCP, PIP, and DIP joints. The goal is full, coordinated motion without paradoxical extension, focusing on isolated FDP and FDS gliding exercises to prevent adhesions and improve tendon excursion.

Question 1268

Topic: 7. Hand and Wrist

Question 4

A 45-year-old patient is undergoing surgical excision of a dorsal wrist ganglion. The surgeon is meticulously dissecting through the subcutaneous tissue and extensor retinaculum. The case highlights the importance of identifying and protecting vulnerable neurovascular structures. Which of the following nerves is *most commonly* at risk of iatrogenic injury during the excision of a dorsal wrist ganglion?

. A. Median nerve
. B. Ulnar nerve
. C. Dorsal sensory branch of the radial nerve
. D. Anterior interosseous nerve
. E. Posterior interosseous nerve

Correct Answer & Explanation

. C. Dorsal sensory branch of the radial nerve

Explanation

Correct Answer: CThe case specifically mentions, 'For instance, volar wrist masses (e.g., ganglion cysts) often lie immediately adjacent to the radial artery and superficial branch of the radial nerve, while masses in the ulnar side of the palm may involve branches of the ulnar nerve.' More directly, under 'Specific Techniques for Common Hand Masses' for 'Dorsal Wrist Ganglion,' it states: 'Identify and protect the dorsal sensory branch of the radial nerve and its branches, which are highly variable and vulnerable.'Option A (Median nerve) is incorrect.The median nerve is located volarly and centrally in the wrist and palm, not typically in the dorsal wrist surgical field for a ganglion.Option B (Ulnar nerve) is incorrect.The ulnar nerve is located on the ulnar side of the wrist and hand, primarily volarly, and is not the most vulnerable nerve during dorsal wrist ganglion excision.Option D (Anterior interosseous nerve) is incorrect.The anterior interosseous nerve is a deep motor branch of the median nerve in the forearm and is not typically at risk during a dorsal wrist approach.Option E (Posterior interosseous nerve) is incorrect.While the posterior interosseous nerve is dorsal, it is a deep motor nerve in the forearm and wrist, and its sensory component is minimal. The superficial dorsal sensory branch of the radial nerve is much more superficially located and directly in the surgical field for dorsal wrist ganglions.

Question 1269

Topic: 7. Hand and Wrist

Question 8

Three weeks after excision of a benign hand mass, a 42-year-old patient presents with severe, burning pain, allodynia (pain from non-painful stimuli), and disproportionate swelling and skin color changes (mottling) in the affected hand. The patient is reluctant to move the hand due to pain. Physical examination reveals increased warmth and tenderness, and limited active range of motion. This clinical presentation is most suggestive of which complication, and what is a key aspect of its management?

. A. Surgical site infection; immediate intravenous antibiotics and surgical debridement.
. B. Neuroma formation; surgical excision and nerve relocation.
. C. Complex Regional Pain Syndrome (CRPS); early recognition and a multidisciplinary approach.
. D. Severe tendon adhesions; surgical tenolysis and aggressive hand therapy.
. E. Post-operative hematoma; aspiration or surgical evacuation.

Correct Answer & Explanation

. C. Complex Regional Pain Syndrome (CRPS); early recognition and a multidisciplinary approach.

Explanation

Correct Answer: CThe clinical presentation of severe burning pain, allodynia, disproportionate swelling, and skin changes (mottling, warmth) is classic for Complex Regional Pain Syndrome (CRPS). The case describes CRPS as 'Rare (<1%), but devastating. More common after nerve injury or highly painful procedures.' For management, it states: 'Early recognition is key. Multidisciplinary approach involving pain management specialists, physical/occupational therapists, and psychological support. Sympathetic nerve blocks, neuromodulation, medications (gabapentinoids, tricyclic antidepressants). Vitamin C supplementation (500mg daily for 50 days) has shown some evidence in reducing CRPS risk.'Option A is incorrect.While infection can cause pain and swelling, the burning quality, allodynia, and disproportionate nature of the symptoms are more characteristic of CRPS.Option B is incorrect.Neuroma formation typically presents as a localized, sharp, shooting pain with percussion (Tinel's sign) at the site of nerve injury, not diffuse burning pain, allodynia, and widespread autonomic changes.Option D is incorrect.Tendon adhesions cause stiffness and restricted motion, but not the severe burning pain, allodynia, and autonomic changes seen in CRPS.Option E is incorrect.A hematoma would typically present as a localized, firm, tender swelling, often with ecchymosis, and would usually manifest earlier in the post-operative course. It would not typically cause allodynia or diffuse burning pain.

Question 1270

Topic: Nerve & Tendon

A 5-year-old boy falls from monkey bars and sustains an extension-type supracondylar humerus fracture. Radiographs demonstrate that the distal fragment is displaced posteromedially. Based on this displacement pattern, which nerve is at the highest risk of injury?

. Anterior interosseous nerve
. Radial nerve
. Ulnar nerve
. Posterior interosseous nerve
. Median nerve (main trunk)

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

In extension-type supracondylar fractures with posteromedial displacement of the distal fragment, the proximal fragment spikes anterolaterally, putting the radial nerve at greatest risk. Posterolateral displacement puts the anterior interosseous nerve (AIN) at highest risk.

Question 1271

Topic: 7. Hand and Wrist

A 24-year-old chef sustains a laceration to the volar aspect of his right hand, severing the flexor tendons. The surgeon notes the injury is located in Zone II of the hand. Which of the following anatomic landmarks defines the boundaries of Zone II?

. From the distal insertion of the flexor digitorum superficialis (FDS) to the distal insertion of the flexor digitorum profundus (FDP)
. From the proximal edge of the A1 pulley to the distal insertion of the FDS
. From the distal edge of the carpal tunnel to the proximal edge of the A1 pulley
. From the musculotendinous junction to the proximal edge of the carpal tunnel
. Within the carpal tunnel itself

Correct Answer & Explanation

. From the proximal edge of the A1 pulley to the distal insertion of the FDS

Explanation

Zone II (historically termed 'no man\'s land') extends from the proximal edge of the A1 pulley to the insertion of the FDS tendon. Both FDS and FDP tendons are enclosed within the same flexor sheath in this zone.

Question 1272

Topic: 7. Hand and Wrist

A 22-year-old rugby player grasps an opponent's jersey and sustains a forced extension injury to a maximally flexed ring finger. He cannot actively flex his DIP joint. Radiographs reveal a bony avulsion fracture of the distal phalanx resting at the level of the proximal interphalangeal (PIP) joint. According to the Leddy-Packer classification, what structure preserves the blood supply to the retracted tendon in this injury type?

. Vincula brevia
. Vincula longa
. Central slip
. Transverse retinacular ligament
. Lumbrical muscle

Correct Answer & Explanation

. Vincula longa

Explanation

This is a Type II Jersey finger, where the FDP tendon and avulsed bone retract to the level of the PIP joint. The tendon is held at this level by the intact vincula longa, which preserves its blood supply.

Question 1273

Topic: Nerve & Tendon

A 30-year-old recreational basketball player jams his right middle finger. He presents with an inability to actively extend the distal interphalangeal (DIP) joint. Radiographs show no fracture. What is the most appropriate treatment for this closed tendinous mallet finger?

. Splinting of the PIP and DIP joints in full extension for 6 weeks
. Splinting of the DIP joint in full extension for 6 to 8 weeks
. Primary surgical repair of the terminal extensor tendon
. Percutaneous pinning of the DIP joint across the physis
. Dynamic extension splinting during the day and static at night

Correct Answer & Explanation

. Splinting of the DIP joint in full extension for 6 to 8 weeks

Explanation

The standard of care for a closed, tendinous mallet finger is continuous, rigid splinting of the DIP joint in full extension or slight hyperextension for 6 to 8 weeks. The PIP joint must be left free to allow full range of motion.

Question 1274

Topic: 7. Hand and Wrist

During a complex flexor tendon repair in Zone II, a surgeon must be careful to preserve the flexor tendon sheath pulleys to prevent biomechanical failure. Which two annular pulleys are the most critical to preserve to prevent bowstringing of the flexor tendons?

. A1 and A3
. A2 and A4
. A1 and A5
. A3 and A5
. C1 and C3

Correct Answer & Explanation

. A2 and A4

Explanation

The A2 (proximal phalanx) and A4 (middle phalanx) pulleys are the most critical biomechanical components of the flexor pulley system. Their preservation or reconstruction is essential to prevent flexor tendon bowstringing and loss of mechanical advantage.

Question 1275

Topic: Nerve & Tendon

A 25-year-old rock climber presents with a sudden 'pop' and inability to flex the DIP joint of his middle finger. MRI confirms a Leddy-Packer Type I flexor digitorum profundus (FDP) avulsion. The tendon has retracted into the palm. Within what timeframe must surgical repair ideally be performed to prevent irreversible tendon necrosis and myostatic contracture?

. Within 7 to 10 days
. Within 3 to 4 weeks
. Within 6 to 8 weeks
. After 3 months using a two-stage tendon graft
. Immediate emergency surgery within 6 hours

Correct Answer & Explanation

. Within 7 to 10 days

Explanation

In a Leddy-Packer Type I Jersey finger, both the vincula brevia and longa are ruptured, and the FDP tendon retracts into the palm. The tendon loses its entire blood supply and relies on synovial diffusion; therefore, primary repair must be performed within 7 to 10 days before the tendon becomes necrotic and irreparably contracted.

Question 1276

Topic: 7. Hand and Wrist

A 30-year-old patient presents with a pathologic fracture of the proximal phalanx after a minor twisting injury. Radiographs show a well-defined, centrally located radiolucent lesion with stippled calcifications. What is the recommended treatment once the fracture has healed?

. Ray amputation
. Curettage and bone grafting
. Observation alone
. Wide local excision
. Primary radiation therapy

Correct Answer & Explanation

. Curettage and bone grafting

Explanation

The presentation and radiographic findings are classic for an enchondroma, the most common primary bone tumor of the hand. Treatment consists of allowing the pathologic fracture to heal, followed by curettage and bone grafting to prevent recurrence.

Question 1277

Topic: Nerve & Tendon

A 25-year-old rugby player sustains a jersey finger (avulsion of the flexor digitorum profundus). Imaging reveals a Leddy-Packer Type 1 injury, where the tendon has retracted into the palm. What is the recommended timing for surgical repair?

. Within 7 to 10 days
. At 3 to 4 weeks
. After 6 weeks to allow inflammation to subside
. Immediate tendon grafting is required
. Primary arthrodesis is the only option

Correct Answer & Explanation

. Within 7 to 10 days

Explanation

A Type 1 FDP avulsion retracts into the palm, disrupting both the vincula brevia and longa, severely compromising the tendon's blood supply. Surgery must be performed within 7-10 days to prevent permanent tendon retraction and necrosis.

Question 1278

Topic: 7. Hand and Wrist

A 40-year-old man was struck on the tip of his long finger by a basketball and presents with a mallet finger deformity. Radiographs show a dorsal avulsion fracture involving 20% of the articular surface without joint subluxation. What is the most appropriate initial management?

. Continuous DIP joint extension splinting for 6 to 8 weeks
. Continuous PIP joint extension splinting for 6 weeks
. Closed reduction and percutaneous pinning
. Open reduction and internal fixation
. Primary arthrodesis of the DIP joint

Correct Answer & Explanation

. Continuous DIP joint extension splinting for 6 to 8 weeks

Explanation

Mallet fractures involving less than 30-50% of the articular surface without volar subluxation of the distal phalanx are successfully treated nonoperatively. Strict, continuous extension splinting of the DIP joint for 6-8 weeks is required.

Question 1279

Topic: Hand Trauma & Infection

A 45-year-old diabetic patient presents with a swollen, painful index finger. Which of the following is NOT one of Kanavel's cardinal signs for pyogenic flexor tenosynovitis?

. Flexed resting posture of the digit
. Fusiform swelling of the entire digit
. Erythema extending proximally to the wrist crease
. Exquisite tenderness along the course of the flexor tendon sheath
. Severe pain with passive extension of the digit

Correct Answer & Explanation

. Erythema extending proximally to the wrist crease

Explanation

Kanavel's four cardinal signs of pyogenic flexor tenosynovitis are fusiform swelling, flexed resting posture, tenderness over the flexor sheath, and severe pain on passive extension. Erythema extending to the wrist is not a cardinal sign and may indicate a superficial cellulitis or ascending lymphangitis.

Question 1280

Topic: 7. Hand and Wrist

A 22-year-old chef lacerates his volar index finger. The attending hand surgeon diagnoses a 'Zone II' flexor tendon injury. What are the anatomic boundaries of Zone II?

. From the insertion of the FDS to the insertion of the FDP
. From the proximal edge of the A1 pulley to the insertion of the FDS
. From the distal carpal tunnel to the proximal edge of the A1 pulley
. From the musculotendinous junction to the carpal tunnel
. From the PIP joint to the DIP joint

Correct Answer & Explanation

. From the proximal edge of the A1 pulley to the insertion of the FDS

Explanation

Zone II, historically termed 'No Man's Land', extends from the proximal edge of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS). Both the FDS and FDP tendons run together in a tight fibro-osseous sheath in this region.

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