Hand Surgery Practice Questions

Q: Tardy ulnar nerve palsy is seen in:

Cubitus valgus. ***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.

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

Median. ***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.

Q: Aeroplane splint is used for -

Brachial plexus injury. ***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.

Q: Finkelstein test is used for diagnosis of?

De quervain tenosynovitis. ***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.

Q: 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?

Splint. ***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.

Q: DeQuervain's disease classically affects the:

Extensor pollicis brevis and abductor pollicis longus. ***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.

Q: 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?

Fracture of the neck of the fifth metacarpal. ***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.

Q: Finkelstein's test is done for diagnosis of:

De quervain's tenosynovitis. ***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.

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

Proximal 1/3. ***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.

Question 1

Tardy ulnar nerve palsy is seen in:

Accepted Answer

Cubitus valgus

Answer

Genu varus

Answer

Genu valgus

Answer

Cubitus varus

Question 2

Phalen's test is done for which nerve injury?

Accepted Answer

Median

Answer

Radial

Answer

Ulnar

Answer

Axillary

Question 3

Aeroplane splint is used for -

Accepted Answer

Brachial plexus injury

Answer

Conservative management of proximal humerus fractures

Answer

CTEV

Answer

Axillary nerve palsy

Question 4

Finkelstein test is used for diagnosis of?

Accepted Answer

De quervain tenosynovitis

Answer

Tarsal tunnel syndrome

Answer

Carpal tunnel syndrome

Answer

Thoracic outlet syndrome

Question 5

Which among the following is TRUE regarding mallet finger?

Accepted Answer

Avulsion of extensor tendon at the base of the distal phalanx

Answer

Fracture of distal phalanx

Answer

Fracture of the proximal phalanx

Answer

Avulsion of tendon at the base of the middle phalanx

Question 6

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?

Accepted Answer

Splint

Answer

Wax bath

Answer

Ignore

Answer

Surgery

Question 7

DeQuervain's disease classically affects the:

Accepted Answer

Extensor pollicis brevis and abductor pollicis longus

Answer

Abductor pollicis longus and brevis

Answer

Extensor carpi radialis and extensor pollicis longus

Answer

Flexor pollicis longus and brevis

Question 8

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?

Accepted Answer

Fracture of the neck of the fifth metacarpal

Answer

Colles' fracture of the radius

Answer

Fracture of the styloid process of the ulna

Answer

Smith's fracture of the radius

Question 9

Finkelstein's test is done for diagnosis of:

Accepted Answer

De quervain's tenosynovitis

Answer

Trigger finger (stenosing tenosynovitis)

Answer

Acute compartment syndrome

Answer

Carpal tunnel syndrome

Question 10

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

Accepted Answer

Proximal 1/3

Answer

Distal 1/3

Answer

Scaphoid Tubercle fracture

Answer

Middle 1/3

Hand Surgery — MCQs

Hand Surgery — MCQs

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