- What This Credential Actually Is
- Who Qualifies: Fellowship, Practice, and Caseload
- Exam Format and Remote Proctoring
- The 12-Category Blueprint, Ranked by Weight
- High-Yield Content Inside the Biggest Categories
- Smaller Domains That Still Cost Points
- Sequencing Your Preparation by Domain
- Fees, Dates, and Registration Mechanics
- Keeping the Certification: Ten-Year OCC
- Where the Credential Matters Professionally
- Frequently Asked Questions
- The exam is 100 Type A single-best-answer questions in two hours, with no scheduled break.
- A passing score is 500 on a 200-800 scale.
- Arthritis (13-15%), Nerve (12-14%), and Infection (11-13%) are the three heaviest blueprint categories.
- Award requires 125 major hand cases in a consecutive 12-month period and at least 50% hand operative caseload.
What This Credential Actually Is
Hand Surgery CAQ Certification refers here to the Subspecialty Certification in Hand Surgery issued through the American Osteopathic Board of Orthopedic Surgery (AOBOS) under the American Osteopathic Association (AOA). The official name has moved on from "Certificate of Added Qualifications," but the CAQ label persists in everyday conversation, in job postings, and on this site. If you are searching for a plain-language definition first, our explainers on what Hand Surgery CAQ is and what Hand Surgery CAQ stands for cover the terminology.
The credential is aimed at osteopathic orthopedic surgeons who completed hand fellowship training and want formal subspecialty recognition in a domain that spans bone, joint, nerve, tendon, vascular, and soft tissue pathology from fingertip to elbow. It is not a primary board certification. It sits on top of one, and the AOBOS requirements make that dependency explicit.
Who Qualifies: Fellowship, Practice, and Caseload
Eligibility is staged. You may sit for the examination earlier than you may be awarded the certification, and candidates frequently confuse the two gates. The full breakdown lives in our Hand Surgery CAQ requirements guide, but the structure is as follows.
To sit for the exam
- Completion of a one-year ACGME hand surgery fellowship, with program verification
- A valid, unrestricted license
- Satisfaction of the board's ethics requirements
To be awarded the certification
- Qualifying AOBOS or AOBS primary certification
- Two years of active practice
- Hospital or facility privileges
- 125 major hand cases logged within a consecutive 12-month period, drawn from within the previous three years
- At least 50% of your operative caseload devoted to hand surgery
The 50% hand operative caseload threshold is worth taking seriously if you practice in a hybrid setting. A general orthopedic practice with occasional hand work may struggle to meet it, which is one reason the credential tends to attract surgeons who have deliberately built hand-predominant practices.
Exam Format and Remote Proctoring
The exam is a single block of 100 Type A single-best-answer multiple-choice questions delivered in two hours, with no scheduled break. That works out to roughly 72 seconds per item, which is tight for clinical vignettes that include imaging descriptions, exam findings, and a surgical decision point.
| Feature | Detail |
|---|---|
| Question type | Type A, single best answer |
| Number of questions | 100 |
| Time allowed | Two hours, one block |
| Scheduled break | None |
| Passing score | 500 on a 200-800 scale |
| Delivery | Remote proctoring through MonitorEDU |
| Practice interface | AOA guidance references PARADIGM |
Delivery is remote. You test from a private setting that meets the proctoring requirements, complete equipment checks beforehand, and may use authorized whiteboard or note tools as specified in the candidate instructions. We have not verified any open-book or adaptive-testing claims, so assume neither applies. Because the AOA guidance points candidates to the PARADIGM practice interface, spend time in it before test day; navigating an unfamiliar interface costs seconds you cannot spare in a 72-second-per-question format.
For a closer look at what the 500 threshold means in practice, see our breakdown of the Hand Surgery CAQ passing score.
The 12-Category Blueprint, Ranked by Weight
The official blueprint is undated and expressed as ranges rather than fixed counts. That means actual forms can shift slightly in emphasis, but the ranges tell you where preparation hours earn the most return. A detailed walk-through is available in our complete guide to all 12 content areas.
| Domain | Weight |
|---|---|
| Arthritis | 13-15% |
| Nerve | 12-14% |
| Infection | 11-13% |
| Joint | 10-12% |
| Osseous | 9-11% |
| Tendon | 8-10% |
| Tumor | 7-9% |
| Microsurgery | 6-8% |
| Vascular | 5-7% |
| Amputation | 3-5% |
| Pediatrics | 3-5% |
| Soft Tissue | 1-3% |
The top four categories (Arthritis, Nerve, Infection, Joint) together account for a large share of the exam. Add Osseous and Tendon and you have covered the bulk of the question pool. This is a hand surgeon's blueprint: it reflects the conditions that dominate an elective and urgent hand practice rather than the rare, dramatic cases that dominate fellowship conversation.
High-Yield Content Inside the Biggest Categories
Arthritis (13-15%)
The single heaviest category. Expect questions that ask you to choose among operative options based on joint, stage, and patient demands.
- Thumb carpometacarpal arthritis: staging and the logic behind resection, suspension, and fusion choices
- Distal radioulnar joint and wrist arthritis, including salvage procedure selection such as proximal row carpectomy versus limited or total fusion
- Inflammatory arthritis of the hand, including rheumatoid deformity patterns and tendon rupture risk
- PIP and DIP arthritis: arthrodesis versus arthroplasty tradeoffs
Nerve (12-14%)
Both compression neuropathies and traumatic injuries appear. Questions reward precise anatomy and clear thinking about timing and reconstruction.
- Carpal tunnel, cubital tunnel, and radial tunnel: exam findings, electrodiagnostic interpretation, and indications for surgery
- Peripheral nerve injury classification and timing of repair versus graft or transfer
- Nerve transfers for upper extremity palsy and brachial plexus patterns
- Complex regional pain syndrome recognition and management principles
Infection (11-13%)
A category that surprises candidates by its weight. Hand infections are a staple of urgent practice, and the exam tests recognition and first-line management.
- Flexor tenosynovitis: Kanavel signs and the decision between drainage and antibiotics
- Deep space infections, felon, paronychia, and septic arthritis
- Human and animal bite management and the organisms involved
- Necrotizing infection, atypical mycobacterial and fungal infections, and the clues that should prompt consideration of each
If you want to calibrate how demanding this content is relative to your fellowship exposure, our piece on how hard the Hand Surgery CAQ exam is addresses the difficulty question directly.
Smaller Domains That Still Cost Points
It is tempting to ignore the low-weight categories. Resist that instinct, particularly for the mid-range ones, because they are where fellowship-trained surgeons with narrow case mixes tend to leak points.
Joint, Osseous, and Tendon
Joint (10-12%) covers instability, dislocations, and ligament injury, including scapholunate and perilunate patterns, thumb ulnar collateral ligament injury, and PIP fracture-dislocation. Osseous (9-11%) is fracture and nonunion territory: distal radius, scaphoid, metacarpal, and phalangeal injuries, with attention to fixation choices. Tendon (8-10%) pulls in flexor and extensor tendon repair zones, rehabilitation protocols, and tendon transfers.
Tumor, Microsurgery, and Vascular
Tumor (7-9%) expects you to recognize common benign lesions such as ganglion cysts, giant cell tumor of tendon sheath, and enchondroma, and to identify the presentation that signals malignancy. Microsurgery (6-8%) addresses replantation indications, flap selection, and postoperative monitoring. Vascular (5-7%) includes ischemia evaluation, vasospastic conditions, and arterial injury or thrombosis.
Amputation, Pediatrics, and Soft Tissue
Amputation (3-5%) and Pediatrics (3-5%) are small but conceptually dense. Pediatric content spans congenital hand differences such as syndactyly, polydactyly, and radial dysplasia, plus pediatric fractures and growth plate considerations. Soft Tissue (1-3%) is the smallest slice and usually covers wound coverage and Dupuytren-type pathology in a limited number of items.
Key Takeaway
Allocate preparation time in proportion to blueprint weight, but never below a baseline pass over every category. The ranges mean a "small" domain can still contribute several questions, and with a 500-point passing threshold every item matters.
Sequencing Your Preparation by Domain
Generic study advice is plentiful, so here is the one place where we apply scheduling logic, tied directly to this blueprint. Our Hand Surgery CAQ study guide goes deeper; this timeline shows how to sequence domains over an eight-week build.
Front-load the heavy hitters
- Arthritis and Joint: tie wrist and thumb arthritis staging to the instability patterns that precede them
- Take a short diagnostic block in the PARADIGM-style interface to establish a baseline
Nerve and Infection
- Nerve: compression syndromes, injury classification, transfers
- Infection: build decision trees for flexor tenosynovitis, deep space infection, and bites
Osseous, Tendon, Tumor
- Fracture fixation logic and nonunion management
- Tendon repair zones and rehabilitation protocols
- Benign versus malignant tumor recognition
Low-weight sweep and timed practice
- Microsurgery, Vascular, Amputation, Pediatrics, Soft Tissue
- Full 100-question, two-hour simulations with no break to build stamina
The reasoning is simple. Heavy domains get your freshest attention and most repetition, while the final two weeks are reserved for timed, uninterrupted sessions. Because the real exam offers no scheduled break, practicing in full two-hour blocks is not optional conditioning; it is rehearsal for the actual constraint.
A concise reference to keep beside you during review is our Hand Surgery CAQ cheat sheet, and you can pressure-test your recall with the questions on the main practice test site.
Fees, Dates, and Registration Mechanics
The initial fee is $3,000. That is the figure to plan around for first-time certification. For context on what else might accumulate around that number, see our Hand Surgery CAQ certification cost breakdown.
On timing, note that the September 25, 2026 sitting has already passed. Because scheduling windows and deadlines are set by the board and can change, confirm the next available window directly with AOBOS and the AOA rather than relying on a cached date. Our exam dates and scheduling guide tracks how the windows have been structured.
Keeping the Certification: Ten-Year OCC
Certification is valid for ten years and is maintained through Osteopathic Continuous Certification (OCC). For the 2025-2027 cycle, requirements include:
- 60 hours of CME, of which 15 must be Category 1-A
- A quality-improvement attestation
- Documentation of professional standing
Hand surgery retains the long-form ten-year OCC exam, so recertification involves a substantive assessment rather than only a CME log. Building a habit of keeping CME records organized, and continuing to read broadly across the twelve blueprint categories, makes the ten-year exam far less daunting than starting from scratch a year before it is due.
Where the Credential Matters Professionally
Hand surgery is practiced in orthopedic groups with dedicated hand divisions, hospital-employed hand programs, trauma-oriented centers that need upper extremity coverage, and academic departments with fellowship teaching responsibilities. In each setting, formal subspecialty certification is a clear marker of focused competence for credentialing committees, referring physicians, and patients who ask about it.
We deliberately avoid quoting salary or hiring figures here, because we will not present numbers we cannot source. For a fuller discussion of the career case, our analyses of whether the certification is worth it, the earnings picture, and the Hand Surgery CAQ job landscape take that up in more depth. If you are weighing how selective the exam is, our review of the Hand Surgery CAQ pass rate explains what is and is not publicly known.
Frequently Asked Questions
The exam contains 100 Type A single-best-answer multiple-choice questions, delivered in a single two-hour block with no scheduled break. Pacing matters because there is roughly 72 seconds available per question.
The passing score is 500 on a 200-800 scale. Our passing score guide explains how to interpret that threshold when planning your preparation.
Arthritis is the largest category at 13-15%, followed by Nerve at 12-14% and Infection at 11-13%. Joint at 10-12% and Osseous at 9-11% round out the heavier content areas, while Soft Tissue at 1-3% is the smallest.
It is remotely proctored through MonitorEDU, taken from a private setting after equipment checks, with authorized whiteboard or tools permitted. AOA guidance references the PARADIGM practice interface, so familiarize yourself with it before test day.
You may sit for the exam after a one-year ACGME hand fellowship with verification, licensure, and ethics requirements. To be awarded the certification you also need qualifying AOBOS or AOBS primary certification, two years of active practice, privileges, 125 major hand cases in a consecutive 12-month period within three years, and at least 50% hand operative caseload.