Hand Surgery Practice Questions

Q: Froment's sign is positive in cases of weakness of ?

Adductor pollicis muscle weakness. ***Adductor pollicis muscle weakness*** - **Froment's sign** is elicited when a patient attempts to hold a piece of paper between the thumb and index finger, and due to weakness of the **adductor pollicis**, they compensate by flexing the **flexor pollicis longus**. - This compensation results in **hyperflexion of the interphalangeal joint** of the thumb, indicating **ulnar nerve palsy**. *Thumb abduction weakness* - Weakness in thumb abduction involves muscles like the **abductor pollicis brevis**, which is primarily innervated by the **median nerve**. - This type of weakness is tested by assessing the ability to move the thumb perpendicularly away from the palm, not with Froment's sign. *Thumb flexion weakness* - Weakness in thumb flexion involves muscles such as the **flexor pollicis longus** (median nerve) and **flexor pollicis brevis** (median and ulnar nerve). - While the flexor pollicis longus compensates in Froment's sign, the sign itself indicates a deficit in adduction rather than primary flexion weakness. *Thumb extension weakness* - Thumb extension is primarily mediated by the **extensor pollicis longus** and **extensor pollicis brevis**, both innervated by the **radial nerve**. - Weakness in these muscles would manifest as an inability to extend the thumb, which is unrelated to Froment's sign.

Q: Keinbock's disease is osteochondritis of ?

Lunate. ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.

Q: A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms hanging from the bed. Which of the following options correctly describes his condition and the test used to assess it?

Carpal tunnel syndrome, Durkan's test. ***Carpal tunnel syndrome, Durkan's test*** - The symptoms of **numbness and tingling** in the **lateral 3 digits** (thumb, index, middle, and radial half of the ring finger) are classic for **carpal tunnel syndrome (CTS)**, caused by compression of the **median nerve**. Relief with hanging the arm is due to gravity reducing swelling and pressure. - **Durkan's test** (or **median nerve compression test**) is highly specific for CTS. It involves direct pressure over the carpal tunnel, reproducing symptoms within 30 seconds. *Guyon's canal syndrome, Froment's test* - **Guyon's canal syndrome** involves compression of the **ulnar nerve** at the wrist, primarily affecting the **little finger** and the **ulnar half of the ring finger**, not the lateral 3 digits. - **Froment's test** assesses **ulnar nerve palsy** by observing the strength of adductor pollicis during a pinch grip, which is unrelated to median nerve compression. *Carpal tunnel syndrome, Froment's test* - While **carpal tunnel syndrome** is correctly identified based on the symptoms, **Froment's test** is not used to assess it. - As mentioned, Froment's test evaluates **ulnar nerve function**, particularly the adductor pollicis muscle. *Guyon's canal syndrome, Durkan's test* - The symptoms described (lateral 3 digits) are inconsistent with **Guyon's canal syndrome**, which affects the ulnar nerve distribution. - Although **Durkan's test** is appropriate for carpal tunnel syndrome, the diagnosis for Guyon's canal syndrome is incorrect.

Q: Which part of scaphoid fracture is most susceptible to avascular necrosis?

Proximal 1/3rd. ***Proximal 1/3rd*** - The **scaphoid bone** has a **retrograde blood supply**, meaning blood vessels enter distally and flow towards the proximal pole. - A fracture in the **proximal 1/3rd** can disrupt the blood supply to the **proximal fragment**, making it highly susceptible to **avascular necrosis**. *Distal 1/3rd* - Fractures in the **distal 1/3rd** of the scaphoid generally have a robust blood supply due to the entry of vessels from the distal pole. - While still requiring proper management, the risk of **avascular necrosis** is significantly lower compared to proximal fractures. *Middle 1/3rd* - Fractures in the **middle 1/3rd** (waist) of the scaphoid are common and can still compromise blood flow to the proximal segment, but the risk of **avascular necrosis** is intermediate. - The more proximal the fracture within the middle third, the higher the risk of **avascular necrosis**. *Scaphoid Tubercle* - The **scaphoid tubercle** is a distal projection of the scaphoid bone. - Fractures of the **scaphoid tubercle** are extra-articular and typically have an excellent blood supply; thus, they are at very low risk for **avascular necrosis**.

Q: Which muscles are primarily affected in De Quervain's tenosynovitis?

Abductor pollicis longus and extensor pollicis brevis. ***Abductor pollicis longus and extensor pollicis brevis*** - De Quervain's tenosynovitis is an **inflammation** of the tendons and their synovial sheaths in the **first extensor compartment** of the wrist. - These two muscles, the **abductor pollicis longus** and **extensor pollicis brevis**, share this compartment and are thus primarily affected by the condition. *Extensor pollicis longus and extensor pollicis brevis* - The **extensor pollicis longus** travels through the **third extensor compartment** and is not primarily involved in De Quervain's tenosynovitis. - While the **extensor pollicis brevis** is involved, the inclusion of the extensor pollicis longus makes this option incorrect. *Abductor pollicis longus and flexor pollicis longus* - The **flexor pollicis longus** is a muscle of the forearm that **flexes the thumb** and is located on the palmar aspect, unrelated to the dorsal compartment affected in De Quervain's. - Its inclusion makes this option incorrect, despite the correct identification of the abductor pollicis longus. *Flexor pollicis longus and flexor pollicis brevis* - Both the **flexor pollicis longus** and **flexor pollicis brevis** are muscles responsible for thumb flexion and are located in the **anterior compartment** of the forearm and hand, respectively. - These muscles are not involved in De Quervain's tenosynovitis, which affects the dorsal wrist extensors.

Q: In which of the following deformities is the distal interphalangeal joint extended?

Boutonniere deformity. ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint**. - It often results from injury to the **central slip of the extensor tendon** at the PIP joint. *Swan neck deformity* - This deformity presents with **hyperextension of the PIP joint** and **flexion of the DIP joint**, which is the opposite of the question's premise. - It is commonly associated with underlying conditions like **rheumatoid arthritis** or **lupus**. *Z deformity* - This typically refers to the **thumb in rheumatoid arthritis**, where the carpometacarpal (CMC) joint is flexed, the metacarpophalangeal (MCP) joint is hyperextended, and the interphalangeal (IP) joint is flexed. - It does not primarily describe an extended DIP joint in the context of other fingers. *Claw Hand* - This deformity involves **hyperextension of the MCP joints** and **flexion of the PIP and DIP joints**, particularly of the fourth and fifth fingers. - It is caused by **ulnar nerve palsy**, leading to muscle imbalance.

Q: Flexor Digitorum Profundus tendon avulsion injury leads to -

Jersey Finger. ***Jersey Finger*** - **Jersey finger** is a common name for an avulsion injury of the **flexor digitorum profundus (FDP) tendon** from its insertion on the distal phalanx. - This injury typically occurs when the finger is forcibly extended while the FDP tendon is contracting, often seen in sports where a player grabs an opponent's jersey. *Extensor tendon injury* - An **extensor tendon injury** involves the tendons on the dorsal side of the hand, responsible for extending the fingers. - This is distinct from a **flexor tendon injury**, which involves tendons on the palmar side. *Ulnar collateral ligament injury* - An **ulnar collateral ligament (UCL) injury** most commonly affects the thumb's metacarpophalangeal (MCP) joint, often called **"skier's thumb"**. - This injury involves damage to the ligament supporting the joint, not an avulsion of a flexor tendon. *Central slip injury* - A **central slip injury** affects the middle slip of the extensor digitorum communis tendon over the proximal interphalangeal (PIP) joint. - Untreated, it can lead to a **Boutonnière deformity**, which is characterized by PIP joint flexion and distal interphalangeal (DIP) joint hyperextension.

Q: The A1 pulley involved in trigger finger is located at the level of which joint?

Metacarpophalangeal joint. ***Metacarpophalangeal joint*** - The **A1 pulley** is located at the base of the finger, overlying the **metacarpophalangeal (MCP) joint**. - Its pathological thickening or narrowing can impede the smooth gliding of **flexor tendons**, causing **trigger finger**. *Proximal Interphalangeal joint* - The **A2** and **A3 pulleys** are located at the level of the **proximal phalanx** and **proximal interphalangeal (PIP) joint**, respectively. - While essential for tendon function, they are not primarily involved in typical **trigger finger**. *Distal Interphalangeal joint* - The **A4** and **A5 pulleys** are located at the level of the **middle phalanx** and **distal interphalangeal (DIP) joint**, respectively. - Pathologies at these pulleys are less common in trigger finger and typically affect the **distal tendon glide**. *Carpometacarpal joint* - The **carpometacarpal (CMC) joints** are located at the base of the hand, between the carpal bones and metacarpals. - There are no A pulleys associated with the CMC joints, and they are not directly involved in the mechanism of **trigger finger**.

Q: Aeroplane splint is used in ?

Brachial plexus injury. ***Brachial plexus injury*** - The **aeroplane splint** is specifically designed to support the arm in **abduction** and **external rotation** at the shoulder, with the elbow flexed. - This position helps to relieve tension on the injured **brachial plexus** nerves and prevents contractures, particularly after an **upper brachial plexus injury** (e.g., Erb's palsy). *Radial nerve injury* - Radial nerve injuries typically present with **wrist drop** and difficulty with finger extension. - Splints for radial nerve injury, such as a **dynamic wrist extension splint**, focus on supporting wrist and finger extension, not shoulder abduction. *Ulnar nerve injury* - Ulnar nerve injuries lead to a **claw hand deformity** and sensory loss in the pinky and half of the ring finger. - Splints for ulnar nerve injury aim to prevent hyperextension of the metacarpophalangeal joints and support the interphalangeal joints, often involving static or dynamic splints for the hand. *Scoliosis* - Scoliosis is a **lateral curvature of the spine**, usually treated with bracing (e.g., Boston brace or Milwaukee brace) or surgery. - An aeroplane splint has no role in the management or treatment of scoliosis.

Q: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Median nerve. ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.

Question 1

Froment's sign is positive in cases of weakness of ?

Accepted Answer

Adductor pollicis muscle weakness

Answer

Thumb abduction weakness

Answer

Thumb flexion weakness

Answer

Thumb extension weakness

Question 2

Keinbock's disease is osteochondritis of ?

Accepted Answer

Lunate

Answer

Scaphoid

Answer

Calcaneum

Answer

Tibial tuberosity

Question 3

A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and    tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms    hanging from the bed. Which of the following options correctly describes his condition and the    test used to assess it?

Accepted Answer

Carpal tunnel syndrome, Durkan's test

Answer

Guyon's canal syndrome, Froment's test

Answer

Carpal tunnel syndrome, Froment's test

Answer

Guyon's canal syndrome, Durkan's test

Question 4

Which part of scaphoid fracture is most susceptible to avascular necrosis?

Accepted Answer

Proximal 1/3rd

Answer

Distal 1/3rd

Answer

Middle 1/3rd

Answer

Scaphoid Tubercle

Question 5

Which muscles are primarily affected in De Quervain's tenosynovitis?

Accepted Answer

Abductor pollicis longus and extensor pollicis brevis

Answer

Extensor pollicis longus and extensor pollicis brevis

Answer

Abductor pollicis longus and flexor pollicis longus

Answer

Flexor pollicis longus and flexor pollicis brevis

Question 6

In which of the following deformities is the distal interphalangeal joint extended?

Accepted Answer

Boutonniere deformity

Answer

Swan neck deformity

Answer

Claw Hand

Answer

Z deformity

Question 7

Flexor Digitorum Profundus tendon avulsion injury leads to -

Accepted Answer

Jersey Finger

Answer

Extensor tendon injury

Answer

Ulnar collateral ligament injury

Answer

Central slip injury

Question 8

The A1 pulley involved in trigger finger is located at the level of which joint?

Accepted Answer

Metacarpophalangeal joint

Answer

Proximal Interphalngeal joint

Answer

Carpometacarpal joint

Answer

Distal Interphalangeal joint

Question 9

Aeroplane splint is used in ?

Accepted Answer

Brachial plexus injury

Answer

Ulnar nerve injury

Answer

Radial nerve injury

Answer

Scoliosis

Question 10

Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Accepted Answer

Median nerve

Answer

Ulnar

Answer

Radial nerve

Answer

Median & ulnar nerve

Hand Surgery — MCQs

Hand Surgery — MCQs

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