Wrist and Hand Anatomy
Your patient is unable to extend the PIP of their middle finger. What might be compromised?
A. Ulnar nerve
B. Central slip of the extensor hood
C. Extensor digiti minimi
D. Lateral band of the extensor hood
B. Central slip of the extensor hood
Why does a nerve that is responsible for wrist and finger extension typically (radial nerve), have a role in grip strength?
A. It innervates the flexor digitorum profundus
B. It innervates the flexor digitorum superficialis
C. The tenodesis effect that happens with wrist extension
D. It innervates the palmaris longus
C. The tenodesis effect that happens with wrist extension
Which is a sign or symptom of CRPS?
a. Lack of pain and swelling during the acute stage of a fracture
b. Extreme pain with light palpation, which normally would not evoke pain
c. Heightened motor control
d. Exceptionally accurate 2-point discrimination
b. Extreme pain with light palpation, which normally would not evoke pain
Gamekeepers or skiers thumb is an injury to:
a. UCL of the first MCP joint
b. UCL of the medial carpals
c. Central slip to the middle phalange
d. Extensor hood of the 2nd finger
a. UCL of the first MCP joint
Which symptom would assist with ruling in Rheumatoid arthritis?
a. Fatigue
b. Swelling
c. Morning stiffness
d. All these options, especially morning stiffness
d. All these options, especially morning stiffness
Your patient presents with jersey finger, which is the inability to flex the DIP of the finger. What might be compromised with this condition?
A. Flexor digitorum superficialis
B. Volar plate
C. Flexor digitorum profundus
D. Radial nerve
C. Flexor digitorum profundus
What is NOT innervated by the median nerve?
A. Radial lumbricals
B. Opponens brevis
C. Abductor pollicis brevis
D. Interossei muscles
D. Interossei muscles
Which is not an essential component of pain neuroscience education with CRPS?
a. Education about why the brain perceives significant pain
b. PROM to improve a movement deficit
c. Understanding that the brain can change the way we experience stimulus
d. Training about why the brain struggles to differentiate right from left
b. PROM to improve a movement deficit
Your patient has pain, numbness and tingling in the median nerve distribution of their hand. What positive test is paired with the correct diagnosis for the differential diagnosis you would include?
a. Positive flick sign for carpal tunnel syndrome
b. Positive resisted pronation for C6 nerve root entrapment
c. Decreased light touch to anterior middle finger for anterior interosseous syndrome
d. Positive Spurling test for pronator teres syndrome
a. Positive flick sign for carpal tunnel syndrome
Which is an example of a swan neck deformity, with dorsal displacement of the lateral band of the extensor mechanism and passive tension of the FDP.
a. Hyperextension of the PIP and flexion of the DIP
b. Flexion of the PIP and hyperextension of the DIP
c. Flexion of both the PIP and DIP of the ring and pinky fingers
d. Normal PIP with inability to actively extend the DIP
a. Hyperextension of the PIP and flexion of the DIP
The CMC joint of the thumb is one of the most common and earliest places to show signs of arthritis. What bone is involved that is proximal to the proximal phalanx of the thumb?
A. Trapezium
B. Scaphoid
C. Lunate
D. Capitate
A. Trapezium
It is rare that you need to take the starting measurement of a joint with ROM measurements, but what motion requires you to start by measuring the thumb’s starting position on the 2nd metatarsal?
A. CMC flexion
B. CMC extension
C. CMC abduction
D. all of the listed options
D. all of the listed options
Your patient has a fracture of their distal radius with a posterior displacement, what is the name of this fracture?
a. Monteggia fracture
b. Galeazzi fracture
c. Colles fracture
d. Smith fracture
c. Colles fracture
What is our best evidence-based intervention for carpal tunnel syndrome?
a. median nerve glides
b. neutral wrist splint
c. thermal ultrasound to the carpal tunnel
d. iontophoresis to the carpal tunnel
b. neutral wrist splint
Which tendon injury would have symptoms that could be mistaken for a scaphoid fracture, based off location alone.
a. Intersection syndrome
b. Trigger finger
c. de Quervain’s
d. Mallet finger
c. de Quervain’s
You suspect a scaphoid fracture due to the MOI being a fall on an outstretched hand and tenderness in the anatomical snuff box. Which is one of the tendons that outline the anatomical snuff box?
A. Extensor carpi ulnaris
B. Carpal tunnel
C. Flexor digitorum profundus
D. Extensor pollicis longus
D. Extensor pollicis longus
Which is not an example of a neuroplastic change in CNS with CRPS?
a. Your patient perceives their injured hand as larger than it really is
b. Your patient has more errors than most in identifying right vs left hand images
c. Your patient spends more time than most in identifying right vs left hand images
d. Your patient has more swelling in their affected hand than most
d. Your patient has more swelling in their affected hand than most
Your patient has tenderness in the anatomical snuff box, what bone is likely fractured?
a. Lunate
b. Capitate
c. Scaphoid
d. TFCC
c. Scaphoid
Which is true of handcuff syndrome, aka Wartenberg’s syndrome?
a. weakness of the wrist extensors
b. weakness of the finger extensors
c. sensation loss on radial dorsal hand
d. no sensation loss
c. sensation loss on radial dorsal hand
What is the hallmark symptom of a flexor pulley injury?
a. Limited passive extension of the DIP
b. Limited active extension of the DIP
c. Bowstinging
d. Inability to isolate flexion of the DIP
c. Bowstinging
What peripheral nerve should we suspect is injured if your patient has weakness with T1 nerve root myotome testing and decreased sensation into the ring finger?
A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve
A. Ulnar nerve
Which is not a risk factor for CRPS?
a. Anxiety
b. Immobilization after fracture
c. Neurogenic inflammation
d. High level of acute pain
a. Anxiety
What structure provides stability to the distal radial ulnar joint on the ulnar side?
a. Radial collateral ligament
b. TFCC
c. UCL of the first MCP joint
d. Carpal ligament
b. TFCC
Your patient has pain, numbness and tingling in the pinky. What positive test is paired with the correct diagnosis for the differential diagnosis you would include?
a. Symptoms with elbow flexion for guyon’s canal syndrome
b. Symptoms with pressure provocation test between the pisiform and hamate for guyon’s canal syndrome
c. Weakness with flexion testing of the DIP of the little finger for guyon’s canal syndrome
d. Positive pinch test and OK sign for ulnar nerve involvement.
b. Symptoms with pressure provocation test between the pisiform and hamate for guyon’s canal syndrome
Your patient has ulnar drift and is having difficulty typing, as she is struggling to abduct her right index finger to reach the “Y” and “H” on the keyboard. Which manual technique should you consider?
a. dorsal MCP mob
b. volar MCP mob
c. radial MCP mob
d. ulnar MCP mob
c. radial MCP mob