Hand Surgery Practice Questions

Q: Which of the following is NOT a characteristic feature of carpal tunnel syndrome?

Pregnancy is the most common cause.. **Explanation:** **Carpal Tunnel Syndrome (CTS)** is the most common entrapment neuropathy, caused by the compression of the **median nerve** as it passes through the fibro-osseous carpal tunnel at the wrist. **Why Option A is the correct answer (The False Statement):** While pregnancy is a well-known physiological cause of CTS due to fluid retention and edema, it is **not the most common cause**. The most common cause of CTS is **idiopathic** (unknown origin). When an underlying pathology is present, it is often associated with repetitive stress, obesity, or systemic conditions like Diabetes Mellitus and Rheumatoid Arthritis. **Analysis of Incorrect Options:** * **Option B:** CTS is significantly **more common in women** (ratio approx. 3:1), likely due to smaller anatomical carpal tunnel dimensions. * **Option C:** The **median nerve** is the only nerve passing through the tunnel (along with nine tendons); its compression leads to the classic symptoms. * **Option D:** **Nocturnal symptoms** are a hallmark of CTS. Patients often wake up with numbness or pain, frequently relieved by shaking their hands (**"Flick sign"**). This occurs due to venous stasis and natural wrist flexion during sleep. **High-Yield Clinical Pearls for NEET-PG:** * **Sensory Loss:** Occurs over the lateral 3.5 fingers. Note: The **palmar cutaneous branch** of the median nerve arises proximal to the tunnel, so sensation over the **thenar eminence is preserved**. * **Motor Loss:** Weakness and atrophy of thenar muscles (LOAF: Lateral two lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis). * **Provocative Tests:** Phalen’s test (most sensitive) and Tinel’s sign. * **Gold Standard Diagnosis:** Nerve Conduction Velocity (NCV) studies showing delayed conduction across the wrist.

Q: What is incorrect regarding Gamekeeper's thumb?

Caused by forced ulnar deviation. **Explanation:** **Gamekeeper’s Thumb** (also known as **Skier’s Thumb**) refers to an injury of the **Ulnar Collateral Ligament (UCL)** at the base of the thumb. 1. **Why Option C is the correct answer (Incorrect statement):** The injury is caused by **forced abduction** and **hyperextension** of the thumb, leading to **radial deviation** (not ulnar deviation). This sudden force pulls the thumb away from the index finger, stressing and eventually tearing the UCL. 2. **Analysis of other options:** * **Option A:** The injury specifically involves the **first metacarpophalangeal (MCP) joint**, where the UCL provides medial stability. * **Option B:** The primary pathology is a partial or complete **tear of the ulnar collateral ligament**, often at its distal insertion on the proximal phalanx. * **Option D:** While "Gamekeeper’s thumb" originally referred to chronic attrition (common in Scottish gamekeepers), the acute presentation is widely known as **Skier’s thumb**, typically occurring when a skier falls while holding a ski pole. **High-Yield Clinical Pearls for NEET-PG:** * **Stener Lesion:** A critical complication where the **Adductor Pollicis aponeurosis** becomes interposed between the ruptured UCL and its insertion site. This prevents primary healing and is an absolute indication for **surgical repair**. * **Clinical Sign:** Weakness of "pincer grasp" (pinch grip) due to instability of the thumb. * **Radiology:** Stress X-rays may show joint opening; however, an MRI or high-resolution Ultrasound is the gold standard for diagnosing a Stener lesion. * **Treatment:** Partial tears are managed with a **thumb spica cast**; complete tears or Stener lesions require surgery.

Q: Bennett's fracture is a fracture-dislocation of the base of which metacarpal?

1st. **Explanation:** **Bennett’s fracture** is a classic high-yield topic in Orthopaedics. It is defined as an **intra-articular fracture-dislocation** at the base of the **1st metacarpal** (the thumb). **Why Option C is Correct:** The injury occurs due to axial loading along the longitudinal axis of the thumb while the metacarpal is in slight flexion. The fracture pattern involves a small triangular fragment of the 1st metacarpal base remaining attached to the **trapezium** via the anterior oblique ligament. Crucially, the rest of the metacarpal shaft is displaced **proximally, dorsally, and radially** by the pull of the **Abductor Pollicis Longus (APL)** muscle. This instability makes it a fracture-dislocation rather than a simple fracture. **Why Other Options are Incorrect:** * **Options A, B, and D:** Fractures at the base of the 2nd, 3rd, or 4th metacarpals are rare and do not carry the eponym "Bennett’s." These metacarpals are more rigidly fixed at the carpo-metacarpal joints and lack the unique mobility and muscular pull (APL) that characterizes the 1st metacarpal injury. **Clinical Pearls for NEET-PG:** * **Rolando Fracture:** A comminuted (T or Y shaped) intra-articular fracture at the base of the 1st metacarpal. It has a worse prognosis than Bennett’s. * **Gamekeeper’s/Skier’s Thumb:** Injury to the Ulnar Collateral Ligament (UCL) of the 1st MCP joint. * **Management:** Bennett’s fracture is inherently unstable; therefore, it usually requires **Closed Reduction and Internal Fixation (CRIF)** with K-wires or Open Reduction (ORIF).

Q: A 54-year-old woman presents with a wrist dislocation after falling onto an outstretched hand. Which of the following carpal bones are most likely involved?

Scaphoid-lunate. **Explanation:** The correct answer is **A. Scaphoid-lunate**. **Underlying Medical Concept:** The most common type of carpal instability and wrist dislocation occurs at the **scapholunate joint**. The scaphoid and lunate are the most critical bones in the proximal carpal row for maintaining wrist stability. A fall on an outstretched hand (FOOSH) with the wrist in extension and ulnar deviation puts maximum stress on the **scapholunate interosseous ligament**. Rupture of this ligament leads to "scapholunate dissociation," the most frequent precursor to perilunate and lunate dislocations. **Analysis of Incorrect Options:** * **B. Trapezoid-trapezium:** These are distal row carpal bones. They are tightly bound by strong interosseous ligaments and are rarely the primary site of dislocation in FOOSH injuries. * **C. Hamate-lunate:** While the lunate articulates with the hamate, the primary axis of instability in wrist trauma is longitudinal between the scaphoid and lunate. A "lunate-hamate" dissociation is not a standard clinical entity in common wrist dislocations. * **D. Pisiform-triquetrum:** The pisiform is a sesamoid bone within the flexor carpi ulnaris tendon. While it can be fractured, it does not play a structural role in the carpal stability required to prevent major wrist dislocations. **NEET-PG High-Yield Pearls:** * **Terry Thomas Sign:** A gap of >3mm between the scaphoid and lunate on an AP X-ray, indicating scapholunate dissociation. * **Lunate Dislocation:** On a lateral X-ray, the lunate looks like a **"spilled teacup."** * **Perilunate Dislocation:** The lunate remains in contact with the radius, but the capitate is displaced posteriorly. * **Most common carpal fracture:** Scaphoid (risk of avascular necrosis) [1]. * **Most common carpal dislocation:** Lunate.

Q: Carpal tunnel syndrome is associated with all of the following conditions, EXCEPT:

Post-menopausal females. **Explanation:** Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve as it passes through the carpal tunnel. The underlying pathophysiology involves any condition that increases the volume of the tunnel contents or decreases the tunnel's capacity. **Why "Post-menopausal females" is the correct answer:** While CTS is more common in females due to smaller anatomical dimensions of the carpal tunnel, it is specifically associated with **pregnancy** and **oral contraceptive use** (due to fluid retention). There is no direct hormonal or physiological link between the post-menopausal state itself and the development of CTS. In fact, if a female develops CTS during menopause, it is usually attributed to age-related degenerative changes or other comorbidities rather than the menopausal state itself. **Analysis of Incorrect Options:** * **Acromegaly:** Excess growth hormone causes soft tissue hypertrophy and bony overgrowth, leading to significant narrowing of the carpal tunnel. * **Myxedema (Hypothyroidism):** This leads to the deposition of mucopolysaccharides (glycosaminoglycans) within the synovial sheath, increasing pressure on the median nerve. * **Pregnancy:** Hormonal changes lead to generalized edema and fluid retention, which increases the interstitial pressure within the carpal tunnel. It often resolves postpartum. **NEET-PG High-Yield Pearls:** * **Most common cause:** Idiopathic. * **Most common systemic cause:** Diabetes Mellitus. * **Clinical Tests:** Phalen’s test (most sensitive) and Tinel’s sign. * **Gold Standard Diagnosis:** Nerve Conduction Velocity (NCV) studies (shows increased latency). * **First muscle to atrophy:** Abductor Pollicis Brevis (APB). * **Other associations:** Rheumatoid Arthritis (synovitis), Amyloidosis (especially in chronic dialysis patients), and Colles’ fracture (malunion).

Q: Which of the following conditions does NOT produce carpal tunnel syndrome?

Addison's disease. **Explanation:** Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the **median nerve** as it passes through the carpal tunnel. Any condition that decreases the volume of the tunnel or increases the volume of its contents can lead to CTS. **1. Why Addison’s Disease is the Correct Answer:** Addison’s disease (primary adrenocortical insufficiency) is characterized by a deficiency of cortisol and aldosterone, leading to weight loss and dehydration. It does **not** cause fluid retention or soft tissue hypertrophy. In contrast, **Cushing’s syndrome** (excess glucocorticoids) can lead to CTS due to increased fat deposition and fluid retention. **2. Why the other options are incorrect:** * **Colles’ Fracture:** This is a common bony cause. Malunion or acute edema/hematoma following a distal radius fracture alters the anatomy of the carpal tunnel, leading to direct pressure on the median nerve. * **Acromegaly:** Excess growth hormone causes **soft tissue hypertrophy** and bony overgrowth of the carpal bones, significantly narrowing the tunnel space. * **Hypothyroidism:** This is a classic metabolic cause. It leads to the deposition of **mucopolysaccharides** (myxedema) and fluid within the synovial sheaths, increasing pressure on the nerve. **Clinical Pearls for NEET-PG:** * **Most common cause:** Idiopathic. * **Most common associated systemic disease:** Diabetes Mellitus. * **Pregnancy:** A high-yield cause due to generalized edema (usually resolves post-partum). * **Clinical Tests:** Phalen’s test (most sensitive) and Tinel’s sign. * **Gold Standard Diagnosis:** Nerve Conduction Velocity (NCV) studies showing delayed conduction across the wrist.

Q: Carpal tunnel syndrome is associated with all of the following conditions except:

Dupuytren's contracture. **Explanation:** Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the **median nerve** as it passes through the carpal tunnel. The pathophysiology involves any condition that increases the volume of the tunnel contents or decreases the capacity of the canal. **Why Dupuytren's Contracture is the correct answer:** Dupuytren’s contracture is a fibroproliferative disorder of the **palmar fascia**, leading to thickening and shortening of the palmar aponeurosis and permanent flexion of the fingers. While it occurs in the hand, it is a superficial pathology and does not involve the carpal tunnel or increase pressure on the median nerve. Therefore, there is no direct causal link between Dupuytren’s and CTS. **Analysis of other options:** * **Myxedema (Hypothyroidism):** This is a classic systemic cause. It leads to the accumulation of glycosaminoglycans (mucopolysaccharides) in the connective tissues, causing fluid retention and swelling within the carpal tunnel. * **Idiopathic:** This is actually the **most common cause** of CTS. In many patients, no specific underlying systemic or local pathology is identified. * **Rheumatoid Arthritis:** This is the most common inflammatory cause. Synovitis of the flexor tendons (tenosynovitis) increases the volume of the tunnel contents, leading to secondary median nerve compression. **NEET-PG High-Yield Pearls:** * **Most common nerve compressed** in the upper limb: Median nerve. * **Clinical Tests:** Phalen’s test (most sensitive) and Tinel’s sign. * **Gold Standard Diagnosis:** Nerve Conduction Velocity (NCV) studies. * **Other common associations:** Pregnancy (fluid retention), Diabetes Mellitus, Acromegaly, and Amyloidosis (especially in dialysis patients). * **First muscle to atrophy:** Abductor Pollicis Brevis (APB).

Question 1

Which of the following is NOT a characteristic feature of carpal tunnel syndrome?

Accepted Answer

Pregnancy is the most common cause.

Answer

It is more common in women.

Answer

The median nerve is compressed.

Answer

Symptoms commonly occur at night.

Question 2

What is incorrect regarding Gamekeeper's thumb?

Accepted Answer

Caused by forced ulnar deviation

Answer

Involvement of the first metacarpophalangeal joint

Answer

Tear of the ulnar collateral ligament

Answer

Also known as skier's thumb

Question 3

Which of the following statements about 'Low' Radial nerve palsy is not true?

Accepted Answer

Loss of nerve supply to brachioradialis

Answer

Loss of nerve supply to extensor carpi radialis brevis

Answer

Loss of nerve supply to extensor pollicis brevis

Answer

Loss of sensation over the first dorsal web space

Question 4

Bennett's fracture is a fracture-dislocation of the base of which metacarpal?

Accepted Answer

1st

Answer

3rd

Answer

4th

Answer

2nd

Question 5

A 54-year-old woman presents with a wrist dislocation after falling onto an outstretched hand. Which of the following carpal bones are most likely involved?

Accepted Answer

Scaphoid-lunate

Answer

Trapezoid-trapezium

Answer

Hamate-lunate

Answer

Pisiform-triquetrum

Question 6

Carpal tunnel syndrome is associated with all of the following conditions, EXCEPT:

Accepted Answer

Post-menopausal females

Answer

Acromegaly

Answer

Myxedema

Answer

Pregnancy

Question 7

A 32-year-old man involved in a motor vehicle accident sustained an injury to his left arm and complains of an inability to open his left hand and loss of sensation to a portion of his left hand. What is the most likely injury?

Accepted Answer

Median nerve injury

Answer

Ulnar nerve injury

Answer

Radial nerve injury

Answer

Axillary nerve injury

Question 8

A Bennet's fracture is difficult to maintain in a reduced position because of the pull of which muscle?

Accepted Answer

Abductor pollicis longus

Answer

Extensor pollicis longus

Answer

Extensor pollicis brevis

Answer

Abductor pollicis brevis

Question 9

Which of the following conditions does NOT produce carpal tunnel syndrome?

Accepted Answer

Addison's disease

Answer

Colles' fracture

Answer

Acromegaly

Answer

Hypothyroidism

Question 10

Carpal tunnel syndrome is associated with all of the following conditions except:

Accepted Answer

Dupuytren's contracture

Answer

Myxedema

Answer

Idiopathic causes

Answer

Rheumatoid arthritis

Hand Surgery — MCQs

Hand Surgery — MCQs

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