Hand Surgery Practice Questions

Q: What is the most common initial treatment for a scaphoid fracture?

Conservative. ***Conservative*** - Initial treatment for a suspected or confirmed **scaphoid fracture** usually involves **immobilization** with a thumb spica cast. - This approach aims to promote **bone healing** by stabilizing the fracture site and preventing movement. *Compression Screws* - This is a **surgical intervention** typically reserved for **displaced scaphoid fractures**, non-unions, or cases where conservative treatment has failed. - It involves inserting a screw across the fracture to provide **internal fixation** and compression. *Compression Plating* - **Compression plating** is generally not the primary method for isolated scaphoid fractures. - It is more commonly used for **complex fractures** of larger bones or reconstructive procedures, not simple scaphoid fractures. *Traction* - **Traction** is used in situations to reduce or stabilize fractures by applying a pulling force, often seen in major long bone fractures. - It is not a standard or effective initial treatment for a scaphoid fracture in the wrist.

Q: A patient presents with wrist trauma and is diagnosed with a wrist sprain. Clinical examination reveals tenderness in the anatomical snuffbox, but imaging shows no evidence of fracture. In this clinical scenario, which ligament is most likely to be involved?

Scapholunate ligament. ***Scapholunate ligament*** - Tenderness in the **anatomical snuffbox** despite negative imaging for scaphoid fracture strongly suggests a **scapholunate ligament injury**. - This ligament is crucial for maintaining **carpal stability**, and its injury can lead to **DISI (dorsal intercalated segmental instability)** if not managed appropriately. *Radial collateral ligament* - Injury to the radial collateral ligament typically presents with pain and tenderness on the **radial aspect of the wrist**, but not specifically localized to the **anatomical snuffbox**. - This ligament primarily resists **ulnar deviation** and contributes to wrist stability. *Lunotriquetral ligament* - A lunotriquetral ligament injury usually manifests as pain on the **ulnar side of the wrist**, often associated with a clunking sensation, distinct from **anatomical snuffbox tenderness**. - Its disruption can lead to **VISI (volar intercalated segmental instability)**. *Ulnar collateral ligament* - Injury to the ulnar collateral ligament causes pain and tenderness on the **ulnar aspect of the wrist**, particularly with **radial deviation**. - This ligament plays a key role in stabilizing the **distal radioulnar joint (DRUJ)** and resisting radial deviation.

Q: What is Wartenberg's sign?

Inability to adduct small finger against the ring finger. Inability to adduct small finger against the ring finger - **Wartenberg's sign** specifically refers to the uncontrolled abduction of the **small finger**, often caused by an imbalance between the extrinsic and intrinsic hand muscles. - This inability to adduct the small finger against the ring finger is a classic sign of **ulnar nerve palsy**, impacting the **palmar interossei** muscles. *Inability to maintain Intrinsic plus position* - The **intrinsic plus position** (lumbrical grip) involves metacarpophalangeal joint flexion and interphalangeal joint extension, which is typically affected by **ulnar and median nerve injuries** or **rheumatoid arthritis** leading to intrinsic minus hand. - This is a broader functional deficit and not specific to Wartenberg's sign. *Inability to grasp a book between the thumb and index finger* - This describes **Froment's sign**, which indicates **ulnar nerve paralysis** affecting the adductor pollicis muscle. - The patient compensates by flexing the **interphalangeal joint of the thumb** using the **flexor pollicis longus** (median nerve innervation), which is different from Wartenberg's sign. *Inability to move the middle finger sideways* - Lateral movement of the middle finger is primarily controlled by the **dorsal interossei** muscles, which are also innervated by the **ulnar nerve**. - While this suggests ulnar nerve involvement, it is not the specific diagnostic sign known as Wartenberg's sign.

Q: Froment's sign is positive in cases of weakness of ?

Adductor pollicis muscle weakness. ***Adductor pollicis muscle weakness*** - **Froment's sign** is elicited when a patient attempts to hold a piece of paper between the thumb and index finger, and due to weakness of the **adductor pollicis**, they compensate by flexing the **flexor pollicis longus**. - This compensation results in **hyperflexion of the interphalangeal joint** of the thumb, indicating **ulnar nerve palsy**. *Thumb abduction weakness* - Weakness in thumb abduction involves muscles like the **abductor pollicis brevis**, which is primarily innervated by the **median nerve**. - This type of weakness is tested by assessing the ability to move the thumb perpendicularly away from the palm, not with Froment's sign. *Thumb flexion weakness* - Weakness in thumb flexion involves muscles such as the **flexor pollicis longus** (median nerve) and **flexor pollicis brevis** (median and ulnar nerve). - While the flexor pollicis longus compensates in Froment's sign, the sign itself indicates a deficit in adduction rather than primary flexion weakness. *Thumb extension weakness* - Thumb extension is primarily mediated by the **extensor pollicis longus** and **extensor pollicis brevis**, both innervated by the **radial nerve**. - Weakness in these muscles would manifest as an inability to extend the thumb, which is unrelated to Froment's sign.

Q: Keinbock's disease is osteochondritis of ?

Lunate. ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.

Q: A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms hanging from the bed. Which of the following options correctly describes his condition and the test used to assess it?

Carpal tunnel syndrome, Durkan's test. ***Carpal tunnel syndrome, Durkan's test*** - The symptoms of **numbness and tingling** in the **lateral 3 digits** (thumb, index, middle, and radial half of the ring finger) are classic for **carpal tunnel syndrome (CTS)**, caused by compression of the **median nerve**. Relief with hanging the arm is due to gravity reducing swelling and pressure. - **Durkan's test** (or **median nerve compression test**) is highly specific for CTS. It involves direct pressure over the carpal tunnel, reproducing symptoms within 30 seconds. *Guyon's canal syndrome, Froment's test* - **Guyon's canal syndrome** involves compression of the **ulnar nerve** at the wrist, primarily affecting the **little finger** and the **ulnar half of the ring finger**, not the lateral 3 digits. - **Froment's test** assesses **ulnar nerve palsy** by observing the strength of adductor pollicis during a pinch grip, which is unrelated to median nerve compression. *Carpal tunnel syndrome, Froment's test* - While **carpal tunnel syndrome** is correctly identified based on the symptoms, **Froment's test** is not used to assess it. - As mentioned, Froment's test evaluates **ulnar nerve function**, particularly the adductor pollicis muscle. *Guyon's canal syndrome, Durkan's test* - The symptoms described (lateral 3 digits) are inconsistent with **Guyon's canal syndrome**, which affects the ulnar nerve distribution. - Although **Durkan's test** is appropriate for carpal tunnel syndrome, the diagnosis for Guyon's canal syndrome is incorrect.

Q: Which part of scaphoid fracture is most susceptible to avascular necrosis?

Proximal 1/3rd. ***Proximal 1/3rd*** - The **scaphoid bone** has a **retrograde blood supply**, meaning blood vessels enter distally and flow towards the proximal pole. - A fracture in the **proximal 1/3rd** can disrupt the blood supply to the **proximal fragment**, making it highly susceptible to **avascular necrosis**. *Distal 1/3rd* - Fractures in the **distal 1/3rd** of the scaphoid generally have a robust blood supply due to the entry of vessels from the distal pole. - While still requiring proper management, the risk of **avascular necrosis** is significantly lower compared to proximal fractures. *Middle 1/3rd* - Fractures in the **middle 1/3rd** (waist) of the scaphoid are common and can still compromise blood flow to the proximal segment, but the risk of **avascular necrosis** is intermediate. - The more proximal the fracture within the middle third, the higher the risk of **avascular necrosis**. *Scaphoid Tubercle* - The **scaphoid tubercle** is a distal projection of the scaphoid bone. - Fractures of the **scaphoid tubercle** are extra-articular and typically have an excellent blood supply; thus, they are at very low risk for **avascular necrosis**.

Q: Which muscles are primarily affected in De Quervain's tenosynovitis?

Abductor pollicis longus and extensor pollicis brevis. ***Abductor pollicis longus and extensor pollicis brevis*** - De Quervain's tenosynovitis is an **inflammation** of the tendons and their synovial sheaths in the **first extensor compartment** of the wrist. - These two muscles, the **abductor pollicis longus** and **extensor pollicis brevis**, share this compartment and are thus primarily affected by the condition. *Extensor pollicis longus and extensor pollicis brevis* - The **extensor pollicis longus** travels through the **third extensor compartment** and is not primarily involved in De Quervain's tenosynovitis. - While the **extensor pollicis brevis** is involved, the inclusion of the extensor pollicis longus makes this option incorrect. *Abductor pollicis longus and flexor pollicis longus* - The **flexor pollicis longus** is a muscle of the forearm that **flexes the thumb** and is located on the palmar aspect, unrelated to the dorsal compartment affected in De Quervain's. - Its inclusion makes this option incorrect, despite the correct identification of the abductor pollicis longus. *Flexor pollicis longus and flexor pollicis brevis* - Both the **flexor pollicis longus** and **flexor pollicis brevis** are muscles responsible for thumb flexion and are located in the **anterior compartment** of the forearm and hand, respectively. - These muscles are not involved in De Quervain's tenosynovitis, which affects the dorsal wrist extensors.

Q: Flexor Digitorum Profundus tendon avulsion injury leads to -

Jersey Finger. ***Jersey Finger*** - **Jersey finger** is a common name for an avulsion injury of the **flexor digitorum profundus (FDP) tendon** from its insertion on the distal phalanx. - This injury typically occurs when the finger is forcibly extended while the FDP tendon is contracting, often seen in sports where a player grabs an opponent's jersey. *Extensor tendon injury* - An **extensor tendon injury** involves the tendons on the dorsal side of the hand, responsible for extending the fingers. - This is distinct from a **flexor tendon injury**, which involves tendons on the palmar side. *Ulnar collateral ligament injury* - An **ulnar collateral ligament (UCL) injury** most commonly affects the thumb's metacarpophalangeal (MCP) joint, often called **"skier's thumb"**. - This injury involves damage to the ligament supporting the joint, not an avulsion of a flexor tendon. *Central slip injury* - A **central slip injury** affects the middle slip of the extensor digitorum communis tendon over the proximal interphalangeal (PIP) joint. - Untreated, it can lead to a **Boutonnière deformity**, which is characterized by PIP joint flexion and distal interphalangeal (DIP) joint hyperextension.

Question 1

Which tendons are primarily involved in pain around the base of the thumb?

Accepted Answer

Abductor Pollicis Longus (APL) & Extensor Pollicis Brevis (EPB)

Answer

Flexor Pollicis Longus (FPL) & Extensor Pollicis Longus (EPL)

Answer

Flexor Pollicis Brevis (FPB) & Extensor Pollicis Brevis (EPB)

Answer

Abductor Pollicis Longus (APL) & Extensor Pollicis Longus (EPL)

Question 2

What is the most common initial treatment for a scaphoid fracture?

Accepted Answer

Conservative

Answer

Compression Screws

Answer

Compression Plating

Answer

Traction

Question 3

A patient presents with wrist trauma and is diagnosed with a wrist sprain. Clinical examination reveals tenderness in the anatomical snuffbox, but imaging shows no evidence of fracture. In this clinical scenario, which ligament is most likely to be involved?

Accepted Answer

Scapholunate ligament

Answer

Radial collateral ligament

Answer

Lunotriquetral ligament

Answer

Ulnar collateral ligament

Question 4

What is Wartenberg's sign?

Accepted Answer

Inability to adduct small finger against the ring finger

Answer

Inability to maintain Intrinsic plus position

Answer

Inability to grasp a book between the thumb and index finger

Answer

Inability to move the middle finger sideways

Question 5

Froment's sign is positive in cases of weakness of ?

Accepted Answer

Adductor pollicis muscle weakness

Answer

Thumb abduction weakness

Answer

Thumb flexion weakness

Answer

Thumb extension weakness

Question 6

Keinbock's disease is osteochondritis of ?

Accepted Answer

Lunate

Answer

Scaphoid

Answer

Calcaneum

Answer

Tibial tuberosity

Question 7

A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and    tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms    hanging from the bed. Which of the following options correctly describes his condition and the    test used to assess it?

Accepted Answer

Carpal tunnel syndrome, Durkan's test

Answer

Guyon's canal syndrome, Froment's test

Answer

Carpal tunnel syndrome, Froment's test

Answer

Guyon's canal syndrome, Durkan's test

Question 8

Which part of scaphoid fracture is most susceptible to avascular necrosis?

Accepted Answer

Proximal 1/3rd

Answer

Distal 1/3rd

Answer

Middle 1/3rd

Answer

Scaphoid Tubercle

Question 9

Which muscles are primarily affected in De Quervain's tenosynovitis?

Accepted Answer

Abductor pollicis longus and extensor pollicis brevis

Answer

Extensor pollicis longus and extensor pollicis brevis

Answer

Abductor pollicis longus and flexor pollicis longus

Answer

Flexor pollicis longus and flexor pollicis brevis

Question 10

Flexor Digitorum Profundus tendon avulsion injury leads to -

Accepted Answer

Jersey Finger

Answer

Extensor tendon injury

Answer

Ulnar collateral ligament injury

Answer

Central slip injury

Hand Surgery — MCQs

Hand Surgery — MCQs

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