Hand Surgery Practice Questions

Q: Aeroplane splint is used in ?

Brachial plexus injury. ***Brachial plexus injury*** - The **aeroplane splint** is specifically designed to support the arm in **abduction** and **external rotation** at the shoulder, with the elbow flexed. - This position helps to relieve tension on the injured **brachial plexus** nerves and prevents contractures, particularly after an **upper brachial plexus injury** (e.g., Erb's palsy). *Radial nerve injury* - Radial nerve injuries typically present with **wrist drop** and difficulty with finger extension. - Splints for radial nerve injury, such as a **dynamic wrist extension splint**, focus on supporting wrist and finger extension, not shoulder abduction. *Ulnar nerve injury* - Ulnar nerve injuries lead to a **claw hand deformity** and sensory loss in the pinky and half of the ring finger. - Splints for ulnar nerve injury aim to prevent hyperextension of the metacarpophalangeal joints and support the interphalangeal joints, often involving static or dynamic splints for the hand. *Scoliosis* - Scoliosis is a **lateral curvature of the spine**, usually treated with bracing (e.g., Boston brace or Milwaukee brace) or surgery. - An aeroplane splint has no role in the management or treatment of scoliosis.

Q: In which of the following deformities is the distal interphalangeal joint extended?

Boutonniere deformity. ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint**. - It often results from injury to the **central slip of the extensor tendon** at the PIP joint. *Swan neck deformity* - This deformity presents with **hyperextension of the PIP joint** and **flexion of the DIP joint**, which is the opposite of the question's premise. - It is commonly associated with underlying conditions like **rheumatoid arthritis** or **lupus**. *Z deformity* - This typically refers to the **thumb in rheumatoid arthritis**, where the carpometacarpal (CMC) joint is flexed, the metacarpophalangeal (MCP) joint is hyperextended, and the interphalangeal (IP) joint is flexed. - It does not primarily describe an extended DIP joint in the context of other fingers. *Claw Hand* - This deformity involves **hyperextension of the MCP joints** and **flexion of the PIP and DIP joints**, particularly of the fourth and fifth fingers. - It is caused by **ulnar nerve palsy**, leading to muscle imbalance.

Q: The A1 pulley involved in trigger finger is located at the level of which joint?

Metacarpophalangeal joint. ***Metacarpophalangeal joint*** - The **A1 pulley** is located at the base of the finger, overlying the **metacarpophalangeal (MCP) joint**. - Its pathological thickening or narrowing can impede the smooth gliding of **flexor tendons**, causing **trigger finger**. *Proximal Interphalangeal joint* - The **A2** and **A3 pulleys** are located at the level of the **proximal phalanx** and **proximal interphalangeal (PIP) joint**, respectively. - While essential for tendon function, they are not primarily involved in typical **trigger finger**. *Distal Interphalangeal joint* - The **A4** and **A5 pulleys** are located at the level of the **middle phalanx** and **distal interphalangeal (DIP) joint**, respectively. - Pathologies at these pulleys are less common in trigger finger and typically affect the **distal tendon glide**. *Carpometacarpal joint* - The **carpometacarpal (CMC) joints** are located at the base of the hand, between the carpal bones and metacarpals. - There are no A pulleys associated with the CMC joints, and they are not directly involved in the mechanism of **trigger finger**.

Q: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Median nerve. ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.

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

Ulnar nerve dysfunction. ***Ulnar nerve dysfunction*** - Carpal tunnel syndrome specifically involves compression of the **median nerve**, not the ulnar nerve. - Symptoms related to the median nerve include numbness and tingling in the **thumb, index, middle, and radial half of the ring finger**, along with **thenar muscle wasting**. *Tinel sign* - The **Tinel sign** is a common physical examination finding in carpal tunnel syndrome, elicited by tapping over the **median nerve** at the wrist. - A positive sign involves tingling or electric shock-like sensations in the **median nerve distribution**. *Phalen's sign* - **Phalen's sign** is another classic physical maneuver used to diagnose carpal tunnel syndrome, where exaggerated wrist flexion for 60 seconds reproduces symptoms. - This maneuver increases pressure within the **carpal tunnel**, exacerbating median nerve compression. *Pain & paraesthesia of wrist* - **Pain and paraesthesia (numbness and tingling)** in the wrist and hand are hallmark symptoms of carpal tunnel syndrome. - These symptoms are often worse at night or with repetitive hand movements, reflecting **median nerve irritation**.

Q: What is the primary use of a knuckle bender splint?

Ulnar nerve palsy. ***Ulnar nerve palsy*** - A knuckle bender splint is primarily used to counteract the characteristic **claw hand deformity** seen in ulnar nerve palsy [1] by maintaining the **metacarpophalangeal (MCP) joints** in flexion. - This splint helps improve function by preventing hyperextension of the MCP joints, which commonly occurs due to the unopposed action of the extensor muscles when the ulnar nerve is compromised. *Radial nerve palsy* - Radial nerve palsy typically results in **wrist drop** and an inability to extend the wrist and fingers, which is managed with wrist extension splints, not knuckle benders. - The primary goal of splinting in radial nerve palsy is to support the wrist in extension to facilitate grasping and carrying objects. *Median nerve palsy* - Median nerve palsy causes problems with thumb opposition and sensation in the first three and a half digits, often leading to an **ape hand deformity**. - Splints for median nerve palsy focus on maintaining the thumb in opposition, such as a **thumb spica splint**, which differs from a knuckle bender. *Axillary nerve palsy* - Axillary nerve palsy primarily affects the **deltoid muscle**, leading to weakness in shoulder abduction and external rotation. - Splinting for axillary nerve palsy typically involves shoulder immobilizers or abduction splints, which address shoulder joint positioning rather than hand function.

Q: What is the most common complication associated with carpal tunnel release surgery?

Finger stiffness. ***Finger stiffness*** - Among the options listed, **finger stiffness** is the most recognized complication of carpal tunnel release surgery. - **Post-operative pain, swelling, and scar tissue formation** can lead to reduced range of motion in the digits. - Patients may develop stiffness due to **immobilization**, **scar adhesions**, or apprehension in mobilizing the hand after surgery. - **Note:** In clinical practice, **pillar pain** (pain at the thenar and hypothenar eminences) is actually the most common complication (10-30% of cases), but it is not among the options provided. *Malunion* - **Malunion** refers to improper healing of a fractured bone. - Carpal tunnel release involves dividing the **transverse carpal ligament** (flexor retinaculum), which is a **soft tissue procedure**. - No bone is cut or fractured, so malunion is not relevant to this surgery. *Avascular necrosis* - **Avascular necrosis (AVN)** is bone death due to interrupted blood supply. - AVN affects bones with precarious blood supply (femoral head, scaphoid, lunate in Kienböck's disease). - Carpal tunnel release does not involve bone manipulation and **AVN is not a recognized complication** of this procedure. *Rupture of EPL tendon* - **Extensor Pollicis Longus (EPL) tendon rupture** is classically associated with **distal radius fractures** or inflammatory arthritis. - EPL runs through the **third dorsal compartment** and is anatomically distant from the carpal tunnel (volar wrist). - While median nerve injury is a rare but serious complication of carpal tunnel release, **EPL rupture is not associated** with this surgery.

Q: A 54-year-old female marathon runner presents with pain in her right wrist that resulted from a fall onto her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone. Which of the following bones is most likely dislocated?

Lunate. ***Lunate*** - The **lunate bone** is the most commonly dislocated carpal bone, especially with a fall onto an **outstretched hand**. - Its central position in the proximal carpal row and its articulation with the radius make it vulnerable to **anterior dislocation** with forced dorsiflexion. *Capitate* - The **capitate** is the largest carpal bone but is more stable due to its central position and strong ligamentous attachments. - Isolated dislocation of the capitate is **rare** and usually accompanies other carpal injuries. *Trapezoid* - The **trapezoid** is a small, irregularly shaped carpal bone in the distal row, which is very stable. - Its strong articulations with the trapezium, capitate, and second metacarpal make its dislocation **extremely uncommon**. *Triquetrum* - The **triquetrum** is the second most commonly fractured carpal bone but is less prone to dislocation than the lunate. - While it can dislocate, it typically occurs with **ulnar impaction** or other complex carpal instabilities rather than an isolated anterior dislocation from a fall onto an outstretched hand.

Q: A cricketer holds a catch and then presents with pain at the base of the right thumb; he should be examined to specifically rule out damage to which of the following structures?

Ulnar collateral ligament. ***Ulnar collateral ligament*** - A cricketer catching a ball can experience a sudden **valgus stress** at the thumb's metacarpophalangeal (MCP) joint, leading to a tear of the **ulnar collateral ligament (UCL)**. - This injury is commonly known as **"gamekeeper's thumb"** or "skier's thumb" and is characterized by pain, swelling, and instability at the base of the thumb on the ulnar side. *Extensor pollicis brevis* - This muscle is primarily involved in **extending the thumb** at the metacarpophalangeal joint. - Injury to the extensor pollicis brevis would more likely cause pain with active extension of the thumb rather than from a forceful catch mechanism. *Abductor pollicis longus* - The abductor pollicis longus is responsible for **abducting and extending the thumb** at the carpometacarpal joint. - While overuse can lead to conditions like de Quervain's tenosynovitis, acute injury from a catch is less common compared to UCL rupture. *Volar plate* - The volar plate is a fibrous structure on the palmar aspect of a joint that prevents **hyperextension**. - While it can be injured by hyperextension, its location and primary function make it less likely to be the primary structure damaged by the type of forceful valgus stress experienced during a catch, compared to the UCL.

Q: In carpal tunnel syndrome evaluation, the Semmes-Weinstein monofilament test is primarily used to assess which nerve's sensory function?

Median Nerve. ***Median Nerve*** - The **Semmes-Weinstein monofilament test** is a quantitative sensory test used to assess **pressure threshold detection**, which is crucial for diagnosing and monitoring **carpal tunnel syndrome** [2]. - **Carpal tunnel syndrome** is caused by compression of the **median nerve** as it passes through the carpal tunnel, leading to sensory deficits in the **thumb, index, middle, and radial half of the ring finger** [1]. *Ulnar Nerve* - The **ulnar nerve** provides sensation to the **little finger and the ulnar half of the ring finger**, as well as motor innervation to most intrinsic hand muscles [1]. - While it can be assessed with monofilaments, its involvement is characteristic of **cubital tunnel syndrome** or other ulnar neuropathies, not carpal tunnel syndrome. *Radial Nerve* - The **radial nerve** primarily provides sensation to the **dorsal aspect of the hand**, particularly the thumb, index, and middle fingers, but not the palmar aspect affected in carpal tunnel syndrome [1]. - Its sensory distribution is distinct from the median nerve and is typically assessed in cases of **radial nerve palsy** or injury. *Posterior Interosseus Nerve* - The **posterior interosseus nerve** is a **purely motor branch** of the deep radial nerve and has no sensory function. - Compression or injury to this nerve would result in **motor weakness** (e.g., wrist drop), not sensory deficits measured by monofilaments.

Question 1

Aeroplane splint is used in ?

Accepted Answer

Brachial plexus injury

Answer

Ulnar nerve injury

Answer

Radial nerve injury

Answer

Scoliosis

Question 2

In which of the following deformities is the distal interphalangeal joint extended?

Accepted Answer

Boutonniere deformity

Answer

Swan neck deformity

Answer

Claw Hand

Answer

Z deformity

Question 3

The A1 pulley involved in trigger finger is located at the level of which joint?

Accepted Answer

Metacarpophalangeal joint

Answer

Proximal Interphalngeal joint

Answer

Carpometacarpal joint

Answer

Distal Interphalangeal joint

Question 4

Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Accepted Answer

Median nerve

Answer

Ulnar

Answer

Radial nerve

Answer

Median & ulnar nerve

Question 5

Which of the following is NOT a symptom of carpal tunnel syndrome?

Accepted Answer

Ulnar nerve dysfunction

Answer

Phalen's sign

Answer

Pain & paraesthesia of wrist

Answer

Tinel sign

Question 6

What is the primary use of a knuckle bender splint?

Accepted Answer

Ulnar nerve palsy

Answer

Radial nerve palsy

Answer

Median nerve palsy

Answer

Axillary nerve palsy

Question 7

What is the most common complication associated with carpal tunnel release surgery?

Accepted Answer

Finger stiffness

Answer

Malunion

Answer

Avascular necrosis

Answer

Rupture of EPL tendon

Question 8

A 54-year-old female marathon runner presents with pain in her right wrist that resulted from a fall onto her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone. Which of the following bones is most likely dislocated?

Accepted Answer

Lunate

Answer

Capitate

Answer

Trapezoid

Answer

Triquetrum

Question 9

A cricketer holds a catch and then presents with pain at the base of the right thumb; he should be examined to specifically rule out damage to which of the following structures?

Accepted Answer

Ulnar collateral ligament

Answer

Extensor pollicis brevis

Answer

Abductor pollicis longus

Answer

Volar plate

Question 10

In carpal tunnel syndrome evaluation, the Semmes-Weinstein monofilament test is primarily used to assess which nerve's sensory function?

Accepted Answer

Median Nerve

Answer

Ulnar Nerve

Answer

Radial Nerve

Answer

Posterior Interosseus Nerve

Hand Surgery — MCQs

Hand Surgery — MCQs

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