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Shoulder & Hip Sports MCQs

Practice Set 19 of 142

This practice set contains high-yield board review questions covering key concepts in Shoulder & Hip Sports. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 361

Topic: Shoulder & Hip Sports

A 21-year-old throwing athlete has persistent shoulder pain. Figures 73a and 73b are arthroscopic photographs taken from a posterior viewing portal and an anterior viewing portal. During which phase of the throwing motion did the injury most likely occur? Review Topic

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Deceleration

Correct Answer & Explanation

. Late cocking

Explanation

Five distinct phases of the throwing motion have been identified, each of which places the static and dynamic stabilizers of the shoulder under different stresses. In the late cocking phase, the throwing arm is abducted and maximally externally rotated.Rotator cuff tears in throwing athletes may be the result of either tensile or compressive forces. Tensile failure is believed to be the result of repetitive eccentric contractions. Compressive failure is thought to result from direct contact of the articular side of the rotator cuff between the greater tuberosity and posterior glenoid. Compressive failure results in tearing of the posterior supraspinatus and anterior infraspinatus, in contrast to the more common partial tearing of the anterior supraspinatus seen in the general population. In addition to tearing of the articular side of the rotator cuff, compressive forces also contribute to the peel-back mechanism and resultant avulsion of the posterosuperior labrum and biceps anchor. Articular-sided posterior supraspinatus and infraspinatus tears in combination with posterosuperior labral and biceps anchor detachment has been termed internal impingement. It is believed to be the primary result of either posterior capsular contracture (GIRD) or anterior capsular laxity.

Question 362

Topic: Shoulder & Hip Sports
A 65-year-old woman sustained an axial load on the arm followed by an abduction injury after falling on ice. Treatment in the emergency department consisted of reduction of an anterior dislocation. She now has a positive drop arm sign and a positive lift-off test. An MRI scan is shown in Figure 9. Based on these findings, management should consist of
. tenolysis of the biceps.
. repair of the subscapularis using suture anchors.
. repair of the subscapularis tendon and biceps tenodesis.
. repair of the subscapularis tendon and removal of the loose body.
. observation.

Correct Answer & Explanation

. repair of the subscapularis tendon and biceps tenodesis.

Explanation

DISCUSSION: Dislocation of the long head of the biceps tendon is the result of a defect in the region of the rotator cuff interval, coracohumeral ligament-superior glenohumeral ligament pulley, or an associated tear of the medial insertion of the subscapularis tendon. In the case of an intra-articular dislocation of the long head of the biceps tendon associated with a tear of the subscapularis tendon, stabilization of the biceps tendon is difficult in this situation; therefore, biceps release or tenodesis and repair of the subscapularis tendon is the treatment of choice. REFERENCES: Eakin CL, Faber KJ, Hawkins RJ, et al: Biceps tendon disorders in athletes. J Am Acad Orthop Surg 1999;7:300-310. Sethi N, Wright R, Yamaguchi K: Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg 1999;8:644-654. Walch G, Boileau P: Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg 1998;7:100-108.

Question 363

Topic: Shoulder & Hip Sports

What phase of overhead throwing puts the rotator cuff at most risk of injury from internal impingement?

. Wind up
. Late cocking
. Deceleration
. Follow through

Correct Answer & Explanation

. Late cocking

Explanation

Internal impingement occurs when there is repetitive contact of the posterior superior aspect of the glenoid with the humeral head causing damage to the undersurface of the supraspinatus and anterior aspect of the infraspinatus tendons, as well as posterior superior glenoid labrum. This occurs when the arm is in maximum abduction and external rotation such as during the late cocking phase of the normal throwing motion. The 6 phases of throwing are wind up, early cocking, late cocking, deceleration, and follow through. When the arm is repeatedly placed in the abducted externally rotated position, the anterior capsule can become lax and posterior capsular contractures can develop. When there are kinetic chain abnormalities such as scapular internal rotation or muscle fatigue, there is exacerbation of abnormal anterior humeral head translation and increased contact of the rotator cuff on the posterior glenoid rim, with concomitant increased risk of injuryand symptoms.

Question 364

Topic: Shoulder & Hip Sports

Figure 41 shows the MRI scan of a 38-year-old weightlifter. What does the arrow on the MRI scan indicate? Review Topic

. Biceps tear
. Pectoralis minor tear
. Pectoralis major tear
. Subscapularis tear
. Abscess formation

Correct Answer & Explanation

. Pectoralis major tear

Explanation

Pectoralis major ruptures typically occur in avid weightlifters (often on supplements) and typically while bench-pressing. Clinically there is significant discoloration/bruising over the pectoralis and into the axilla. MRI helps confirm the diagnosis and may help determine if the tear is in the muscle belly or at the bone-tendon junction.

Question 365

Topic: Shoulder & Hip Sports

A 25-year-old volleyball player reports pain and clicking in his dominant shoulder during overhand serving. Three months of physical therapy fail to provide relief. Radiographs are normal, and an MRI scan is shown in figures 18a and 18b. Atrophy and weakness are most likely to be localized to which of the following muscles?

. Deltoid
. Supraspinatus
. Subscapularis Infraspinatus
. Infraspinatus
. Infraspinatus and teres minor

Correct Answer & Explanation

. Infraspinatus

Explanation

The MRI of the shoulder shows multiple ganglion type cysts of the genoid labrum. These cyst have a correlation with overhead type repeative motion. It has been suggested in the volleyball players that the rapid deceleration after a spike can lead to a SLAP(superior labral) lesion. This in turn can lead to genoid cyst formation. Now remember that the suprascapular nerve comes off the superior trunk of the Brachial plexus, goes under the superortransverse scapular ligament (in the scapular notch, nerve under artery above). It then descends right behind the posterior glenoid/labrum. Therefore, a large cyst in this area will impinge/entrap the nerve. This nerve supplies the infraspinatus muscle and over time will give you atrophy/ pain of this muscle. 87.

Question 366

Topic: Shoulder & Hip Sports

What is the most likely complication after surgical treatment in this scenario?

. Recurrent instability
. Degenerative joint disease
. Shoulder stiffness
. Axillary nerve injury

Correct Answer & Explanation

. Shoulder stiffness

Explanation

DISCUSSIONPosterior shoulder instability is a rare form of instability that often presents with pain rather than feelings of instability. It often occurs in young athletes during activities that put the shoulder in an “at-risk position” (flexion, adduction, and internal rotation). Repetitive microtrauma can lead to posterior shoulder instability such as seen in football linemen. Swinging a bat or golf club places the lead arm in a flexed, adducted, and internally rotated position, which can lead to posterior translation of the humeral head that is forcibly reduced in follow-through as seen in this patient.The glenohumeral joint relies on static and dynamic stabilizers. Static stabilizers help prevent instability at the end ranges of motion when the ligaments are taut. Dynamic stabilizers work to prevent subluxation at midranges of motion at which the ligaments are lax. The rotator cuff is integral as a dynamic stabilizer of the shoulder. It works through a process called concavity compression. The 4 muscles of the rotator cuff compress the humeral head into the concavity of the glenoid-labrum. This prevents the humeral head from subluxing during the midranges of motion. Of the 4 rotator cuff muscles, the subscapularis is most important at preventing posterior subluxation.This patient has posterior instability, and various surgical techniques may be indicated depending on findings. Arthroscopic labral repair is indicated for anterior instability. Arthroscopic posterior labral repair is indicated for this patient because he has a posterior labral tear and posterior instability. If a patient has ligamentous laxity (not seen in this scenario because sulcus and Brighton sign findings would be negative), a posterior capsular shift with rotator interval closure is indicated. If a patient has excessive glenoid retroversion, a posterior opening-wedge osteotomy is appropriate.The most common complication seen after arthroscopic posterior labral repair is stiffness, followed by recurrent instability and degenerative joint disease.

Question 367

Topic: Shoulder & Hip Sports

A 35-year-old man presents one week after an acute right shoulder posterior dislocation after being electrocuted. He  is  evaluated in  the emergency department and  undergoes closed  reduction.  The  patient reports global right shoulder pain and limited active and passive range of motion. He has mild anterior and lateral bruising. He is distally neurovascularly intact. Current radiographs and an MRI scan are shown in Figures 1 through 3. What is the best next step?

. Open reduction internal fixation(ORIF)
. Sling immobilization in external rotation
. Bristow-Latarjet
. Shoulder hemiarthroplastyThe patient has sustained a displaced lesser tuberosity fracture with medial displacement following a posterior shoulder dislocation. Nonoperative management would risk long-term loss of normal subscapularis function, as well as anterior shoulder instability. An ORIF of lesser tuberosity is recommended. The current radiographs do not demonstrate any obvious compromise of glenoid bone stock that would necessitate a coracoid transfer. The humeral head is not compromised; therefore, a hemiarthroplasty is notindicated. Correct answer : A                                                                                5776- A 51-year-old man sustains the injury shown in the MRI scan in Figures 1 and 2 following a fall. After a thorough discussion regarding risks and benefits, he elects to proceed with surgery. What is the most appropriate surgical treatment for his fracture?
. Open reduction internal fixation with locking plate
. Intramedullary (IM) nail
. Hemiarthroplasty
. Closed reduction and percutaneous pinningThe patient has sustained a complex proximal humerus fracture with head split component and multiple articular fragments. When the articular surface is significantly compromised, arthroplasty procedures are favored. The only procedure  listed  that  addresses  the  damaged  humeral  head  is hemiarthroplasty, making it the correct response. Although a possible option, ORIF would be difficult due to the fragmented humeral head, and there would be a high risk for fracture collapse or avascular necrosis. IM nailing will not provide enough control of the fracture pieces, nor will it replace the damaged articular surface. Closed reduction is not an option given the complex nature of the fracture.

Correct Answer & Explanation

. Hemiarthroplasty

Explanation

A 68-year-old man presents with chronic progressive right shoulder pain and loss of motion. He has active shoulder elevation of 120° and 5-/5 shoulder forward flexion strength limited by pain. He  has exhausted nonsurgical management over the past year and is now interested in surgical intervention. Figure 1 is the preoperative axial CT scan of his shoulder. During surgical reconstruction, the surgeon should anticipate the location of maximal glenoid erosion to be

Question 368

Topic: Shoulder & Hip Sports

Which of the following statements best describes labral tears in the hip?

. They are unrelated to degenerative joint disease.
. They lead to increased movement of the femur relative to the acetabulum.
. They usually result from lesions of the ligamentum teres.
. They only occur with abnormal bone morphology.
. They commonly occur in the posteroinferior quadrant of the hip.

Correct Answer & Explanation

. They commonly occur in the posteroinferior quadrant of the hip.

Explanation

DISCUSSION: Labral and chondral lesions are observed within the anterosuperior quadrant of the acetabulum. Tearing of the labrum markedly reduces resistance to joint motion, leading to instability.The most common associated lesions are chondral injuries. They can occur with or without abnormal bone morphology. The etiology for labral tears can be from traumatic and degenerative causes, structural abnormalities from femoroacetabular  impingement, developmental abnormalities, and hip instability.REFERENCES: Beck M, Kalhor M, Leunig M, et al: Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 2005;87:1012-1018.Ito K, Leunig M, Ganz R: Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 2004;429:262-271.Crawford MJ, Dy CJ, Alexander JW, et al: The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res 2007;465:16-22.

Question 369

Topic: Shoulder & Hip Sports
A previously asymptomatic 40-year-old man injures his shoulder in a fall. Examination shows that he is unable to lift the hand away from his back while maximally internally rotated. An axial MRI scan of the shoulder is shown in Figure 14. What is the most likely diagnosis?
. Pectoralis major tendon rupture
. Supraspinatus rupture
. Subscapularis rupture
. Bankart tear
. Humeral avulsion of the inferior glenohumeral ligament

Correct Answer & Explanation

. Subscapularis rupture

Explanation

DISCUSSION: The MRI scan shows detachment of the subscapularis from its insertion on the lesser tuberosity. The examination finding is consistent with a positive lift-off test, also indicating a tear of the subscapularis. REFERENCES: Lyons RP, Green A: Subscapularis tendon tears. J Am Acad Orthop Surg 2005;13:353-363. Warner JJ, Higgins L, Parsons IM, et al: Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 2001;10:37-46.

Question 370

Topic: Shoulder & Hip Sports
Atraumatic neuropathy of the suprascapular nerve usually occurs at what anatomic location?
. Suprascapular and spinoglenoid notches
. Omohyoid muscle
. Anterior trapezius muscle
. Infraspinatus fascia
. Teres minor superior border

Correct Answer & Explanation

. Suprascapular and spinoglenoid notches

Explanation

DISCUSSION: The suprascapular nerve passes through the suprascapular notch and the spinoglenoid notch before innervating the infraspinatus muscle. At both locations, the suprascapular nerve is prone to nerve compression, which often results from a ganglion cyst. The other anatomic locations are not associated with suprascapular nerve impingement. REFERENCES: Romeo AA, Rotenberg DD, Bach BR: Suprascapular neuropathy. J Am Acad Orthop Surg 1999;7:358-367. Post M, Mayer J: Suprascapular nerve entrapment: Diagnosis and treatment. Clin Orthop 1987;223:126-136.

Question 371

Topic: Shoulder & Hip Sports

This image represents the end stage of an uncompensated rotator cuff tear.

. Figure 59a is the CT image of an 86-year-old woman with acromiohumeral distance of less than 2 mm, night pain, and an inability to actively raise the affected arm above shoulder level.
. Figure 59b is the radiograph of a 45-year-old man with acromiohumeral distance equal to 7 mm. He is able to actively raise his arm above shoulder level, has lateral arm pain,
. and abduction and external rotation weakness.56
. Figures 59c and 59d are the radiographs of a 72-year-old man with night pain and reduced range of motion.

Correct Answer & Explanation

. Figure 59a is the CT image of an 86-year-old woman with acromiohumeral distance of less than 2 mm, night pain, and an inability to actively raise the affected arm above shoulder level.

Explanation

DISCUSSIONAxillary lateral and anteroposterior (AP) images of the right shoulder (Figures 59c and 59d) reveal osteoarthrosis of the glenohumeral joint, which typically is not associated with significant rotator cuff pathology. An examination often shows limitations in range of motion, crepitance, and pain with motion. An AP radiographic image of the right shoulder (Figure 59b) reveals proximal humeral migration, which normally correlates with rotator cuff tear size. Tears extending into the infraspinatus tendon are associated with more humeral migration than is seen with isolated supraspinatus tears. Presenting complaints are usually of pain and weakness. Examination findings include subacromial crepitance and weakness during rotator cuff testing. Rarely, this may be associated with pseudoparalysis in large uncompensated rotator cuff tears. The CT image of the right shoulder (Figure 59a) shows superior migration of the humerus with respect to the glenoid surface and end-stagedegenerative changes at the glenohumeral joint. These changes are classified as rotator cuff arthropathy. Pain and weakness are common, as is the presence of pseudoparalysis and limited range of motion.RECOMMENDED READINGSKelly JD Jr, Norris TR. Decision making in glenohumeral arthroplasty. J Arthroplasty. 2003 Jan;18(1):75-82. Review. PubMed PMID: 12555187.View Abstract at PubMedKeener JD, Wei AS, Kim HM, Steger-May K, Yamaguchi K. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009 Jun;91(6):1405-13. doi: 10.2106/JBJS.H.00854. PubMed PMID:

Question 372

Topic: Shoulder & Hip Sports
Figures 83a and 83b are the radiographs of a 53-year-old otherwise healthy homemaker who had a syncopal episode and sustained a ground-level fall and injury to her right elbow. She presently admits to right elbow pain, swelling, and an inability to bend her elbow. What is the best initial treatment for this injury?
. Closed reduction with immobilization
. Closed reduction with percutaneous pinning
. Open reduction, bicolumnar fixation with plate and screws
. Open reduction, bicolumnar fixation with Kirschner wires

Correct Answer & Explanation

. Open reduction, bicolumnar fixation with plate and screws

Explanation

The radiographs and CT scans indicate a comminuted and displaced intra-articular fracture of the distal humerus. Rigid internal fixation with bicolumnar orthogonal or parallel plating is the treatment of choice for most fractures of the distal humerus that involve the joint surface. Closed reduction and variations thereof will not yield a stable environment for healing. To achieve adequate exposure for fixation, a chevron olecranon osteotomy is the preferred approach. Disadvantages associated with this approach include complications such as nonunion of the osteotomy site and intra-articular adhesions. Prominent hardware may need to be removed during a secondary procedure, and intraoperative conversion to an elbow arthroplasty may be limited. The most common complications after open reduction and internal fixation include elbow stiffness, nonunion (2%-10%), and ulnar neuropathy (0%-12%).

Question 373

Topic: Shoulder & Hip Sports
Initial postoperative management after repair of an acute rotator cuff tear includes
. active range of motion.
. active abduction to prevent scarring.
. passive forward elevation and external rotation within a safe zone determined at surgery.
. eccentric strengthening exercises.
. internal rotation behind the back.

Correct Answer & Explanation

. passive forward elevation and external rotation within a safe zone determined at surgery.

Explanation

In the immediate postoperative period following repair of an acute rotator cuff tear, passive forward elevation and external rotation should be performed within the safe zone determined at surgery. Early active range of motion (prior to tendon healing), internal rotation behind the back, and resistive exercises increase the risk of rupture of the repair.

Question 374

Topic: Shoulder & Hip Sports
The modified Judet approach to the posterior scapula exploits the internervous interval between what two muscles?
. Supraspinatus and infraspinatus
. Supraspinatus and subscapularis
. Infraspinatus and teres minor
. Teres minor and teres major
. Teres major and latissimus

Correct Answer & Explanation

. Infraspinatus and teres minor

Explanation

Discussion: The posterior or modified Judet approach to the scapula is typically used for internal fixation of scapular fractures. This approach utilizes a transverse incision over the scapular spine with detachment of the posterior deltoid. The interval between the infraspinatus (suprascapular n.) and teres minor (axillary n.) is identified and used to gain access to the posterior aspect of the scapula and glenoid. The reference by Obremskey et al argues the approach combines several important goals including: 1) exposure of all bony elements of the scapula which have adequate bone stock for internal fixation; 2) minimal trauma to the rotator cuff musculature; and 3) protection of the major neurologic structures (suprascapular nerve superiorly and axillary nerve laterally).

Question 375

Topic: Shoulder & Hip Sports

The MRI scans and diagnostic ultrasound shown in Figures 2a through 2c show what pathologic condition? Review Topic

. Articular-sided supraspinatus tendon tear
. Bursal-sided supraspinatus tear
. Superior labral tear
. Humeral avulsion of the anterior glenoid ligament
. Avulsion of the anterior inferior glenohumeral ligament

Correct Answer & Explanation

. Articular-sided supraspinatus tendon tear

Explanation

The MRI scans and ultrasound show an articular surface partial-thickness rotator cuff tear of the supraspinatus tendon. This condition most commonly involves the supraspinatus tendon and is usually found on the articular surface where the blood supply is less robust. There are multiple intrinsic and extrinsic factors contributing to this condition which include age-related metabolic and vascular changes that lead to degenerative tearing, subacromial impingement, shoulder instability (typically anterior), internal impingement, and repetitive microtrauma. Acute trauma is less often the cause. The physical examination for this condition is often nonspecific and requires supplemental imaging studies for diagnosis.

Question 376

Topic: Shoulder & Hip Sports

Internal impingement of the shoulder and posterosuperior labral pathology in throwers has been most clearly associated with which of the following? Review Topic

. Posterior capsular contracture
. Anterior capsular laxity
. Coracoacromial arch stenosis
. Rotator cuff disease
. Bennet's lesion

Correct Answer & Explanation

. Posterior capsular contracture

Explanation

Posterior capular contracture has been recognized to be the primary pathologic process resulting in internal impingement. Internal impingement of the shoulder describes contact between the posterosuperior glenoid labrum and the undersurface of the rotator cuff at the level of the posterior supraspinatus when the shoulder comes into abduction and external rotation. This contact may be physiologic or pathologic and is frequently seen in overhead throwing athletes, possibly resulting in articular-sided rotator cuff tears, glenoid labral tears, tendinitis of the long head of the biceps, anterior instability, glenohumeral internal rotation deficit, and dysfunction of scapular rhythm. Nonsurgical management is the initial treatment of choice with an emphasis on increasing range of motion and improving scapular mechanics. Anterior capsular laxity may be present with internal impingement but is variable and less directly associated with internal impingement than posterior capsular contracture.Coracoacromial arch stenosis is associated with subacromial impingement and unrelated to internal impingement. Bennett's lesion refers to exostosis or calcification at the posterior capsule and while potentially associated with overhead throwing athletes who may have internal impingement, a causal link between the two has not been established and therefore posterior capsular contracture is the preferred response.

Question 377

Topic: Shoulder & Hip Sports
Figure 52 shows the MRI scan of a 28-year-old baseball pitcher. Examination will most likely reveal which of the following findings?
. Clinical findings similar to a large rotator cuff tear
. Weakness of the deltoid
. Numbness in the C7 dermatomal distribution
. Winging of the scapula
. A positive lift-off test

Correct Answer & Explanation

. Clinical findings similar to a large rotator cuff tear

Explanation

DISCUSSION: A ganglion cyst compressing the suprascapular nerve results in poorly localized pain in the shoulder girdle. Sensation is intact, with weakness of external rotation and abduction. Supraspinatus and infraspinatus atrophy is often noted when viewed from behind. These cysts are typically associated with labral tears. Deltoid weakness is associated with an axillary nerve injury, and scapular winging results from injury to the long thoracic nerve.

Question 378

Topic: Shoulder & Hip Sports

A 56-year-old woman undergoes an arthroscopic rotator cuff repair for a two-tendon retracted tear (supraspinatus and infraspinatus), requiring the use of four suture anchors placed in a double row technique. At her 1 month follow-up visit, what is the appropriate recommendation for her continued rehabilitation program? Review Topic

. Initiate isometric external rotation strengthening and continue passive range of motion.
. Initiate eccentric supraspinatus strengthening and continue passive range of motion.
. Initiate light resistance training to minimize atrophy and continue passive range of motion.
. Continue passive range of motion and initiate concentric deltoid strengthening.
. Continue passive range of motion with no active strengthening of the shoulder muscles.

Correct Answer & Explanation

. Initiate isometric external rotation strengthening and continue passive range of motion.

Explanation

Regardless of the technique of rotator cuff repair, the biology of tendon healing remains the same. Therefore, the repaired muscle tendon(s) must be protected from stress for a minimum of 6 weeks and more likely 8 weeks in a large two-tendon tear such as this patient had repaired. Therefore, at the 1 month follow-up visit, the patient should continue strict passive motion exercises and should perform no strengthening activities. Deltoid strengthening cannot be isolated from rotator cuff strengthening; therefore, deltoid strengthening is inappropriate as well. Because the infraspinatus is the primary shoulder external rotator, it should not be strengthened for 6 to 8 weeks. Supraspinatus strengthening at this time frame would likely ensure its disruption and result in failure of the surgery. Any resistance training at 1 month from surgery would likely result in tendon failure at the tendon-bone interface. The obligatory need to protect the muscles during healing will predictably result in atrophy but it is easier to strengthen healed muscles than it is to strengthen muscle/tendon units that have failed to heal.

Question 379

Topic: Shoulder & Hip Sports
A patient underwent anterior stabilization of the shoulder 6 months ago, and examination now reveals lack of external rotation beyond 0°. The patient has a normal apprehension sign and normal strength, and the radiographs are normal. Based on these findings, the patient is at greater risk for the development of
. recurring instability.
. osteoarthritis.
. osteonecrosis.
. a tear of the rotator cuff.
. internal impingement.

Correct Answer & Explanation

. osteoarthritis.

Explanation

Because the patient’s shoulders are overtensioned anteriorly, premature osteoarthritis may develop. This may create obligate translation posteriorly and increase the interarticular pressure of the humeral head against the glenoid. Patients should achieve 20° to 30° of external rotation with the elbow at the side. Late degenerative arthritis following a Putti-Platt procedure is associated with significant restriction of external rotation. This patient’s shoulder has a reduced risk of anterior instability, rotator cuff tear, and internal impingement because of the limitation of motion.

Question 380

Topic: Shoulder & Hip Sports
A 22-year-old volleyball player has atrophy of the infraspinatus muscle. This deficit is the result of entrapment of what nerve?
. Axillary nerve in the posterolateral space
. Dorsal scapular nerve at the medial border of the scapula
. Suprascapular nerve in the scapular notch
. Suprascapular nerve in the spinoglenoid notch
. Subscapular nerve at the rotator interval

Correct Answer & Explanation

. Suprascapular nerve in the spinoglenoid notch

Explanation

Suprascapular deficits, as the result of repetitive forceful internal rotation with overhead ball striking, occur in the spinoglenoid notch. Compression interferes with distal suprascapular nerve innervation to the infraspinatus, while allowing the supraspinatus to function normally. A scapular notch entrapment of this nerve would involve both the supraspinatus and the infraspinatus.

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