- What the Label Actually Means
- Who Certifies It and Under What Name
- What the Credential Signals About Your Training and Practice
- How the Exam Is Built: Format and Delivery
- Reading the 12-Category Blueprint
- Concrete Topics Behind the Biggest Categories
- Fees, Scoring and Logistics at a Glance
- What Holding the Credential Requires Afterward
- Sequencing Your Preparation by Blueprint Weight
- Where the Credential Matters Professionally
- Frequently Asked Questions
- Hand Surgery CAQ here means Subspecialty Certification in Hand Surgery, issued through the American Osteopathic Board of Orthopedic Surgery (AOBOS).
- The exam is 100 Type A single-best-answer questions in two hours, one block, no scheduled break.
- A scaled score of 500 on a 200-800 scale is the passing standard.
- Arthritis (13-15%), Nerve (12-14%) and Infection (11-13%) carry the heaviest blueprint ranges.
What the Label Actually Means
If you have seen "Hand Surgery CAQ" on a credentialing form, a job posting or a colleague's CV, the short answer is this: it refers to Subspecialty Certification in Hand Surgery, a formal recognition that an osteopathic orthopedic surgeon has completed focused hand surgery training, met practice-volume requirements and passed a dedicated subspecialty examination. "CAQ" is the label this site retains for the credential, while the current official name used by the certifying board is the subspecialty certification title.
The acronym is a convenience. The substance is the credential itself: a defined training pathway, a case-volume attestation, a 100-question computer-based exam, and a ten-year certification that must be maintained. If you want deeper definitions of the terminology, our companion pieces on what Hand Surgery CAQ is and what the label stands for cover the naming history in more detail.
Who Certifies It and Under What Name
This credential is administered through the American Osteopathic Board of Orthopedic Surgery (AOBOS) under the American Osteopathic Association (AOA) certification framework. That matters because the certifying body determines everything downstream: eligibility rules, the content blueprint, exam delivery, fees and the maintenance cycle. Details from any other certifying organization do not apply to this credential, so avoid applying exam rules, fees or timelines you may have read about elsewhere.
For a full walkthrough of the formal definition, see what Hand Surgery CAQ certification is and the broader Hand Surgery CAQ certification overview.
What the Credential Signals About Your Training and Practice
The meaning of the credential is best understood through what it takes to earn it. Sitting for the exam and being awarded certification are two related but distinct steps.
Eligibility to sit for the exam
A candidate may sit after completing a one-year ACGME hand fellowship, with verification of that training, plus licensure and ethics requirements.
Requirements for the award itself
Passing the exam is not the final gate. The award additionally requires:
- Qualifying AOBOS/AOBS primary certification
- Two years of active practice
- Appropriate hospital or surgical privileges
- 125 major hand cases logged in a consecutive 12-month period within three years
- At least 50% of your operative caseload in hand surgery
That final pair of requirements is what separates this credential from a simple fellowship completion certificate. It signals that the surgeon not only trained in hand surgery but is actively practicing it at meaningful volume. For the complete checklist, see our Hand Surgery CAQ requirements guide.
Key Takeaway
Plan your case log early. The 125-major-case window (12 consecutive months within three years) and the 50% hand-operative-caseload threshold are practice-based requirements that cannot be rushed after passing the exam, so track qualifying cases from the start of independent practice.
How the Exam Is Built: Format and Delivery
The examination is intentionally compact but dense.
| Feature | Detail |
|---|---|
| Question count | 100 questions |
| Question style | Type A, single-best-answer multiple choice |
| Time | Two hours, one block |
| Breaks | No scheduled break |
| Passing score | 500 on a 200-800 scale |
| Proctoring | MonitorEDU remote proctoring |
| Interface reference | AOA guidance references the PARADIGM practice interface |
Two hours for 100 questions averages roughly 72 seconds per item, and there is no scheduled break to reset your focus. Type A questions ask you to choose the single best answer from the options, which rewards clinical judgment: several choices may be defensible, but one is most appropriate for the scenario given.
Remote delivery conditions
The exam is delivered with remote proctoring. Expect a private remote setting, equipment checks before you begin, and authorized whiteboard or tools only as permitted. We have not verified any open-book or adaptive format, so prepare for a standard closed-book, fixed-length exam. For a candid look at what that feels like in practice, read how hard the Hand Surgery CAQ exam is, and for scoring specifics see the passing score breakdown.
Reading the 12-Category Blueprint
The official content outline is organized into twelve categories, each expressed as a percentage range rather than a fixed number of questions. The blueprint we reference is undated, so treat the ranges as a guide to relative emphasis.
| Domain | Blueprint Range |
|---|---|
| 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% |
Notice how the top three categories (Arthritis, Nerve and Infection) together account for a large share of the exam, while Soft Tissue is a very small slice. That does not mean small domains are ignorable, since a handful of questions can decide a borderline score, but it should inform where you invest hours. Our complete guide to all 12 content areas goes deeper on each category.
Concrete Topics Behind the Biggest Categories
Blueprint labels are broad. Here is how to translate the largest categories into the kinds of clinical content a hand surgeon should be fluent in.
Arthritis (13-15%)
The single heaviest category. Expect questions that test diagnosis, staging and operative decision-making for degenerative and inflammatory conditions of the hand and wrist.
- Thumb carpometacarpal arthritis and the range of reconstructive options
- Inflammatory arthropathies and their characteristic hand deformities
- Wrist arthritis patterns and motion-preserving versus fusion strategies
- Finger joint arthritis and indications for arthroplasty versus arthrodesis
Nerve (12-14%)
Second-heaviest. Questions center on compression neuropathies, injury patterns and reconstruction.
- Carpal tunnel and cubital tunnel syndromes: diagnosis, electrodiagnostic correlation and surgical technique
- Peripheral nerve injury classification and timing of repair
- Nerve transfers and tendon transfers for restoring function after nerve palsy
- Brachial plexus and radial, median and ulnar nerve palsy patterns
Infection (11-13%)
A high-yield category because management is time-sensitive and heavily algorithmic.
- Flexor tenosynovitis, felon, paronychia and deep space infections
- Septic arthritis and osteomyelitis of the hand
- Bite wounds and organism-specific antibiotic selection
- Necrotizing infections and the urgency of surgical debridement
The remaining categories reward the same approach: know the classic presentation, the best next step, and the indications that tip you toward one operation over another. Joint, Osseous and Tendon questions in particular tend to hinge on fracture patterns, stabilization choices and repair or reconstruction principles. A focused one-page cheat sheet can help consolidate these decision points near exam day.
Fees, Scoring and Logistics at a Glance
Budgeting is part of understanding the credential. The initial fee is $3,000. That figure is the baseline from which you should plan, and you should confirm any additional charges directly with the board before registering. Our certification cost breakdown explains how to think through the full financial picture.
On timing, the September 25, 2026 sitting has already passed. If you are planning your attempt, check the current scheduling guidance in our exam dates article and confirm the next available window with the certifying board rather than relying on a date that has gone by.
If you are curious how candidates have fared historically, our pass rate discussion explains what the available data can and cannot tell you, since we do not cite unverified percentages.
What Holding the Credential Requires Afterward
Certification is ten years in length and is maintained through ongoing continuous certification (OCC). For the 2025-2027 cycle, the requirements include:
- 60 CME credits, of which 15 must be Category 1-A
- A quality-improvement attestation
- Professional standing
Hand surgery retains the long-form ten-year OCC exam, which means the credential is not a one-and-done achievement. Plan to keep your knowledge current across all twelve domains throughout the decade, not just during the months before your first attempt.
Sequencing Your Preparation by Blueprint Weight
Rather than a generic schedule, tie your calendar to the blueprint. The heaviest categories deserve the earliest and most repeated attention, and the smallest ones can be consolidated into a single review week. Here is one way to structure an eight-week lead-up. For a fuller strategy, see the Hand Surgery CAQ study guide.
Arthritis and Nerve
- Cover the two largest ranges first (13-15% and 12-14%)
- Build decision trees for thumb CMC options and nerve palsy transfers
Infection and Joint
- Drill time-sensitive infection algorithms
- Review joint instability and reconstruction principles
Osseous and Tendon
- Fracture patterns, fixation choices and nonunion management
- Flexor and extensor repair and rehabilitation concepts
Tumor, Microsurgery and Vascular
- Benign versus malignant lesion recognition
- Replantation indications, flap principles and vascular compromise
Amputation, Pediatrics and Soft Tissue
- Consolidate the smallest ranges into one pass
- Congenital hand differences and pediatric fracture considerations
Timed 100-question practice
- Simulate the two-hour, no-break format
- Review misses and revisit your weakest categories
Because the real exam has no scheduled break, practice sitting for the full two hours in one block at least a couple of times. Pacing at roughly 72 seconds per question is a skill you build, not something you can improvise. You can run timed sets on our main practice test site to rehearse that rhythm.
Where the Credential Matters Professionally
Subspecialty certification in hand surgery is most relevant to osteopathic orthopedic surgeons whose practice is concentrated in the hand and upper extremity. Because the award itself requires that hand surgery make up at least half of your operative caseload, the credential naturally aligns with surgeons practicing in settings that value dedicated hand expertise: orthopedic groups with hand divisions, hospital systems seeking upper-extremity coverage, academic programs, and trauma-capable centers needing reliable hand call.
We do not quote specific salary figures here because we will not invent numbers. If you want to weigh the career case, our ROI analysis, earnings discussion and overview of Hand Surgery CAQ jobs walk through the considerations qualitatively. For a look at the learning side, see our notes on Hand Surgery CAQ training.
Frequently Asked Questions
On this site it refers to Subspecialty Certification in Hand Surgery, awarded through the American Osteopathic Board of Orthopedic Surgery (AOBOS). "CAQ" is the retained shorthand label, while the official credential name is the subspecialty certification title. See also our page on Hand Surgery CAQ meaning.
The exam has 100 Type A single-best-answer multiple-choice questions delivered in one two-hour block with no scheduled break. The passing score is 500 on a 200-800 scale.
Arthritis (13-15%) is the largest category, followed by Nerve (12-14%) and Infection (11-13%). Soft Tissue is the smallest at 1-3%. The blueprint uses ranges, and the version we reference is undated.
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.
Certification lasts ten years and is maintained through OCC. The 2025-2027 cycle requires 60 CME including 15 Category 1-A, a quality-improvement attestation and professional standing, and hand surgery retains the long-form ten-year OCC exam.
Understanding what the label means is the first step. The credential represents focused fellowship training, documented hand-surgery volume, a demanding two-hour closed-book exam and a decade-long commitment to staying current. Build your preparation around the blueprint, practice the exact format, and verify all logistics directly with the certifying board before you register.