Hand Surgery Practice Questions

Q: Carpal tunnel syndrome is due to involvement of which nerve?

Median nerve. **Explanation:** **Carpal Tunnel Syndrome (CTS)** is the most common entrapment neuropathy, caused by the compression of the **Median nerve** as it passes through the carpal tunnel—a narrow osteofibrous passage at the wrist. The tunnel is bounded by the carpal bones (floor) and the flexor retinaculum (roof). The median nerve is the most superficial structure in this tunnel, making it highly susceptible to pressure from inflammation, fluid retention, or space-occupying lesions. **Analysis of Options:** * **Median Nerve (Correct):** It provides sensory innervation to the lateral 3.5 fingers and motor supply to the thenar muscles. Compression leads to classic symptoms: nocturnal paresthesia, thenar atrophy, and a positive **Phalen’s test** or **Tinel’s sign**. * **Radial Nerve:** This nerve passes through the radial tunnel and the anatomical snuffbox. Compression usually occurs at the spiral groove (Saturday Night Palsy) or the arcade of Frohse (PIN palsy), leading to wrist drop. * **Ulnar Nerve:** It passes through the **Guyon’s canal** (not the carpal tunnel). Compression here causes "Ulnar Tunnel Syndrome," affecting the medial 1.5 fingers. * **Axillary Nerve:** This nerve winds around the surgical neck of the humerus. Injury typically follows shoulder dislocation or proximal humerus fractures, resulting in deltoid paralysis. **High-Yield Clinical Pearls for NEET-PG:** * **Contents of Carpal Tunnel:** 10 structures (1 Median nerve, 4 tendons of FDS, 4 tendons of FDP, and 1 tendon of FPL). * **Most Common Cause:** Idiopathic; however, secondary causes include Hypothyroidism, Diabetes, Pregnancy, and Rheumatoid Arthritis. * **Clinical Sign:** **Ape Thumb Deformity** (due to thenar muscle wasting). * **Treatment:** First-line is wrist splinting in neutral; definitive treatment is surgical release of the **Flexor Retinaculum**.

Q: Which anatomical compartment is involved in De Quervain's tenosynovitis?

First dorsal compartment. **Explanation:** **De Quervain’s Tenosynovitis** is a stenosing tenosynovitis involving the tendons of the **First Dorsal Compartment** of the wrist. This condition is caused by repetitive friction or overuse, leading to thickening of the extensor retinaculum and narrowing of the fibro-osseous tunnel. 1. **Why the First Dorsal Compartment is correct:** This compartment contains two specific tendons: the **Abductor Pollicis Longus (APL)** and the **Extensor Pollicis Brevis (EPB)**. Inflammation here results in pain over the radial styloid process. 2. **Why the other options are incorrect:** * **Second Compartment:** Contains the Extensor Carpi Radialis Longus (ECRL) and Brevis (ECRB). Inflammation here is known as *Intersection Syndrome*. * **Fifth Compartment:** Contains the Extensor Digiti Minimi (EDM). * **Sixth Compartment:** Contains the Extensor Carpi Ulnaris (ECU). Inflammation here causes ulnar-sided wrist pain. **High-Yield Clinical Pearls for NEET-PG:** * **Finkelstein’s Test:** The pathognomonic clinical test where the patient makes a fist with the thumb tucked inside the fingers, followed by ulnar deviation of the wrist. A positive test elicits sharp pain over the first compartment. * **Demographics:** Most common in females aged 30–50 and often seen in **new mothers** (due to repetitive lifting of the infant). * **Anatomical Variation:** A common cause of treatment failure (steroid injection) is the presence of a **septum** separating the APL and EPB within the first compartment. * **Treatment:** Conservative management includes thumb spica splinting, NSAIDs, and corticosteroid injections. Surgical release is reserved for refractory cases.

Q: What is the most common site of a scaphoid fracture?

Waist. **Explanation:** The **scaphoid** is the most commonly fractured carpal bone, typically resulting from a fall on an outstretched hand (FOOSH). **1. Why "Waist" is correct:** The scaphoid is anatomically divided into the distal pole, the waist, and the proximal pole. The **waist** is the narrowest middle portion of the bone and is the most common site of fracture, accounting for approximately **70-80%** of all scaphoid fractures. This area is particularly vulnerable because it acts as a mechanical fulcrum during hyperextension of the wrist. **2. Why other options are incorrect:** * **Distal fragment (Option A):** Fractures of the distal pole or tubercle are less common (approx. 10-15%). These usually have a better prognosis because the blood supply enters the scaphoid distally. * **Tilting of the lunate (Option B):** This is a radiological sign (e.g., DISI or VISI) associated with carpal instability or ligamentous injury, not a site of fracture. * **Proximal fragment (Option D):** Proximal pole fractures occur in about 5-10% of cases. They are clinically significant because the blood supply to the scaphoid is **retrograde** (from distal to proximal); therefore, proximal fractures carry the highest risk of **Avascular Necrosis (AVN)** and non-union. **Clinical Pearls for NEET-PG:** * **Blood Supply:** Derived from the radial artery; enters via the distal pole (retrograde flow). * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox**. * **Radiology:** If initial X-rays are negative but clinical suspicion is high, repeat X-rays in 10-14 days or perform an MRI (most sensitive). * **Complication:** Avascular Necrosis (AVN) is the most dreaded complication, especially in proximal pole fractures.

Q: Which of the following statements about Keinböck's osteonecrosis is FALSE?

Pain is more on wrist flexion than wrist extension.. **Explanation:** **Kienböck’s disease** is the avascular necrosis (AVN) or osteochondritis of the **lunate bone**. Understanding the anatomy and biomechanics of the carpus is key to identifying the clinical features. **Why Option B is the FALSE statement:** In Kienböck’s disease, **pain is typically more severe during wrist extension** rather than flexion. This is because, during extension, the lunate is compressed between the distal radius and the capitate. This increased axial loading on the necrotic, structurally weakened lunate exacerbates the pain. **Analysis of other options:** * **Option A:** The lunate is located centrally in the proximal carpal row, directly proximal to the **base of the 3rd metacarpal** (via the capitate). Therefore, localized tenderness is most prominent at this anatomical landmark. * **Option C:** It is indeed classified as **osteochondritis** (idiopathic AVN) of the lunate, similar to Perthes' disease in the hip. * **Option D:** The condition typically affects young adults, most commonly in the **20–40 year** age range, often involving the dominant hand of manual laborers. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Strongly associated with **Ulnar Negative Variance** (the ulna is shorter than the radius), which leads to increased force transmission through the lunate. * **Radiology:** The **Stahl Classification** or **Lichtman Classification** is used for staging. Early stages may show normal X-rays (MRI is the investigation of choice), while late stages show sclerosis, collapse, and carpal instability. * **Treatment:** Depends on the stage; options include radial shortening osteotomy (to correct ulnar negative variance) or proximal row carpectomy in advanced cases.

Question 1

Carpal tunnel syndrome is due to involvement of which nerve?

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Axillary nerve

Question 2

Which anatomical compartment is involved in De Quervain's tenosynovitis?

Accepted Answer

First dorsal compartment

Answer

Second dorsal compartment

Answer

Fifth dorsal compartment

Answer

Sixth dorsal compartment

Question 3

A man presents to the emergency department after an alcohol binge the previous night and sleeping in an armchair. In the morning, he is unable to move his hand and a diagnosis of ulnar palsy is made. What is the next line of management?

Accepted Answer

Knuckle bender splint

Answer

Perform EMG study after 2 days

Answer

Immediately operate and explore the nerve

Answer

Wait and watch

Question 4

What is the most common site of a scaphoid fracture?

Accepted Answer

Waist

Answer

Distal fragment

Answer

Tilting of the lunate

Answer

Proximal fragment

Question 5

Which of the following statements about Keinböck's osteonecrosis is FALSE?

Accepted Answer

Pain is more on wrist flexion than wrist extension.

Answer

Tenderness over the base of the 3rd metacarpal is present.

Answer

It is osteochondritis of the lunate.

Answer

The common age group is 20-40 years.

Question 6

In hand surgery, which anatomical area is referred to as "no man's land"?

Accepted Answer

The area between the distal palmar crease and the flexor crease of the proximal interphalangeal joint

Answer

Proximal phalanx

Answer

Distal phalanx

Answer

Wrist

Question 7

In which pattern does inheritance of Dupuytren's contracture take place?

Accepted Answer

Autosomal dominant

Answer

X linked recessive

Answer

Autosomal recessive

Answer

Mitochondrial inheritance

Question 8

A patient with a Bennett fracture experiences impaired thumb movement. Which of the following intrinsic muscles of the thumb is most likely injured?

Accepted Answer

Opponens pollicis

Answer

Abductor pollicis brevis

Answer

Flexor pollicis brevis (superficial head)

Answer

Adductor pollicis

Question 9

In nonunion of scaphoid, which vascularized muscle pedicle graft is taken from?

Accepted Answer

Pronator quadratus

Answer

Pronator teres

Answer

Brachioradialis

Answer

Extensor pollicis longus

Question 10

Which of the following is true about trigger finger?

Accepted Answer

Stenosis tenovaginitis of the flexor tendon of the affected finger.

Answer

Injury to fingers while operating a gun.

Answer

A feature of carpal tunnel syndrome.

Answer

Any of the above.

Hand Surgery — MCQs

Hand Surgery — MCQs

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