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Question 1981

Topic: Shoulder & Hip Sports

A 30-year-old male volleyball player presents with isolated weakness in external rotation of his dominant shoulder. Forward elevation and internal rotation strength are normal. MRI reveals a paralabral cyst. At what anatomical location is this cyst most likely compressing the affected nerve?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Isolated infraspinatus weakness (external rotation) with normal supraspinatus function (forward elevation) indicates distal suprascapular nerve compression. This typically occurs at the spinoglenoid notch, often due to a paralabral cyst from a posterior labral tear.

Question 1982

Topic: Shoulder & Hip Sports

Latissimus dorsi tendon transfer is occasionally considered for patients with massive, irreparable posterosuperior rotator cuff tears. Which of the following is generally considered an absolute contraindication for this procedure?

. Age greater than 60 years
. Intact subscapularis tendon
. Subscapularis tear insufficiency
. Hamada Grade 1 radiographic changes
. Intact teres minor

Correct Answer & Explanation

. Intact subscapularis tendon


Explanation

Latissimus dorsi transfer requires an intact, functioning subscapularis to provide an anterior counterforce for glenohumeral stability. Subscapularis insufficiency, advanced glenohumeral arthritis, and deltoid paralysis are primary contraindications.

Question 1983

Topic: Shoulder & Hip Sports

A 21-year-old collegiate linebacker undergoes arthroscopic stabilization for recurrent anterior shoulder instability. During diagnostic arthroscopy, the surgeon notes an avulsion of the anteroinferior capsulolabral complex from the glenoid rim. What is the classic eponym for this lesion?

. ALPSA lesion
. Bankart lesion
. HAGL lesion
. GLAD lesion
. Hill-Sachs lesion

Correct Answer & Explanation

. Bankart lesion


Explanation

A Bankart lesion is defined as the avulsion of the anteroinferior capsulolabral complex from the glenoid rim. It is the essential soft-tissue lesion seen in traumatic, unidirectional anterior shoulder instability.

Question 1984

Topic: Shoulder & Hip Sports

An MRI of the shoulder reveals a paralabral cyst compressing the suprascapular nerve strictly at the spinoglenoid notch. Which physical exam finding is most likely to be isolated in this patient?

. Weakness in forward elevation
. Weakness in external rotation with isolated atrophy of the infraspinatus
. Weakness in internal rotation with atrophy of the subscapularis
. Atrophy of both the supraspinatus and infraspinatus
. Loss of sensation over the lateral deltoid

Correct Answer & Explanation

. Weakness in external rotation with isolated atrophy of the infraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus prior to passing through the spinoglenoid notch. Compression at the spinoglenoid notch isolatedly denervates the infraspinatus, causing weakness in external rotation.

Question 1985

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness. Examination reveals isolated external rotation weakness with the arm at the side and visible atrophy of the infraspinatus. Supraspinatus strength is normal. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Triangular space

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branch to the infraspinatus. This leads to isolated weakness in external rotation and infraspinatus atrophy.

Question 1986

Topic: Shoulder & Hip Sports

A patient presents with weakness in shoulder abduction and external rotation following a traction injury. EMG reveals denervation isolated to the supraspinatus and infraspinatus muscles. Which of the following anatomic landmarks is the most frequent site of compression?

. Spinoglenoid notch
. Suprascapular notch
. Quadrilateral space
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Suprascapular notch


Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles and is most commonly compressed at the suprascapular notch beneath the superior transverse scapular ligament. Entrapment further distally at the spinoglenoid notch would typically spare the supraspinatus and isolate weakness to the infraspinatus.

Question 1987

Topic: Shoulder & Hip Sports

A 26-year-old professional baseball pitcher presents with isolated, painless weakness in external rotation of his throwing shoulder. Magnetic resonance imaging demonstrates isolated atrophy of the infraspinatus muscle. At which of the following anatomical locations is the affected nerve most likely compressed?

. Quadrilateral space
. Suprascapular notch
. Spinoglenoid notch
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus, presenting with painless weakness in external rotation. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1988

Topic: Shoulder & Hip Sports

A 34-year-old professional volleyball player presents with insidious onset of right shoulder weakness. Examination reveals isolated atrophy of the infraspinatus with normal supraspinatus bulk and strength. Where is the most likely site of nerve compression?

. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch results in isolated infraspinatus weakness and atrophy. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1989

Topic: Shoulder & Hip Sports

A 25-year-old man sustains a severe traction injury to his shoulder, resulting in a disruption of the posterior cord of the brachial plexus. Which of the following muscles will most likely demonstrate profound weakness on clinical examination?

. Pectoralis major
. Latissimus dorsi
. Biceps brachii
. Flexor carpi ulnaris
. Supraspinatus

Correct Answer & Explanation

. Latissimus dorsi


Explanation

The latissimus dorsi is innervated by the thoracodorsal nerve, which arises from the posterior cord. The pectoralis major (medial/lateral cords), biceps (lateral cord), flexor carpi ulnaris (medial cord), and supraspinatus (upper trunk) do not receive primary innervation from the posterior cord.

Question 1990

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with isolated weakness of external rotation in his dominant shoulder. MRI reveals a paralabral cyst in the spinoglenoid notch. Which nerve is compressed, and which muscle(s) will demonstrate denervation changes?

. Suprascapular nerve; supraspinatus and infraspinatus
. Suprascapular nerve; infraspinatus only
. Axillary nerve; teres minor
. Dorsal scapular nerve; rhomboids
. Radial nerve; triceps

Correct Answer & Explanation

. Suprascapular nerve; infraspinatus only


Explanation

The suprascapular nerve passes through the suprascapular notch to innervate the supraspinatus, then travels through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch causes isolated infraspinatus weakness.

Question 1991

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder with the arm at the side, but has normal abduction strength and no sensory deficits. An MRI reveals a paralabral cyst in the spinoglenoid notch. From which structural level of the brachial plexus does the affected nerve originate?

. C5 and C6 nerve roots directly
. Upper trunk
. Middle trunk
. Lateral cord
. Posterior cord

Correct Answer & Explanation

. Upper trunk


Explanation

The suprascapular nerve originates from the upper trunk of the brachial plexus (C5, C6). Compression at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness.

Question 1992

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the conjoined tendon is mobilized and retracted to gain exposure to the anterior glenoid. The surgeon must be mindful of the musculocutaneous nerve entering the coracobrachialis muscle. What is the typical distance from the tip of the coracoid process to the point where this nerve enters the muscle?

. 1-3 cm
. 5-8 cm
. 10-12 cm
. 13-15 cm
. It does not enter the coracobrachialis

Correct Answer & Explanation

. 5-8 cm


Explanation

The musculocutaneous nerve typically enters the coracobrachialis muscle 5 to 8 cm distal to the tip of the coracoid process. Vigorous retraction of the conjoined tendon past this limit can cause a stretch injury to the nerve.

Question 1993

Topic: Shoulder & Hip Sports

A professional volleyball player presents with isolated weakness of the infraspinatus muscle. MRI reveals a ganglion cyst compressing a nerve at the spinoglenoid notch. Which ligament forms the roof of this notch?

. Coracoacromial ligament
. Superior transverse scapular ligament
. Spinoglenoid ligament
. Coracohumeral ligament
. Superior glenohumeral ligament

Correct Answer & Explanation

. Spinoglenoid ligament


Explanation

The suprascapular nerve passes through the spinoglenoid notch, where it is roofed by the spinoglenoid ligament (inferior transverse scapular ligament). Entrapment here causes isolated infraspinatus weakness, sparring the supraspinatus.

Question 1994

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness of external rotation of the shoulder with preserved abduction. At which of the following anatomical locations is nerve entrapment most likely occurring?

. Quadrangular space
. Suprascapular notch
. Spinoglenoid notch
. Spiral groove
. Triangular interval

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Entrapment at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 1995

Topic: Shoulder & Hip Sports

A professional volleyball player presents with isolated weakness in external rotation of the shoulder. Atrophy is noted in the infraspinatus fossa, while the supraspinatus is normal. Entrapment of the suprascapular nerve is suspected at which location?

. Quadrilateral space
. Suprascapular notch
. Spinoglenoid notch
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus, leading to isolated weakness in external rotation. Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1996

Topic: Shoulder & Hip Sports

A 24-year-old male sustains a posterior shoulder dislocation. After reduction, he exhibits numbness over the lateral aspect of his shoulder and weak shoulder abduction. The injured nerve exits the axilla through a space bounded by which of the following structures?

. Teres minor, teres major, long head of triceps, surgical neck of humerus
. Teres minor, teres major, long head of triceps
. Teres major, lateral head of triceps, long head of triceps
. Subscapularis, coracobrachialis, short head of biceps
. Infraspinatus, supraspinatus, spine of scapula

Correct Answer & Explanation

. Teres minor, teres major, long head of triceps, surgical neck of humerus


Explanation

The axillary nerve exits through the quadrangular space, bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus.

Question 1997

Topic: Shoulder & Hip Sports

A professional volleyball player presents with isolated atrophy and weakness of the infraspinatus muscle. Supraspinatus strength and muscle bulk are entirely normal. Where is the most likely site of nerve entrapment?

. Suprascapular notch
. Spinoglenoid notch
. Quadrangular space
. Triangular space
. Subcoracoid space

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch, often by a paralabral cyst, causes isolated infraspinatus weakness.

Question 1998

Topic: Shoulder & Hip Sports

A volleyball player presents with painless weakness in external rotation of the shoulder. Examination reveals atrophy isolated to the infraspinatus fossa. An MRI demonstrates a paralabral cyst. Where is the cyst most likely located to cause this specific presentation?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Subcoracoid space

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. Compression at the spinoglenoid notch, typically by a paralabral cyst associated with a posterior labral tear, affects only the branch to the infraspinatus, causing isolated external rotation weakness and infraspinatus atrophy.

Question 1999

Topic: Shoulder & Hip Sports

A 35-year-old professional volleyball player presents with painless shoulder weakness. Examination reveals isolated profound atrophy of the infraspinatus with completely preserved supraspinatus muscle bulk. Where is the most likely anatomic site of nerve entrapment?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spinal root C5

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branches to the infraspinatus. Entrapment at the more proximal suprascapular notch would cause atrophy of both the supraspinatus and infraspinatus.

Question 2000

Topic: Shoulder & Hip Sports

A patient presents with vague posterior shoulder pain and isolated weakness of the teres minor and deltoid. MRI reveals a paralabral cyst compressing structures within the quadrilateral space. Which of the following correctly describes the anatomical borders of this space?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)
. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humerus (medial)
. Teres major (superior), teres minor (inferior), long head of triceps (medial), humerus (lateral)
. Subscapularis (superior), teres minor (inferior), short head of biceps (medial), humerus (lateral)
. Teres minor (superior), latissimus dorsi (inferior), long head of triceps (lateral), humerus (medial)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)


Explanation

The quadrilateral space is bordered by the teres minor superiorly, teres major inferiorly, the long head of the triceps medially, and the surgical neck of the humerus laterally. It transmits the axillary nerve and posterior circumflex humeral artery.