Hand Surgery Practice Questions

Q: Mallet finger is caused by injury to the extensor tendon insertion at which location?

Distal phalanx. **Explanation:** **Mallet Finger** (also known as Baseball finger) is a common sports injury characterized by the loss of active extension at the **Distal Interphalangeal (DIP) joint**. 1. **Why the Correct Answer is Right:** The extensor mechanism of the finger terminates as the **terminal extensor tendon**, which inserts into the dorsal base of the **distal phalanx**. An injury (either a formal tendon rupture or an avulsion fracture) at this specific insertion point prevents the patient from extending the DIP joint, resulting in a characteristic "droop" of the fingertip while the joint remains passively mobile. 2. **Why Incorrect Options are Wrong:** * **Middle Phalanx:** Injury to the extensor insertion here (the central slip) leads to a **Boutonnière deformity**, characterized by PIP joint flexion and DIP joint hyperextension. * **Proximal Phalanx:** This is the site of the insertion for the interossei and lumbricals (via the extensor expansion), but isolated injury here does not cause Mallet finger. * **Second Metacarpal:** This is the site of insertion for the Extensor Carpi Radialis Longus (ECRL). Injury here would affect wrist extension, not individual finger DIP joints. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Sudden forceful flexion of an extended finger (e.g., a ball hitting the tip of the finger). * **Clinical Feature:** "Droop" at the DIP joint with inability to actively straighten the tip. * **Radiology:** May show a "Bony Mallet" (avulsion fracture of the dorsal base of the distal phalanx). * **Management:** Most cases are treated conservatively with **continuous splinting of the DIP joint in extension** (or slight hyperextension) for 6–8 weeks. If the splint is removed even once, the healing process restarts.

Q: From which structure is a flexor tendon graft typically harvested for repair?

Extensor indicis. **Explanation:** The goal of a tendon graft is to replace a damaged segment of a flexor tendon using a donor tendon that provides adequate length and strength without causing significant functional deficit at the donor site. **Why Extensor Indicis (EIP) is the Correct Answer:** The **Extensor Indicis Proprius (EIP)** is a preferred donor for flexor tendon repairs, particularly in the hand. Because the index finger has a dual nerve supply/musculature for extension (the Extensor Digitorum Communis and the EIP), harvesting the EIP allows for a long, high-quality graft while the index finger retains its ability to extend via the EDC. It is frequently used for **Extensor Pollicis Longus (EPL) reconstruction**. **Analysis of Incorrect Options:** * **Plantaris (A):** While the plantaris is a classic donor for long tendon grafts (e.g., in the leg or hand), it is absent in approximately 7–10% of the population. It is a vestigial muscle and not the primary choice when a local hand graft like EIP is specified in this context. * **Palmaris Longus (B):** This is the **most common** donor for tendon grafts because it is easily accessible and functionally redundant. However, it is absent in ~15% of people. While it is a "typical" source, in many board-style questions, if EIP is listed, it specifically tests the knowledge of redundant extensors in the hand. * **Extensor Digitorum (C):** Harvesting the EDC would result in a significant loss of extension for the respective finger, making it an unsuitable donor site. **NEET-PG High-Yield Pearls:** * **Most common donor for tendon graft:** Palmaris Longus. * **Test for Palmaris Longus:** Thompson’s test (opposition of thumb and little finger with wrist flexion). * **Donor for ACL reconstruction:** Semitendinosus and Gracilis. * **EIP Transfer:** Specifically used to treat **rupture of the Extensor Pollicis Longus (EPL)**, often seen secondary to distal radius fractures (Colles' fracture).

Q: Froment's sign is seen in which of the following conditions?

Ulnar nerve palsy. **Explanation:** **Froment’s sign** is a classic clinical test used to identify **Ulnar Nerve Palsy**, specifically assessing the paralysis of the **Adductor Pollicis** muscle [1]. 1. **Mechanism of the Correct Answer (Ulnar Nerve Palsy):** The Adductor Pollicis is the only muscle of the thumb innervated by the Ulnar nerve. When a patient with ulnar nerve palsy attempts to grip a piece of paper between the thumb and index finger (key pinch), they cannot adduct the thumb [1]. To compensate, the patient uses the **Flexor Pollicis Longus (FPL)**, which is innervated by the Median nerve. This results in **flexion of the Interphalangeal (IP) joint** of the thumb, signifying a positive Froment’s sign [1]. 2. **Analysis of Incorrect Options:** * **Median Nerve Palsy:** Characterized by "Ape Thumb" deformity and loss of opposition (Opponens pollicis) [2]. The FPL would be weak, making Froment's sign impossible to perform. * **Anterior Interosseous Nerve (AIN) Palsy:** A branch of the median nerve. Damage leads to the inability to flex the IP joint of the thumb and the DIP joint of the index finger, resulting in a positive **"Kiloh-Nevin" (OK sign) test**, not Froment's [3]. * **Radial Nerve Palsy:** Presents with **Wrist Drop** or finger drop due to paralysis of the extensors [4]. It does not affect the adduction or flexion of the thumb. **High-Yield Clinical Pearls for NEET-PG:** * **Jeanne’s Sign:** If the thumb MCP joint hyperextends along with IP flexion during the Froment's test, it is called Jeanne’s sign (also indicates Ulnar nerve palsy). * **Wartenberg’s Sign:** Inability to adduct the little finger due to weak third palmar interosseous muscle (Ulnar nerve). * **Mnemonic:** Ulnar nerve is the **"Musician’s Nerve"** (fine movements) and the **"Laborer’s Nerve"** (power grip).

Question 1

Which of the following describes the deformity occurring in Boutonnière deformity?

Accepted Answer

Flexion at Distal interphalangeal joint and Extension at Metacarpophalangeal joint

Answer

Flexion of Proximal interphalangeal joint

Answer

Extension at Distal interphalangeal joint and Extension at Metacarpophalangeal joint

Answer

Flexion at Metacarpophalangeal joint

Question 2

Mallet finger is caused by injury to the extensor tendon insertion at which location?

Accepted Answer

Distal phalanx

Answer

Middle phalanx

Answer

Proximal phalanx

Answer

Second metacarpal bone

Question 3

In hand surgery, which anatomical area is referred to as "no man's land"?

Accepted Answer

The area between the distal palmar crease and the flexor crease of the proximal interphalangeal joint

Answer

Proximal phalanx

Answer

Distal phalanx

Answer

Wrist

Question 4

In which pattern does inheritance of Dupuytren's contracture take place?

Accepted Answer

Autosomal dominant

Answer

X linked recessive

Answer

Autosomal recessive

Answer

Mitochondrial inheritance

Question 5

A patient with a Bennett fracture experiences impaired thumb movement. Which of the following intrinsic muscles of the thumb is most likely injured?

Accepted Answer

Opponens pollicis

Answer

Abductor pollicis brevis

Answer

Flexor pollicis brevis (superficial head)

Answer

Adductor pollicis

Question 6

From which structure is a flexor tendon graft typically harvested for repair?

Accepted Answer

Extensor indicis

Answer

Plantaris

Answer

Palmaris longus

Answer

Extensor digitorum

Question 7

Which of the following is true about trigger finger?

Accepted Answer

Stenosis tenovaginitis of the flexor tendon of the affected finger.

Answer

Injury to fingers while operating a gun.

Answer

A feature of carpal tunnel syndrome.

Answer

Any of the above.

Question 8

Froment's sign is seen in which of the following conditions?

Accepted Answer

Ulnar nerve palsy

Answer

Median nerve palsy

Answer

Anterior interosseous nerve palsy

Answer

Radial nerve palsy

Question 9

A 48-year-old female piano player presented with numbness and tingling in her left hand. She was diagnosed with carpal tunnel syndrome and underwent an endoscopic nerve release. Two weeks postoperatively, she developed profound weakness in her thumb with loss of thumb opposition. Sensation to the hand was unaffected. Which of the following nerves was injured during the operation?

Accepted Answer

Recurrent branch of median nerve

Answer

The first common digital branch of the median nerve

Answer

The second common digital branch of the median nerve

Answer

Deep branch of the ulnar nerve

Question 10

Which of the following is true regarding De Quervain's tenosynovitis?

Accepted Answer

It affects Abductor Pollicis Longus and Extensor Pollicis Brevis

Answer

Fingers are held in mild extension

Answer

Most common involvement is the index finger

Answer

Treatment is always surgery

Hand Surgery — MCQs

Hand Surgery — MCQs

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