Free medical quiz

Hand and Wrist OSCE Examination Quiz

Focused SBA-style practice, followed by the answer and explanation for every question.

Free now: 7 questions
Full bank: 7 questions
Answers: Explained

Free question

Try one with the answer

A question from this quiz. Answer it to see the explanation students get.

A patient with wrist pain has reduced sensation over the palm side of the thumb, index and middle fingers. Their power grip is intact when they squeeze your fingers, but they struggle to pick up a coin and do up a shirt button. Which test, and its interpretation, best links these findings?

Ask them to pinch your finger between thumb and index finger; weakness here points to loss of the precision grip, which relies on the median nerve. Ask them to extend the wrist against resistance; weakness here is the main functional test for difficulty with buttons. Ask them to spread the fingers apart against resistance; weakness here directly explains being unable to pick up a coin with thumb and index finger. Ask them to hold a piece of paper between the thumb and the side of the index finger; weakness here points to adductor pollicis, supplied by the ulnar nerve. Ask them to make a fist and then straighten the fingers against resistance; weakness here points to a median nerve lesion.

A Ask them to pinch your finger between thumb and index finger; weakness here points to loss of the precision grip, which relies on the median nerve. ✓
B Ask them to extend the wrist against resistance; weakness here is the main functional test for difficulty with buttons.
C Ask them to spread the fingers apart against resistance; weakness here directly explains being unable to pick up a coin with thumb and index finger.
D Ask them to hold a piece of paper between the thumb and the side of the index finger; weakness here points to adductor pollicis, supplied by the ulnar nerve.
E Ask them to make a fist and then straighten the fingers against resistance; weakness here points to a median nerve lesion.

The answer is A: Ask them to pinch your finger between thumb and index finger; weakness here points to loss of the precision grip, which relies on the median nerve.

Explanation

Why A is correct

See Assessment of Function. Option A is correct because the story is carpal tunnel syndrome until proven otherwise: reduced sensation on the palm side of the thumb, index and middle fingers is the territory of the median nerve, which is squeezed as it passes through the carpal tunnel (the narrow channel at the wrist). Its motor branch supplies the thenar muscles, the bulky muscles at the base of the thumb, which give the thumb its strength for pinching and opposition (touching the thumb to the other fingers). So the patient keeps a good power grip, which uses the long finger flexors in the forearm, but loses the precision grip needed for a coin or a button. A pinch test, asking the patient to pinch your finger between the thumb and index finger, reproduces exactly this problem. Reduced hand grip and pinch grip strength are recognised features of carpal tunnel syndrome, so a weak pinch fits the median nerve.

Likely diagnosis: Carpal tunnel syndrome.
Nerve involved: The median nerve, which supplies the thumb, index and middle fingers and the thenar muscles.
Grip: Power grip is preserved but precision grip and pinch are weak.

Why the other options are incorrect

B. Ask them to extend the wrist against resistance; weakness here is the main functional test for difficulty with buttons.: Wrist extension against resistance tests the radial nerve, and weakness causes a wrist drop. It is not the test for difficulty picking up coins or doing up buttons.
C. Ask them to spread the fingers apart against resistance; weakness here directly explains being unable to pick up a coin with thumb and index finger.: Spreading the fingers against resistance tests the ulnar nerve. It does not explain being unable to pick up a coin between the thumb and index finger.
D. Ask them to hold a piece of paper between the thumb and the side of the index finger; weakness here points to adductor pollicis, supplied by the ulnar nerve.: Holding paper between the thumb and side of the index finger tests adductor pollicis, an ulnar-nerve-supplied muscle, so it does not explain the reduced median nerve sensation or the weak thumb-index pinch.
E. Ask them to make a fist and then straighten the fingers against resistance; weakness here points to a median nerve lesion.: Straightening the fingers against resistance tests finger extension, which is supplied by the radial nerve, not the median nerve, so this would not demonstrate the problem described.

Hard

With Premium, questions you miss become Revision Coach flashcards, scheduled for review.

Question preview

What you will practise

More questions from this set. Start the quiz to answer them and see each explanation.

1
After finishing the focused hand assessment, which action best completes the examination?
2
On general inspection at the start of a hand examination, which observation most directly suggests long-standing loss of hand function?

Need wider coverage?

Explore every OSCE topic set, or build a tailored mixed session.

Browse subject quizzes