Hand Surgery — MCQs

Q: Most common tumor in the hand is

Enchondroma. ***Enchondroma*** - **Enchondromas** are the most common primary osseous tumors of the hand, frequently found in the small bones of the **phalanges** and **metacarpals**. - They are **benign cartilaginous tumors** and are often asymptomatic, discovered incidentally, although they can present with pain, swelling, or pathologic fractures. *Exostosis* - An **exostosis** (osteochondroma) is a bony outgrowth capped with cartilage, typically arising from the surface of long bones near growth plates. - While they can occur in the hand, they are less common than enchondromas and usually present as a palpable bony mass. *Giant cell tumour* - **Giant cell tumors (GCTs)** are aggressive but usually benign tumors that most commonly occur around the **knee** (distal femur and proximal tibia). - They are rare in the bones of the hand, accounting for only a small percentage of hand bone tumors. *Synovial sarcoma* - **Synovial sarcoma** is a malignant soft tissue tumor that can occur near joints, but it is **not a bone tumor**. - While it can arise in the extremities, including the hand, it is a tumor of the soft tissues rather than directly from the bone like an enchondroma.

Q: Froment's sign is positive in injury of which nerve?

Ulnar nerve. ***Ulnar nerve*** - **Froment's sign** assesses the weakness of the **adductor pollicis muscle**, which is innervated by the ulnar nerve [1]. - A positive sign is indicated when the patient compensates for this weakness by hyperflexing the interphalangeal joint of the thumb using the **flexor pollicis longus** (median nerve innervation), creating a *key pinch*. *Median nerve* - Injury to the median nerve would primarily affect the **thenar muscles** and sensation over the radial side of the palm, not primarily the adductor pollicis [1]. - While the flexor pollicis longus is innervated by the median nerve, its hyperflexion is a **compensatory action** in ulnar nerve palsy, not a direct sign of median nerve injury. *Radial nerve* - Radial nerve injury primarily causes **wrist drop** and impaired extension of the wrist and fingers [1]. - It does not directly affect the intrinsic hand muscles involved in Froment's sign [1]. *None of the options* - This option is incorrect because **Froment's sign** is a classic clinical test specifically associated with **ulnar nerve palsy**. [2]

Q: What is the primary deforming force on the proximal fragment in a Bennett's fracture?

APL. **APL** - In a **Bennett's fracture**, the **abductor pollicis longus (APL)** tendon inserts onto the **first metacarpal base** and exerts a strong pull that displaces the small, ulnar-sided proximal fragment. - This pull is largely responsible for the typical **subluxation** and **instability** seen in this fracture. *Adductor Pollicis* - The **adductor pollicis** muscle primarily adducts the thumb and acts on the **proximal phalanx**, not the base of the first metacarpal. - Its action tends to *pull the entire first metacarpal toward the palm*, rather than specifically displacing the small fracture fragment. *EPL* - The **extensor pollicis longus (EPL)** extends the interphalangeal joint and assists in extension of the metacarpophalangeal joint of the thumb, inserting on the **distal phalanx**. - It does not have a direct insertion or significant deforming force on the **proximal fragment of the first metacarpal base** in a Bennett's fracture. *EPB* - The **extensor pollicis brevis (EPB)** extends the metacarpophalangeal joint of the thumb, inserting on the **proximal phalanx**. - Similar to the EPL, it does not exert a primary deforming force on the **fracture fragment at the base of the first metacarpal**.

Practice by Chapter

Hand Anatomy and Biomechanics

Practice Questions

Hand Fractures and Dislocations

Practice Questions

Tendon Injuries

Practice Questions

Nerve Injuries in Hand

Practice Questions

Dupuytren's Disease

Practice Questions

Carpal Tunnel Syndrome

Practice Questions

Rheumatoid Hand

Practice Questions

Reconstructive Hand Surgery

Practice Questions

Tendon Transfers

Practice Questions

Congenital Hand Anomalies

Practice Questions

Hand Infections

Practice Questions

Microsurgery in Hand Surgery

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Scan to download app