Question 71#

In the surgical treatment of trigger finger, what structure is incised?

A. The A1 pulley alone

The A1 pulley alone. In surgical treatment of trigger finger, the A1 pulley is incised - either through an open or a percutaneous approach. It is important to ensure complete release of the annulus that is contributing to the triggering and to avoid injury to the adjacent proximal edge of the A2 pulley. Division of the A1 pulley alone causes no significant loss of flexor function. The oblique pulley in the thumb and A2 pulley in a finger must be preserved when the A1 is divided in order to prevent bowstringing.

Question 72#

The following is true of congenital upper limb anomalies except:

A. They are commonly sub-classified according to thumb status

They occur in 1:150 births. This statement is incorrect; the actual incidence is approximately 1:500 births and are often bilateral. The teratologic sequence of Ogino includes clefting, symbrachydactyly and polydactyly. 

Question 73#

The middle finger extension test (active extension against resistance) is useful for all except:

A. Intrinsic tightness

Intrinsic tightness. A is incorrect. Intrinsic tightness is tested by the Bunnell-Finochietto test. When tightness is present, the PIP joints can be passively flexed without difficulty when the MCP joint is flexed, but are tight when the MCP joint is extended.

Question 74#

In rheumatoid arthritis:

A. Anti-TNF alpha prevents articular destruction and tendon rupture

Thumb surgery is considered a low-risk, high-benefit procedure. Souter from Edinburgh described thumb surgery as a low-risk, high-benefit strategy. He wrote up his extensive series of results from rheumatoid surgeries, and ranked procedures in terms of predictability and efficacy of outcomes.

Question 75#

Which one of the following is a diagnostic criterion for rheumatoid arthritis according to the American Academy of Rheumatology?

A. Arthritis of the hand for >6 weeks

Arthritis of the hand for >6 weeks. To diagnose rheumatoid arthritis, four of the following seven must be present according to the American Academy of Rheumatology: 1) morning stiffness >1hr for >6 weeks; 2) arthritis for >6 weeks in three or more joints; 3) arthritis of the hand for >6 weeks; 4) positive rheumatoid factor; 5) presence of rheumatoid nodules; 6) typical radiographic changes; and, 7) symmetric arthritis for >6 weeks.