This practice set contains high-yield board review questions covering key concepts in Surgical Anatomy & Approaches. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.
Question 261
Topic: Surgical Anatomy & Approaches
A surgeon is planning a TKR for a patient with a valgus knee. While a medial parapatellar approach is commonly used, the surgeon considers a lateral approach. According to the case, what is the theoretical advantage of utilizing a lateral surgical approach for total knee arthroplasty in a valgus knee?
Correct Answer & Explanation
. It is a direct approach providing easier access and preserves the neurovascular supply to the extensor mechanism.
Explanation
The case directly addresses this: 'EXAMINER: What is the theoretical advantage of a lateral approach? CANDIDATE: It is a direct approach providing easier access and preserves the neurovascular supply to the extensor mechanism.' This statement directly supports option C. Option A is incorrect because a lateral approach would make medial compartment access more challenging, not easier. Option B is incorrect because the case states that a medial parapatellar approach 'gives good access to the whole knee and better soft tissue cover,' implying this is an advantage of the medial approach, not the lateral. Option D is incorrect because while component rotation is critical, the advantage of the lateral approach is not specifically tied to easier correction of femoral internal rotation compared to other approaches. Option E is incorrect because the risk of peroneal nerve palsy is related to the degree of valgus correction and traction on the nerve, not inherently reduced by the surgical approach itself.
Question 262
Topic: Surgical Anatomy & Approaches
A 32-year-old male sustains a high-energy motor vehicle collision resulting in a displaced anterior column acetabular fracture. During open reduction and internal fixation via the Smith-Petersen approach, the surgeon identifies the primary internervous plane. Which two muscles define this critical interval, and what are their respective innervations?
Correct Answer & Explanation
. C. Sartorius (femoral nerve) and tensor fascia lata (superior gluteal nerve)
Explanation
Correct Answer: CThe Smith-Petersen approach primarily utilizes an internervous plane proximally between the sartorius muscle and the tensor fascia lata (TFL) muscle. The sartorius muscle is innervated by the femoral nerve (L2-L4), and the TFL muscle is innervated by the superior gluteal nerve (L4-S1). This distinct innervation pattern allows for dissection without denervating either muscle, theoretically minimizing muscle damage and facilitating recovery.Why other options are incorrect:A. Gluteus medius (superior gluteal nerve) and rectus femoris (femoral nerve):While these muscles are in the vicinity, the gluteus medius is lateral to the primary interval and the rectus femoris is deep to it, requiring reflection. This is not the primary internervous plane.B. Sartorius (femoral nerve) and rectus femoris (femoral nerve):Both muscles are innervated by the femoral nerve, making this an intramuscular plane, not an internervous one. The rectus femoris is also deep to the sartorius, not adjacent in the primary interval.D. Tensor fascia lata (superior gluteal nerve) and vastus lateralis (femoral nerve):The vastus lateralis is a component of the quadriceps femoris, located more distally and deep to the TFL. This is not the primary internervous plane for initial hip joint access.E. Iliopsoas (femoral nerve) and pectineus (femoral nerve):Both are medial to the primary approach and innervated by the femoral nerve. The iliopsoas lies posteromedial to the rectus femoris and inferior to the anterior hip joint, requiring careful medial retraction if needed for deeper exposure, but it does not define the primary internervous plane.F. Gluteus minimus (superior gluteal nerve) and sartorius (femoral nerve):The gluteus minimus is deep to the gluteus medius and lateral to the primary interval. It is not directly involved in defining the primary internervous plane of the Smith-Petersen approach.
Question 263
Topic: Surgical Anatomy & Approaches
A 58-year-old female undergoes a revision total hip arthroplasty via the Smith-Petersen approach for a loose acetabular component. Two weeks post-operatively, she complains of persistent numbness, burning, and dysesthesia over the anterolateral aspect of her operative thigh. Physical examination confirms sensory deficits in this distribution without motor weakness. Which of the following nerves is most likely injured, and what is its typical anatomical course relative to the ASIS?
Correct Answer & Explanation
. D. Lateral femoral cutaneous nerve; exits the pelvis typically inferior to the ASIS and courses inferomedially, often piercing or passing deep to the sartorius or TFL.
Explanation
Correct Answer: DThe patient's symptoms of numbness, burning, and dysesthesia over the anterolateral thigh are classic for meralgia paresthetica, which is caused by injury to the lateral femoral cutaneous nerve (LFCN). The LFCN is a purely sensory nerve (L2-L3) that exits the pelvis, typically inferior to the ASIS, and courses inferomedially. Its course is highly variable, often piercing or passing deep to the sartorius or tensor fascia lata (TFL), making it particularly vulnerable during the Smith-Petersen approach. It is the most common neurological complication of this approach.Why other options are incorrect:A. Femoral nerve; exits the pelvis medial to the ASIS and courses inferomedially:While the femoral nerve is medial to the sartorius and vulnerable to medial retraction, its injury would typically result in quadriceps weakness (motor deficit) and sensory loss on the anterior thigh and medial leg, not specifically the anterolateral thigh dysesthesia.B. Sciatic nerve; exits the pelvis through the greater sciatic notch, posterior to the hip joint:The sciatic nerve is located posteriorly and is not typically at risk during an anterior approach like Smith-Petersen. Injury would cause motor and sensory deficits in the posterior thigh and entire lower leg/foot.C. Obturator nerve; exits the pelvis through the obturator foramen, medial to the hip joint:The obturator nerve supplies the adductor muscles and sensation to the medial thigh. It is not typically at risk with the Smith-Petersen approach and its injury would present with adductor weakness and medial thigh sensory changes.E. Superior gluteal nerve; exits the pelvis through the greater sciatic notch, superior to the piriformis muscle:The superior gluteal nerve supplies the gluteus medius, minimus, and TFL. It is located superior and lateral to the primary approach and is generally not directly at risk unless dissection extends significantly superiorly and laterally along the iliac crest. Injury would cause abductor weakness (Trendelenburg gait).
Question 264
Topic: Surgical Anatomy & Approaches
During the deep dissection phase of a Smith-Petersen approach for an anterior column acetabular fracture, after detaching the direct and indirect heads of the rectus femoris and reflecting the muscle distally and laterally, the surgical team encounters a pulsatile bleed deep to the reflected rectus femoris. Which vessel is most likely the source of this bleeding?
Correct Answer & Explanation
. C. Ascending branch of the lateral circumflex femoral artery
Explanation
Correct Answer: CAs the rectus femoris muscle is reflected distally and laterally during the deep dissection of the Smith-Petersen approach, the ascending branch of the lateral circumflex femoral artery is almost always encountered. This vessel, a branch of the deep femoral artery (profunda femoris), runs deep to the rectus femoris and supplies the vastus lateralis and contributes to the vascular supply of the femoral head. It must be carefully identified and ligated or cauterized to prevent hemorrhage. Its ligation is generally well-tolerated due to redundant blood supply.Why other options are incorrect:A. Femoral artery:The femoral artery is located more medially within the femoral triangle, medial to the femoral nerve and iliopsoas. While at risk with aggressive medial retraction, it is not typically encountered deep to the rectus femoris during its reflection.B. Superior gluteal artery:The superior gluteal artery is located more superiorly and laterally, exiting the pelvis through the greater sciatic notch. It supplies the gluteal muscles and TFL and is generally not directly at risk during the standard Smith-Petersen approach unless dissection extends significantly superiorly and laterally along the iliac crest.D. Obturator artery:The obturator artery is located medially within the pelvis, supplying structures in the obturator region. It is not typically encountered in the field of view during rectus femoris reflection in a Smith-Petersen approach.E. Deep femoral artery (profunda femoris):While the ascending branch of the lateral circumflex femoral artery originates from the deep femoral artery, the main trunk of the deep femoral artery is located more medially and deeper in the thigh, not typically exposed directly during rectus femoris reflection.
Question 265
Topic: Surgical Anatomy & Approaches
A surgical resident is preparing a patient for a Smith-Petersen approach to address developmental dysplasia of the hip (DDH) requiring a pelvic osteotomy. The patient is positioned supine on a radiolucent operating table. To optimize exposure of the anterior acetabulum and iliac wing, a firm bolster is placed under the ipsilateral gluteal region. What is the primary biomechanical effect of this bolster placement?
Correct Answer & Explanation
. B. To internally rotate the pelvis, bringing the ASIS and iliac crest more anteriorly.
Explanation
Correct Answer: BPlacing a firm bolster or rolled towel under the ipsilateral gluteal region (from the sacrum to the greater trochanter) internally rotates the pelvis. This maneuver brings the Anterior Superior Iliac Spine (ASIS) and the iliac crest more anteriorly, which significantly facilitates access to the anterior acetabulum and iliac wing, crucial for the Smith-Petersen approach. This positioning optimizes the surgical field for the anterior approach.Why other options are incorrect:A. To facilitate hip extension and external rotation:This positioning would typically be achieved by placing a bolster under the contralateral hip or by specific leg manipulation, but not primarily by an ipsilateral gluteal bolster for anterior exposure.C. To externally rotate the pelvis, moving the ASIS laterally:This is the opposite effect of the ipsilateral gluteal bolster, which aims to internally rotate the pelvis.D. To increase lumbar lordosis, improving access to the posterior pelvis:A bolster under the gluteal region does not primarily aim to increase lumbar lordosis, and the Smith-Petersen approach is for anterior, not posterior, pelvic access.E. To abduct the hip, tensioning the gluteal muscles:While leg draping allows for hip manipulation, the primary purpose of the ipsilateral gluteal bolster is not to abduct the hip or tension the gluteal muscles.
Question 266
Topic: Surgical Anatomy & Approaches
A 40-year-old male is undergoing a Smith-Petersen approach for open reduction and internal fixation of a complex anterior column acetabular fracture. During deep dissection, the surgeon requires extensive medial exposure to access the pubic ramus and quadrilateral surface. The iliopsoas muscle is retracted medially. What critical neurovascular structure is immediately medial to the iliopsoas and at significant risk with aggressive or prolonged retraction in this area?
Correct Answer & Explanation
. D. Femoral nerve and vessels
Explanation
Correct Answer: DThe text explicitly states: 'Care must be taken as the femoral nerve and vessels lie directly medial to the iliopsoas.' When the iliopsoas muscle is retracted medially for extensive medial exposure (e.g., to access the pubic ramus or quadrilateral surface for acetabular fractures), the femoral nerve and vessels (artery and vein) are immediately adjacent and highly vulnerable to direct trauma or excessive/prolonged retraction. Injury to the femoral nerve can lead to significant quadriceps weakness and sensory deficits.Why other options are incorrect:A. Sciatic nerve:The sciatic nerve is located posteriorly and is not at risk during medial retraction of the iliopsoas in an anterior approach.B. Superior gluteal nerve and artery:These structures are located more superior and lateral, supplying the gluteus medius, minimus, and TFL. They are not immediately medial to the iliopsoas.C. Lateral femoral cutaneous nerve:While the LFCN is vulnerable in the Smith-Petersen approach, it typically exits inferior to the ASIS and courses inferomedially, often piercing the sartorius or TFL. It is not immediately medial to the iliopsoas in the deep dissection plane.E. Obturator nerve:The obturator nerve is located more medially within the pelvis, exiting through the obturator foramen. While it is a pelvic nerve, it is not immediately adjacent to the iliopsoas in the context of medial retraction during the Smith-Petersen approach.
Question 267
Topic: Surgical Anatomy & Approaches
A 65-year-old patient is undergoing a primary total hip arthroplasty via a modified Smith-Petersen (direct anterior) approach. During exposure of the hip capsule, the surgeon notes a strong, inverted Y-shaped ligament reinforcing the anterior aspect of the capsule, extending from the anterior inferior iliac spine (AIIS) to the intertrochanteric line. What is the name of this ligament, and what is its primary biomechanical function?
Correct Answer & Explanation
. D. Iliofemoral ligament (Ligament of Bigelow); prevents hyperextension.
Explanation
Correct Answer: DThe description of a strong, inverted Y-shaped ligament extending from the AIIS to the intertrochanteric line is characteristic of the iliofemoral ligament, also known as the Ligament of Bigelow. This is recognized as the strongest ligament of the hip joint, and its primary biomechanical function is to prevent hyperextension of the hip, contributing significantly to anterior hip stability.Why other options are incorrect:A. Pubofemoral ligament; prevents excessive abduction:The pubofemoral ligament is located inferiorly and anteriorly, and while it contributes to hip stability, its primary role is to prevent excessive abduction and external rotation, not hyperextension, and it does not have the described Y-shape.B. Ischiofemoral ligament; prevents excessive internal rotation:The ischiofemoral ligament is located posteriorly and primarily prevents excessive internal rotation and hyperextension, but it is not the strongest anterior ligament and is not encountered in the anterior approach in the same manner.C. Ligamentum teres; provides vascular supply to the femoral head:The ligamentum teres is an intra-articular ligament connecting the fovea of the femoral head to the acetabular notch. While it can provide some vascular supply (artery to the head of the femur), it is not a primary stabilizer of the hip joint and does not have the described shape or location.E. Transverse acetabular ligament; deepens the acetabular socket:The transverse acetabular ligament bridges the acetabular notch, converting it into a foramen. Its function is to deepen the acetabular socket and provide a passage for neurovascular structures, but it is not the primary anterior capsular ligament.
Question 268
Topic: Surgical Anatomy & Approaches
A 50-year-old male is undergoing a Smith-Petersen approach for excision of a benign tumor located on the anterior acetabulum. During the approach, after developing the internervous plane and reflecting the rectus femoris, the surgeon needs to open the hip joint capsule for direct visualization. Which of the following capsulotomy techniques is commonly employed to achieve wide exposure of the femoral head and acetabular articular surface?
Correct Answer & Explanation
. C. H-shaped capsulotomy or a longitudinal incision parallel to the femoral neck.
Explanation
Correct Answer: CWhen the hip joint needs to be opened via the Smith-Petersen approach (e.g., for intra-articular fracture reduction, arthroplasty, synovectomy, FAI, or tumor excision), a common and effective technique is an H-shaped capsulotomy or a longitudinal incision parallel to the femoral neck. The arms of the H extend superiorly and inferiorly, allowing for wide exposure of the femoral head, femoral neck, and acetabular articular surface, while preserving a cuff of capsular tissue for later repair.Why other options are incorrect:A. Posterior capsulotomy along the piriformis fossa:This is a technique used in posterior approaches to the hip, not the anterior Smith-Petersen approach.B. Transverse capsulotomy across the femoral neck:While a transverse incision might be made, an H-shaped or longitudinal incision provides better extensibility and allows for easier repair, minimizing the risk of instability. A purely transverse incision might also compromise vascularity to the femoral neck.D. Inferior capsulotomy along the pubofemoral ligament:While the pubofemoral ligament is part of the anterior capsule, an isolated inferior capsulotomy would not provide the broad exposure needed for most intra-articular procedures.E. Superior capsulotomy along the iliofemoral ligament:The iliofemoral ligament is the strongest anterior ligament and is crucial for hip stability. While the capsule is incised, directly incising along the entire length of the iliofemoral ligament as a primary capsulotomy technique is not standard for wide exposure, as it might compromise stability. The H-shaped or longitudinal incision typically works around or through less critical parts of the capsule while respecting the overall integrity for later repair.
Question 269
Topic: Surgical Anatomy & Approaches
A 68-year-old female is undergoing a total shoulder arthroplasty via the deltopectoral approach for severe glenohumeral osteoarthritis. During the procedure, after the subscapularis tenotomy and medial retraction, the surgeon is performing an inferior capsular release to improve external rotation and posterior translation. Which of the following neurovascular structures is at the highest risk of iatrogenic injury during this specific maneuver?
Correct Answer & Explanation
. Axillary nerve
Explanation
Correct Answer: DExplanation:Theaxillary nerveis at the highest risk during an inferior capsular release via the deltopectoral approach. The case explicitly states: "The axillary nerve... courses inferiorly and then anteriorly, approximately 5-7 cm distal to the acromion, around the surgical neck of the humerus. It runs in close proximity to the inferior border of the subscapularis muscle and the inferior glenohumeral joint capsule. The anterior humeral circumflex artery typically accompanies the nerve anteriorly. These structures are highly susceptible to injury during inferior capsular releases, humeral head resection, and subscapularis dissection or repair. Meticulous protection with a blunt Hohmann retractor beneath the inferior border of the subscapularis is essential."A. Axillary artery:While part of the axillary neurovascular bundle, the axillary artery is situated more medially and deeper, typically protected by the conjoined tendon and pectoralis minor. It is at risk with extreme medial retraction, but less directly vulnerable during an inferior capsular release compared to the axillary nerve.B. Musculocutaneous nerve:This nerve enters the deep surface of the coracobrachialis muscle approximately 5-8 cm distal to the coracoid tip. It is at risk with aggressive medial retraction or mobilization of the conjoined tendon, but not directly during an inferior capsular release of the glenohumeral joint capsule.C. Cephalic vein:This superficial vein lies within the deltopectoral groove. It is managed early in the approach (usually retracted medially) and is not typically at risk during deep intra-articular maneuvers like capsular release.E. Lateral pectoral nerve:This nerve innervates the pectoralis major muscle. It is located more superiorly and medially, and while theoretically at risk with excessive superior dissection or muscle division, it is not directly threatened by an inferior capsular release.
Question 270
Topic: Surgical Anatomy & Approaches
During a deltopectoral approach for a complex proximal humerus fracture, the surgeon identifies the cephalic vein within the deltopectoral groove. According to the comprehensive guide, what is the preferred management strategy for the cephalic vein, and why?
Correct Answer & Explanation
. Medial retraction with the pectoralis major, to protect the axillary nerve and avoid kinking.
Explanation
Correct Answer: CExplanation:The case states: "TheCephalic Vein... is typically identified early, carefully dissected free from its surrounding areolar tissue, and gently mobilized.Preferred Management:The cephalic vein is typically retracted medially along with the pectoralis major muscle. This minimizes the risk of injury from retractors against the deltoid and protects the axillary nerve (which lies laterally) and prevents kinking or compression of the vein against the deltoid."A. Ligation, to prevent kinking and improve exposure:While ligation can improve exposure, it is explicitly stated as an option only if retraction is inadequate or the vein is compromised, and should be avoided if possible to mitigate post-operative venous congestion and swelling. It is not the preferred strategy.B. Lateral retraction with the deltoid, to protect the pectoralis major:Lateral retraction is generally discouraged because it places the vein at risk of injury from retractors against the deltoid and potentially obscures the axillary nerve, which lies laterally.D. Splitting the vein longitudinally, to maintain partial venous return:This is not a recognized or safe surgical technique for managing the cephalic vein in this approach and would likely lead to significant bleeding and thrombosis.E. Dissection and transposition to a subcutaneous pocket, to ensure full preservation:While preservation is desired, transposition to a subcutaneous pocket is an overly complex and unnecessary maneuver for the cephalic vein in this context. Simple medial retraction is sufficient for preservation.
Question 271
Topic: Surgical Anatomy & Approaches
A surgeon is performing a deltopectoral approach. After incising the clavipectoral fascia and retracting the conjoined tendon medially, they are preparing to expose the subscapularis. Which nerve is most vulnerable to injury with excessive or forceful medial retraction of the conjoined tendon?
Correct Answer & Explanation
. Musculocutaneous nerve
Explanation
Correct Answer: DExplanation:The case states: "TheMusculocutaneous Nerve (C5-C7): This nerve typically enters the deep surface of the coracobrachialis muscle approximately 5-8 cm distal to the coracoid tip. Excessive or unmindful medial retraction or division of the conjoined tendon risks injury to this nerve." The conjoined tendon is formed by the short head of the biceps and coracobrachialis, and the musculocutaneous nerve innervates the coracobrachialis and then the biceps.A. Axillary nerve:While the axillary nerve is highly vulnerable in the deltopectoral approach, its primary risk is during inferior capsular release, humeral head resection, or fracture fixation around the surgical neck, not directly from medial retraction of the conjoined tendon itself. The axillary neurovascular bundle (which includes the axillary artery, vein, and brachial plexus cords) is deep and medial to the conjoined tendon, and at risk withextrememedial retraction, but the musculocutaneous nerve iswithinor immediately adjacent to the conjoined tendon.B. Suprascapular nerve:This nerve is located more posteriorly, passing through the suprascapular notch, and is not typically at risk during an anterior deltopectoral approach unless there is extensive posterior dissection or specific superior glenoid pathology.C. Long thoracic nerve:This nerve innervates the serratus anterior and courses along the lateral chest wall. It is not typically at risk during a deltopectoral approach.E. Dorsal scapular nerve:This nerve innervates the rhomboids and levator scapulae and is located more posteriorly, not in the field of the deltopectoral approach.
Question 272
Topic: Surgical Anatomy & Approaches
A 45-year-old male undergoes open reduction and internal fixation of a 3-part proximal humerus fracture via a standard deltopectoral approach. Which of the following best describes the internervous plane utilized during the superficial dissection?
Correct Answer & Explanation
. Deltoid (axillary nerve) and Pectoralis major (medial and lateral pectoral nerves)
Explanation
The deltopectoral approach utilizes the internervous plane between the deltoid (axillary nerve) and pectoralis major (medial and lateral pectoral nerves). This true internervous plane allows for safe anterior exposure of the proximal humerus.
Question 273
Topic: Surgical Anatomy & Approaches
A surgeon is performing an open rotator cuff repair via a lateral deltoid-splitting approach. To avoid iatrogenic injury to the axillary nerve, the distal extent of the deltoid split should not exceed what distance from the lateral edge of the acromion?
Correct Answer & Explanation
. 5 cm
Explanation
The axillary nerve runs transversely across the deep surface of the deltoid approximately 5 cm (range 4-7 cm) distal to the lateral edge of the acromion. Extending the deltoid split beyond 5 cm puts the nerve at significant risk.
Question 274
Topic: Surgical Anatomy & Approaches
A 65-year-old female undergoes total hip arthroplasty via an anterolateral (Watson-Jones) approach. Which two muscles define the primary intermuscular interval utilized in this approach?
Correct Answer & Explanation
. Tensor fasciae latae and Gluteus medius
Explanation
The Watson-Jones approach exploits the intermuscular interval between the tensor fasciae latae and the gluteus medius. This is not a true internervous plane, as both muscles are innervated by the superior gluteal nerve.
Question 275
Topic: Surgical Anatomy & Approaches
During the ilioinguinal approach for an anterior column acetabular fracture, three specific surgical windows are developed. Which structures define the medial and lateral borders of the middle window?
Correct Answer & Explanation
. External iliac vessels and iliopsoas/femoral nerve
Explanation
The middle window of the ilioinguinal approach is bordered medially by the external iliac vessels and laterally by the iliopsoas muscle and femoral nerve. Access to the pelvic brim and quadrilateral plate is achieved through this interval.
Question 276
Topic: Surgical Anatomy & Approaches
A surgeon utilizes the modified Stoppa approach for an anterior acetabular fracture. Severe bleeding occurs over the superior pubic ramus during dissection. This is most likely due to injury to the "corona mortis," which is an anastomosis between which two vascular systems?
Correct Answer & Explanation
. External iliac (or inferior epigastric) and Internal iliac (obturator)
Explanation
The corona mortis is a vascular anastomosis between the obturator vessels (from the internal iliac system) and the inferior epigastric vessels (from the external iliac system). It crosses the superior pubic ramus and is highly vulnerable during anterior intrapelvic approaches.
Question 277
Topic: Surgical Anatomy & Approaches
A surgeon is utilizing the deltopectoral approach for a total shoulder arthroplasty. The cephalic vein is identified within the internervous plane. To minimize bleeding and preserve venous drainage from the deltoid, what is the standard recommended handling of the cephalic vein?
Correct Answer & Explanation
. Retract the vein laterally with the deltoid
Explanation
The cephalic vein is typically retracted laterally with the deltoid to preserve its major venous tributaries, which predominantly drain the deltoid muscle. Medial retraction risks tearing these delicate branches.
Question 278
Topic: Surgical Anatomy & Approaches
During a lateral deltoid-splitting approach for a proximal humerus fracture, the surgeon must avoid propagating the split too far distally. What is the maximum safe distance from the lateral edge of the acromion to prevent injury to the axillary nerve?
Correct Answer & Explanation
. 5-7 cm
Explanation
The axillary nerve courses horizontally along the deep surface of the deltoid approximately 5 to 7 cm distal to the lateral edge of the acromion. Extending the deltoid split beyond this distance risks denervating the anterior deltoid.
Question 279
Topic: Surgical Anatomy & Approaches
During a Watson-Jones (anterolateral) approach to the hip for a femoral neck fracture, the surgical interval is developed between the tensor fasciae latae and the gluteus medius. Why is this technically considered an intermuscular rather than a true internervous plane?
Correct Answer & Explanation
. Both muscles are innervated by the superior gluteal nerve.
Explanation
The Watson-Jones approach develops the plane between the tensor fasciae latae and the gluteus medius. It is considered an intermuscular plane because both muscles are innervated by the superior gluteal nerve.
Question 280
Topic: Surgical Anatomy & Approaches
During a deltopectoral approach for a total shoulder arthroplasty, the conjoint tendon is retracted medially. At what approximate distance distal to the tip of the coracoid process does the musculocutaneous nerve typically enter the coracobrachialis?
Correct Answer & Explanation
. 3 to 8 cm
Explanation
The musculocutaneous nerve typically penetrates the coracobrachialis 5 to 8 cm distal to the coracoid process. Vigorous medial retraction of the conjoint tendon risks neuropraxia to this nerve.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.