Diseases of Tendons and Fascia — MCQs
Finkelstein test is used for diagnosis of?
Rupture of extensor pollicis longus tendon occurs in all of the following except -
A 35-year-old tennis player presents with pain on the outer aspect of the elbow that worsens with gripping activities and wrist extension. The pain is localized over the lateral epicondyle. This condition most likely involves:
Test for De-quervain's tenovaginitis -
Dupuytrens Contracture occurs in
An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Finkelstein's test is done for diagnosis of:
What is the primary function of the Golgi tendon organ?
A 67-year-old male presents with progressive difficulty in walking, frequent falls, and stiffness in the legs. Neurological examination reveals increased muscle tone, brisk deep tendon reflexes, and a positive Babinski sign. MRI of the brain shows multiple white matter lesions. Which of the following is the most likely diagnosis?
Diseases of Tendons and Fascia Indian Medical PG Practice Questions and MCQs
Question 1: Finkelstein test is used for diagnosis of?
- A. Tarsal tunnel syndrome
- B. Carpal tunnel syndrome
- C. Thoracic outlet syndrome
- D. De quervain tenosynovitis (Correct Answer)
Explanation: ***De quervain tenosynovitis*** - The **Finkelstein test** is a specific diagnostic maneuver for **De Quervain's tenosynovitis**, where a positive test elicits pain at the wrist. - This condition involves inflammation of the **extensor pollicis brevis** and **abductor pollicis longus tendons** within the first dorsal compartment of the wrist. *Tarsal tunnel syndrome* - This syndrome involves compression of the **posterior tibial nerve** in the ankle, not the wrist. - Diagnosis typically involves **Tinel's sign** over the tarsal tunnel and nerve conduction studies. *Carpal tunnel syndrome* - This condition involves compression of the **median nerve** at the wrist. - Diagnostic tests include **Phalen's maneuver** and **Tinel's sign** over the carpal tunnel, which differ from the Finkelstein test. *Thoracic outlet syndrome* - This involves compression of neurovascular structures in the **thoracic outlet**, typically affecting the neck and upper extremity but not the wrist specifically. - Diagnostic tests involve specific provocative maneuvers that assess for vascular or neurological compromise in the shoulder and arm.
Question 2: Rupture of extensor pollicis longus tendon occurs in all of the following except -
- A. De Quervain's disease (Correct Answer)
- B. Rheumatoid arthritis
- C. Drummers
- D. Colles' fracture
Explanation: ***De Quervain's disease*** - This condition involves **tenosynovitis** of the **extensor pollicis brevis** and **abductor pollicis longus** tendons, not a rupture of the extensor pollicis longus. - The pathology is an inflammation and thickening of the tendon sheaths, distinct from a tendon tear. *Rheumatoid arthritis* - **Chronic inflammation** in rheumatoid arthritis can lead to weakening and eventual rupture of tendons, including the **extensor pollicis longus**, often due to synovitis eroding the tendon. - The condition creates an environment where tendons are vulnerable to **attrition** and damage, making rupture a recognized complication. *Drummers* - Repetitive, high-force movements involved in drumming can cause significant **stress** and microscopic damage to tendons, including the **extensor pollicis longus**. - Over time, this cumulative trauma can lead to inflammation, degeneration, and eventual **rupture** due to overuse. *Colles' fracture* - A **Colles' fracture** of the distal radius can cause a delayed rupture of the **extensor pollicis longus (EPL)** tendon. - This occurs due to attrition of the tendon as it rubs over the **roughened fracture site** or due to *avascular necrosis* of the tendon as it passes through a narrow osteofibrous tunnel.
Question 3: A 35-year-old tennis player presents with pain on the outer aspect of the elbow that worsens with gripping activities and wrist extension. The pain is localized over the lateral epicondyle. This condition most likely involves:
- A. Inflammation of the flexor tendons at the medial epicondyle of the humerus
- B. Inflammation of the biceps tendon at the shoulder
- C. Inflammation of the triceps tendon at the elbow
- D. Inflammation of the extensor tendons at the lateral epicondyle of the humerus (Correct Answer)
Explanation: ***Inflammation of the extensor tendons at the lateral epicondyle of the humerus*** - Pain on the **outer aspect of the elbow** that worsens with gripping and wrist extension is characteristic of **lateral epicondylitis**, also known as **tennis elbow**. - This condition involves inflammation and degeneration of the common **extensor tendons** originating from the **lateral epicondyle**, particularly the **extensor carpi radialis brevis**. *Inflammation of the flexor tendons at the medial epicondyle of the humerus* - This describes **medial epicondylitis**, or **golfer's elbow**, which causes pain on the **inner aspect of the elbow**. - It involves the **flexor-pronator mass tendons** and is aggravated by wrist flexion and forearm pronation, not wrist extension. *Inflammation of the biceps tendon at the shoulder* - **Bicipital tendonitis** presents with pain in the **anterior shoulder**, often radiating down the arm, and is typically exacerbated by lifting or overhead activities. - The pain is localized to the shoulder region and is not associated with wrist movements or elbow epicondyles. *Inflammation of the triceps tendon at the elbow* - **Triceps tendonitis** causes pain at the **posterior aspect of the elbow**, primarily with activities involving elbow extension against resistance. - While it affects the elbow, its location and aggravating factors differ from the described lateral elbow pain with gripping and wrist extension.
Question 4: Test for De-quervain's tenovaginitis -
- A. Phalen test
- B. Cozen test
- C. Kanavel's sign
- D. Finkelstein test (Correct Answer)
Explanation: ***Finkelstein test*** - The **Finkelstein test** is performed to diagnose **De Quervain's tenosynovitis**, which involves inflammation of the **abductor pollicis longus** and **extensor pollicis brevis** tendons. - The test involves making a fist with the thumb tucked inside the fingers, followed by **ulnar deviation** of the wrist. Pain along the **radial styloid** is a positive sign. *Phalen test* - The **Phalen test** is used to diagnose **carpal tunnel syndrome**, which is compression of the **median nerve**. - This test involves holding the wrists in maximal **flexion** for 30-60 seconds, which exacerbates median nerve symptoms like **numbness** and **tingling**. *Cozen test* - The **Cozen test** is used to diagnose **lateral epicondylitis**, also known as "tennis elbow." - It involves resisted **wrist extension** and **radial deviation** with the elbow extended, causing pain at the **lateral epicondyle**. *Kanavel's sign* - **Kanavel's signs** (pain on passive extension, uniform swelling, flexed posture of digit, tenderness along the tendon sheath) are clinical indicators for **flexor tenosynovitis** in the hand. - These signs suggest a severe infection of the **flexor tendon sheath**, requiring urgent surgical intervention.
Question 5: Dupuytrens Contracture occurs in
- A. Plantar fascia
- B. Shoulder fascia
- C. Palmar fascia (Correct Answer)
- D. Hip joint fascia
Explanation: ***Palmar fascia*** - **Dupuytren's contracture** is a fibromatosis affecting the palmar fascia, causing gradual flexion contractures of the fingers. - The condition leads to thickening and shortening of the **fibrous tissue** in the palm, particularly affecting the fourth and fifth digits. *Plantar fascia* - The plantar fascia is located on the sole of the foot; its inflammation or degeneration leads to **plantar fasciitis**, characterized by heel pain. - While it is a type of fibromatosis, it is distinct from Dupuytren's contracture, which specifically affects the hand. *Shoulder fascia* - The shoulder fascia is not typically associated with contractures in the same way Dupuytren's affects the hand. - Conditions affecting the shoulder, like **adhesive capsulitis** (frozen shoulder), involve the joint capsule, not primarily the fascia in this context. *Hip joint fascia* - The fascia around the hip joint can be involved in various conditions, but it does not develop **Dupuytren's-like contractures**. - Hip problems often involve the joint itself, muscles, or tendons, not a localized fascial contracture similar to that seen in the palm.
Question 6: An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:
- A. Gout
- B. Buerger's disease
- C. Stress fracture (Correct Answer)
- D. Lumbar canal stenosis
Explanation: ***Stress fracture*** - A **stress fracture** is highly likely in a recruit undergoing rigorous training, as repetitive stress on bones, especially in the legs, can lead to micro-fractures. - The symptoms of **localized pain** at the posteromedial aspect of both legs, acute point tenderness, and pain aggravated by physical activity are classic for stress fractures. *Gout* - **Gout** typically presents with sudden, severe pain and inflammation in a single joint, most commonly the big toe; it is less likely to cause bilateral, activity-related leg pain. - While smoking is a risk factor for gout, the clinical presentation does not align with a **gout flare-up**. *Buerger's disease* - **Buerger's disease** (thromboangiitis obliterans) is a rare inflammatory disease of the small and medium-sized arteries and veins, mainly affecting the hands and feet of heavy smokers. - It causes pain, numbness, and tingling due to **ischemia**, often leading to gangrene; it does not manifest as point tenderness and activity-aggravated pain along the posteromedial aspect of the legs. *Lumbar canal stenosis* - **Lumbar canal stenosis** typically causes neurogenic claudication, characterized by radiating pain, numbness, or weakness in the legs that is exacerbated by standing or walking and relieved by sitting or leaning forward. - The symptoms described, including **acute point tenderness** and posteromedial leg pain, are not characteristic of spinal canal narrowing.
Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 8: Finkelstein's test is done for diagnosis of:
- A. Trigger finger (stenosing tenosynovitis)
- B. Acute compartment syndrome
- C. De quervain's tenosynovitis (Correct Answer)
- D. Carpal tunnel syndrome
Explanation: ***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.
Question 9: What is the primary function of the Golgi tendon organ?
- A. Detects the muscle tension (Correct Answer)
- B. Detects changes in muscle length
- C. Detects the stretch of muscles
- D. Detects joint position and movement
Explanation: ***Detects the muscle tension*** - The **Golgi tendon organ (GTO)** is a proprioceptor located at the junction of skeletal muscle fibers and tendons. - Its primary function is to **monitor and regulate muscle tension** to prevent excessive force generation that could damage the muscle or tendon. - GTOs are **tension receptors** that respond to active muscle contraction and provide feedback for the inverse stretch reflex (autogenic inhibition). *Detects changes in muscle length* - This is the primary function of the **muscle spindle**, not the GTO. - Muscle spindles sense **changes in muscle length** and the rate of change, playing a key role in the stretch reflex. *Detects the stretch of muscles* - This also describes **muscle spindle** function. - While muscle stretch can generate tension, muscle spindles specifically detect **length changes**, whereas GTOs detect **tension/force**. *Detects joint position and movement* - This is the function of **joint kinesthetic receptors** (Ruffini endings and Pacinian corpuscles in joint capsules). - These receptors provide information about **joint angle and movement**, which is distinct from the GTO's role in detecting muscle tension.
Question 10: A 67-year-old male presents with progressive difficulty in walking, frequent falls, and stiffness in the legs. Neurological examination reveals increased muscle tone, brisk deep tendon reflexes, and a positive Babinski sign. MRI of the brain shows multiple white matter lesions. Which of the following is the most likely diagnosis?
- A. Amyotrophic lateral sclerosis
- B. Multiple sclerosis (Correct Answer)
- C. Parkinson's disease
- D. Primary lateral sclerosis
Explanation: ***Multiple sclerosis*** - The combination of **progressive neurological symptoms (walking difficulty, falls, leg stiffness)**, **upper motor neuron signs (increased muscle tone, brisk reflexes, positive Babinski)** and **multiple white matter lesions on MRI** is highly suggestive of **multiple sclerosis (MS)** [1]. - While MS typically presents in younger individuals, presentation in the late 60s, though less common, is possible and referred to as **late-onset MS** [1]. *Amyotrophic lateral sclerosis* - **Amyotrophic lateral sclerosis (ALS)** involves both **upper and lower motor neuron degeneration**, but typically presents with significant **muscle wasting and fasciculations (lower motor neuron signs)** [3]. - The MRI findings of **multiple white matter lesions** are not characteristic of ALS [3]. *Parkinson's disease* - **Parkinson's disease** is primarily characterized by **tremor at rest, bradykinesia, rigidity, and postural instability**, which are **extrapyramidal symptoms** [2]. - While stiffness and walking difficulty can occur, the presence of **brisk deep tendon reflexes** and a **positive Babinski sign (upper motor neuron signs)** are not typical for Parkinson's. *Primary lateral sclerosis* - **Primary lateral sclerosis (PLS)** is a **rare motor neuron disease** characterized by **pure upper motor neuron dysfunction**, leading to progressive **spasticity and weakness**. - While PLS can explain the upper motor neuron signs, **multiple white matter lesions on MRI** are not a defining feature; rather, they are highly indicative of **demyelination seen in MS**.
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