Hand Surgery Practice Questions

Q: Tardy ulnar nerve palsy caused by:

Cubitus valgus and lateral condylar fracture. ***Cubitus valgus and lateral condylar fracture*** - **Cubitus valgus**, often a sequela of a **lateral condylar fracture** in childhood, is the most common cause of **tardy ulnar nerve palsy**. - The increased valgus angle stretches the ulnar nerve behind the medial epicondyle over time, leading to demyelination and eventual palsy. *Cubitus varus and medial epicondylitis* - **Cubitus varus** is not typically associated with ulnar nerve compression; it can cause elbow instability but less commonly affects the ulnar nerve directly. - **Medial epicondylitis** (golfer's elbow) is an inflammation of the common flexor tendon origin and does not primarily cause ulnar nerve compression or palsy through anatomical deformity. *Cubitus varus* - **Cubitus varus**, also known as **gunstock deformity**, is a decrease in the carrying angle of the elbow. - It usually does not directly cause ulnar nerve compression, but rather can lead to other issues like elbow instability. *Medial epicondylitis and lateral epicondylitis* - **Medial epicondylitis** (golfer's elbow) involves inflammation at the medial epicondyle, and **lateral epicondylitis** (tennis elbow) involves inflammation at the lateral epicondyle; neither is a direct cause of tardy ulnar nerve palsy. - While prolonged inflammation or swelling around the medial epicondyle in some severe cases *might* indirectly affect the ulnar nerve, these conditions are not the primary cause of **tardy palsy** linked to a long-standing anatomical deformity. *Lateral condylar fracture* - A **lateral condylar fracture** itself, particularly if it heals with a **cubitus valgus** deformity, is an indirect cause. - The immediate fracture does not cause tardy palsy; rather, the *consequence* of the fracture (the deformity) causes the delayed onset of symptoms.

Q: Dupuytrens Contracture occurs in

Palmar fascia. ***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.

Q: Most common cause of trigger finger -

Repetitive use. ***Repetitive use*** - **Repetitive gripping** activities are the most common cause of trigger finger (stenosing tenosynovitis), leading to inflammation and thickening of the flexor tendon sheath. - This inflammation restricts the smooth gliding of the tendon, causing it to catch, particularly at the **A1 pulley**. *Diabetes* - While **diabetes** is a common risk factor for trigger finger, it is not the direct cause but rather predisposes individuals to the condition due to microvascular changes and increased tendon thickness. - Diabetic patients often experience more severe or multiple digit involvement, but the immediate precipitating factor is often overuse. *Trauma* - **Acute trauma** can sometimes lead to trigger finger if it directly injures the tendon sheath, but it is a less common cause than chronic repetitive strain. - Direct impact or lacerations are typically required for trauma to be the sole cause. *Rheumatoid arthritis* - **Rheumatoid arthritis** can cause tenosynovitis and contribute to trigger finger due to systemic inflammation, but it is not the most common direct cause. - In rheumatoid arthritis, the inflammation is widespread and often affects multiple joints, with trigger finger being one possible manifestation in that context.

Q: Bennett's fracture-dislocation is associated with fracture of

First metacarpal. ***First metacarpal*** - A **Bennett's fracture** is an **intra-articular fracture** of the base of the **first metacarpal** bone. - It involves a small fragment remaining attached to the **carpus** while the rest of the metacarpal displaces radially and dorsally due to muscle pull. *Carpal* - **Carpal fractures** involve the bones of the wrist (e.g., scaphoid, lunate) and are distinct from fractures of the metacarpals. - While the first metacarpal articulates with the trapezium (a carpal bone), the fracture itself is of the metacarpal, not the carpal bone directly. *Phalanx* - **Phalanx fractures** involve the bones of the fingers or toes, which are distal to the metacarpals. - These are typically caused by direct trauma to the digits, not typically associated with the specific mechanism of a Bennett's fracture. *Ulna* - The **ulna** is one of the two long bones in the forearm and is not directly involved in hand fractures like Bennett's. - Fractures of the ulna (e.g., Monteggia, Galeazzi fractures) are distinct injuries affecting the forearm.

Q: Swan neck deformity is:

Flexion at DIP, Hyperextension at PIP. ***Flexion at DIP, Hyperextension at PIP*** - In a **swan neck deformity**, the **proximal interphalangeal (PIP) joint** is hyperextended, and the **distal interphalangeal (DIP) joint** is flexed. - This characteristic posture resembles the neck of a swan and is commonly seen in conditions like **rheumatoid arthritis**. *Extension of both DIP & PIP* - This describes a neutral or extended position of the finger joints, which is not characteristic of a **swan neck deformity**. - A swan neck deformity involves abnormal angulation at both the PIP and DIP joints. *Hyperextension at DIP, Flexion of PIP* - This configuration describes a **Boutonnière deformity**, which is the reverse of a swan neck deformity. - In a **Boutonnière deformity**, the **PIP joint is flexed**, and the **DIP joint is hyperextended**. *Extension of DIP, Hyperflexion at PIP* - This describes **flexion at the PIP joint** with the DIP joint extended, which is also seen in a **Boutonnière deformity**, not a swan neck deformity. - The key distinguishing feature of a swan neck is **PIP hyperextension**.

Q: Froment's sign is positive due to loss of -

Adduction of thumb due to ulnar nerve palsy. ***Adduction of thumb due to ulnar nerve palsy*** - **Froment's sign** is a clinical test for **ulnar nerve palsy**, specifically evaluating the weakness of the **adductor pollicis muscle** in the thumb [1]. - When asked to pinch a piece of paper, a patient with ulnar nerve palsy will excessively **flex the thumb's interphalangeal joint** due to compensation by the median-innervated flexor pollicis longus. *Abduction of finger due to ulnar nerve palsy* - While the ulnar nerve does innervate some intrinsic hand muscles responsible for finger abduction (e.g., dorsal interossei), **Froment's sign** specifically tests adduction of the thumb, not finger abduction [1]. - Loss of **finger abduction** would be more generally assessed by testing the interossei muscles directly. *Adduction of finger due to median nerve palsy* - **Froment's sign** is associated with **ulnar nerve palsy**, not median nerve palsy [1]. - The adduction of fingers is primarily mediated by the ulnar nerve (palmar interossei), while the median nerve primarily affects the thenar muscles and some intrinsic hand muscles. *Extension of thumb due to radial nerve palsy* - **Radial nerve palsy** would affect the **extensors of the wrist and fingers**, including the thumb [1]. - Loss of thumb extension would manifest as a

Q: The most commonly involved nerve in lunate dislocation is -

Median nerve. ***Median nerve*** - In a **lunate dislocation**, the lunate bone dislocates anteriorly and rotates. This displaced lunate can directly compress the **median nerve** within the carpal tunnel, which lies just anterior to it. - Compression of the median nerve leads to symptoms of **carpal tunnel syndrome**, including numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar nerve* - The **ulnar nerve** passes through Guyon's canal, which is located more medially and is generally not directly compressed by an isolated lunate dislocation. - While other wrist injuries can affect the ulnar nerve, it is not the most common nerve involved in lunate dislocation. *Posterior interosseous* - The **posterior interosseous nerve** is a branch of the radial nerve and supplies muscles in the posterior compartment of the forearm; it is located away from the carpal bones and is very rarely affected by lunate dislocation. - Injury to this nerve typically results in wrist drop or issues with finger extension. *Anterior interosseous* - The **anterior interosseous nerve** is a branch of the median nerve that supplies deep flexor muscles in the forearm; it also lies away from the direct path of a dislocated lunate. - Injury to this nerve leads to an inability to make the "ok" sign due to paralysis of the flexor pollicis longus and flexor digitorum profundus to the index finger.

Q: In hand injury, the first structure to be repaired should be?

Bone. ***Bone*** - In hand injury, **skeletal stability** is paramount and is typically the first structure to be addressed to provide a stable foundation. - Repairing bone first allows for proper alignment and length restoration, which is crucial for the subsequent repair of soft tissues like tendons, nerves, and vessels. *Skin* - While skin closure is the final step in wound management, it should only be performed after deeper structures like bone, tendons, and nerves have been repaired. - Repairing the skin first would prevent access to underlying damaged structures and could lead to functional impairment. *Muscle* - Muscle repair is important for restoring function but should follow bone stabilization to ensure proper length and tension. - Unstable bone fragments can impede effective muscle repair and healing. *Nerve* - Nerve repair is critical for restoring sensation and motor function and should be done with meticulous attention to detail. - However, nerve repair typically follows bone stabilization and sometimes tendon repair, as a stable environment is necessary for successful nerve coaptation and healing.

Q: Dequervain's tenosynovitis is a stenosing tenosynovitis of the

First extensor compartment of the wrist. ***First extensor compartment of the wrist*** - **De Quervain's tenosynovitis** specifically involves the tendons of the **abductor pollicis longus (APL)** and **extensor pollicis brevis (EPB)** as they pass through the first dorsal extensor compartment of the wrist. - Inflammation and thickening of the tendon sheaths within this compartment lead to **pain and tenderness** on the radial side of the wrist, aggravated by movements of the thumb and wrist. *Median nerve* - The **median nerve** is associated with **carpal tunnel syndrome**, which presents with numbness, tingling, and weakness in the thumb, index, middle, and radial half of the ring fingers. - This condition involves compression of the median nerve as it passes through the carpal tunnel, not tenosynovitis of a specific tendon compartment. *Tendo Achilles* - The **Achilles tendon** is located at the back of the ankle and connects the calf muscles to the heel bone. - Conditions affecting the Achilles tendon include **Achilles tendinopathy** or rupture, causing pain and stiffness in the heel, which is distinct from wrist pain. *Iliolumbar ligament* - The **iliolumbar ligament** connects the transverse process of the fifth lumbar vertebra to the iliac crest. - Pain in this area is typically associated with **low back pain** or iliolumbar ligament sprain, not tenosynovitis in the wrist.

Q: Cubital tunnel syndrome involves compression of which nerve?

Ulnar nerve. ***Ulnar nerve*** - **Cubital tunnel syndrome** specifically refers to the compression of the **ulnar nerve** as it passes through the cubital tunnel at the elbow. - Symptoms include **numbness** and **tingling** in the little finger and half of the ring finger, and sometimes weakness of intrinsic hand muscles. *Radial nerve* - The **radial nerve** is compressed in conditions like **radial tunnel syndrome** or **wrist drop**, but not cubital tunnel syndrome. - It supplies sensation to the **dorsum of the hand** and motor function to the **extensor muscles** of the forearm and hand. *Popliteal nerve* - The **popliteal nerve** is located in the **lower limb**, specifically in the posterior knee region. - Compression of this nerve is typically associated with conditions like **peroneal nerve palsy**, affecting foot and ankle function, and is unrelated to the elbow. *Brachial nerve* - The term "brachial nerve" is generally not used in clinical anatomy; rather, it refers to the nerves originating from the **brachial plexus**. - The **brachial plexus** gives rise to several major nerves of the upper limb, including the ulnar, radial, and median nerves, but itself is not a specific site of compression in cubital tunnel syndrome.

Question 1

Tardy ulnar nerve palsy caused by:

Accepted Answer

Cubitus valgus and lateral condylar fracture

Answer

Cubitus varus and medial epicondylitis

Answer

Cubitus varus

Answer

Medial epicondylitis and lateral epicondylitis

Answer

Lateral condylar fracture

Question 2

Dupuytrens Contracture occurs in

Accepted Answer

Palmar fascia

Answer

Plantar fascia

Answer

Shoulder fascia

Answer

Hip joint fascia

Question 3

Most common cause of trigger finger -

Accepted Answer

Repetitive use

Answer

Diabetes

Answer

Trauma

Answer

Rheumatoid arthritis

Question 4

Bennett's fracture-dislocation is associated with fracture of

Accepted Answer

First metacarpal

Answer

Carpal

Answer

Phalanx

Answer

Ulna

Question 5

Swan neck deformity is:

Accepted Answer

Flexion at DIP, Hyperextension at PIP

Answer

Extension of both DIP & PIP

Answer

Hyperextension at DIP, Flexion of PIP

Answer

Extension of DIP, Hyperflexion at PIP

Question 6

Froment's sign is positive due to loss of -

Accepted Answer

Adduction of thumb due to ulnar nerve palsy

Answer

Abduction of finger due to ulnar nerve palsy

Answer

Adduction of finger due to median nerve palsy

Answer

Extension of thumb due to radial nerve palsy

Question 7

The most commonly involved nerve in lunate dislocation is -

Accepted Answer

Median nerve

Answer

Ulnar nerve

Answer

Posterior interosseous

Answer

Anterior interosseous

Question 8

In hand injury, the first structure to be repaired should be?

Accepted Answer

Bone

Answer

Skin

Answer

Muscle

Answer

Nerve

Question 9

Dequervain's tenosynovitis is a stenosing tenosynovitis of the

Accepted Answer

First extensor compartment of the wrist

Answer

Median nerve

Answer

Tendo Achilles

Answer

Iliolumbar ligament

Question 10

Cubital tunnel syndrome involves compression of which nerve?

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Popliteal nerve

Answer

Brachial nerve

Hand Surgery — MCQs

Hand Surgery — MCQs

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