Hand Surgery Practice Questions

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.

Q: A 45-year-old woman presents with burning pain and numbness in the wrist and hand. Tinel's sign is positive. What is the most likely diagnosis?

Carpal tunnel syndrome. ***Carpal tunnel syndrome*** - **Burning pain**, **numbness** in the hand, and a **positive Tinel's sign** at the wrist are classic symptoms of median nerve compression within the carpal tunnel [1]. - The median nerve supplies sensation to the thumb, index, middle, and radial half of the ring finger, which is where symptoms are typically experienced [1]. *Radial nerve palsy* - This condition affects the **radial nerve**, causing **wrist drop** and sensory loss over the posterior forearm and dorsum of the hand [1]. - It does not typically present with burning pain or numbness in the distribution described. *Cubital tunnel syndrome* - Involves compression of the **ulnar nerve** at the elbow, leading to numbness and tingling in the **little finger** and ulnar half of the ring finger [1]. - While it can cause burning pain, the anatomical distribution of symptoms is distinct from the patient's presentation. *Thoracic outlet syndrome* - Results from compression of neurovascular structures in the **thoracic outlet**, causing varied symptoms such as pain, numbness, and weakness in the arm and hand [2]. - A positive Tinel's sign at the wrist is not a characteristic finding, and the symptom distribution is often broader or less specific to a single nerve.

Q: A 42-year-old female presents with pain and swelling in the right wrist after a fall. An X-ray shows a fracture in the carpal bones. Which bone is most commonly fractured in such injuries?

Scaphoid. ***Scaphoid*** - The **scaphoid bone** is the most commonly fractured carpal bone, often due to a **fall on an outstretched hand (FOOSH)**, which transmits force directly to it. - Its **poor blood supply** makes it prone to **avascular necrosis** and delayed healing if not properly managed. *Lunate* - While the lunate can be injured, particularly in **Kienbock's disease** (avascular necrosis), it is less commonly fractured than the scaphoid in trauma. - Fractures of the lunate often result from high-energy trauma and are less frequent than scaphoid fractures. *Triquetrum* - The **triquetrum** is the **second most commonly fractured carpal bone**, usually due to impaction against the ulna or from avulsion injuries. - However, its fracture rate is still significantly lower than that of the scaphoid. *Pisiform* - Fractures of the **pisiform** are rare and typically result from **direct trauma** to the hypothenar eminence or avulsion injuries. - It is located anterior to the triquetrum and functions primarily as a sesamoid bone for the flexor carpi ulnaris tendon.

Q: A patient with ulnar nerve compression at the elbow (cubital tunnel syndrome) presents with early clawing of the ring and little fingers, numbness, and progressive weakness of hand intrinsic muscles. What is the most appropriate surgical intervention to prevent further deterioration of hand function?

Ulnar nerve transposition; prevents further deterioration. ***Ulnar nerve transposition*** - This procedure involves surgically relocating the ulnar nerve from its position behind the medial epicondyle to a new, less constricted position (anterior to the medial epicondyle), relieving compression at the **cubital tunnel** - By decompressing the nerve, it can **prevent further deterioration** of ulnar nerve function and may allow recovery of the **intrinsic hand muscles** (lumbricals, interossei), thus halting progression of the **claw hand deformity** - This is the definitive treatment for **cubital tunnel syndrome** with progressive neurological deficits - Note: For established, fixed claw deformity, **tendon transfer procedures** (like Zancolli lasso or modified Stiles-Bunnell) would be needed *Carpal tunnel release* - This procedure addresses compression of the **median nerve** at the wrist, causing symptoms like tingling and numbness in the thumb, index, middle, and radial half of the ring finger - Classic presentation includes nocturnal paresthesias, thenar atrophy, and weak thumb opposition - Would not address **ulnar nerve compression at the elbow** or ulnar-innervated muscle weakness *Median nerve repair* - This is performed for traumatic injuries causing **complete median nerve transection** and aims to restore motor function (pronation, wrist/finger flexion, thumb opposition) and sensation - Not appropriate for **ulnar nerve compression neuropathy**, which requires decompression, not repair *Radial nerve decompression* - This procedure targets compression of the **radial nerve** (commonly at the spiral groove or radial tunnel), which typically presents with **wrist drop** and weakness of finger/thumb extension - Sensory changes occur over the dorsal first web space - Not relevant for **ulnar nerve pathology at the elbow** causing intrinsic hand muscle weakness

Q: A 50-year-old office worker presents with numbness and tingling in the hand, which worsens at night. Tinel's sign is positive. Analyze the condition and select the best initial treatment option.

NSAIDs and wrist splinting. ***NSAIDs and wrist splinting*** - This is the **first-line treatment** for mild to moderate carpal tunnel syndrome, aiming to reduce inflammation and stabilize the wrist. - **Nocturnal wrist splinting** helps maintain a neutral wrist position, preventing compression of the **median nerve** during sleep and alleviating night symptoms. *Surgical decompression* - This is typically reserved for **severe cases** or when conservative treatments have failed after a prolonged period. - It involves cutting the **transverse carpal ligament** to relieve pressure on the median nerve. *Steroid injections* - **Corticosteroid injections** can provide temporary relief by reducing inflammation and swelling around the **median nerve**. - They are often used when initial conservative measures are insufficient but surgery is not yet indicated, not as a primary first-line treatment. *Physical therapy* - **Physical therapy** may include nerve gliding exercises, stretching, and strengthening, but it is often used as an adjunct to splinting or in later stages. - It is generally not considered the sole initial treatment for symptom relief in **carpal tunnel syndrome**.

Q: What is the most common initial treatment for a scaphoid fracture?

Conservative. ***Conservative*** - Initial treatment for a suspected or confirmed **scaphoid fracture** usually involves **immobilization** with a thumb spica cast. - This approach aims to promote **bone healing** by stabilizing the fracture site and preventing movement. *Compression Screws* - This is a **surgical intervention** typically reserved for **displaced scaphoid fractures**, non-unions, or cases where conservative treatment has failed. - It involves inserting a screw across the fracture to provide **internal fixation** and compression. *Compression Plating* - **Compression plating** is generally not the primary method for isolated scaphoid fractures. - It is more commonly used for **complex fractures** of larger bones or reconstructive procedures, not simple scaphoid fractures. *Traction* - **Traction** is used in situations to reduce or stabilize fractures by applying a pulling force, often seen in major long bone fractures. - It is not a standard or effective initial treatment for a scaphoid fracture in the wrist.

Q: A patient presents with wrist trauma and is diagnosed with a wrist sprain. Clinical examination reveals tenderness in the anatomical snuffbox, but imaging shows no evidence of fracture. In this clinical scenario, which ligament is most likely to be involved?

Scapholunate ligament. ***Scapholunate ligament*** - Tenderness in the **anatomical snuffbox** despite negative imaging for scaphoid fracture strongly suggests a **scapholunate ligament injury**. - This ligament is crucial for maintaining **carpal stability**, and its injury can lead to **DISI (dorsal intercalated segmental instability)** if not managed appropriately. *Radial collateral ligament* - Injury to the radial collateral ligament typically presents with pain and tenderness on the **radial aspect of the wrist**, but not specifically localized to the **anatomical snuffbox**. - This ligament primarily resists **ulnar deviation** and contributes to wrist stability. *Lunotriquetral ligament* - A lunotriquetral ligament injury usually manifests as pain on the **ulnar side of the wrist**, often associated with a clunking sensation, distinct from **anatomical snuffbox tenderness**. - Its disruption can lead to **VISI (volar intercalated segmental instability)**. *Ulnar collateral ligament* - Injury to the ulnar collateral ligament causes pain and tenderness on the **ulnar aspect of the wrist**, particularly with **radial deviation**. - This ligament plays a key role in stabilizing the **distal radioulnar joint (DRUJ)** and resisting radial deviation.

Q: What is Wartenberg's sign?

Inability to adduct small finger against the ring finger. Inability to adduct small finger against the ring finger - **Wartenberg's sign** specifically refers to the uncontrolled abduction of the **small finger**, often caused by an imbalance between the extrinsic and intrinsic hand muscles. - This inability to adduct the small finger against the ring finger is a classic sign of **ulnar nerve palsy**, impacting the **palmar interossei** muscles. *Inability to maintain Intrinsic plus position* - The **intrinsic plus position** (lumbrical grip) involves metacarpophalangeal joint flexion and interphalangeal joint extension, which is typically affected by **ulnar and median nerve injuries** or **rheumatoid arthritis** leading to intrinsic minus hand. - This is a broader functional deficit and not specific to Wartenberg's sign. *Inability to grasp a book between the thumb and index finger* - This describes **Froment's sign**, which indicates **ulnar nerve paralysis** affecting the adductor pollicis muscle. - The patient compensates by flexing the **interphalangeal joint of the thumb** using the **flexor pollicis longus** (median nerve innervation), which is different from Wartenberg's sign. *Inability to move the middle finger sideways* - Lateral movement of the middle finger is primarily controlled by the **dorsal interossei** muscles, which are also innervated by the **ulnar nerve**. - While this suggests ulnar nerve involvement, it is not the specific diagnostic sign known as Wartenberg's sign.

Question 1

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 2

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

Question 3

A 45-year-old woman presents with burning pain and numbness in the wrist and hand. Tinel's sign is positive. What is the most likely diagnosis?

Accepted Answer

Carpal tunnel syndrome

Answer

Radial nerve palsy

Answer

Cubital tunnel syndrome

Answer

Thoracic outlet syndrome

Question 4

A 42-year-old female presents with pain and swelling in the right wrist after a fall. An X-ray shows a fracture in the carpal bones. Which bone is most commonly fractured in such injuries?

Accepted Answer

Scaphoid

Answer

Lunate

Answer

Triquetrum

Answer

Pisiform

Question 5

A patient with ulnar nerve compression at the elbow (cubital tunnel syndrome) presents with early clawing of the ring and little fingers, numbness, and progressive weakness of hand intrinsic muscles. What is the most appropriate surgical intervention to prevent further deterioration of hand function?

Accepted Answer

Ulnar nerve transposition; prevents further deterioration

Answer

Carpal tunnel release; reduced pain

Answer

Median nerve repair; restored thumb opposition

Answer

Radial nerve decompression; enhanced wrist extension

Question 6

A 50-year-old office worker presents with numbness and tingling in the hand, which worsens at night. Tinel's sign is positive. Analyze the condition and select the best initial treatment option.

Accepted Answer

NSAIDs and wrist splinting

Answer

Surgical decompression

Answer

Steroid injections

Answer

Physical therapy

Question 7

Which tendons are primarily involved in pain around the base of the thumb?

Accepted Answer

Abductor Pollicis Longus (APL) & Extensor Pollicis Brevis (EPB)

Answer

Flexor Pollicis Longus (FPL) & Extensor Pollicis Longus (EPL)

Answer

Flexor Pollicis Brevis (FPB) & Extensor Pollicis Brevis (EPB)

Answer

Abductor Pollicis Longus (APL) & Extensor Pollicis Longus (EPL)

Question 8

What is the most common initial treatment for a scaphoid fracture?

Accepted Answer

Conservative

Answer

Compression Screws

Answer

Compression Plating

Answer

Traction

Question 9

A patient presents with wrist trauma and is diagnosed with a wrist sprain. Clinical examination reveals tenderness in the anatomical snuffbox, but imaging shows no evidence of fracture. In this clinical scenario, which ligament is most likely to be involved?

Accepted Answer

Scapholunate ligament

Answer

Radial collateral ligament

Answer

Lunotriquetral ligament

Answer

Ulnar collateral ligament

Question 10

What is Wartenberg's sign?

Accepted Answer

Inability to adduct small finger against the ring finger

Answer

Inability to maintain Intrinsic plus position

Answer

Inability to grasp a book between the thumb and index finger

Answer

Inability to move the middle finger sideways

Hand Surgery — MCQs

Hand Surgery — MCQs

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