Hand Surgery — MCQs

A 22-year-old male medical student was seen in the emergency department with a complaint of pain in his hand. He confessed that he had hit a vending machine in the hospital when he did not receive his soft drink after inserting money twice. The medial side of the dorsum of the hand was quite swollen, and one of his knuckles could not be seen when he "made a fist." The physician made a diagnosis of a "boxer's fracture." What was the nature of the impatient student's injury?

Q119

Finkelstein's test is done for diagnosis of:

Q120

Scaphoid fracture which area has maximum chances of AVN/Non-union/Malunion:-

Hand Surgery Indian Medical PG Practice Questions and MCQs

Question 111: Tardy ulnar nerve palsy is seen in:

A. Genu varus
B. Genu valgus
C. Cubitus varus
D. Cubitus valgus (Correct Answer)

Explanation: ***Cubitus valgus*** - **Cubitus valgus** is an increased carrying angle of the elbow, which can lead to stretching and compression of the **ulnar nerve** over time. - This chronic irritation often presents as **tardy ulnar nerve palsy**, characterized by numbness, tingling, and weakness in the distribution of the ulnar nerve. *Genu varus* - **Genu varus**, or bow-leggedness, affects the **knee joint** and has no direct anatomical connection or pathogenic mechanism causing ulnar nerve palsy. - While it can lead to other orthopedic issues, it does not involve the elbow or ulnar nerve. *Genu valgus* - **Genu valgus**, or knock-knees, also affects the **knee joint** and is unrelated to the elbow or ulnar nerve innervation. - This condition impacts lower limb mechanics and does not contribute to upper limb neuropathies. *Cubitus varus* - **Cubitus varus**, or gunstock deformity, is a decrease in the carrying angle of the elbow, often resulting from a **supracondylar humerus fracture**. - Although it can cause cosmetic and functional issues, it typically does not lead to **ulnar nerve palsy**, as the nerve is less stretched in this position.

Question 112: Phalen's test is done for which nerve injury?

A. Median (Correct Answer)
B. Radial
C. Ulnar
D. Axillary

Explanation: ***Median*** - **Phalen's test** is used to diagnose **carpal tunnel syndrome**, which results from compression of the **median nerve** as it passes through the wrist. - The test involves holding the wrists in maximal flexion for 30-60 seconds, which increases pressure on the median nerve. *Radial* - The **radial nerve** is primarily involved in wrist and finger extension, and its injury typically results in **wrist drop**. - No specific provocative test like Phalen's is associated with radial nerve compression at the wrist. *Ulnar* - The **ulnar nerve** innervates muscles in the hand and forearm, and its injury can present as a "claw hand" deformity. - Tests such as **Tinel's sign at the cubital tunnel** are used for ulnar nerve compression, not Phalen's test. *Axillary* - The **axillary nerve** innervates the deltoid and teres minor muscles and provides sensation over the lateral shoulder. - Injury often occurs with shoulder dislocations and causes **deltoid weakness** and **sensory loss over the lateral arm**, which is completely unrelated to Phalen's test.

Question 113: Aeroplane splint is used for -

A. Conservative management of proximal humerus fractures
B. CTEV
C. Brachial plexus injury (Correct Answer)
D. Axillary nerve palsy

Explanation: ***Brachial plexus injury*** - An **aeroplane splint** is commonly used in **brachial plexus injuries** to position the arm in **abduction**, external rotation, and slight flexion. - This position helps to **prevent contractures** and allow for optimal nerve recovery by **reducing tension** on the damaged plexus. *Conservative management of proximal humerus fractures* - **Proximal humerus fractures** are typically managed with a **sling and swathe** or a **collar and cuff**, which immobilize the arm against the body. - An **aeroplane splint** provides an abducted position, which is generally not ideal for early immobilization of most proximal humerus fractures. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot addressed with methods like the **Ponseti method (serial casting)**. - An **aeroplane splint** is an upper extremity device and has no application in the management of foot deformities. *Axillary nerve palsy* - **Axillary nerve palsy** primarily affects the **deltoid muscle**, leading to weakness in shoulder abduction, and **teres minor**. - While rehabilitation involves strengthening and maintaining range of motion, an aeroplane splint is not the primary or specific orthosis for isolated axillary nerve palsy.

Question 114: Finkelstein test is used for diagnosis of?

A. Tarsal tunnel syndrome
B. Carpal tunnel syndrome
C. Thoracic outlet syndrome
D. De quervain tenosynovitis (Correct Answer)

Explanation: ***De quervain tenosynovitis*** - The **Finkelstein test** is a specific diagnostic maneuver for **De Quervain's tenosynovitis**, where a positive test elicits pain at the wrist. - This condition involves inflammation of the **extensor pollicis brevis** and **abductor pollicis longus tendons** within the first dorsal compartment of the wrist. *Tarsal tunnel syndrome* - This syndrome involves compression of the **posterior tibial nerve** in the ankle, not the wrist. - Diagnosis typically involves **Tinel's sign** over the tarsal tunnel and nerve conduction studies. *Carpal tunnel syndrome* - This condition involves compression of the **median nerve** at the wrist. - Diagnostic tests include **Phalen's maneuver** and **Tinel's sign** over the carpal tunnel, which differ from the Finkelstein test. *Thoracic outlet syndrome* - This involves compression of neurovascular structures in the **thoracic outlet**, typically affecting the neck and upper extremity but not the wrist specifically. - Diagnostic tests involve specific provocative maneuvers that assess for vascular or neurological compromise in the shoulder and arm.

Question 115: Which among the following is TRUE regarding mallet finger?

A. Fracture of distal phalanx
B. Fracture of the proximal phalanx
C. Avulsion of extensor tendon at the base of the distal phalanx (Correct Answer)
D. Avulsion of tendon at the base of the middle phalanx

Explanation: ***Avulsion of extensor tendon at the base of the distal phalanx*** - **Mallet finger** occurs when the **extensor tendon** is avulsed (torn away) from its insertion point at the base of the **distal phalanx**. - This injury results in an inability to actively extend the **distal interphalangeal (DIP) joint**, leading to a characteristic droop of the fingertip. *Fracture of distal phalanx* - While a fracture of the distal phalanx can occur, **mallet finger specifically refers to a tendon injury**, not necessarily a bone fracture. - A fracture might be present in some cases if the tendon pulls off a piece of bone (**bony mallet**), but the primary pathology is the tendon avulsion. *Fracture of the proximal phalanx* - A fracture of the **proximal phalanx** would affect the **metacarpophalangeal (MCP) joint** or the **proximal interphalangeal (PIP) joint**, not the distal interphalangeal (DIP) joint which is characteristic of mallet finger. - This injury would lead to different functional limitations and deformities. *Avulsion of tendon at the base of the middle phalanx* - An avulsion at the base of the **middle phalanx** would involve the insertion of the **central slip of the extensor tendon**, leading to a **Boutonnière deformity**, which affects the **PIP joint**. - This is distinct from mallet finger, which involves the **DIP joint**.

Question 116: After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?

A. Splint (Correct Answer)
B. Wax bath
C. Ignore
D. Surgery

Explanation: ***Splint*** - The patient presents with **inability to extend the distal interphalangeal joint** after an injury, with a **normal X-ray**. This clinical picture is highly suggestive of a **mallet finger**. - **Splinting** the distal interphalangeal joint in **extension** for 6-8 weeks is the primary non-surgical treatment for mallet finger, aiming to allow the ruptured extensor tendon to heal. *Wax bath* - A **wax bath** is a form of thermotherapy used to relieve pain and stiffness in joints by applying heat. - While it can be helpful for chronic conditions like **arthritis**, it is not an appropriate initial treatment for an acute **tendon injury** like mallet finger, as it does not promote healing of the extensor mechanism. *Ignore* - **Ignoring** the symptoms would lead to a failure to treat the injury, potentially resulting in a **chronic extensor lag deformity** (mallet finger deformity). - Untreated, this condition can cause persistent functional impairment and cosmetic deformity of the affected finger. *Surgery* - **Surgery** is typically reserved for specific cases of mallet finger, such as those with a **large avulsion fracture** of the dorsal base of the distal phalanx (where the fragment involves more than 30-50% of the articular surface), or if non-surgical treatment fails. - Since the **X-ray was normal** in this case, indicating no significant bony avulsion, and it's an acute presentation, surgery is not the appropriate first-line management.

Question 117: DeQuervain's disease classically affects the:

A. Abductor pollicis longus and brevis
B. Extensor carpi radialis and extensor pollicis longus
C. Extensor pollicis brevis and abductor pollicis longus (Correct Answer)
D. Flexor pollicis longus and brevis

Explanation: ***Extensor pollicis brevis and abductor pollicis longus*** - **DeQuervain's tenosynovitis** is an inflammation of the tendons and their synovial sheaths that pass through the first dorsal compartment of the wrist. - This compartment specifically houses the **extensor pollicis brevis (EPB)** and **abductor pollicis longus (APL)** tendons. *Abductor pollicis longus and brevis* - While the **abductor pollicis longus (APL)** is affected, the "abductor pollicis brevis" is an intrinsic hand muscle, not typically involved in DeQuervain's tenosynovitis, which affects wrist tendons. - The **abductor pollicis brevis** is innervated by the median nerve and acts at the carpometacarpal and metacarpophalangeal joints of the thumb, distal to the wrist compartment. *Extensor carpi radialis and extensor pollicis longus* - The **extensor carpi radialis (longus and brevis)** tendons are located in the second dorsal compartment of the wrist, lateral to the first compartment but are not primarily affected in DeQuervain's. - The **extensor pollicis longus (EPL)** tendon is located in the third dorsal compartment and is responsible for thumb interphalangeal joint extension, not the primary site of DeQuervain's inflammation. *Flexor pollicis longus and brevis* - The **flexor pollicis longus (FPL)** and **flexor pollicis brevis (FPB)** are involved in thumb flexion and are located on the palmar side of the wrist and hand. - DeQuervain's tenosynovitis is a condition affecting the dorsal (extensor side) compartment of the wrist, so these flexor tendons are not involved.

Question 118: A 22-year-old male medical student was seen in the emergency department with a complaint of pain in his hand. He confessed that he had hit a vending machine in the hospital when he did not receive his soft drink after inserting money twice. The medial side of the dorsum of the hand was quite swollen, and one of his knuckles could not be seen when he "made a fist." The physician made a diagnosis of a "boxer's fracture." What was the nature of the impatient student's injury?

A. Colles' fracture of the radius
B. Fracture of the styloid process of the ulna
C. Smith's fracture of the radius
D. Fracture of the neck of the fifth metacarpal (Correct Answer)

Explanation: ***Fracture of the neck of the fifth metacarpal*** - A **boxer's fracture** specifically refers to a fracture of the neck of the fifth metacarpal bone. - This injury commonly occurs when punching a hard object, leading to swelling and loss of the knuckle prominence. *Colles' fracture of the radius* - A **Colles' fracture** involves the distal radius, typically caused by a fall on an outstretched hand, resulting in a "dinner fork" deformity. - It does not involve the metacarpals or knuckles. *Fracture of the styloid process of the ulna* - This fracture often accompanies a **Colles' fracture** of the radius but can also occur in isolation. - It's a fracture of the distal end of the ulna and does not cause the loss of a knuckle. *Smith's fracture of the radius* - A **Smith's fracture** is a fracture of the distal radius with volar displacement, often called a "reverse Colles' fracture." - It is caused by a fall on the back of the hand or a direct blow to the forearm and does not affect the metacarpals or knuckles.

Question 119: Finkelstein's test is done for diagnosis of:

A. Trigger finger (stenosing tenosynovitis)
B. Acute compartment syndrome
C. De quervain's tenosynovitis (Correct Answer)
D. Carpal tunnel syndrome

Explanation: ***De Quervain's tenosynovitis*** - **Finkelstein's test** is the classic physical examination maneuver used to diagnose **De Quervain's tenosynovitis**. - The test involves pain elicited when the patient makes a **fist with the thumb tucked inside** the other fingers, and then ulnar deviates the wrist. *Trigger finger (stenosing tenosynovitis)* - While it is also a tenosynovitis, **trigger finger** affects the flexor tendons of the digits and is characterized by painful clicking or locking. - Diagnosis is clinical, based on observing the **finger catching or locking** during attempted extension. *Acute compartment syndrome* - This is a limb-threatening condition involving increased pressure within a muscle compartment, often due to trauma. - Diagnosis is based on **clinical signs** (pain out of proportion, pallor, paresthesia, pulselessness, paralysis) and **intracompartmental pressure measurements**. *Carpal tunnel syndrome* - This condition results from compression of the **median nerve** within the carpal tunnel, causing numbness, tingling, and weakness in the hand. - Diagnostic tests include **Tinel's sign** (tapping over the median nerve) and **Phalen's maneuver** (wrist flexion), not Finkelstein's test.

Question 120: Scaphoid fracture which area has maximum chances of AVN/Non-union/Malunion:-

A. Distal 1/3
B. Proximal 1/3 (Correct Answer)
C. Scaphoid Tubercle fracture
D. Middle 1/3

Explanation: ***Proximal 1/3*** - The **proximal pole of the scaphoid** has a precarious blood supply, primarily from retrograde extraosseous vessels entering distally. A fracture in this region can compromise this supply, leading to **avascular necrosis (AVN)**. - Due to the limited blood flow to the proximal fragment, healing is often impaired, increasing the risk of **non-union** and **malunion**. *Distal 1/3* - Fractures in the **distal 1/3 (distal pole)** of the scaphoid typically have a better prognosis. - This area has a more robust blood supply, reducing the risk of AVN and promoting faster healing. *Scaphoid Tubercle fracture* - Fractures of the **scaphoid tubercle** are usually considered stable and intra-articular, with a good blood supply. - These fractures generally heal well with conservative treatment and have a very low incidence of AVN or non-union. *Middle 1/3* - Fractures in the **middle 1/3 (waist)** of the scaphoid are the most common but still pose a significant risk of non-union. - While the risk of AVN is lower than for proximal pole fractures, it is still higher than for distal fractures, due to the critical vascular supply to both fragments.

Practice by Chapter

Hand Anatomy and Biomechanics

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Hand Fractures and Dislocations

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Tendon Injuries

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Nerve Injuries in Hand

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Dupuytren's Disease

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Carpal Tunnel Syndrome

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Rheumatoid Hand

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Reconstructive Hand Surgery

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Tendon Transfers

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Congenital Hand Anomalies

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Hand Infections

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Microsurgery in Hand Surgery

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