Peripheral nerve injuries: Vaughan-Jackson syndrome: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Peripheral nerve injuries: Vaughan-Jackson syndrome

Sample item

A woman with long-standing rheumatoid arthritis suddenly cannot extend her little finger at the metacarpophalangeal joint, and over the next weeks the ring finger follows. The head of the ulna is prominent. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Attritional rupture of extensor tendons over a prominent ulnar head

In Vaughan-Jackson syndrome, synovitis and a dorsally subluxed ulnar head erode the extensor tendons, so they rupture one by one from the ulnar side, starting with extensor digiti minimi. A posterior interosseous nerve palsy would weaken all digits and the thumb together. Treatment is tendon transfer or grafting with ulnar head resection.

Option by option

  • A. Ulnar nerve compression at the cubital tunnel

    Cubital tunnel compression causes ulnar intrinsic weakness and clawing, not loss of metacarpophalangeal extension.

  • B. Posterior interosseous nerve palsy

    A posterior interosseous palsy would paralyse finger and thumb extension together, not one finger at a time.

  • C. Attritional rupture of extensor tendons over a prominent ulnar head (correct)

    Correct. Sequential tendon rupture from the ulnar side over a prominent ulnar head is the classic pattern.

  • D. Stenosing tenosynovitis of the A1 pulley

    A trigger finger gives painful catching in flexion, with no loss of active extension.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Attritional rupture of extensor tendons over a prominent ulnar head. In Vaughan-Jackson syndrome, synovitis and a dorsally subluxed ulnar head erode the extensor tendons, so they rupture one by one from the ulnar side, starting with extensor digiti minimi.

Why is "Ulnar nerve compression at the cubital tunnel" not the answer?

Cubital tunnel compression causes ulnar intrinsic weakness and clawing, not loss of metacarpophalangeal extension.

Why is "Posterior interosseous nerve palsy" not the answer?

A posterior interosseous palsy would paralyse finger and thumb extension together, not one finger at a time.

Why is "Stenosing tenosynovitis of the A1 pulley" not the answer?

A trigger finger gives painful catching in flexion, with no loss of active extension.

What concept does this question test?

It tests Peripheral nerve injuries: Vaughan-Jackson syndrome in Orthopaedics. A posterior interosseous nerve palsy would weaken all digits and the thumb together. Treatment is tendon transfer or grafting with ulnar head resection.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Peripheral nerve injuries: Vaughan-Jackson syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.