Hand Surgery Practice Questions

Q: X-ray of hand of the picture shows:

Bennett fracture. ***Bennett fracture*** - The X-ray image shows an **intra-articular fracture** at the base of the **first metacarpal bone**, extending into the carpometacarpal (CMC) joint of the thumb. - This fracture is often **unstable** due to the pull of the abductor pollicis longus muscle, leading to dorsal and radial displacement of the metacarpal shaft. *Boxer fracture* - A Boxer fracture involves a break in the **neck of the fifth metacarpal bone**, typically occurring after punching a hard object. - While it is a common hand injury, the image clearly shows the fracture at the base of the thumb's metacarpal, not the fifth metacarpal. *Gamekeeper thumb* - Also known as skier's thumb, this injury is a tear or rupture of the **ulnar collateral ligament** of the metacarpophalangeal (MCP) joint of the thumb. - This condition is a soft tissue injury and would not typically present as a bone fracture on an X-ray, although avulsion fractures can sometimes be associated. *Colle's fracture* - A Colles' fracture is a fracture of the **distal radius** with dorsal displacement of the distal fragment, occurring about 1 inch proximal to the radiocarpal joint. - The fracture shown in the image is in the hand, specifically at the base of the thumb's metacarpal, and not in the distal forearm.

Q: The test performed below shows involvement of which of the following nerve?

Median nerve. ***Median nerve*** - The image depicts the **Phalen's test**, where prolonged forced wrist flexion compresses the **median nerve** within the **carpal tunnel**. - The lightning bolt symbol indicates the characteristic **paresthesia** (tingling, numbness) experienced in the distribution of the median nerve, affecting the **thumb, index finger, middle finger, and radial half of the ring finger**. *Radial nerve* - The **radial nerve** primarily innervates the **extensor muscles** of the forearm and hand and provides sensation to the posterior aspect of the forearm and hand, as well as the dorsal side of the lateral 3.5 digits; it is not compressed by Phalen's maneuver. - Injury to the radial nerve typically causes **wrist drop** and sensory loss in a different distribution. *Axillary nerve* - The **axillary nerve** innervates the **deltoid** and **teres minor** muscles and provides sensation over the lateral shoulder. - It is not involved in conditions affecting the wrist or hand tested by maneuvers like Phalen's. *Ulnar nerve* - The **ulnar nerve** provides sensation to the **little finger** and **ulnar half of the ring finger**, and innervates most of the intrinsic hand muscles. - Compression of the ulnar nerve is typically tested by **Tinel's sign** at the **cubital tunnel** or Guyon's canal, not Phalen's test.

Q: The test performed below shows involvement of which of the following nerve?

Ulnar nerve. ***Ulnar nerve*** - The image on the right depicts **Froment's sign**, which is a clinical test for **ulnar nerve palsy**. The patient attempts to hold a piece of paper between the thumb and index finger. - When the adductor pollicis (innervated by the ulnar nerve) is weak, the patient compensates by flexing the **interphalangeal joint of the thumb** using the flexor pollicis longus (innervated by the median nerve). *Median nerve* - Damage to the median nerve would typically affect **thumb opposition**, abduction, and sensation over the first three and a half digits, but would not cause the compensatory action seen in Froment's sign. - While the median nerve compensates for ulnar nerve weakness in Froment's sign, the primary deficit points to the ulnar nerve. *Radial nerve* - Radial nerve injury primarily affects **wrist extension** and **finger extension**, leading to **wrist drop**. It does not typically present with the inability to hold paper between the thumb and index finger. - Sensory deficits for the radial nerve affect the dorsum of the hand, which is unrelated to the motor function tested here. *Axillary nerve* - The axillary nerve innervates the **deltoid muscle** and **teres minor**, responsible for shoulder abduction and external rotation. - Injury to the axillary nerve would cause weakness in shoulder movements and sensory loss over the lateral shoulder, not hand intrinsic muscle weakness.

Q: The contracture shown in the image is associated with all except:

Table top test is negative. ***Table top test is negative*** - The image shows a hand affected by **Dupuytren's contracture**, characterized by fixed flexion deformities of the finger joints. - In Dupuytren's contracture, the **tabletop test** is typically **positive** (meaning the hand cannot be laid flat on a table) when the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint contracture exceeds 30 degrees, indicating significant fascial thickening and shortening. *Seen in cirrhosis* - **Dupuytren's contracture** is indeed associated with conditions like **alcoholism** and **liver cirrhosis**, though the exact pathophysiological link is not fully understood. - Other associated conditions include diabetes mellitus, manual labor, and certain anti-epileptic medications. *Involves the ring and little finger* - Dupuytren's contracture most commonly affects the **ulnar side of the hand**, particularly the **ring finger** and **little finger**, due to fibrosis and shortening of the palmar fascia. - It can also involve the middle finger and rarely the index finger and thumb. *Clostridial collagenase for resolution* - **Collagenase clostridium histolyticum (CCH)**, derived from *Clostridium histolyticum*, is an approved non-surgical treatment for Dupuytren's contracture. - It works by injecting the enzyme directly into the palmar cord to **dissolve the collagen fibers** responsible for the contracture, allowing for manipulation to release the contracture.

Q: A 35-year-old male comes with a swollen finger. A few days ago he got a cut on his index finger. The swelling has worsened with the development of redness. He also feels feverish. All of the following clinical features are correct about the diagnosis except:

Pain upon passive flexion. ***Pain upon passive flexion*** - This is an incorrect statement because pain on **passive extension** of the affected digit (rather than passive flexion) is a classic sign of **flexor tenosynovitis (Kanavel's sign)**. - In flexor tenosynovitis, the inflamed tendon sheath makes passive extension painful as it stretches the inflamed tissues. *Tenderness* - **Tenderness along the course of the flexor tendon sheath** is one of Kanavel's cardinal signs for flexor tenosynovitis. - This symptom indicates inflammation and infection within the tendon sheath. *Flexion* - The affected finger typically rests in a position of **slight flexion** to relieve tension on the inflamed flexor tendon sheath. - This guarded posture is a characteristic feature of tenosynovitis. *Uniform swelling* - There is typically **uniform swelling of the affected digit** because the infection and inflammation are contained within the closed space of the flexor tendon sheath. - This swelling differentiates it from more localized infections like cellulitis or abscesses.

Q: The given nature of injury will lead to the development of:

Mallet finger. ***Mallet finger*** - The image shows a **rupture of the extensor tendon** at its insertion into the distal phalanx, or an avulsion fracture of the distal phalanx, causing an inability to extend the distal interphalangeal (DIP) joint. - This injury results in the characteristic **flexion deformity** of the DIP joint, known as mallet finger. *Jersey finger* - This injury involves the **rupture of the flexor digitorum profundus tendon** from its insertion at the base of the distal phalanx. - Patients cannot actively **flex their DIP joint**, unlike the extensor tendon injury shown. *Jammed finger* - This is a general term for an **axial load injury** to the finger, usually causing a sprain or mild fracture without a specific tendon rupture as depicted. - It typically results from impact on the fingertip, leading to **ligamentous injury** or joint capsule damage. *Boxer knuckle* - **Boxer's knuckle** refers to a sagital band rupture at the metacarpophalangeal (MCP) joint, affecting the central slip of the extensor tendon. - This injury primarily involves the **MCP joint** and not the DIP joint, as shown in the image.

Q: What does the following image show?

Jersey finger. ***Jersey finger*** - The image depicts an **avulsion fracture** of the distal phalanx where the **flexor digitorum profundus (FDP) tendon** has pulled off a piece of bone from its insertion point. - This injury commonly occurs when a fully flexed finger (often the ring finger) is forcefully extended, such as snagging a finger on an opponent's jersey, preventing active flexion of the **distal interphalangeal (DIP) joint**. *Mallet finger* - This injury involves a rupture or avulsion of the **extensor tendon** at the **DIP joint**, leading to an inability to actively extend the distal phalanx. - The digit would appear in a characteristic **flexed position at the DIP joint**, which is not shown in the image. *Jammed finger* - A jammed finger is a general term for a sprain or contusion of the finger joints, usually caused by axial compression. - It does not typically involve a **tendon avulsion** or bone fracture as clearly depicted in the image. *Boxer knuckle* - This term usually refers to an injury of the **extensor digitorum communis (EDC) tendon** at the **metacarpophalangeal (MCP) joint**, often sustained during punching. - The injury shown is clearly at the **distal interphalangeal (DIP) joint** and involves the flexor tendon, not the MCP joint or extensor tendon.

Q: What is correct about the fracture shown in the figure?

A= Bennett fracture, B= Rolando fracture. ***A= Bennett fracture, B= Rolando fracture*** * **Bennett fracture** (A) is an **intra-articular fracture** of the base of the first metacarpal bone with a characteristic **two-part fracture** pattern. It involves a small fragment of the metacarpal base remaining attached to the carpometacarpal joint, while the rest of the metacarpal is dislocated. * **Rolando fracture** (B) is a **comminuted intra-articular fracture** at the base of the first metacarpal. It is characterized by a **Y or T-shaped fracture pattern**, indicating a more complex, three-part or more fragment involvement compared to a Bennett fracture. *A= Rolando fracture, B= Bennett fracture* * This option incorrectly identifies A as a Rolando fracture; Image A clearly shows a **two-part fracture** typical of a Bennett fracture, not the comminuted pattern of a Rolando. * Similarly, B is incorrectly identified as a Bennett fracture as it depicts a **multi-fragmented, Y-shaped fracture**, which defines a Rolando fracture. *A= Boxer's fracture, B= Bennett fracture* * **Boxer's fracture** is a fracture of the **neck of the fifth metacarpal**, which is not depicted in either image A or B. Both images show fractures at the base of the first metacarpal. * Image A is a **Bennett fracture**, not a Boxer's fracture, and B is a **Rolando fracture**, not a Bennett fracture. *A= Bennett fracture, B= Boxer's fracture* * While A is correctly identified as a **Bennett fracture**, B is incorrectly identified as a Boxer's fracture. * As previously stated, a **Boxer's fracture affects the fifth metacarpal**, whereas image B clearly shows a fracture of the first metacarpal base with multiple fragments.

Q: Identify the deformity:

Mallet finger. ***Mallet finger*** - This image clearly shows a **flexion deformity of the distal interphalangeal (DIP) joint**, where the fingertip is bent downwards, characteristic of a mallet finger. - This deformity results from an injury to the **extensor tendon** at its insertion on the distal phalanx, preventing full extension of the fingertip. *Swan neck* - A swan neck deformity involves **hyperextension of the proximal interphalangeal (PIP) joint** and flexion of the DIP joint, which is the opposite of what is seen in the image for the PIP joint. - It often results from conditions like **rheumatoid arthritis** or a ruptured flexor digitalis superficialis tendon. *Boutonniere deformity* - This deformity is characterized by **flexion of the PIP joint** and **hyperextension of the DIP joint**, resembling a buttonhole. - It occurs due to a rupture of the central slip of the **extensor tendon** over the PIP joint. *Jersey finger* - Jersey finger is an injury to the **flexor digitorum profundus tendon**, preventing the patient from flexing the DIP joint against resistance. - The digit would typically appear extended or unable to actively flex, not in a *flexed* position as shown in the image.

Q: The image shows flexion at PIP and extension at DIP, which is suggestive of presence of:

Boutonniere deformity. ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint** - Results from disruption of the **central slip of the extensor tendon** at the PIP joint - Commonly seen in **rheumatoid arthritis**, trauma, or inflammatory conditions - The lateral bands slip volarly, causing the characteristic deformity pattern *Swan neck deformity* - Shows the **opposite pattern**: hyperextension at PIP joint and flexion at DIP joint - Not consistent with the described clinical findings of PIP flexion and DIP extension - Also commonly associated with rheumatoid arthritis but has different mechanism *Mallet finger* - Characterized by **isolated DIP joint flexion** with inability to actively extend - Results from disruption of the extensor tendon at its insertion on the distal phalanx - Does not involve PIP joint abnormality as described in the image *Trigger finger* - Presents with **catching or locking during finger flexion/extension** - Involves flexor tendon entrapment, not a fixed deformity pattern - Does not produce the specific PIP flexion with DIP extension pattern shown

Question 1

X-ray of hand of the picture shows:

Accepted Answer

Bennett fracture

Answer

Boxer fracture

Answer

Gamekeeper thumb

Answer

Colle's fracture

Question 2

The test performed below shows involvement of which of the following nerve?

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Axillary nerve

Answer

Ulnar nerve

Question 3

The test performed below shows involvement of which of the following nerve?

Accepted Answer

Ulnar nerve

Answer

Median nerve

Answer

Radial nerve

Answer

Axillary nerve

Question 4

The contracture shown in the image is associated with all except:

Accepted Answer

Table top test is negative

Answer

Seen in cirrhosis

Answer

Involves the ring and little finger

Answer

Clostridial collagenase for resolution

Question 5

A 35-year-old male comes with a swollen finger. A few days ago he got a cut on his index finger. The swelling has worsened with the development of redness. He also feels feverish. All of the following clinical features are correct about the diagnosis except:

Accepted Answer

Pain upon passive flexion

Answer

Tenderness

Answer

Flexion

Answer

Uniform swelling

Question 6

The given nature of injury will lead to the development of:

Accepted Answer

Mallet finger

Answer

Jersey finger

Answer

Jammed finger

Answer

Boxer knuckle

Question 7

What does the following image show?

Accepted Answer

Jersey finger

Answer

Mallet finger

Answer

Jammed finger

Answer

Boxer knuckle

Question 8

What is correct about the fracture shown in the figure?

Accepted Answer

A= Bennett fracture, B= Rolando fracture

Answer

A= Rolando fracture, B= Bennett fracture

Answer

A= Boxer's fracture, B= Bennett fracture

Answer

A= Bennett fracture, B= Boxer's fracture

Question 9

Identify the deformity:

Accepted Answer

Mallet finger

Answer

Swan neck

Answer

Boutonniere deformity

Answer

Jersey finger

Question 10

The image shows flexion at PIP and extension at DIP, which is suggestive of presence of:

Accepted Answer

Boutonniere deformity

Answer

Swan neck deformity

Answer

Mallet finger

Answer

Trigger finger

Hand Surgery — MCQs

Hand Surgery — MCQs

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