Hand - MCQ V2

Boutonniere deformity, what is true?
A) Can be a DIP, PIP or MCP problem
B) If passively correctable, may treat by dividing the lateral bands
C) Soft tissue procedures work when severe joint destruction is present
D) none are true
E) You do a dorsal tenotomy of the extensor tendon at the PIP to treat

All are options to treat bony mallet finger, except?
A) Dorsal-block pinning
B) Excision bony fragment and advance extensor tendon
C) Splint in neutral (exact wording)
D) Pin DIP

What is true regarding non-displaced scaphoid fractures?
A) There is good evidence supporting immobilization of the thumb
B) 90% of these will heal after 8 weeks of immobilization
C) Patients will not return to work faster with surgery
D) Surgery decreases nonunion rates

Patient has a mass in the supinator muscle, what do you expect clinically?
A) Weak wrist extension 
B) Weak anconeus – radial nerve
C) Numbness in radial forearm – 
D) Weak thumb IP extension

All are affected in lesser arc perilunate dislocation, except?
A) SL ligament
B)  LT ligament
C) Volar radiolunate capsule
D) Dorsal radiocarpal capsule

A patient sustains a PIP dorsal fracture-dislocation with 50% of the middle phalanx volar articular surface involved. What is the best treatment?
A) Hamate arthroplasty
B) Dorsal block pinning
C) Fragment excision
D) Dorsal block splint

Patient unable to extend IP joint 2 months after undisplaced distal radius fracture, plan?

All are true regarding Madelung’s deformity EXCEPT?
A) Volar subluxation of carpus
B) Disruption of dorsal ulnar aspect of distal radial physis
C) Ulnar positive
D) Associated with Ollier’s disease

What is true about syndactyly ?
A) Synonychia is never treatable
B) Surgery for functional reasons
C) Complex means shared nerve
D) Complete means up to PIP joint

What is true about flexor tendon repair?
A) Early ROM protocols lead to decreased adhesion formation
B) Repairs of both strands of FDS in zone 2 lead to the best outcome
C) Less strands per tendon is better

What is true about Kienbock’s disease?
A) STT fusion does not affect wrist ROM
B) Radial shortening is not indicated in ulnar neutral wrists
C) Closing-wedge radial osteotomy increases radial inclination

All of the following are true regarding congenital trigger thumb, EXCEPT?
A) Tendon sheath is relatively normal
B) Also called congenital clasped thumb
C) Rarely is bilateral
D) Rarely triggers

What is the best indication to re-implant?
A) Transverse amputation at the wrist
B) Transverse amputation of the thumb distal to FDP insertion
C) Transverse amputation of the forearm, 7 hours of warm ischemia time
D) Transverse amputation of the index through zone II

Patient with FDP tendon avulsion of the index finger. What is the proper direction of the suture anchor placed on the distal phalanx?
A) From proximal to distal
B) From distal to proximal
C) Skirting the subchondral bone
D) Perpendicular to cortex

What is the most common complication after Carpal tunnel release?
A) Recurrence of symptoms
B) Neuroma at scar
C) Infection
D) Finger stiffness
E) Pilar pain

Person with intrinsic wasting but no sensory deficits. Where is the compression happening?
A) Proximal to pisiform
B) At brachial plexus
C) At Cubital tunnel
D) Between Fexor Digiti Minimi and Abductor digiti minimi

What gets between the UCL and its native site in a gamekeeper thumb? (repeat)
A) Capsule
B) EPL
C) adductor tendon
D) adductor pollicis fascia

What is acceptable reduction in a MC neck # (repeat)
A) Angulation of small finger 40deg
B) Rotation 5deg
C) Shortening 1cm
D) Angulation of long (index) finger 20deg

Boutonniere deformity in RA, what is true?
A) Dorsal subluxation of lateral bands
B) Release FDS to treat it
C) Fuse PIP is not an option if it is stiff
D) Is not a result of DIP or MCP problems

What is true about Dupuytrens?
A) Needle fasciotomy works better for the PIP than MCP
B) If there is persistent flexion contracture of the PIP after resecting palmar fascia, then PIP should be released surgically
C) There is a high incidence of complications with the open palm technique
D) Cutaneous graft creates a separation between healthy and diseases tissues

What is most important for good outcomes in dorsal PIP fracture-dislocation? (repeat)
A) Correction of any intra-articular step in the joint
B) Achieve proper reduction of the joint
C) Early range of motion

What is true regarding paediatric scaphoid fractures? REPEAT
A) Usually nondisplaced
B) Usually are distal tubercle fractures
C) They represent 5% of upper extremity trauma

What is the typical finding in a lunotriquetral ligament tear? REPEAT
A) Absent ring sign
B) LT widening
C) Scaphoid flexion
D) SL angle 45°
E) Smaller scaphoid on AP view

What is true regarding non-displaced scaphoid fractures? REPEAT
A) There is good evidence supporting immobilization of the thumb
B) Majority (80-90%) of these will heal after 8 weeks of immobilization
C) Patients will return to work faster with surgery
D) Surgery decreases nonunion rates

Which is true regarding trigger finger?
A) When secondary to Rheumatoid arthritis, they have the same pathophysiology as primary trigger fingers.
B) Must release A2 pulley
C) Should avoid percutaneous release of the thumb

A patient sustains a PIP dorsal fracture-dislocation with 50% of the middle phalanx volar articular surface involved. What is the best treatment?
A) Dorsal block splint
B) Dorsal block pinning
C) Hamate arthroplasty
D) Fragment excision

A 47yo female with longstanding rheumatoid arthritis presents to your clinic with an inability to extend her 4th and 5th On exam you note an ulnar prominence. She has pain with supination/pronation but not with flexion/extension. What is the best treatment?
A) Tendon transfers, tenosynovectomy and Sauve-Kapanji
B) Tendon transfers, tenosynovectomy and distal ulnar resection
C) Splint (unsure if tenosynovectomy and tendon transfers included)
D) Tendon transfers, tenosynovectomy and wrist fusion

A patient sustains multiple lacerations on the ulnar side of their hand and wrist. They have loss of dorsal sensation over ulnar aspect of hand, but preserved palmar sensation and preserved motor function. Where is the injury?
A) Zone 1 Guyon’s canal
B) Proximal to Guyon’s canal
C) Zone 3 Guyon’s canal
D) Zone 2 Guyon’s canal

A patient presents with sensation loss over distal ulnar forearm and hand (5th digit) but normal motor function. What is the cause?
A) C6/7 disk herniation
B) Ulnar nerve compression at the wrist
C) C7/T1 disk herniation
D) Ulnar nerve compression at the cubital tunnel

Regarding a 5th metacarpal shaft fracture, which of the following is the best indication for operative intervention?
A) Oblique fracture
B) Shortening of 3mm
C) 5 degrees of rotation
D) 30 degrees dorsal angulation

What is the primary functional loss with a low median nerve palsy?
A) Thumb opposition
B) Index IP flexion
C) Thumb IP flexion
D) Key pinch

Regarding a volar PIP dislocation, what is the block to reduction?
A) Transverse retinacular ligament
B) Collateral ligament
C) Lateral band
D) Oblique retinacular ligament

In regards to distal ulna, what is true about the TFCC?
A) The force it transmits is reduced in an ulnar positive wrist
B) The force it transmits is reduced in the presence of a dorsal distal radius malunion
C) 18% force is transmitted through ulna when ulna variance is neutral

In a Bennett’s fracture, the intraarticular fragment is held in position by which of the following ligaments?
A) Dorsoradial
B) Posterior oblique
C) Intermetacarpal
D) Anterior oblique

All of the following are physical exam signs of ulnar nerve compression EXCEPT?
A) Froment sign
B) Claw hand
C) Finkelstein test
D) Wartenburg sign

All of the following are true regarding DISI deformity EXCEPT?
A) Scapholunate ligament disruption
B) Lunate extends
C) Scaphoid supinates
D) Incongruent radiolunate joint

All of the following are true regarding congenital trigger thumb, EXCEPT?
A) Rarely is bilateral
B) Also called congenital clasp thumb
C) Rarely triggers 
D) Tendon sheath is relatively normal

All of the following are principles of tendon transfer EXCEPT?
A) Wait to perform transfers until soft tissue is in equilibrium
B) Wrist fusion will help with tenodesis
C) Straight line of pull is more efficient
D) Must not use a tendon that would compromise function

All are true regarding tight hand extrinsics EXCEPT?
A) The extensor tendon is scarred down to the metacarpal
B) PIP Flexion causes MCP extension
C) PIP extension causes MCP flexion
D) There is a block to passive MCP flexion
E) MCP flexion causes PIP extension

In extensor tendon dislocation injury, what is disrupted?
A) Transverse ligament
B) Pretendinous band or Collateral ligs
C) Dorsal Oblique sheath
D) Sagittal bands

All of the following ligaments are disrupted in lunate dislocation, except?
A) Dorsal Radiocarpal ligament
B) Volar Radiolunate
C) Lunotriquetral
D) Scapholunate

All of the following are signs of scapholunate dissociation except?
A) Positive stress view
B) Ring sign of scaphoid
C) Widened schapholunate gap
D) Scapholunate angle decreases

All of the following are potential sources of compression of ulnar N. except?
A) FCU head
B) Medial intermuscular septum
C) Arcade of Struthers
D) Brachialis

Distal ulna resection Darrach procedure specifically. All true except?
A) Done for Ulnocarpal abbutment
B) OA pt experience same relief than patients with RA
C) Get ulnar drift of the carpus
D) Get dorsal translation of the ulna

Question about trigger finger what do you release?
A) A1 pulley
B) A3 pulley
C) A4 pulley
D) A2 pulley

22 yo female worker 5 months post carpal tunnel release, comes back c/o symptoms. Has 5 mm 2-point in fingers, normal thenar muscle function, negative Phalens, but positive Tinels over radial aspect of scar at distal wrist crease. What is the reason for this?
A) Recurrent carpal tunnel
B) Incomplete release of transverse carpal ligament
C) Injury to palmar cutaneous branch (thenar recurrent)

Most common nerve injured in FCR approach
A) Nerve to pronator quadratus
B) Palmar cutaneous branch of the median nerve
C) Median nerve

FDP injury, retracted to palm, all true except?
A) Good results if done within 6 weeks
B) Usually involves ring finger
C) Least common type of FDP injury

Which of the following is most predictive of DRUJ issues post distal radius fracture?
A) Radial inclination < 10 degrees
B) Radial shortening of 5 mm
C) Articular step of 2 mm
D) Extension of the fracture into the sigmoid notch

Not a predictor of loss of reduction in DR#?
A) Dorsal angulation
B) Metaphyseal comminution
C) Radial shortening
D) Age > 80

Which tendon is affected in Mannerfelt lesion?
A) EPL
B) FPL
C) FBP

Click in wrist in 20 yo female, AP xray shows triangular, volar flexed lunate. You suspect lunotriquetral tear. What feature would go with that?
A) Absent ring sign
B) Scapholunate angle of 45 degrees
C) Short scaphoid
D) Widened lunotriquetral interval

Which of the following is not involved in Dupuytren’s?
A) Grayson’s ligament
B) Cleland ligament
C) Natatory ligament
D) Spiral band

A patient presents with ulnar nerve compression at the elbow. What is true about simple ulnar nerve decompression versus subcutaneous transposition?
A) Same results, lower complications with simple decompression
B) Same results, same complications
C) Better results with transposition, less complications with transposition
D) Better results with transposition, same complications

Which of the following is true regarding the wrist?
A) A radial lengthening osteotomy is a good option for early Kienbock
B) Preiser disease of the triquetrum is usually self-limited
C) Lunate intraosseous pressures change with flexion & extension of wrist
D) A capitate lengthening osteotomy is a good option for early Kienbock

Which of the following is an indication for proximal row carpectomy?
a) Pancarpal arthritis
b) Kienbock’s disease

Middle aged worker with several month history of elbow/forearm pain, weak finger extension, wrist radial deviation. Where should you release?
A) Arcade of Struthers
B) Lacertus fibrosus
C) Proximal edge of supinator
D) 10 cm proximal to elbow

Regarding Duputryen’s contracture, all of the following are true EXCEPT:
A) 4th and 5th digits most commonly involved
B) DIP effected more than MCP
C) Men affected more than women
D) Autosomal dominance inheritance with variable penetrance

All of the following are true with DRUJ stability EXCEPT:
A) Palmer RU ligament is major stabilizer to palmer radius translation
B) ECU and volar UlnoCarpal ligaments are secondary stabilizers
C) Distal IOM prevents radius from going dorsal
D) 20% from osseous sigmoid notch

All of the following are true with Radius and Ulna EXCEPT:
A) Force at wrist almost equal to force at elbow
B) IOM goes from proximal radius to distal ulnar
C) TFCC allows for 6mm translation under axial load
D) Primary stabilizer in small central IOM band

The following are true regarding the DRUJ Except:
A) 6mm of longitudinal translation occurs at the DRUJ with motion
B) the volar ulnocarpal ligament prevents anterior displacement of the distal radius with respect to ulna
C) the interosseus membrane runs from the proximal radius to the distal ulna
D) A small central band is the primary component of the IOM

All of the following are true with SLAC EXCEPT:
A) Stage 1 has profound styloid involvement
B) In stage 3, Capitate moves after proximal pole involved radiographically
C) 4 corner fusion is good for this, it transfers forces to Ulna and TFCC
D) Associated with triquetral dorsiflexion

All of the following are true regarding the treatment of Swan Neck deformity EXCEPT:
A) FDS tenodesis
B) Oblique retinaculum reconstruction
C) DIP fusion
D) Correction includes crossed intrinsic tendon transfer

All of the following are associated with Dupuytrenes, EXCEPT;
A) DIP more common than PIP
B) Penile disease
C) 4th and 5th digits most commonly
D) Male

Weakness of thumb and finger flexors, forearm pronators, no numbness
A) Median n compression
B) Carpal tunnel syndrome
C) Pronator syndrome
D) AIN compression

43 y old man with pain in the right forearm and weakness of forearm pronation. Associated with FPL weakness and weakness of the FDP to the index and middle finger. What is the likely pathology?
A) Pronator syndrome
B) Median nerve entrapment
C) AIN compression syndrome

What is the most important structure for PIP stability
A) Lat band
B) Volar plate
C) Collateral lig

What is true regarding metacarpal shaft fracture:
A) Transverse fractures can be treated with closed reduction by longitudinal traction
B) Short oblique fractures can often be treated closed
C) Apex dorsal angulation due to intrinsics and extensors
D) Displacement, shortening and rotation of 2.5 mm is indication for ORIF

Regarding PIN what is true?
A) Can occur due to compression at the fibrous edge of pronator
B) Most common nerve injury with Monteggia fractures
C) Causes weakness of power grip

Which of the following is the most useful test in the diagnosis of Carpal tunnel syndrome?
A) EMG
B) Conduction Velocity studies
C) Sensory latency
D) MRI

Why is the risk of AVN low in lunate dislocation?
A) Scapholunate blood supply
B) Intraosseus blood supply has many branches
C) Dorsal blood supply
D) Volar blood supply

Patient has numbness on small and ring finger, and decreased strength in FDP of those two fingers (Dalhousie has dec strength in D2 and D3). Where is the nerve injury:
A) AIN
B) Cubital tunnel
C) C8 root radiculopathy
D) Carpal tunnel with Martin-Gruber anastomosis
E) Dalhousie also has- C7 and also Guyon’s canal anhydrosis, & dilated pupil (Horner's syndrome);

30yo male with scaphoid nonunion, 3mm displaced (waist?). SL angle 70 degrees. What to do?
A) ORIF volar with a screw and ICBG
B) ORIF volar with k-wires and ICBG
C) Percutaneous screw (CRPP)
D) Above elbow cast and ultrasound

All are associated with thumb hypoplasia except
A) UCL deficiency
B) IP joint stiffness
C) short first webspace
D) proximal location of thumb

What is the earliest sign seen in carpal tunnel syndrome (most sensitive test for early CT)?
A) EMG changes
B) 2-point dynamic discrimination
C) 2-point static discrimination
D) Loss of vibration

Young female with a history of fingertips turning blue and white. She will also have all these other features except:
A) Telengectasia
B) Calcinosis
C) Pitting of Nails
D) Arthritis

What is true when comparing ulnar nerve release and transposition versus simple decompression for cubital tunnel syndrome?
A) Similar functional outcomes with fewer complications in simple decompression
B) Better outcomes for transposition with more complications
C) Lower recurrence for transposition
D) Better outcomes for transposition, no difference in complication rates

Causes of swan neck in a rheumatoid arthritis patient include all EXCEPT:
A) Volar subluxation of proximal phalanx
B) FDP laceration
C) Intrinsic tightness
D) Mallet finger deformity

What accentuates the ulnar deviation of the digits in Rheumatoid Arthiritis (UBC has has “following cause ulnar deviation of fingers in RA EXCEPT)
A) Extensor tenosynovitis
B) Wrist ulnar deviation
C) SL ligament instability
D) Tight intrinsics
E) SL dissociation

Regarding wrist ligaments (Dalhousie has “intercarpal ligaments”), all are true EXCEPT:
A) Dorsal intercarpal ligament is attached to scaphoid, trapezium and trapezoid
B) Dorsal SL ligament is stronger than volar    
C) The radioscaphocapitate ligament is not seen during arthroscopy
D) Volar LT ligament is stronger than dorsal  

Distal radius malunion healed with shortening. What is the most common complaint?
A) DRUJ pain
B) Decreased grip strength
C) Carpal tunnel

Traumatic extensor tendon dislocation at the level of the MCP joint, what structure is involved (ruptured)
A) Collateral ligament
B) Central slip
C) Oblique retinacular band
D) Sagittal band
E) Lateral band

All these are true for Darrach procedure (distal ulna resection) EXCEPT:
a) Traumatic DRUJ OA does better than rheumatoid
b) Ulnar abutment against the radius is a complication and can be prevented with tendon sling
c) Ulno-carpal impaction is a complication
d) Get dorsal subluxation of the distal ulnar stump
e) Ulnar shift of carpus (UBC has Ulnar translocation)

Regarding tendonopathy in the hand, which is true:
A) Trigger finger is more common in a male labourer
B) DeQuervain’s is more common than trigger finger
C) none
D) Trigger finger is typically caused by RA
E) Trigger finger usually has an underlying disease

About hand anatomy and the palmar arches, which is TRUE
A) The deep arch is superficial to the flexor digitorum profundus
B) Radial artery is main supply of superficial arch
C) The radial artery passes between the first and second metacarpal to reach the deep arch
D) The superficial arch provides the most vascularisation to the fingers

Regarding the blood supply to the palm, which is true?
A) Deep is superficial to FDP
B) Radial joins superficial between 1 and 2 metacarpals
C) Digital supply is mostly from the superficial arch
D) Superficial arch mostly from the radial

In Dupuytrens, what pulls the NV bundle medial?
A) Clelands
B) Spiral cord
C) Pretendinous
D) Natatory

Scaphoid xray with non union of the proximal pole that is 5 months out in young guy, what to do? Ottawa: 5 months post- FOOSH injury. Has wrist pain. Xrays show Proximal scaphoid fracture with non-union:
A) Cast for 6 weeks in thumb spica
B) U/S
C) Volar approach ORIF and bone graft
D) Dorsal approach and ORIF

11 yo girl with scaphoid #, not healed after a few months, next step:
A) Tx as if she were an adult
B) Electromagnetism
C) Do nothing
D) Cast for 6 more months as stiffness doesn’t happen

Question regarding the carpal ligaments. All of the following are true EXCEPT:
A) volar aspect of triquetolunate ligament is the strongest
B) during wrist arthroscopy you can see the radioscaphocapitate ligament
C) the dorsal intercarpal ligament anchors on the scaphoid, triquetrum and trapezium
D) All correct
E) dorsal side of scapholunate ligament is biomechanically the strongest

Old dude with weak thumb ADDuction, (Ottawa: atrophy of m/m), tinels at elbow over ulnar nerve, tx? Calgary: Hand wasting and weakness of adduction of thumb w/ +ve tinels at elbow and +ve EMG at elbow. What to do?
A) Decompress guyon canal (ulnar nerve at wrist)
B) Decompress median nerve
C) Decompress and transpose ulnar nerve
D) Simple decompression of ulnar nerve at elbow

Which of the following do not get ulnar impaction?
A) Ulnar positive peoples
B) Reconstruct the radial shaft in trauma/tumor
C) Functionally (physiologically) long ulnar people that work in pronation
D) Repetitive work in supination
E) Former Essex Lopresti and RH fracture

Golfer with pain on ulnar side of hand and numbness to small and ring.       What is the most predictable test to get the diagnosis
A) X-ray
B) EMGs
C) MRI wrist
D) CT carpal bones

Some stems about hand intrinsic contracture all true EXCEPT:
A) MCP flexion allows PIP motion better
B) Often found with mallet
C) Contraction is mostly caused by an ischemic event and not bone injury
D) Will have a tip palm gap with flexion

All of the following can lead to Swan neck in RA except:
A) Inability to fully extend MCP
B) MCP Collateral ligament laxity when tested in 90 flexion
C) Intrinsic tightness
D) Mallet finger
E) PIP synovitis

Lateral Xray of perilunate # DL and scaphoid # (no AP given), what do you do?
A) Functional bracing (splint and early ROM)
B) Cast immobilization
C) Reduce, ORIF Scaphoid
D) Repair (Pin) SL disruption

Volar carpal dislocation xray with volar DR chip # and thumb DL, what do to? Ottawa: volar carpal dislocation (SL intact) with small distal radial rim fracture + 1st CMC dislocation
A) Pin thumb and ORIF scaphoid
B) Pin thumb and ORIF DR
C) Cast immobilization
D) Pin thumb and pin SL joint

PIN (Radial Tunnel Syndrome), most common site of compression?
A) Fibrous band at proximal edge of supinator
B) ECRB
C) Recurrent leash of Henry
D) Fascial band at RH

Metacarpal fractures, what is true?
A) 2.5 mm shortening
B) Short oblique can be treated with immobilization
C) Transverse fracture are apex dorsal due to intrinsics and extensor tendon
D) Transverse needs to be reduced under strict fluoro with inline (longitudinal) traction

Scaphoid xray with non union of the proximal pole that is 5 months out in young guy, what to do? Ottawa: 5 months post- FOOSH injury. Has wrist pain. Xrays show Proximal scaphoid fracture with non-union:
a) Volar approach ORIF and bone graft
d) Cast for 6 weeks in thumb spica
c) Dorsal approach and ORIF
d) U/S

LT tear, how to tell on xray? Young woman falls on wrist, painful. Xray shows triangular, volar flexed lunate. What other abnormalities would support lunatotriquetral dissociation?
A) SL angle 45
B) Flexed scaphoid
C) Lunotriquetral gap
D) Scaphoid foreshortening
E) Signet ring is absent

MetaCarpal #, all are reasons to operate for sure EXCEPT?
A) Shortening and open fracture
B) Multiple MC#s
C) Comminution
D) Rotation

Pulley anatomy, what is false?
A) C2 distal to A4
B) A2 and A4 most important
C) C1 is distal to A2
D) A1 of little functional use

Most common reason for compression of ulnar nerve in Guyon’s canal?
A) Fracture
B) Synovitis
C) Vascular occlusion (thrombosis of ulnar artery)
D) Ganglion

Quadrigia, you do what?
A) Release the quadriceps off the femur
B) Release the flexor tendon
C) Fix it in CP hip
D) You call your staff this when he’s totally dumb

In ulnar nerve anterior transposition, what is the most common cause of failure?
A) Unresected FCU fascia
B) Unresected medial intermuscular septum
C) Unresected arcade of struthers
D) Unresected Osbourne’s ligament

What is a definitive indication to fix MC (metacarpal) fractures, EXCEPT
A) Open fracture
B) Malrotation
C) Multiple MC fractures
D) Lots of comminution of MC

With regards to the 3rd lumbrical
A) it extends the ring PIP
B) inserts on proximal phalanx
C) it is innervated by the AIN nerve

A 62 year old lady with RA is losing function of her thumb. She has IP hyperextension with 50 degrees extension that is passively correctable. Her MCP has an extensor lag and normal flexion. Her EPL is intact. What would you do to improve function.
A) EPL to EPB transfer
B) EIP to EPB transfer
C) Arthrodesis of IP joint
D) Arthrodesis of MCP joint

67 year old farmer with longstanding RA has few weeks history of inability to extend fingers, Now she also has pain at elbow. Treatment at this time should be
A) explore radial nerve at elbow
B) dynamic splinting and something else
C) dynamic splinting and tendon transfers later if doesn’t resolve
D) explore using proximal Henry

What is the blood supply of the scaphoid?
A) dorsal carpal and volar branch of radial artery
B) superficial radial artery
C) recurrent radial artery

Which test will not help diagnose Pronator syndrome?
A) Resisted middle finger PIP flexion
B) Resisted wrist flexion and supination
C) Resisted elbow flexion and supination
D) Resisted forearm pronation in extension

What is the most common cause of a Swan Neck deformity with a negative Bunnell test
A) volar subluxation of Proximal phalanx
B) Flexor paralysis
C) Extensor paralysis
D) Instrinsic contracture

All are true regarding the wrist ligaments EXCEPT
a) The dorsal intercarpal ligament is associated with the scaphoid, triquetrum and trapezium
b) The volar LT ligament is the most important
c) The dorsal SL ligament is the most important
d) You can visualize the radioscaphoid ligament during wrist arthroscopy

Each of these are special tests for pronator syndrome (median nerve) EXCEPT?
A) resisted pronation and wrist flexion
B) resisted flexion of elbow and supination
C) resisted flexion of 3rd PIP
D) resisted pronation in extension

Proximal row carpectomy is appropriate for which of the following
A) Late stage Kienboch’s
B) Unrepairable TFCC tear
C) Septic arthritis
D) Ulnocarpal impaction

A patient suffers a laceration to small finger, volar surface 2 mm proximal to DIP. Examination reveals the patient can not actively flex small DIP and if the ring and middle fingers held in extension, can’t flex PIP of small. If the ring is allowed to flex, he is still unable to flex the PIP of the short. What is going on?
A) Congenital absence of FDP in ring and small
B) Laceration of FDP and FDS
C) Laceration of FDP and congenital absence of FDS
D) Laceration of FDP in ring and small fingers

Possible sites of radial nerve impingement, except?
A) ECRL edge
B) Radial recurrent vessels
C) ECRB edge
D) Radiocapitellar joint

Where is “No man’s land” in the hand?

A) Proximal palmar crease to PIP crease
B) PIP to DIP crease
C) Distal palmar crease to FDS insertion
D) Wrist to distal palmar crease

MCP replacement in RA
A) Must centralize EDC by imbricating radially, releasing ulnarly
B) Can’t remember
C) Must release radial collateral
D) Must repair ulnar collateral

Treatment of swan neck, all except
A) Crossed intrinsic transfer
B) Tendodesis of superficialis
C) DIP fusion
D) Oblique retinacular ligament repair

Extrinsic tightness, all except
A) EDC tendon can adhere to metacarpals
B) PIP flexion forces MCP extension
C) MCP flexion forces PIP extension
D) Cannot passively flex MCP

Interpositional hemiarthroplasty (Bower’s) is appropriate for all except
A) Chronic TFCC tear
B) Limited forearm rotation secondary to DRUJ
C) Painful DRUJ instability
D) Ulnocarpal abutment

Possible sites of radial nerve impingement, except?
A) Radiocapitellar joint
B) Radial recurrent vessels
C) ECRB edge
D) ECRL edge

What is not correct about carpal synostosis
A) Carpal-metacarpal synostosis most common
B) Incidence higher in whites than blacks
C) Others

Windswept hand – all except are true
A) Bilateral presentation at birth
B) Flexion contracture of all fingers
C) Ulnar translation of MCPs
D) Thumb adduction and extension contracture

Best ABX for suppurative flexor tenosynovitis
A) Pen
B) Clox
C) Clinda

Distal radius fracture with unstable DRUJ. How do you address the DRUJ instability
A) Supinate in cast x 6 weeks
B) Pin and immobilize in pronation x 6 weeks
C) Tension band ORIF of styloid
D) Fix TFCC and motion in 2 weeks

Anatomy of hand – what’s true
A) Metacarpal fractures are apex-volar because of intrinsics and extrinsic flexors
B) Dorsal interossei insert at base of dorso-lateral prox phalanx
C) MCP sheath is coalescence of extensor sheath and intrinsic muscle tendons
D) Palmar interossei are bipennate and originate off volar 2/3 of metacarpals

Baseball player with 25% articular involvement dorsal PIP fracture dislocation - Best predictor of outcome in PIP fracture
A) ORIF articular surface
B) Dedicated hand therapy program
C) Early ROM
D) Reduce PIP subluxation

Low median nerve injury after palmar laceration
A) Brachioradialis to FPL
B) FDP side to side transfer (D3-D4)
C) Biceps to radius transfer
D) FDS of ring to APB

Regarding anomalous innervation of the upper extremity
A) Martin Gruber supplies motor ulnar to median
B) Riche-Cannieu is an anomalous recurrent motor branch of the median nerve supplying the thenar musculature
C) Riche-Cannieu is most common anomaly in hand
D) Riche-Cannieu is most common anomaly in forearm

question on PIN nerve compression with RA and approach to decompress
a) posterior
b) anterolateral

With regard to total wrist arthroplasty
A) If distal stem is needed use 2nd metacarpal to ensure proper alignment
B) Other
C) Most common mechanism of failure is implant breaking
D) Radial stem loosening is rare

All of the following cause ulnar nerve compression EXCEPT
A) Hypertrophic medial triceps
B) Valgus deformity
C) Ligament of Osborne
D) Ligament of Struthers

Most common injury of wrist arthroscopy
A) Tendon and nerve laceration
B) Traction nerve injury
C) Major and minor complication incidence is 4%
D) RSD

LT tear with dorso-ulnar pain
A) Others
B) Dorsal LT ligament is most important for stability
C) LT ligament is not intact with VISI deformity

Distal radius + styloid fracture in 18 year old baseball player. What is the treatment?
A) Pins
B) Cast
C) ORIF dorsal plate + fix styloid
D) ORIF volar plate + fix styloid

SLAC wrist (ALL true EXCEPT)
A) Stage 1 = profound radial styloid involvement
B) 4 corner fusion is good because it transfers forces to TFCC and ulna
C) Stage 3 = capitate migration
D) Triquetrum is dorsiflexed

Patient with Dequervain’s undergoes release of 1st This releases what muslces
A) APL and EPB
B) APL and EPL
C) APL
D) EPL

Trigger finger, release what pulley
A) A2
B) A3
C) A1
D) A4

Presents with MCP and PIP flexion contracture of insidious onset, also has adduction contracture. The question was: what structure is responsible for the adduction contracture?
A) Pretendinous Cord
B) Natatory Cord
C) Spiral cord
D) Lateral cord

Mannerfelt Syndrome: which tendon is affected?
A) FCR
B) FPL
C) APL
D) EPL

45 yo female production line worker 3 months history of pain in mid-forearm with palpation and resisted extension long finger as well as supination. Rx:
A) Radial nerve decompression beneath brachioradialis
B) Carpal tunnel release
C) Radial nerve decompression at supinator
D) Cubital tunnel release

Which of the following is not correct regarding trigger finger in rheumatoid arthritis ?
A) Type I involves focal tenosynovitis
B) All correct
C) Type IV involves diffuse nodularity throughout the tendon
D) Type II involves nodularity in PALM
E) Type III involves nodularity in FDP adjacent to A2 pulley

Ulnar nerve site of compression (except)?
A) Brachialis
B) medial intermuscular septum
C) Arcade of Struthers
D) Osborne’s ligament and cubital tunnel

Static Scapholunate Dissociation (except)
A) Terry Thomas sign
B) Scaphoid Ring Sign
C) Ring-pole distance sign
D) Taleisnik C – sign
E) Cortical Ring Sign

Dynamic S-L or Partial Tear of SL Ligament
A) Arthroscopic Debridement and CRPP
B) Dorsal Capsulodesis contraindicated in chronic
C) 4-Corner Fusion with Scaphoid Excision
D) Mandatory to splint post-op in ulnar deviation and supination

When should you perform an ORIF of a Scaphoid Non-union?
A) terrible radioscaphoid arthritis
B) 25 y.o. Asymptomatic Nonunion
C) Patient has been in a cast for 6 weeks with no evidence of healing
D) Proximal Pole Undisplaced
E) CT Shows healing

LEAST likely to receive innervation from AIN?
A) Volar DRUJ capsule
B) Ulnar half of FDP
C) Volar carpal capsule
D) Pronator Quadratus

Picture of Wrist with Pancarpal Arthritis and SLAC Grade III. What should you do?
A) Total Wrist Fusion
B) Styloidectomy
C) PRC
D) Scaphoid excision

Triscaphe (STT Fusion) question – all TRUE, Except?
A) ROM is 50% after Rehab
B) Performing Styloidectomy important
C) Secondary revision surgery is uncommon
D) Grip Strength Returns to 90% of contralateral hand

AIN palsy showing weakness in FDP of D2 & D3, and Weak FPL
A) Arthrodesis DIP D2D3 and IP of thumb
B) Arthrodesis DIP d2d3 and brachioradialis FPL
C) Side-to-side D2&D3 / D4&D5 and Brachioradialis to FPL
D) Opponensplasty, EIP transfer to Proximal Phalanx of Thumb

12 yr-old girl with a dislocated thumb MCP joint. You are told that you can feel the metacarpal head through the palmar skin. The X-ray shows a dislocation with no obvious fracture. The sesamoids are not obvious but may be in the joint (Ottawa/MUN thought was in joint). What is the treatment?
A) Open reduction
B) Immobolization with later reconstruction
C) Volar plate advancement arthroplasty
D) Thumb spica cast
E) Child services

PIP dislocation of finger, what makes it irreducible?
A) Collateral ligament
B) Lateral band
C) Transverse ligament
D) Oblique retinaculum

45 yr-old lady with a history of remote trauma to her wrist. No real pain, but comes complaining of swelling and deformity of her wrist. You are presented with an X-ray showing a fragmenting non-union of the distal radius. What should be your next investigation?
A) ESR + CRP
B) CT
C) HBA1C
D) Bone and gallium scans
E) MRI spine

45 year old patient with RA and has ulnar sided tendon ruptures (Vaughn Jackson) with unstable prominent ulna, no wrist problems but having pain with supination. What is the best treatment?
A) Synvectomy, tendon transfer, wrist fusion
B) Synvectomy, tendon transfer and sauve-kapandji
C) Synvectomy, tendon transfer and distal ulnar resection (Darrach)

Kid with hypoplastic thumb type 4 
A) toe thumb
B) index pollicization
C) opponsplasty

Child with macrodactyly of the index finger that is stiff PIP and DIP, the diagnosis was lipofibromatosis which was progressive and it mentioned that he was already bypassing the index finger to pinch with long-finger but was having problems due to the large finger, what is the best treatment?
A) Lengthening of thumb
B) Arthrodesis
C) Debride/Debulk
D) Ray amputate

Upper extremity CP surgery. The following are indicators to proceed EXCEPT?
A) Texture discrimination (stereognosis)
B) Two Point Discrimination of 10 mm
C) Hand from Knee to head in 5 sec
D) IQ of 90

In a Bennett’s fracture, the intraarticular fragment is held in position by which of the following ligaments?
A) Posterior/Dorsal oblique
B) Dorsoradial
C) Anterior/Volar oblique
D) Intermetacarpal

Arthroscopic TFCC repair, poor outcome with?
A) Better pre-op grip strength
B) Ulnar Negative
C) Decrease ROM
D) Decreasing age

Distal radius fracture treated by ORIF. After ORIF of DR #, DRUJ reducible but unstable and dislocates “ulnar dorsally” (exact wording!) in pronation. How to treat:
A) k-wire distal ulnar to radius in pronation
B) Acute repair of TFCC and early
C) long-arm cast in supination