This study analyzed the performance of ChatGPT-4 on the 2023 American Society for Surgery of the Hand (ASSH) Maintenance of Certification Self-Assessment Examination (SAE) before and after being exposed to five previous versions of the test. In March 2024, 195 questions from the 2023 ASSH SAE were used to evaluate the GPT-4 performance with no prior exposure to previous exams. On a separate system, completed ASSH SAEs from 2014, 2015, 2017, 2018, and 2020 were uploaded to GPT-4 with all questions, correct answers, and explanations. This GPT-4 then took the 2023 ASSH SAE, with all questions administered exactly the same as they were for the system with no prior exposure. Before prompting, GPT-4 correctly answered 131/195 (67.2%), and after, GPT-4 correctly answered 138/195 (70.8%). There was no statistically significant difference in performance between pre- and post-prompting. The results were then further broken down into categories: image vs text questions, anatomical distribution (finger, hand, wrist, forearm, elbow, misc.), and question sub-category (anatomy, basic science, diagnostic, management). No statistically significant difference in performance between pre- and post-prompting was found in any of these categories. The threshold to pass the ASSH SAE is a 50%, which both pre- and post-prompting Chat-GPT4 scored well above. The lack of statistically significant improvements in performance indicates that the sources for hand pathology that GPT-4 accesses are adequate on their own. This demonstrates a significant capacity of GPT-4 to accurately diagnose patient pathology and additionally score well on exams designed for orthopedic surgery residents.