100+ Free ABOS Surgery of the Hand Practice Questions

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A 28-year-old falls on an outstretched hand and has anatomic snuffbox tenderness. Radiographs appear normal. What is the BEST next step?

Discharge with activity as tolerated

Thumb spica splint/cast and repeat imaging (X-ray in 10-14 days OR MRI/CT for earlier diagnosis) to rule out occult scaphoid fracture

NSAIDs only with immediate return to activity

Ulnar nerve release

to track

2026 Statistics

Key Facts: ABOS Surgery of the Hand Exam

175

Multiple-Choice Items

Single session, computer-based

4.5 hrs

Test Center Duration

Includes testing, break, tutorial

$2,450

Total 2026 Fee

ABOS $1,225 application + $1,225 exam

3 boards

Joint Certificate

ABOS, ABPS, and ABS (added 2024)

7 domains

Blueprint Content Areas

Bone, Joint/Ligament, Nerve, Tendon, General, Skin, Circulation

~2,500

Current ABOS Diplomates

Holding the Hand Surgery subspecialty certificate

The ABOS Surgery of the Hand exam is a 4.5-hour, 175-question computer-based subspecialty examination at Pearson VUE. The ABOS blueprint allocates Bone 20%, Joint/Ligament 20%, Nerve 15%, Muscle/Tendon 13%, General Principles/Other 13%, Skin/Fascia/Nails 12%, and Circulatory System 7%. The certificate is a joint offering of ABOS, ABPS, and ABS (added 2024). ABOS candidates pay $1,225 application + $1,225 exam = $2,450. Applications/case lists due February 1. Approximately 2,500 ABOS diplomates hold this subspecialty certificate; 36 hold both Sports Medicine and Hand Surgery subspecialties.

Sample ABOS Surgery of the Hand Practice Questions

Try these sample questions to test your ABOS Surgery of the Hand exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old falls on an outstretched hand and has anatomic snuffbox tenderness. Radiographs appear normal. What is the BEST next step?

A.Discharge with activity as tolerated

B.Thumb spica splint/cast and repeat imaging (X-ray in 10-14 days OR MRI/CT for earlier diagnosis) to rule out occult scaphoid fracture

C.NSAIDs only with immediate return to activity

D.Ulnar nerve release

Explanation: Snuffbox tenderness after FOOSH (fall on outstretched hand) is presumed scaphoid fracture until proven otherwise — up to 15-20% of scaphoid fractures are occult on initial X-rays. Treatment: thumb spica splint/cast AND repeat imaging (X-ray at 10-14 days or MRI/CT for earlier definitive diagnosis). Missed scaphoid fractures lead to nonunion, SNAC (scaphoid nonunion advanced collapse), and wrist arthritis. Scaphoid tubercle tenderness and pain with axial thumb load also support the diagnosis.

2A 25-year-old has a displaced proximal pole scaphoid fracture. What is the MOST concerning complication given the blood supply of the scaphoid?

A.High rate of healing with casting alone

B.High risk of nonunion (~30%) and AVN due to retrograde blood supply from the dorsal carpal branch of the radial artery entering at the distal/waist region

C.Median nerve palsy

D.Thumb opposition weakness

Explanation: The scaphoid receives 80% of its blood supply from the dorsal carpal branch of the radial artery, which enters the distal pole and flows retrograde toward the proximal pole. Proximal pole fractures have ~30% nonunion rate and high AVN risk with nonoperative management. Treatment: displaced or proximal pole fractures → ORIF with Herbert screw (compression cannulated screw); delayed/nonunion → vascularized bone grafting (1,2 ICSRA pedicle graft, volar vascularized distal radius graft, or medial femoral condyle free flap for large defects with avascular proximal pole).

3A 55-year-old has a comminuted intra-articular distal radius fracture with dorsal angulation of 25° and radial shortening of 5 mm. What is the BEST surgical management?

A.Short-arm cast only

B.Volar locking plate fixation — gold-standard for unstable intra-articular distal radius fractures; restores radial length, radial inclination, volar tilt, and articular congruity

C.External fixator only

D.Observation

Explanation: Volar locking plate (VLP) is the workhorse for unstable distal radius fractures (AO/OTA type B and C, intra-articular fractures with significant dorsal angulation, radial shortening, or articular step-off). Advantages: angular stability with locking screws preserves reduction; direct buttress of the volar cortex; excellent visualization of articular surface via volar approach (Henry). Normal distal radius parameters — radial inclination ~22°, volar tilt ~11°, radial length ~12 mm. Acceptable reduction criteria in young active patients: dorsal angulation ≤5-10° (ideally preserve volar tilt ≥0°), radial shortening <2-5 mm, intra-articular step-off <2 mm.

4Which parameter is MOST critical to restore in surgical treatment of a distal radius fracture?

A.Only radial length

B.All three: radial length (~12 mm), radial inclination (~22°), and volar tilt (~11°) — plus intra-articular congruity (<2 mm step-off); restoration of these optimizes wrist function

C.Only volar tilt

D.Only radial inclination

Explanation: Distal radius anatomic parameters: radial inclination ~22° (15-25°), volar tilt ~11° (10-15°), radial length ~12 mm relative to ulna (10-13 mm), and articular congruity. Loss of any parameter impacts function and may cause DRUJ instability, wrist pain, and secondary arthritis. Acceptable reduction criteria (consensus): dorsal angulation ≤5-10°, radial length within 2-5 mm of contralateral, intra-articular step-off <2 mm. Malunion with persistent dorsal angulation >20° or radial shortening >5 mm in active patients can cause ulnocarpal abutment, carpal malalignment (DISI), and may warrant corrective osteotomy.

5Lichtman staging of Kienböck disease: a patient with lunate collapse AND fixed scaphoid rotation (DISI with scaphoid ring sign) is classified as:

A.Stage I

B.Stage IIIB — collapsed lunate + fixed scaphoid rotation; treatment options include STT fusion, scaphocapitate fusion, or proximal row carpectomy

C.Stage II

D.Stage IV

Explanation: Lichtman Kienböck staging: I — normal radiograph, MRI edema; II — sclerosis without collapse; IIIA — lunate collapse without fixed scaphoid rotation; IIIB — collapse WITH fixed scaphoid rotation (DISI, 'scaphoid ring sign'); IV — pancarpal arthritis. Stage IIIB treatment options: salvage procedures including STT (scaphotrapeziotrapezoid) fusion, scaphocapitate fusion, or proximal row carpectomy (PRC) for lunate replacement. Stage IIIA: joint leveling (radial shortening osteotomy for negative ulnar variance) OR revascularization (vascularized bone graft). Stage IV: total wrist fusion or wrist arthroplasty.

6A 30-year-old factory worker has a closed, nondisplaced 5th metacarpal neck fracture (boxer's fracture) with 30° of apex-dorsal angulation. Best management?

A.ORIF always

B.Closed treatment (ulnar gutter splint/cast with MCP in 70-90° flexion) — up to 40° of angulation is typically acceptable at the 5th metacarpal neck given the mobility of the CMC joint

C.Percutaneous K-wire fixation required

D.Observation without immobilization

Explanation: Boxer's fractures (5th metacarpal neck) allow significant angulation acceptance due to the mobility of the 5th CMC joint. Acceptable angulation (general guidelines): 2nd-3rd MC <10-15° (fixed CMCs), 4th MC ~15-20°, 5th MC ~30-40° (some sources accept up to 40-50°). Malrotation (finger overlap on fist, scissoring) and pseudoclawing (with hyperextension at MCP) are INDICATIONS for surgery. Closed treatment: ulnar gutter splint/cast with MCP flexed 70-90° and PIP free (intrinsic plus position). Operative fixation for multiple adjacent fractures, open fractures, or malrotation — options include CRPP (transverse intermetacarpal K-wires) or ORIF with plate.

7In a displaced intra-articular phalangeal fracture of the middle phalanx base involving the PIP joint, which operative approach is typical?

A.Observation always

B.ORIF with a dorsal approach, cerclage wire or mini-fragment screw fixation; for severely comminuted pilon-type PIP fractures → hemi-hamate arthroplasty or dynamic external fixation

C.Complete amputation

D.Radial shortening osteotomy

Explanation: Intra-articular PIP fractures: (1) Simple (<40% articular involvement, reducible) → closed reduction + extension block splinting or percutaneous pinning; (2) Moderate comminution or irreducible → ORIF with mini-fragment (1.0-1.5 mm) screws, cerclage wires, or buttress plate; (3) Severe pilon-type (>50% articular comminution, impaction) → reconstructive options include hemi-hamate arthroplasty (osteochondral graft from dorsal hamate replacing volar articular surface), dynamic external fixation (Suzuki pin + rubber band traction), or volar plate arthroplasty. Untreated PIP joint fracture-dislocations develop stiffness and arthritis. Early controlled motion is essential.

8A 40-year-old has a displaced scaphoid waist fracture with >1 mm displacement. Best management for earlier return to full activity?

A.Long-arm thumb spica casting for 12 weeks

B.Percutaneous or mini-open Herbert screw (cannulated compression screw) fixation — allows earlier mobilization and may shorten time to union compared to casting

C.Observation

D.Complete amputation

Explanation: Displaced scaphoid fractures (>1 mm displacement, >10° angulation, humpback deformity) have higher nonunion rates with casting alone (~30-40%) vs nondisplaced fractures (~5-10%). Herbert screw fixation (cannulated compression screw) via percutaneous or mini-open approach — dorsal percutaneous technique for proximal pole and waist fractures (screw perpendicular to fracture plane), volar approach for distal pole. Advantages: earlier range of motion and strengthening, shorter time to union (6-8 weeks vs 10-16 weeks casting), faster return to sport/work. Bone grafting (autograft or allograft) added for established nonunion or humpback deformity correction.

9Perilunate dislocation: Mayfield staging identifies the progression of force through the carpus. Stage IV represents:

A.Scapholunate dissociation only

B.Volar lunate dislocation — the lunate is dislocated volarly with the rest of the carpus remaining aligned; 'spilled teacup' appearance on lateral radiograph

C.Stable distal radius fracture

D.Simple wrist sprain

Explanation: Mayfield classification of perilunate injuries (greater arc through bones, lesser arc through ligaments): Stage I — SL dissociation; Stage II — SL + lunocapitate disruption (capitate dislocates dorsal to lunate); Stage III — + LT dissociation (perilunate dislocation — lunate aligned, capitate dorsal); Stage IV — volar lunate dislocation ('spilled teacup' sign on lateral X-ray — lunate rotated volarly with capitate aligned). Emergency closed reduction and immobilization; most require definitive ORIF with SL and LT repair, K-wire stabilization, and possibly vascularized bone graft for chronic cases. Missed perilunate injuries are a leading cause of chronic wrist dysfunction.

10In SLAC wrist (scapholunate advanced collapse), which stage is characterized by arthritis between the radial styloid and distal scaphoid with otherwise preserved radiocarpal and capitolunate articulations?

A.Stage I (radial styloidectomy)

B.Stage II

C.Stage III

D.Stage IV

Explanation: SLAC wrist staging (progression over 10-20 years from chronic SL dissociation): Stage I — radial styloid to scaphoid tip arthritis → radial styloidectomy (limited procedure); Stage II — whole radioscaphoid joint arthritis; Stage III — capitolunate joint involvement; Stage IV — pancarpal arthritis. Treatment: I → radial styloidectomy; II-III → proximal row carpectomy (PRC) OR scaphoid excision + 4-corner fusion; IV → total wrist arthrodesis or total wrist arthroplasty. PRC vs 4-corner fusion outcomes similar; PRC preserves more motion but has higher risk with degenerative capitate dome. SNAC (scaphoid nonunion advanced collapse) follows a similar progression from untreated scaphoid nonunion.

About the ABOS Surgery of the Hand Exam

The ABOS Surgery of the Hand Subspecialty Examination is the subspecialty certification exam for hand surgeons, developed and administered by the Joint Committee on Surgery of the Hand of the American Boards of Orthopaedic Surgery (ABOS) and Plastic Surgery (ABPS). Established in 1989, the certificate is jointly recognized — candidates enter through their primary board: orthopaedic surgery (ABOS), plastic surgery (ABPS), or general surgery (ABS, effective 2024 via ABPS pathway). Content covers the full breadth of hand surgery: bone (distal radius, scaphoid, carpal, hand fractures, Kienböck), joint/ligament (arthritis, SL/LT dissociation, TFCC, thumb UCL Stener), nerve (CTS, cubital tunnel, brachial plexus), muscle/tendon (flexor/extensor tendon zones, Dupuytren, tendon transfers), circulation (vascular injury, replantation, Raynaud), skin/fascia/nails (flap coverage, Dupuytren, infections), and congenital/general principles. Candidates must complete a one-year ACGME-accredited hand fellowship and submit a case list meeting minimum requirements in 5 of 9 categories.

Questions

175 scored questions

Time Limit

4.5 hours at test center (includes testing, break, and tutorial)

Passing Score

Criterion-referenced scaled passing standard set by the Joint Committee on Surgery of the Hand of ABOS and ABPS

Exam Fee

$1,225 application + $1,225 exam = $2,450 (ABOS 2026) (American Board of Orthopaedic Surgery (ABOS) — joint certificate with ABPS and ABS; administered at Pearson VUE)

ABOS Surgery of the Hand Exam Content Outline

20%

Bone

Hand fractures 5% (metacarpal — boxer's fracture, phalangeal), distal radius 4% (volar locked plate for AO/OTA type C, dorsal tilt >10°, radial inclination <15°, intra-articular step-off >2 mm), forearm 1%, carpal 2% (scaphoid — snuffbox tenderness, Herbert screw for displaced or proximal pole; 30% proximal pole nonunion due to retrograde blood supply), malunion/nonunion 2% (osteotomy, bone grafting — vascularized for Kienböck/proximal pole scaphoid), infection/osteonecrosis 2% (Kienböck — Lichtman staging, Preiser), physeal 1%, anatomy/physiology/metabolic 3%.

20%

Joint/Ligament

Acute dislocations/fracture-dislocations 4% (perilunate, Mayfield stages, greater/lesser arc injuries), infection 1%, degenerative/posttraumatic arthritis 5% (CMC — LRTI/suspensionplasty, MCP, PIP — silicone vs pyrocarbon arthroplasty, DIP fusion, SLAC wrist staging and proximal row carpectomy vs 4-corner fusion), contractures/stiffness 1%, inflammatory arthritis 4% (RA, crystalline, SLE, psoriatic, scleroderma — DMARDs, soft-tissue reconstruction), ligament injury 3% (DRUJ/TFCC — Palmer classification, SL dissociation — Watson test and Terry Thomas sign, thumb UCL Stener lesion → open repair), anatomy 2%.

15%

Nerve

Compressive neuropathies — carpal tunnel syndrome (Phalen 60s, Tinel, Durkan carpal compression test; electrodiagnostics confirm but negative EDX does not exclude; open vs endoscopic release equivalent long-term outcomes), cubital tunnel (in-situ decompression vs anterior transposition), radial tunnel/PIN/AIN; traumatic injuries (Seddon neurapraxia/axonotmesis/neurotmesis; Sunderland I-V; primary end-to-end repair <2 cm tension, nerve autograft — sural, conduit for short gaps <3 cm, allograft processing); brachial plexus (obstetric and adult); nerve tumors (schwannoma, neurofibroma); CRPS types I and II.

13%

Muscle/Tendon

Flexor tendon injuries — zones I (distal to FDS insertion — FDP avulsion/jersey finger — Leddy-Packer), II (classic 'no man's land', zone of pulleys), III (palm), IV (carpal tunnel), V (proximal to carpal tunnel); core suture techniques (4-strand modified Kessler, Bunnell, cruciate; epitendinous 6-0 running); early active motion (Indiana, Strickland/Glogovac) protocols; pulley system A1-A5 with A2 and A4 critical. Extensor zones I (DIP — mallet finger), III (PIP — boutonnière), IV (proximal phalanx — sagittal band rupture); tendon transfers for radial nerve palsy (PT→ECRB, FCR→EDC, PL→EPL), median (FDS III→EPB, PL→APB), ulnar (ECRL→ADQ/APB, FDS ring→lumbricals); trigger finger (A1 release), de Quervain (1st dorsal compartment EPB/APL).

13%

General Principles / Other

Patient safety 2% (polytrauma triage, DVT prophylaxis, radiation exposure minimization, physician wellness, medication reconciliation), benign tumors 3% (ganglion — most common hand mass, giant cell tumor of tendon sheath, lipoma, inclusion cyst, osteochondroma, enchondroma — Ollier/Maffucci), skin tumors 1%, metastatic/sarcoma 1%, congenital hand plate 1% (trigger thumb, camptodactyly, clinodactyly, syndactyly — Oberg-Manske-Tonkin classification, polydactyly — Wassel for radial, symbrachydactyly), radial/thumb deficiency 1% (Blauth thumb classification, pollicization), common syndromes 1% (Apert, Poland, Madelung — Vickers ligament), biostatistics 1%.

12%

Skin/Fascia/Nails

Dupuytren disease (collagenase Clostridium histolyticum injection, percutaneous needle aponeurotomy, limited fasciectomy — highest recurrence but best for severe disease, dermofasciectomy for recurrence; Hueston tabletop test; palmar/digital cords; PIP contracture is hardest to correct); fingertip injuries and nailbed repair (V-Y advancement, cross-finger flap, thenar flap, Moberg advancement for thumb); soft-tissue coverage (reverse radial forearm flap, posterior interosseous artery flap, groin flap, free flap for large defects); hand infections — paronychia, felon (I&D), flexor tenosynovitis (Kanavel signs: fusiform swelling, flexed position, pain with passive extension, percussion tenderness — surgical emergency); hidradenitis; burns.

Circulatory System

Vascular injuries (ulnar/radial artery laceration, Allen test — confirm dual blood supply before radial harvest), replantation indications (thumb, multiple digits, child, sharp proximal to FDS insertion, hand/wrist/forearm) vs contraindications (single digit distal to FDS insertion in adult — except thumb/child, severe crush/avulsion, prolonged warm ischemia >12 h for digit/>6 h for hand), microsurgical technique (10-0 nylon, vein grafts, under magnification); Raynaud phenomenon (primary vs secondary — scleroderma, SLE); thrombosis — ulnar artery thrombosis at hypothenar hammer syndrome (Guyon's canal); vascular malformations; frostbite; high-pressure injection injuries (surgical emergency regardless of benign initial appearance).

How to Pass the ABOS Surgery of the Hand Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing standard set by the Joint Committee on Surgery of the Hand of ABOS and ABPS
Exam length: 175 questions
Time limit: 4.5 hours at test center (includes testing, break, and tutorial)
Exam fee: $1,225 application + $1,225 exam = $2,450 (ABOS 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABOS Surgery of the Hand Study Tips from Top Performers

1Master flexor tendon zones — Zone I distal to FDS insertion (FDP avulsion/jersey finger — Leddy-Packer I-III), Zone II the classic 'no man's land' (pulleys A1-A5 with A2 and A4 critical, 4-strand core suture + 6-0 epitendinous, early active motion rehab per Strickland/Indiana), Zone III palm, Zone IV carpal tunnel (rare, often require CTR), Zone V proximal

2Know scaphoid fracture management cold — snuffbox + scaphoid tubercle tenderness + axial thumb load pain → thumb spica immobilization even with negative XR; repeat XR or MRI in 10-14 days; nondisplaced waist → thumb spica cast 8-12 weeks vs percutaneous Herbert screw; proximal pole or displaced → ORIF with Herbert screw; 30% nonunion rate for proximal pole due to retrograde blood supply from dorsal carpal branch of radial artery

3Memorize tendon transfer principles (Boyes): one tendon one function, synergy, adequate excursion (wrist motors 33 mm, finger extensors 50 mm, finger flexors 70 mm), strength preservation, straight line of pull, expendable donor. Classic transfers — radial nerve palsy: PT→ECRB, FCR→EDC, PL→EPL; low median: opponensplasty (PL abductorplasty or FDS ring to APB); low ulnar: FDS ring for intrinsic claw correction

4Know Kanavel signs of suppurative flexor tenosynovitis — (1) fusiform swelling of the digit, (2) finger held in flexed position, (3) severe pain with passive extension (most sensitive), (4) tenderness along flexor sheath — surgical emergency requiring I&D of the sheath and IV antibiotics to prevent tendon rupture and stiffness

5Distinguish thumb UCL injury — Gamekeeper's thumb (chronic stress) vs Skier's thumb (acute); Stener lesion = UCL displaced proximal and superficial to the adductor aponeurosis, preventing healing → requires open repair/bone anchor fixation; nondisplaced UCL injuries may be treated with thumb spica immobilization 4-6 weeks

Frequently Asked Questions

What is the ABOS Surgery of the Hand subspecialty exam?

The ABOS Surgery of the Hand Subspecialty Examination is a joint subspecialty certification examination offered by the Joint Committee on Surgery of the Hand of the American Boards of Orthopaedic Surgery (ABOS) and Plastic Surgery (ABPS). Established in 1989, it is for board-certified surgeons who have demonstrated advanced qualifications in hand surgery through additional fellowship training and clinical volume. The certificate is recognized across three primary boards: ABOS (orthopaedic surgery), ABPS (plastic surgery), and ABS (general surgery, added 2024 via the ABPS pathway).

How is the exam structured and how many questions does it contain?

The exam contains 175 multiple-choice items delivered at Pearson VUE test centers. Candidates spend approximately 4.5 hours at the test center, which includes testing time, an optional break, and a tutorial. The ABOS blueprint organizes content into seven domains: Bone 20%, Joint/Ligament 20%, Nerve 15%, Muscle/Tendon 13%, General Principles/Other 13%, Skin/Fascia/Nails 12%, and Circulatory System 7%. Both ABOS and ABPS candidates take the same examination content, though fees and registration are handled by the primary board.

Who is eligible to take the exam?

Candidates must hold primary board certification — ABOS (orthopaedic surgery), ABPS (plastic surgery), or ABS (general surgery, effective 2024). They must also complete a one-year ACGME-accredited hand surgery fellowship and submit a one-year case list demonstrating minimum case volume in at least 5 of 9 surgery-of-the-hand categories (bone, joint/ligament, tendon, nerve, vascular, congenital, tumor, skin/soft-tissue, amputation/replantation). Applications and case lists are due by February 1 for that year's examination. Approximately 2,500 ABOS diplomates currently hold this subspecialty certificate.

How much does the exam cost?

For ABOS candidates, the 2026 fee structure is $1,225 application fee plus $1,225 examination fee for a total of $2,450. A $750 late fee applies to applications submitted after the initial deadline. The application fee is non-refundable but transferable for one year; the examination fee is refundable if the candidate withdraws in writing at least 5 days prior to the exam. ABPS hand candidates register through ABPS and pay fees set by that board (2026 ABPS initial: $800 registration + $800 application plus other fees). ABS candidates apply through the ABPS pathway.

How is this different from the ABPS/ABS hand surgery certification?

The examination CONTENT is the same — it is a single joint examination developed by the Joint Committee on Surgery of the Hand of ABOS and ABPS. What differs is the primary board pathway: ABOS candidates apply through ABOS (must be ABOS board certified, case list reviewed by ABOS), ABPS candidates apply through ABPS, and ABS candidates apply through the ABPS pathway (as of 2024). Fees and registration differ by primary board, but all candidates sit the same examination and earn the same joint Hand Surgery subspecialty certificate.

What are the highest-yield topics on the exam?

Bone + Joint/Ligament together are 40% — master distal radius fixation indications (volar locking plate, external fixation for severely comminuted), scaphoid fracture with snuffbox tenderness (Herbert screw, 30% proximal pole nonunion due to retrograde blood supply from dorsal carpal branch), Kienböck staging (Lichtman I-IV: MRI edema → fragmentation), SLAC wrist staging, CMC arthritis staging, and thumb UCL Stener lesion requiring open repair. Nerve (15%) — CTS (Phalen/Tinel/Durkan), cubital tunnel, Seddon/Sunderland. Tendon (13%) — flexor zone II repair, extensor zones, tendon transfers for nerve palsies.

What are the key surgical concepts for Dupuytren and CTS?

Dupuytren: Hueston tabletop test positive → surgical treatment; MCP contracture corrects well with any technique; PIP contracture is hardest; options are collagenase injection (shortest recovery, moderate recurrence), needle aponeurotomy (quick, higher recurrence), limited fasciectomy (gold standard for severe), dermofasciectomy (reserved for recurrence with skin involvement). Carpal Tunnel Syndrome: Phalen 60s, Tinel over median nerve, Durkan compression test (most sensitive clinical test); EDX confirms but may be normal in mild cases; open carpal tunnel release (OCTR) and endoscopic (ECTR) have equivalent long-term outcomes — ECTR has faster return to work, OCTR simpler and cheaper.

How should I prepare for the exam?

Start 6-9 months before the exam. Use Green's Operative Hand Surgery as the core reference, supplemented by JHS/ASSH review articles and Orthobullets. Cover flexor and extensor tendon zones (zone II repair technique and rehab), tendon transfers for radial/median/ulnar nerve palsies, scaphoid and Kienböck management, inflammatory arthritis surgery, replantation indications, congenital hand (Oberg-Manske-Tonkin, Wassel, Blauth), and microsurgery principles. Complete thousands of practice questions and take at least two timed 175-question practice exams. Review the ABOS Surgery of the Hand Blueprint to ensure proportional coverage across all seven domains.