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Question 2141

Topic: Shoulder & Hip Sports

A patient presents with vague posterior shoulder pain and isolated atrophy of the teres minor. An MRI demonstrates quadrilateral space syndrome. Which of the following correctly defines the borders of the quadrilateral space?

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, humeral shaft laterally
. Teres major superiorly, teres minor inferiorly, long head of triceps laterally, humeral shaft medially
. Subscapularis superiorly, teres major inferiorly, short head of biceps medially, humeral shaft laterally
. Teres minor superiorly, latissimus dorsi inferiorly, lateral head of triceps medially, humerus laterally
. Infraspinatus superiorly, teres minor inferiorly, long head of triceps medially, glenoid laterally

Correct Answer & Explanation

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, humeral shaft laterally


Explanation

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

Question 2142

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player has weakness in external rotation of the shoulder. Examination reveals isolated atrophy of the infraspinatus without supraspinatus involvement. Entrapment of the suprascapular nerve at the spinoglenoid notch is typically associated with which of the following?

. Weakness of shoulder abduction and external rotation
. Hypertrophy of the transverse scapular ligament
. A ganglion cyst arising from a posterior labral tear
. Weakness of the deltoid and teres minor
. Compression by the coracoacromial ligament

Correct Answer & Explanation

. A ganglion cyst arising from a posterior labral tear


Explanation

Entrapment at the spinoglenoid notch affects only the motor branch to the infraspinatus, leading to isolated external rotation weakness. It is most commonly caused by a ganglion cyst associated with a posterior labral tear.

Question 2143

Topic: Shoulder & Hip Sports

A 30-year-old swimmer undergoes shoulder arthroscopy for instability. The surgeon evaluates the rotator interval, an anatomical space in the anterior shoulder. Which of the following tendons forms the inferior border of the rotator interval?

. Supraspinatus
. Subscapularis
. Infraspinatus
. Teres minor
. Long head of the biceps

Correct Answer & Explanation

. Subscapularis


Explanation

The rotator interval is a triangular space bordered superiorly by the anterior margin of the supraspinatus and inferiorly by the superior margin of the subscapularis. It contains the coracohumeral ligament, superior glenohumeral ligament, and biceps tendon.

Question 2144

Topic: Shoulder & Hip Sports

During an arthroscopic procedure for adhesive capsulitis, the surgeon releases the structures within the rotator interval. Which of the following anatomic structures forms the superior border of this interval?

. Supraspinatus tendon
. Subscapularis tendon
. Coracohumeral ligament
. Superior glenohumeral ligament
. Long head of the biceps tendon

Correct Answer & Explanation

. Subscapularis tendon


Explanation

The rotator interval is a triangular anatomic space in the anterosuperior shoulder. It is bordered superiorly by the anterior margin of the supraspinatus tendon, inferiorly by the superior margin of the subscapularis tendon, and medially by the base of the coracoid process.

Question 2145

Topic: Shoulder & Hip Sports

During the Latarjet procedure for recurrent anterior shoulder instability, the musculocutaneous nerve is at risk. It typically pierces the coracobrachialis muscle at what average distance distal to the tip of the coracoid process?

. 1-3 cm
. 5-8 cm
. 10-12 cm
. 15-18 cm
. 20-22 cm

Correct Answer & Explanation

. 5-8 cm


Explanation

The musculocutaneous nerve typically enters the coracobrachialis muscle approximately 5-8 cm distal to the coracoid process. Care must be taken during anterior shoulder approaches and coracoid osteotomy down to this level.

Question 2146

Topic: Shoulder & Hip Sports

A patient presents with posterior shoulder pain and selective weakness of external rotation. MRI reveals a large paralabral ganglion cyst isolated to the spinoglenoid notch. Which muscle will exhibit denervation changes?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Infraspinatus


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the terminal motor branch to the infraspinatus. Compression at the more proximal suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2147

Topic: Shoulder & Hip Sports

The rotator interval is a triangular anatomical space in the anterior shoulder. Which of the following sets of structures is contained within this interval?

. Supraspinatus tendon and coracoacromial ligament
. Coracohumeral ligament and long head of the biceps tendon
. Middle glenohumeral ligament and subscapularis tendon
. Infraspinatus tendon and teres minor tendon
. Short head of the biceps and coracobrachialis

Correct Answer & Explanation

. Coracohumeral ligament and long head of the biceps tendon


Explanation

The rotator interval is bordered by the supraspinatus superiorly, subscapularis inferiorly, and the coracoid base medially. It contains the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 2148

Topic: Shoulder & Hip Sports

A 28-year-old weightlifter presents with right shoulder pain and weakness in external rotation. An MRI shows an isolated cyst compressing the nerve in the quadrangular space. Which of the following muscles is most likely denervated?

. Teres minor
. Teres major
. Infraspinatus
. Supraspinatus
. Subscapularis

Correct Answer & Explanation

. Teres minor


Explanation

The axillary nerve passes through the quadrangular space and innervates the deltoid and teres minor. Compression in this space leads to weakness in shoulder abduction and external rotation, along with teres minor denervation.

Question 2149

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with progressive right shoulder weakness. Examination reveals normal shoulder abduction and internal rotation but weakness in external rotation. Atrophy is noted over the posterior scapula, but the supraspinatus fossa appears normal. Compression of the suprascapular nerve is most likely occurring at which location?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Isolated weakness of the infraspinatus with normal supraspinatus function indicates suprascapular nerve compression at the spinoglenoid notch. Compression at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 2150

Topic: Shoulder & Hip Sports

In planning a surgical dislocation of the hip for femoroacetabular impingement, the surgeon must protect the primary blood supply to the femoral head. Which of the following represents the primary blood supply to the adult femoral head?

. Ligamentum teres artery
. Medial femoral circumflex artery
. Lateral femoral circumflex artery
. Inferior gluteal artery
. Obturator artery

Correct Answer & Explanation

. Medial femoral circumflex artery


Explanation

The medial femoral circumflex artery (MFCA) provides the primary blood supply to the adult femoral head via its deep branch and lateral epiphyseal vessels. It must be carefully protected during posterior approaches and surgical dislocations.

Question 2151

Topic: Shoulder & Hip Sports

A surgeon is performing an arthroscopic rotator interval closure for shoulder instability. Which of the following structures form the superior and inferior borders of the rotator interval, respectively?

. Supraspinatus and subscapularis
. Infraspinatus and teres minor
. Supraspinatus and infraspinatus
. Subscapularis and pectoralis major
. Biceps tendon and subscapularis

Correct Answer & Explanation

. Supraspinatus and subscapularis


Explanation

The rotator interval is an anatomical space in the anterosuperior shoulder bordered superiorly by the anterior margin of the supraspinatus and inferiorly by the superior margin of the subscapularis. It contains the long head of the biceps tendon and the coracohumeral ligament.

Question 2152

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with painless weakness in shoulder external rotation. Clinical examination demonstrates isolated atrophy of the infraspinatus, with normal bulk and strength of the supraspinatus. Entrapment of the suprascapular nerve is most likely occurring at which anatomical location?

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

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 due to a paralabral cyst from a SLAP tear, causes isolated infraspinatus atrophy.

Question 2153

Topic: Shoulder & Hip Sports

An orthopedic surgeon is evaluating a volleyball player with an isolated suprascapular nerve entrapment at the spinoglenoid notch. Which of the following physical exam findings is most expected?

. Weakness in forward elevation
. Isolated weakness in external rotation
. Weakness in both initial abduction and external rotation
. Loss of sensation over the lateral deltoid
. Atrophy of the teres minor

Correct Answer & Explanation

. Isolated weakness in external rotation


Explanation

Entrapment at the spinoglenoid notch affects the suprascapular nerve after it has already innervated the supraspinatus. Therefore, it causes isolated denervation and weakness of the infraspinatus (external rotation).

Question 2154

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with isolated weakness in external rotation of the shoulder. Atrophy of the infraspinatus is noted without supraspinatus involvement. Entrapment of the suprascapular nerve is most likely occurring at which location?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch results in isolated infraspinatus weakness and atrophy. Entrapment at the suprascapular notch, which is more proximal, would affect both the supraspinatus and infraspinatus.

Question 2155

Topic: Shoulder & Hip Sports

A professional volleyball player presents with isolated weakness of the infraspinatus and normal supraspinatus strength. Entrapment of the suprascapular nerve is most likely occurring at which location?

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

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 (commonly by a paralabral cyst) causes isolated infraspinatus weakness.

Question 2156

Topic: Shoulder & Hip Sports

In performing a transfer of the latissimus dorsi for a massive, irreparable posterosuperior rotator cuff tear, the nerve supplying the transferred muscle must be protected. This nerve arises from which portion of the brachial plexus?

. Lateral cord
. Medial cord
. Posterior cord
. Upper trunk
. Lower trunk

Correct Answer & Explanation

. Posterior cord


Explanation

The latissimus dorsi is innervated by the thoracodorsal nerve. This nerve is a branch of the posterior cord of the brachial plexus, carrying fibers from C6, C7, and C8.

Question 2157

Topic: Shoulder & Hip Sports

A surgeon is navigating the rotator interval during a shoulder arthroscopy for a patient with adhesive capsulitis. Which of the following accurately describes a true boundary or content of this anatomical space?

. Inferiorly bounded by the subscapularis tendon
. Superiorly bounded by the infraspinatus tendon
. Contains the inferior glenohumeral ligament
. Bounded laterally by the coracoid process
. Floor is formed by the coracoacromial ligament

Correct Answer & Explanation

. Inferiorly bounded by the subscapularis tendon


Explanation

The rotator interval is bounded superiorly by the supraspinatus and inferiorly by the subscapularis. It contains the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 2158

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the right shoulder. Atrophy of the infraspinatus is noted, but supraspinatus strength is normal. Entrapment of the affected nerve at which anatomical location is most likely?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

The suprascapular nerve supplies the supraspinatus and infraspinatus. Entrapment at the spinoglenoid notch affects only the infraspinatus, while entrapment at the suprascapular notch affects both muscles.

Question 2159

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. Forward elevation and abduction strength are normal. MRI reveals a paralabral cyst compressing a nerve. Where is the most likely location of the cyst?

. Quadrangular space
. Suprascapular notch
. Spinoglenoid notch
. Triangular interval
. Coracoid base

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Isolated infraspinatus weakness (decreased external rotation) with normal supraspinatus function (abduction) suggests suprascapular nerve entrapment at the spinoglenoid notch. Entrapment at the suprascapular notch affects both the supraspinatus and infraspinatus muscles.

Question 2160

Topic: Shoulder & Hip Sports

A 45-year-old patient undergoes arthroscopic shoulder surgery. The surgeon identifies the rotator interval. Which of the following structures form the superior and inferior borders of the rotator interval, respectively?

. Infraspinatus and teres minor
. Supraspinatus and subscapularis
. Supraspinatus and infraspinatus
. Coracohumeral ligament and superior glenohumeral ligament
. Subscapularis and teres major

Correct Answer & Explanation

. Supraspinatus and subscapularis


Explanation

The rotator interval is a triangular anatomic space in the shoulder. Its borders are the supraspinatus tendon superiorly and the subscapularis tendon inferiorly, with the base formed by the coracoid process.