Tendon Transfers — MCQs
What is the primary function of the extensor carpi radialis longus muscle?
The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?
For tendon transfer, the most common tendon used is
Ruptured tendons are most commonly seen in
Which muscle receives a muscular branch from the ulnar nerve?
Cock-up splint is used in the treatment of
What is the MOST characteristic feature of low ulnar nerve palsy? a) Claw hand b) Sensory loss of medial four digits c) Weakness of grip d) Inability to abduct the thumb
Which of the following statements about the anterior compartment of the forearm is correct?
Which of the following structures passes deep to the flexor retinaculum at the wrist along with the tendon of flexor digitorum profundus?
A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?
Tendon Transfers Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary function of the extensor carpi radialis longus muscle?
- A. Wrist extensor (Correct Answer)
- B. Wrist adductor
- C. Extensor of MCP joint
- D. Extensor of IP joint
Explanation: ***Wrist extensor*** - The **extensor carpi radialis longus** originates from the **lateral supracondylar ridge of the humerus** and inserts at the **base of the second metacarpal** [2]. - Its primary action is **extension and abduction of the wrist** (along with the extensor carpi radialis brevis) [2]. *Wrist adductor* - **Wrist adduction** (ulnar deviation) is primarily performed by the **flexor carpi ulnaris** and **extensor carpi ulnaris** muscles [2]. - The extensor carpi radialis longus contributes to wrist abduction (radial deviation), not adduction [2]. *Extensor of MCP joint* - **Extension of the metacarpophalangeal (MCP) joints** is mainly carried out by the **extensor digitorum**, **extensor indicis**, and **extensor digiti minimi** muscles [1], [2]. - The extensor carpi radialis longus acts on the wrist joint, not directly on the MCP joints [2], [3]. *Extensor of IP joint* - **Extension of the interphalangeal (IP) joints** is primarily performed by the **lumbricals**, **interossei**, and the more distal actions of the **extensor digitorum** [1]. - The extensor carpi radialis longus does not have attachments or direct actions on the IP joints [2].
Question 2: The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?
- A. APB & EPL
- B. APL & EPB (Correct Answer)
- C. APB & EPB
- D. APL & EPL
Explanation: ***APL & EPB*** - Pain around the base of the thumb, especially with movement, is characteristic of De Quervain's tenosynovitis [1]. This condition involves the **abductor pollicis longus (APL)** and **extensor pollicis brevis (EPB)** tendons [1]. - These two tendons share a common synovial sheath as they pass through the first dorsal compartment of the wrist, making them susceptible to inflammation and friction [1]. *APB & EPL* - **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle found in the thenar eminence, primarily involved in thumb abduction, and is not typically associated with De Quervain's tenosynovitis. - **EPL (Extensor Pollicis Longus)** is part of the third dorsal compartment and its tendon crosses over the other thumb tendons, and is not inflamed in De Quervain's tenosynovitis. *APB & EPB* - As mentioned, **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle, not involved in De Quervain's tenosynovitis. - While **EPB (Extensor Pollicis Brevis)** is involved, its combination with APB incorrectly identifies the primary tendons affected in the first dorsal compartment. *APL & EPL* - **APL (Abductor Pollicis Longus)** is one of the correct tendons involved. - **EPL (Extensor Pollicis Longus)** belongs to the third dorsal compartment of the wrist and is not typically affected in De Quervain's tenosynovitis, differentiating it from the tendons in the first dorsal compartment [1].
Question 3: For tendon transfer, the most common tendon used is
- A. Achilles tendon
- B. Palmaris longus tendon (Correct Answer)
- C. Flexor carpi ulnaris tendon
- D. Tibialis posterior tendon
Explanation: ***Palmaris longus tendon*** - The **palmaris longus tendon** is the **most commonly used donor tendon** for tendon transfers due to multiple advantages: - **Dispensability**: Absent in 10-15% of the population without causing functional deficit, making it expendable - **Ideal dimensions**: Adequate length (12-15 cm) and appropriate diameter for various reconstructive procedures - **Easy access**: Superficial location with straightforward surgical harvest - **Minimal donor site morbidity**: Its removal causes virtually no functional impairment - Commonly used for tendon grafts in hand surgery, wrist reconstruction, and even ligament repairs (e.g., UCL reconstruction in elbow) *Achilles tendon* - The **Achilles tendon** is a large, critical tendon for ankle plantarflexion and is **not used as a donor** for tendon transfers due to its essential function - It is the strongest tendon in the body and its harvest would cause severe functional disability - May be involved in major reconstructive procedures of the ankle and foot, but not as a donor graft *Flexor carpi ulnaris tendon* - The **flexor carpi ulnaris tendon** is sometimes used for specific wrist transfers (e.g., in cerebral palsy or radial nerve palsy), but it is **not the most common donor tendon** overall - It plays an important role in wrist flexion and ulnar deviation, making its harvest potentially more impactful than the palmaris longus - More commonly used as a recipient rather than donor in transfer procedures *Tibialis posterior tendon* - The **tibialis posterior tendon** is commonly used as a **transfer** (not harvest) for specific conditions like foot drop or posterior tibial tendon dysfunction - It is an important stabilizer of the medial longitudinal arch and inversion of the foot - For general tendon grafting across various anatomical sites, it is not as frequently used as the palmaris longus
Question 4: Ruptured tendons are most commonly seen in
- A. Overuse (Correct Answer)
- B. Direct trauma from injury
- C. Structural abnormalities from birth
- D. Tumor-related structural changes
Explanation: ***Overuse*** - Chronic **overuse** leads to **microtrauma and degeneration** within the tendon, weakening it over time and making it susceptible to rupture even with minimal acute stress. - This is particularly common in tendons that experience **repetitive strain**, such as the Achilles tendon, rotator cuff, and patellar tendon. *Direct trauma from injury* - While acute, high-impact **direct trauma** can cause tendon ruptures, it is not the most common mechanism overall. - Many traumatic ruptures occur in tendons already weakened by **chronic degeneration**, rather than purely healthy tendons. *Structural abnormalities from birth* - **Congenital structural abnormalities** are relatively rare causes of primary tendon rupture. - These conditions usually present earlier in life with functional limitations rather than sudden rupture in adulthood. *Tumor-related structural changes* - **Tumors** can, in rare cases, weaken tendons and lead to rupture, but this is a far less common cause compared to overuse. - Tendon compromise due to a tumor usually involves direct invasion or pressure, which is not the predominant etiology for the majority of tendon ruptures.
Question 5: Which muscle receives a muscular branch from the ulnar nerve?
- A. Both FCU and FDP (Correct Answer)
- B. FCU
- C. None of the options
- D. FDP
Explanation: ***Both FCU and FDP*** - The **flexor carpi ulnaris (FCU)** is solely innervated by the **ulnar nerve** in the forearm. - The **flexor digitorum profundus (FDP)** has dual innervation: the **ulnar nerve** supplies the medial half (tendons to ring and little fingers), while the anterior interosseous nerve (branch of median nerve) supplies the lateral half (tendons to index and middle fingers). - Both muscles receive muscular branches from the ulnar nerve, making this the most complete and accurate answer. *FCU* - While the FCU does receive innervation from the ulnar nerve (and only the ulnar nerve), this option is incorrect because the FDP also receives branches from the ulnar nerve. - Selecting only FCU ignores the dual innervation of FDP and is therefore an incomplete answer when "Both FCU and FDP" is available. *FDP* - While the medial half of FDP does receive innervation from the ulnar nerve, this option is incorrect because FCU also receives innervation from the ulnar nerve. - Selecting only FDP ignores the complete innervation of FCU and is therefore an incomplete answer when "Both FCU and FDP" is available. *None of the options* - This option is incorrect because both the **flexor carpi ulnaris** and the medial portion of the **flexor digitorum profundus** definitively receive muscular branches from the ulnar nerve. - The ulnar nerve provides motor innervation to these specific forearm muscles before continuing into the hand.
Question 6: Cock-up splint is used in the treatment of
- A. Radial nerve palsy (Correct Answer)
- B. Ulnar nerve palsy
- C. Median nerve palsy
- D. Posterior interosseous nerve palsy
Explanation: ***Radial nerve palsy*** - A **cock-up splint** is specifically designed to provide **wrist extension**, which is lost in radial nerve palsy due to paralysis of the extensors. - This splint helps in maintaining an optimal position for **hand function** and preventing overstretching of denervated muscles. *Ulnar nerve palsy* - Ulnar nerve palsy typically causes a **claw hand deformity** due to hyperextension at the MCP joints of the 4th and 5th digits. - Treatment often involves splints that prevent MCP joint hyperextension, such as an **anti-claw splint**, not a cock-up splint. *Median nerve palsy* - Median nerve palsy results in conditions like **ape hand deformity** (loss of thumb opposition) and **carpal tunnel syndrome**. - Splints for median nerve palsy focus on maintaining thumb opposition or wrist neutrality, such as a **thumb spica splint** or **wrist splint**, respectively. *Posterior interosseous nerve palsy* - Posterior interosseous nerve palsy (PIN) is a purely motor palsy affecting wrist and finger extensors, similar to radial nerve palsy but sparing the brachioradialis and extensor carpi radialis longus. - While it affects extensors, the term "cock-up splint" is more commonly and broadly associated with the complete presentation of **radial nerve palsy** affecting all extensors.
Question 7: What is the MOST characteristic feature of low ulnar nerve palsy? a) Claw hand b) Sensory loss of medial four digits c) Weakness of grip d) Inability to abduct the thumb
- A. Claw hand (Correct Answer)
- B. Sensory loss of lateral three digits
- C. Weakness of wrist flexion
- D. Inability to oppose the thumb
- E. Inability to extend at M.C.P. joint
Explanation: ***Claw hand*** - A **claw hand** (specifically an **ulnar claw**) is a classic sign of low ulnar nerve palsy, resulting from paralysis of the **interossei** and **medial two lumbricals**. - This leads to hyperextension at the **metacarpophalangeal (MCP) joints** and flexion at the **interphalangeal (IP) joints** of the 4th and 5th digits. *Sensory loss of lateral three digits* - Sensory loss in the **lateral three digits** (thumb, index, middle fingers) is characteristic of **median nerve palsy**, not ulnar nerve palsy. - The ulnar nerve supplies sensation to the **medial 1.5 digits** (half of the ring finger and the little finger). *Weakness of wrist flexion* - While the ulnar nerve contributes to wrist flexion via the **flexor carpi ulnaris**, significant weakness in overall wrist flexion alone is not its most characteristic distinguishing feature. - The median nerve and radial nerve also play crucial roles in wrist flexion and extension, respectively. *Inability to oppose the thumb* - The inability to **oppose the thumb** (touch the thumb to the tips of the other fingers) is a hallmark of **median nerve palsy**, specifically affecting the **opponens pollicis** muscle. - The ulnar nerve primarily affects adduction of the thumb via the **adductor pollicis**. *Inability to extend at M.C.P. joint* - The inability to extend at the **metacarpophalangeal (MCP) joint** is more characteristic of **radial nerve palsy**, which affects the **extensor muscles** of the fingers. - Ulnar nerve palsy causes increased extension at the MCP joints due to paralysis of the lumbricals and interossei.
Question 8: Which of the following statements about the anterior compartment of the forearm is correct?
- A. Flexor pollicis longus is unipennate. (Correct Answer)
- B. The ulnar nerve enters the forearm by passing between the two heads of pronator teres.
- C. Flexor digitorum profundus originates from the radius.
- D. The median nerve enters the forearm by passing between the two heads of flexor carpi ulnaris.
Explanation: The flexor pollicis longus is unipennate. - The **flexor pollicis longus** muscle has a **unipennate** architecture, meaning its muscle fibers insert obliquely into one side of a central tendon. - This specific arrangement provides efficient force generation for thumb flexion. *The ulnar nerve enters the forearm by passing between the two heads of pronator teres.* - This is **incorrect**. The **ulnar nerve** enters the forearm by passing **between the two heads of flexor carpi ulnaris** (humeral and ulnar heads), not pronator teres. - The nerve that passes between the heads of pronator teres is the **median nerve**. *Flexor digitorum profundus originates from the radius.* - This is **incorrect**. The **flexor digitorum profundus** originates primarily from the **anterior and medial surfaces of the ulna** and the **interosseous membrane**, not from the radius. - The muscle arising from the radius in the anterior compartment is the **flexor pollicis longus**. *The median nerve enters the forearm by passing between the two heads of flexor carpi ulnaris.* - This is **incorrect**. The **median nerve** enters the forearm by passing **between the two heads of pronator teres** (humeral and ulnar heads), not flexor carpi ulnaris [1]. - The nerve that passes between the heads of flexor carpi ulnaris is the **ulnar nerve** [1].
Question 9: Which of the following structures passes deep to the flexor retinaculum at the wrist along with the tendon of flexor digitorum profundus?
- A. Ulnar nerve
- B. Median nerve (Correct Answer)
- C. Radial nerve
- D. Ulnar artery
Explanation: ***Median nerve*** - The **median nerve** passes through the **carpal tunnel**, deep to the **flexor retinaculum**, along with the tendons of the **flexor digitorum superficialis**, **flexor digitorum profundus**, and **flexor pollicis longus** [1]. - Compression of the **median nerve** in this confined space leads to **carpal tunnel syndrome**. *Ulnar nerve* - The **ulnar nerve** passes *superficial* to the **flexor retinaculum** within **Guyon's canal**, not deep to it [1]. - It accompanies the **ulnar artery** in this canal. *Radial nerve* - The **radial nerve** typically passes over the **anatomical snuffbox** or more proximally around the lateral epicondyle; it does not pass *deep* to the **flexor retinaculum** at the wrist. - Its superficial branch can be found on the dorsum of the hand. *Ulnar artery* - The **ulnar artery** passes *superficial* to the **flexor retinaculum**, alongside the **ulnar nerve**, within **Guyon's canal** [1]. - It contributes to the blood supply of the hand, forming the superficial palmar arch.
Question 10: A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?
- A. Ganglion cyst (Correct Answer)
- B. Dermoid cyst
- C. Sebaceous cyst
- D. Epidermoid cyst
Explanation: ***Ganglion cyst*** - A **ganglion cyst** is the most common mass of the hand and wrist. It presents as a **smooth, firm, mobile cystic mass** that transilluminates. - It classically appears on the **dorsum of the wrist** and often becomes more prominent with wrist flexion (or plantar flexion of the wrist, as stated in the question, though dorsiflexion/flexion are more common terms for the wrist). *Dermoid cyst* - **Dermoid cysts** are congenital and result from entrapment of ectodermal and mesodermal elements. They are typically found in areas of **embryonic fusion lines** (e.g., face, scalp). - While they can be cystic, they are usually **immobile** and do not typically fluctuate in prominence with wrist movement. *Sebaceous cyst* - Also known as an **epidermoid cyst** (when arising from epidermis) or a **pilar cyst** (when arising from hair follicle), these are typically filled with keratin and sebum. - They tend to occur in areas with **hair follicles** (e.g., scalp, trunk, face) and often have a visible central punctum; they are less common on the dorsum of the wrist. *Epidermoid cyst* - **Epidermoid cysts** are subepidermal nodules formed by the cystic enclosure of epidermal cells. They are typically firm and mobile. - While they can occur anywhere, they are less characteristic of the dorsum of the wrist, and their prominence is generally **not affected by wrist movement**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free