Hand Surgery Practice Questions

Q: Kienböck's disease is due to avascular necrosis of-

Lunate bone. ***Lunate bone*** - **Kienböck's disease** is specifically defined as **avascular necrosis** of the **lunate bone** in the wrist. - This condition leads to the collapse and fragmentation of the lunate, causing wrist pain, stiffness, and weakness. *Medial cuneiform bone* - Avascular necrosis of the medial cuneiform is rare and not associated with Kienböck's disease. - This bone is located in the midfoot and is primarily involved in supporting the arch of the foot. *Femoral neck* - Avascular necrosis of the femoral neck is known as **avascular necrosis of the hip** or **osteonecrosis of the femoral head**, not Kienböck's disease. - It most commonly affects individuals with risk factors like steroid use, alcohol abuse, or trauma, and presents with groin pain. *Scaphoid bone* - Avascular necrosis of the scaphoid bone is known as **Preiser's disease**, which is distinct from Kienböck's disease. - The scaphoid is another carpal bone, and its avascular necrosis is often associated with trauma and presents with radial wrist pain.

Q: What causes mallet finger?

Bony avulsion of distal phalanx at the extensor tendon. ***Bony avulsion of distal phalanx at the extensor tendon*** - Mallet finger commonly results from a **sudden forceful flexion** of an extended finger, leading to avulsion of the **extensor tendon's insertion** from the distal phalanx. - This specific injury, where a piece of bone is pulled away, results in the inability to **actively extend the distal interphalangeal (DIP) joint**. *Strain and subsequent stretching of the extensor tendon* - While stretching of the extensor tendon can occur, it is a less severe injury and typically does not result in the distinct **drooping deformity** characteristic of mallet finger. - This would manifest as weakness rather than a complete loss of **active extension** of the DIP joint. *Extensor tendon rupture* - A simple extensor tendon rupture means the tendon itself is torn, but it does not specify if a piece of bone has been avulsed. - While a rupture causes the inability to extend the DIP joint, the **bony avulsion** is a more precise and common mechanism for mallet finger, especially when due to trauma. *Extensor tendon rupture and bony avulsion of distal phalanx* - This option is partially correct but less precise than the most accurate answer. Mallet finger is specifically defined by the disruption of the **extensor mechanism at the DIP joint**. - Whether it's a pure tendon rupture or an avulsion fracture, the critical aspect is the loss of the tendon's attachment, with **bony avulsion** being a very common and specific cause.

Q: De-Quervain's disease classically affects the -

Extensor pollicis brevis and abductor pollicis longus. ***Extensor pollicis brevis and abductor pollicis longus*** - **De Quervain's tenosynovitis** is an inflammation of the tendons of the **extensor pollicis brevis** and **abductor pollicis longus** within the first dorsal compartment of the wrist. - This condition is characterized by pain and tenderness at the **radial styloid process**, often exacerbated by movements of the thumb or wrist. *Extensor carpi radialis and extensor pollicis longus* - The **extensor carpi radialis** muscles (longus and brevis) primarily extend and abduct the wrist, while the **extensor pollicis longus** extends the distal phalanx of the thumb. - While these muscles are in the forearm and wrist, they are not directly involved in De Quervain's tenosynovitis, which specifically affects the tendons of the first dorsal compartment. *Flexor pollicis longus and brevis* - The **flexor pollicis longus** flexes the interphalangeal joint of the thumb, and the **flexor pollicis brevis** flexes and opposes the thumb at the metacarpophalangeal joint. - These are **flexor muscles** located on the palmar side of the forearm and hand, and their tendons are not affected in De Quervain's disease. *Abductor pollicis longus and brevis* - While the **abductor pollicis longus** is one of the affected tendons in De Quervain's tenosynovitis, the **abductor pollicis brevis** is not. - The abductor pollicis brevis is a thenar muscle that abducts the thumb at the carpometacarpal joint and is typically not involved in the pathogenesis of De Quervain's.

Q: Carpal tunnel syndrome is due to compression of -

Median nerve. ***Median nerve*** - **Carpal tunnel syndrome** is a condition caused by the compression of the **median nerve** as it passes through the confined space of the carpal tunnel in the wrist. - Symptoms include numbness, tingling, and weakness in the thumb, index finger, middle finger, and the radial half of the ring finger, correlating with the median nerve's sensory and motor innervation. *Radial nerve* - The **radial nerve** is primarily responsible for innervation of the extensor muscles of the forearm and hand, and sensation over the back of the hand. - Compression of the radial nerve typically causes symptoms like **wrist drop** or sensory deficits on the dorsal aspect of the hand, which are not characteristic of carpal tunnel syndrome. *Ulnar nerve* - The **ulnar nerve** provides innervation to the little finger and the ulnar half of the ring finger, as well as some intrinsic hand muscles. - Compression of the ulnar nerve (e.g., in **Guyon's canal** or at the elbow in **cubital tunnel syndrome**) results in sensory or motor deficits in its distribution, distinctly different from carpal tunnel syndrome. *Palmar branch of the Ulnar nerve* - The **palmar branch of the ulnar nerve** is a superficial sensory branch of the ulnar nerve that innervates the skin over the hypothenar eminence. - Compression of this specific branch would cause isolated sensory changes in the hypothenar region, not the characteristic distribution seen in carpal tunnel syndrome.

Q: True about carpal tunnel syndrome - a) Occurs in pregnancy b) Affects medial 3½ fingers c) Associated with hypothyroidism d) Froment sign is positive e) Median nerve involvement is present

Median nerve involvement is present. ***Median nerve involvement is present*** - Carpal tunnel syndrome is characterized by **compression of the median nerve** as it passes through the carpal tunnel in the wrist. - This compression leads to the classic symptoms of **numbness, tingling, and pain** in the median nerve distribution. *Associated with Hypothyroidism* - While **hypothyroidism** can *contribute* to carpal tunnel syndrome, it is not always present, nor is it a defining characteristic of the syndrome itself. - Hypothyroidism can cause **fluid retention** and deposition of mucopolysaccharides, which can increase pressure within the carpal tunnel. *Affects medial 3 1/2 finger* - The median nerve supplies sensation to the **thumb, index finger, middle finger, and the radial half of the ring finger** (which totals 3½ digits), not the medial 3½ fingers. - **Medial fingers** would refer to the ulnar digits, which are supplied by the ulnar nerve. *Occur in pregnancy* - **Pregnancy** is a known risk factor for developing carpal tunnel syndrome due to **hormonal changes and fluid retention**, but it is not a universally present feature in all cases. - Many individuals develop carpal tunnel syndrome without being pregnant. *Froment sign positive* - **Froment's sign** is a clinical test for **ulnar nerve palsy**, specifically weakness of the adductor pollicis muscle. - It is **not associated with carpal tunnel syndrome**, which primarily involves the median nerve.

Q: Tardy ulnar nerve palsy is seen in:

Cubitus valgus. ***Cubitus valgus*** - **Cubitus valgus** is an increased carrying angle of the elbow, which can lead to stretching and compression of the **ulnar nerve** over time. - This chronic irritation often presents as **tardy ulnar nerve palsy**, characterized by numbness, tingling, and weakness in the distribution of the ulnar nerve. *Genu varus* - **Genu varus**, or bow-leggedness, affects the **knee joint** and has no direct anatomical connection or pathogenic mechanism causing ulnar nerve palsy. - While it can lead to other orthopedic issues, it does not involve the elbow or ulnar nerve. *Genu valgus* - **Genu valgus**, or knock-knees, also affects the **knee joint** and is unrelated to the elbow or ulnar nerve innervation. - This condition impacts lower limb mechanics and does not contribute to upper limb neuropathies. *Cubitus varus* - **Cubitus varus**, or gunstock deformity, is a decrease in the carrying angle of the elbow, often resulting from a **supracondylar humerus fracture**. - Although it can cause cosmetic and functional issues, it typically does not lead to **ulnar nerve palsy**, as the nerve is less stretched in this position.

Q: Phalen's test is done for which nerve injury?

Median. ***Median*** - **Phalen's test** is used to diagnose **carpal tunnel syndrome**, which results from compression of the **median nerve** as it passes through the wrist. - The test involves holding the wrists in maximal flexion for 30-60 seconds, which increases pressure on the median nerve. *Radial* - The **radial nerve** is primarily involved in wrist and finger extension, and its injury typically results in **wrist drop**. - No specific provocative test like Phalen's is associated with radial nerve compression at the wrist. *Ulnar* - The **ulnar nerve** innervates muscles in the hand and forearm, and its injury can present as a "claw hand" deformity. - Tests such as **Tinel's sign at the cubital tunnel** are used for ulnar nerve compression, not Phalen's test. *Axillary* - The **axillary nerve** innervates the deltoid and teres minor muscles and provides sensation over the lateral shoulder. - Injury often occurs with shoulder dislocations and causes **deltoid weakness** and **sensory loss over the lateral arm**, which is completely unrelated to Phalen's test.

Q: Aeroplane splint is used for -

Brachial plexus injury. ***Brachial plexus injury*** - An **aeroplane splint** is commonly used in **brachial plexus injuries** to position the arm in **abduction**, external rotation, and slight flexion. - This position helps to **prevent contractures** and allow for optimal nerve recovery by **reducing tension** on the damaged plexus. *Conservative management of proximal humerus fractures* - **Proximal humerus fractures** are typically managed with a **sling and swathe** or a **collar and cuff**, which immobilize the arm against the body. - An **aeroplane splint** provides an abducted position, which is generally not ideal for early immobilization of most proximal humerus fractures. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot addressed with methods like the **Ponseti method (serial casting)**. - An **aeroplane splint** is an upper extremity device and has no application in the management of foot deformities. *Axillary nerve palsy* - **Axillary nerve palsy** primarily affects the **deltoid muscle**, leading to weakness in shoulder abduction, and **teres minor**. - While rehabilitation involves strengthening and maintaining range of motion, an aeroplane splint is not the primary or specific orthosis for isolated axillary nerve palsy.

Q: A 30-year-old pregnant woman presents with tingling pain and numbness at the tips of her thumb, index finger, and middle finger following trauma. On examination, when the doctor presses between the wrist joints for 30 seconds, the patient develops increased pain at the tips of the middle, index finger, and thumb. What is the diagnosis?

Carpal tunnel syndrome. **_Carpal tunnel syndrome_** * The symptoms of tingling, pain, and numbness in the thumb, index, and middle fingers are classic for **median nerve compression**, which occurs in the carpal tunnel [1]. * The positive **Phalen's sign** (phalen's test), indicated by increased pain with wrist flexion, also known as pressing between the wrist joints, further supports this diagnosis. * *Pronator syndrome* * Pronator syndrome involves compression of the **median nerve** by the pronator teres muscle, typically causing pain in the proximal forearm and less distinct finger numbness. * While it affects the median nerve, the pain distribution and positive maneuver described are more characteristic of **carpal tunnel syndrome** [1]. * *Tarsal tunnel syndrome* * **Tarsal tunnel syndrome** involves compression of the **posterior tibial nerve** in the ankle, leading to symptoms in the foot and toes, not the hand. * The location of symptoms (thumb, index, and middle fingers) rules out this diagnosis. * *Cubital tunnel syndrome* * **Cubital tunnel syndrome** results from compression of the **ulnar nerve** at the elbow, causing tingling and numbness in the ring and pinky fingers. * The affected fingers (thumb, index, and middle) are innervated by the median nerve, differentiating it from cubital tunnel syndrome.

Q: Finkelstein test is used for diagnosis of?

De quervain tenosynovitis. ***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 1

Kienböck's disease is due to avascular necrosis of-

Accepted Answer

Lunate bone

Answer

Medial cuneiform bone

Answer

Femoral neck

Answer

Scaphoid bone

Question 2

What causes mallet finger?

Accepted Answer

Bony avulsion of distal phalanx at the extensor tendon

Answer

Strain and subsequent stretching of the extensor tendon

Answer

Extensor tendon rupture

Answer

Extensor tendon rupture and bony avulsion of distal phalanx

Question 3

De-Quervain's disease classically affects the -

Accepted Answer

Extensor pollicis brevis and abductor pollicis longus

Answer

Extensor carpi radialis and extensor pollicis longus

Answer

Flexor pollicis longus and brevis

Answer

Abductor pollicis longus and brevis

Question 4

Carpal tunnel syndrome is due to compression of -

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Palmar branch of the Ulnar nerve

Question 5

True about carpal tunnel syndrome - a) Occurs in pregnancy b) Affects medial 3½ fingers c) Associated with hypothyroidism d) Froment sign is positive e) Median nerve involvement is present

Accepted Answer

Median nerve involvement is present

Answer

Associated with Hypothyroidism

Answer

Affects medial 3 1/2 finger

Answer

Occur in pregnancy

Answer

Froment sign positive

Question 6

Tardy ulnar nerve palsy is seen in:

Accepted Answer

Cubitus valgus

Answer

Genu varus

Answer

Genu valgus

Answer

Cubitus varus

Question 7

Phalen's test is done for which nerve injury?

Accepted Answer

Median

Answer

Radial

Answer

Ulnar

Answer

Axillary

Question 8

Aeroplane splint is used for -

Accepted Answer

Brachial plexus injury

Answer

Conservative management of proximal humerus fractures

Answer

CTEV

Answer

Axillary nerve palsy

Question 9

A 30-year-old pregnant woman presents with tingling pain and numbness at the tips of her thumb, index finger, and middle finger following trauma. On examination, when the doctor presses between the wrist joints for 30 seconds, the patient develops increased pain at the tips of the middle, index finger, and thumb. What is the diagnosis?

Accepted Answer

Carpal tunnel syndrome

Answer

Pronator syndrome

Answer

Tarsal tunnel syndrome

Answer

Cubital tunnel syndrome

Question 10

Finkelstein test is used for diagnosis of?

Accepted Answer

De quervain tenosynovitis

Answer

Tarsal tunnel syndrome

Answer

Carpal tunnel syndrome

Answer

Thoracic outlet syndrome

Hand Surgery — MCQs

Hand Surgery — MCQs

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