Complications: tourniquet palsy: 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 · Complications: tourniquet palsy

Sample item

After a 2.5-hour operation on the arm under a pneumatic tourniquet, a patient has a flaccid wrist drop that recovers over 8 weeks. What is the most likely mechanism?

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

The answer and the reasoning

D. Mechanical compression neurapraxia of the radial nerve at the edge of the cuff

Tourniquet palsy is mainly due to mechanical pressure, which is greatest at the cuff edges, rather than ischaemia alone. It is usually a neurapraxia, so it recovers spontaneously over weeks to months. Using the lowest effective pressure and keeping the cuff time to about 2 hours or less reduces the risk.

Option by option

  • A. Complete transection of the radial nerve

    Transection would not recover spontaneously and was not part of this procedure.

  • B. Ischaemia of the brachial plexus roots

    The plexus roots lie proximal to the cuff and are not compressed by it.

  • C. Volkmann ischaemic contracture of the forearm flexors

    Volkmann contracture follows forearm compartment ischaemia and produces flexion deformity, not wrist drop.

  • D. Mechanical compression neurapraxia of the radial nerve at the edge of the cuff (correct)

    Correct. Cuff-edge compression produces a neurapraxia of the radial nerve that recovers.

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 D, Mechanical compression neurapraxia of the radial nerve at the edge of the cuff. Tourniquet palsy is mainly due to mechanical pressure, which is greatest at the cuff edges, rather than ischaemia alone.

Why is "Complete transection of the radial nerve" not the answer?

Transection would not recover spontaneously and was not part of this procedure.

Why is "Ischaemia of the brachial plexus roots" not the answer?

The plexus roots lie proximal to the cuff and are not compressed by it.

Why is "Volkmann ischaemic contracture of the forearm flexors" not the answer?

Volkmann contracture follows forearm compartment ischaemia and produces flexion deformity, not wrist drop.

What concept does this question test?

It tests Complications: tourniquet palsy in Orthopaedics. It is usually a neurapraxia, so it recovers spontaneously over weeks to months. Using the lowest effective pressure and keeping the cuff time to about 2 hours or less reduces the risk.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Complications: tourniquet palsy?

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.