1. General Principles & Basic Science MCQs

A 33-year-old overhead athlete undergoes an arthroscopic labral repair. Post-operatively, he notes new-onset numbness over the lateral aspect of his deltoid. Which arthroscopic portal placement is most strongly associated with this specific iatrogenic nerve injury?

An 18-year-old gymnast sustains an anterior shoulder dislocation. After successful closed reduction, she complains of decreased sensation over the lateral aspect of her deltoid muscle. Which of the following nerve roots primarily contributes to the injured nerve?

During a posterior approach to the shoulder, the surgeon must carefully navigate the quadrangular space to avoid injury to the axillary nerve and posterior circumflex humeral artery. Which muscle forms the superior border of this anatomic space?

A 6-year-old boy is brought to the clinic with an acute onset of right hip pain and a limp. He had a brief upper respiratory infection two weeks prior. He is afebrile, and his WBC, ESR, and CRP are within normal limits. Ultrasound demonstrates a small joint effusion. What is the most appropriate initial management?

During a posterior approach to the hip (Kocher-Langenbeck), the surgeon divides the short external rotators. Which specific tendinous structure is typically tagged and reflected posteriorly over the sciatic nerve to protect it during the procedure?

A 65-year-old female undergoes a total hip arthroplasty utilizing the direct anterior approach (Smith-Petersen interval). Postoperatively, she reports a distressing patch of numbness and burning pain over the anterolateral aspect of her proximal thigh. Which nerve was most likely stretched or injured during the exposure?

A 32-year-old male bodybuilder feels a sudden, painful "pop" in his anterior axilla while performing a heavy bench press. Examination reveals loss of the normal anterior axillary fold contour and pronounced weakness with resisted internal rotation. At which specific anatomical location does this rupture most commonly occur?

A 16-year-old male is tackled forcefully during a football game and presents with shortness of breath, dysphagia, and a palpable defect at the medial aspect of the left clavicle. Which imaging modality is considered the gold standard for evaluating this specific injury?

A 32-year-old male competitive weightlifter feels a sudden "pop" in his axilla while performing a heavy bench press. Examination demonstrates loss of the anterior axillary fold and weakness with internal rotation. He is diagnosed with a pectoralis major rupture. Which of the following best describes the anatomic footprint of the sternal head of the pectoralis major on the humerus?

A 28-year-old male sustains a shoulder injury during a recreational wrestling match. Based on the likely diagnosis shown in the representative radiograph, which of the following is the most commonly associated nerve injury?

A 35-year-old male undergoes open posterior glenohumeral stabilization for recurrent posterior instability with significant glenoid retroversion. The surgeon plans a posterior deltoid-splitting approach to access the joint. During the approach, careful attention is paid to the internervous plane and nerve protection. The image below depicts a posterior shoulder approach.

Which of the following statements accurately describes the internervous plane utilized in this approach and a critical nerve to protect?

A 9-year-old patient underwent lateral proximal tibial hemiepiphysiodesis for Blount disease 18 months ago. At the most recent follow-up, standing full-length radiographs show a mechanical axis that has shifted significantly lateral to the center of the knee, indicating a genu valgum deformity. The patient's skeletal age is 10 years. What is the most appropriate initial management for this complication?

A 50-year-old patient, 5 months post-operative from an open Achilles tendon repair, is struggling with return to sport. He has full range of motion but complains of persistent weakness in push-off and inability to perform a single-leg heel raise more than 5 times. His calf girth is noticeably smaller on the affected side. Based on the potential complications and rehabilitation principles, what is the most likely underlying issue and the recommended next step in his rehabilitation?

A surgeon is performing an open coracoclavicular ligament reconstruction. During the exposure of the coracoid process, the clavipectoral fascia is incised lateral to the conjoint tendon. Referring to the provided image and the neurovascular anatomy described in the case, which critical neurovascular structure is at risk if dissection extends too far distally and medially from the coracoid tip?

A surgeon is performing an anterolateral (deltoid-splitting) approach for a greater tuberosity fracture. To minimize the risk of iatrogenic injury to the axillary nerve, the surgeon must limit the deltoid split to a specific distance distal to the acromial border. What is the approximate safe limit for the deltoid split?

A 48-year-old male sustains a Holstein–Lewis fracture. On initial presentation, he has an incomplete radial nerve palsy (weak wrist extension, intact sensation). After a closed reduction attempt, his radial nerve palsy progresses to a complete motor and sensory deficit.

What is the most appropriate next step in the management of this patient's radial nerve injury?

A 55-year-old patient with a displaced Holstein–Lewis fracture and a complete radial nerve palsy at presentation is scheduled for ORIF.

Which surgical approach is generally preferred for this fracture pattern, and what is the most critical step regarding radial nerve management during the procedure?

A 40-year-old patient presents with a Holstein–Lewis fracture. On initial examination, he has no signs of radial nerve palsy. After successful closed reduction and application of a functional brace, he develops a complete radial nerve palsy 24 hours later.

This scenario represents a secondary radial nerve palsy. What is the critical implication for management compared to a primary palsy present at initial presentation?

A 30-year-old patient with a Holstein–Lewis fracture sustained a complete radial nerve transection that was not amenable to primary repair during initial surgery. Despite secondary nerve grafting 6 months later, there is no evidence of recovery after 18 months.

Given the persistent complete radial nerve palsy after 18 months, what is the most appropriate long-term salvage strategy to restore functional wrist and finger extension?

Anatomical reconstruction of the coracoclavicular (CC) ligaments requires precise knowledge of their insertions. Which of the following accurately describes the anatomy and primary biomechanical role of the conoid ligament?