- The exam is 100 Type A single-best-answer questions in a two-hour block with no scheduled break.
- A passing score is 500 on a 200-800 scale, administered by AOBOS under the AOA.
- Arthritis (13-15%), Nerve (12-14%) and Infection (11-13%) are the three heaviest categories.
- Award requires 125 major hand cases in a consecutive 12-month period and at least 50% hand operative caseload.
Identity and Format at a Glance
This sheet covers one credential only: the Subspecialty Certification in Hand Surgery offered through the American Osteopathic Board of Orthopedic Surgery (AOBOS) under the American Osteopathic Association (AOA). The label "Hand Surgery CAQ" is retained here as a convenient shorthand, but the current official name is Subspecialty Certification in Hand Surgery. If you need a refresher on the terminology, see What Is Hand Surgery CAQ? and What Does Hand Surgery CAQ Stand For?.
| Item | What to Know |
|---|---|
| Certifying body | AOBOS, under the AOA |
| Question count | 100 questions |
| Question type | Type A, single best answer, multiple choice |
| Time | Two hours, one block, no scheduled break |
| Passing score | 500 on a 200-800 scale |
| Initial fee | $3,000 |
| Delivery | Remote proctoring through MonitorEDU |
| Practice interface | AOA guidance references PARADIGM |
| Blueprint | 12 categories, published as percentage ranges |
Two hours for 100 questions works out to roughly 72 seconds per item. Because there is no scheduled break, stamina and pacing matter as much as raw knowledge. A deeper look at the difficulty profile is in How Hard Is the Hand Surgery CAQ Exam?.
Registration, Fees and Proctoring
The initial fee is $3,000. For a full breakdown of what that figure covers and what else to budget for, see Hand Surgery CAQ Certification Cost.
Remote testing mechanics
- Private setting: You test in a private remote location under MonitorEDU proctoring.
- Equipment checks: Run the required system and equipment checks well before test day, not on the morning of the exam.
- Authorized tools: A whiteboard and other authorized tools may be used. Confirm exactly what is permitted in your candidate instructions.
- Practice interface: AOA guidance references the PARADIGM interface, so familiarize yourself with navigation, flagging and review functions before you sit.
Eligibility Cheat Sheet
Eligibility has two layers: what lets you sit for the exam, and what is required for the certification to be awarded. Candidates sometimes conflate them, so keep them separate.
To sit for the exam
- Completion of a one-year ACGME hand fellowship, with verification
- Licensure requirements met
- Ethics requirements met
Additionally required for the award
- Qualifying AOBOS or AOBS primary certification
- Two years of active practice
- Appropriate privileges
- 125 major hand cases within a consecutive 12-month period, within three years
- At least 50% hand operative caseload
Case-Log Trap to Avoid
The 125-case requirement is a consecutive 12-month window, not a cumulative total, and it must fall within a three-year timeframe.
- Track cases from the first month of practice rather than reconstructing later.
- Confirm which procedures count as "major hand cases" in the official criteria.
- Verify that your overall practice mix meets the 50% hand operative caseload threshold.
The full prerequisite walk-through lives in Hand Surgery CAQ Requirements.
The 12-Category Blueprint
The official blueprint is undated and expresses each category as a range rather than a fixed count. Treat the ranges as emphasis guides, not exact question counts. Arthritis is the largest category, followed by Nerve and Infection. For category-by-category depth, see Hand Surgery CAQ Exam Domains: Complete Guide to All 12 Content Areas.
| Domain | Weight | Priority |
|---|---|---|
| Arthritis | 13-15% | Highest |
| Nerve | 12-14% | Very high |
| Infection | 11-13% | Very high |
| Joint | 10-12% | High |
| Osseous | 9-11% | High |
| Tendon | 8-10% | Moderate-high |
| Tumor | 7-9% | Moderate |
| Microsurgery | 6-8% | Moderate |
| Vascular | 5-7% | Moderate |
| Amputation | 3-5% | Lower |
| Pediatrics | 3-5% | Lower |
| Soft Tissue | 1-3% | Lowest |
Together, Arthritis, Nerve, Infection, Joint and Osseous account for a large share of the exam. If you have limited time, those five categories deserve the most disciplined review.
High-Yield Clinical Pearls by Domain
The blueprint names categories but not individual topics, so the lists below are review prompts drawn from standard hand surgery knowledge. Use them to check your own gaps, not as an official content outline.
Arthritis (13-15%)
The heaviest category rewards both pattern recognition and operative decision-making.
- Distinguish osteoarthritis, inflammatory arthritis and post-traumatic patterns by joint distribution and radiographic features.
- Know the operative options for thumb carpometacarpal arthritis and the logic behind choosing among them.
- Review deformities of the rheumatoid hand and wrist, including tendon rupture patterns and the timing of intervention.
- Understand salvage procedures such as arthrodesis and arthroplasty, and when each is appropriate.
Nerve (12-14%)
Expect questions that mix anatomy, electrodiagnostics and surgical strategy.
- Compression neuropathies: carpal tunnel, cubital tunnel, radial tunnel and pronator syndromes, including sites of compression and exam maneuvers.
- Nerve injury classification and recovery expectations after repair, graft or transfer.
- Tendon and nerve transfer principles for restoring function after proximal injury.
- Brachial plexus patterns and how to localize a lesion from the clinical picture.
Infection (11-13%)
This category is unusually high-yield for its size, and many items are management decisions rather than recall.
- Flexor tenosynovitis: Kanavel signs, urgency, and the surgical approach.
- Deep space infections, felon, paronychia and septic arthritis of the hand and wrist.
- Bite wounds and the organisms commonly associated with them, with appropriate antibiotic selection.
- Necrotizing soft tissue infection recognition and the priority of early debridement.
- Mycobacterial and fungal infections, which are classic distinguishing items on subspecialty exams.
Joint (10-12%) and Osseous (9-11%)
These two categories overlap with trauma and reconstruction fundamentals.
- Carpal instability patterns and ligament injuries, including scapholunate and lunotriquetral pathology.
- Distal radius fracture fixation principles, stability assessment and complication recognition.
- Metacarpal and phalangeal fracture patterns, malrotation and fixation options.
- Scaphoid fracture and nonunion management, including vascularity considerations.
- Dislocations of the PIP, MCP and carpometacarpal joints and the logic of reduction versus operative treatment.
Low-Weight Domains Worth a Quick Pass
Smaller categories are easy to neglect, but with 100 questions total, even narrow ranges can translate into several points. A short, targeted review often pays off more than another hour on a domain you already know well.
Tendon (8-10%)
Flexor and extensor tendon injury zones, repair techniques and rehabilitation protocols; tendon transfers; trigger finger and de Quervain disease management.
Tumor (7-9%)
Common benign soft tissue and bone lesions of the hand, such as ganglion cysts, giant cell tumor of tendon sheath and enchondroma; recognizing features that raise suspicion of malignancy; principles of biopsy planning.
Microsurgery (6-8%) and Vascular (5-7%)
Replantation indications and sequence, free tissue transfer principles, flap monitoring and failure management; vascular anatomy, ischemia evaluation, vasospastic and occlusive conditions, and thrombosis management.
Amputation (3-5%), Pediatrics (3-5%) and Soft Tissue (1-3%)
Level selection and stump management in amputation; congenital hand differences, classification and timing of surgery in pediatrics; coverage options and wound management principles in soft tissue.
Sequencing Your Review by Domain
If you are building a plan, let the blueprint drive the order. Put the heaviest, most decision-dense categories first while your energy is highest, and use the final stretch for timed practice. A broader approach to preparation is covered in the Hand Surgery CAQ Study Guide.
Arthritis and Joint
- Cover the largest category first, then pair it with Joint for continuity in wrist and finger pathology.
Nerve and Infection
- Review compression syndromes, nerve repair and transfers, then flexor tenosynovitis and deep space infections.
Osseous, Tendon and Tumor
- Fracture fixation principles, tendon repair zones and rehabilitation, and benign versus malignant lesion recognition.
Microsurgery, Vascular and the Small Categories
- Cover the remaining domains, then run full 100-question, two-hour practice blocks without breaks.
Key Takeaway
Rehearse the exact conditions: 100 questions, two hours, no scheduled break, remote setting. Take at least one full-length timed block at your testing desk with only authorized materials, and use a hand surgery practice test to expose pacing problems before they matter.
After You Pass: Ten Years and OCC
Certification is valid for ten years and is maintained through Osteopathic Continuous Certification (OCC). Hand surgery retains the long-form ten-year OCC exam, so passing the initial exam does not end the testing pathway.
2025-2027 cycle requirements
- 60 CME hours, including 15 Category 1-A
- Quality-improvement attestation
- Professional standing requirements
Because the OCC exam remains part of the picture, it is worth building durable knowledge now instead of cramming. Candidates weighing the long-term value of the credential should read Is the Hand Surgery CAQ Certification Worth It?, and those exploring career implications can look at Hand Surgery CAQ Jobs and the Hand Surgery CAQ Salary Guide.
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.
The passing score is 500 on a 200-800 scale. See Hand Surgery CAQ Passing Score for how to interpret scaled scoring.
Arthritis is the largest at 13-15%, followed by Nerve at 12-14% and Infection at 11-13%. The blueprint covers 12 categories in total, published as ranges.
It is remotely proctored through MonitorEDU, taken in a private setting with required equipment checks. AOA guidance references the PARADIGM practice interface, and authorized whiteboard or tools apply.
Not by itself. The award additionally requires qualifying AOBOS/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.
For a broader look at the credential, start with Hand Surgery CAQ Certification, and for what the data shows about outcomes, see Hand Surgery CAQ Pass Rate.