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Question 3201

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. MRI reveals a paralabral cyst. Compression of the involved nerve at the spinoglenoid notch will selectively denervate which of the following muscles?

. Supraspinatus
. Infraspinatus
. Teres minor
. Deltoid
. Subscapularis

Correct Answer & Explanation

. Infraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus prior to passing through the spinoglenoid notch. Therefore, a cyst at the spinoglenoid notch causes isolated denervation of the infraspinatus muscle.

Question 3202

Topic: Knee Sports

A patient is undergoing reconstruction of the posterolateral corner (PLC) of the knee. Which of the following structures constitutes the primary static stabilizer to external tibial rotation at 30 degrees of knee flexion?

. Popliteus tendon
. Lateral collateral ligament (LCL)
. Popliteofibular ligament (PFL)
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament (PFL)


Explanation

The popliteofibular ligament (PFL) is a critical component of the PLC and acts as the primary static stabilizer against external rotation of the tibia. The LCL is the primary restraint to varus stress.

Question 3203

Topic: 5. Sports Medicine

To avoid iatrogenic injury during placement of the anterolateral portal for ankle arthroscopy, the surgeon must be aware of the path of the superficial peroneal nerve. On average, where does this nerve pierce the deep crural fascia to become subcutaneous?

. 5 cm proximal to the medial malleolus
. 5 cm proximal to the lateral malleolus
. 10 to 12 cm proximal to the medial malleolus
. 10 to 12 cm proximal to the lateral malleolus
. Immediately distal to the fibular head

Correct Answer & Explanation

. 10 to 12 cm proximal to the lateral malleolus


Explanation

The superficial peroneal nerve typically pierces the deep crural fascia to become subcutaneous approximately 10 to 12 cm proximal to the tip of the lateral malleolus. It crosses anteriorly and is at risk during anterolateral ankle portal placement.

Question 3204

Topic: Shoulder & Hip Sports

A surgeon is executing a posterior approach to the shoulder. The superficial dissection interval is between the deltoid and the teres minor. The deep internervous plane separates which two muscles?

. Supraspinatus and Infraspinatus
. Infraspinatus and Teres Minor
. Teres Minor and Teres Major
. Teres Major and Latissimus Dorsi
. Subscapularis and Supraspinatus

Correct Answer & Explanation

. Infraspinatus and Teres Minor


Explanation

The deep internervous plane in the posterior approach to the shoulder is between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve).

Question 3205

Topic: Shoulder & Hip Sports

A 30-year-old baseball pitcher presents with vague posterior shoulder pain and deltoid weakness. MRI reveals isolated atrophy of the teres minor. Which of the following anatomic boundaries defines the quadrilateral space through which the affected nerve passes?

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, surgical neck of humerus laterally
. Teres minor superiorly, teres major inferiorly, long head of triceps laterally, surgical neck of humerus medially
. Teres major superiorly, latissimus dorsi inferiorly, humerus laterally, triceps medially
. Infraspinatus superiorly, teres minor inferiorly, humerus laterally, glenoid medially
. Teres minor superiorly, lateral head of triceps inferiorly, long head of triceps laterally, humerus medially

Correct Answer & Explanation

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, surgical neck of humerus laterally


Explanation

Quadrilateral space syndrome involves compression of the axillary nerve, causing denervation to the teres minor and deltoid. The space is bounded by the teres minor (superior), teres major (inferior), long head of the triceps (medial), and the surgical neck of the humerus (lateral).

Question 3206

Topic: Knee Sports

A patient undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee. The surgeon reconstructs the popliteofibular ligament, which originates from the popliteus musculotendinous junction and inserts onto the fibular styloid. What is its primary biomechanical role?

. Resists posterior tibial translation at 90 degrees of flexion
. Resists anterior tibial translation at 30 degrees of flexion
. Resists primary external rotation of the tibia
. Resists primary internal rotation of the tibia
. Resists valgus gapping at 0 and 30 degrees of flexion

Correct Answer & Explanation

. Resists primary external rotation of the tibia


Explanation

The popliteofibular ligament is a key static stabilizer of the posterolateral corner of the knee. Its primary biomechanical function, along with the lateral collateral ligament and popliteus tendon, is resisting external rotation of the tibia.

Question 3207

Topic: Shoulder & Hip Sports

A 45-year-old patient presents postoperatively with profound isolated weakness in shoulder external rotation following a massive rotator cuff repair. Electromyography reveals denervation of the infraspinatus with normal supraspinatus function. At what anatomical site is the suprascapular nerve most likely entrapped?

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

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 causes isolated infraspinatus weakness, whereas suprascapular notch entrapment affects both muscles.

Question 3208

Topic: 5. Sports Medicine

A 28-year-old overhead athlete presents with vague posterior shoulder pain and deltoid weakness. MRI reveals isolated atrophy of the teres minor. Compression in the quadrilateral space is suspected. What are the correct anatomical boundaries of this space?

. Teres minor (superior), Teres major (inferior), Long head of triceps (medial), Humeral shaft (lateral)
. Teres minor (superior), Teres major (inferior), Long head of triceps (lateral), Humeral shaft (medial)
. Teres major (superior), Latissimus dorsi (inferior), Long head of triceps (medial), Humeral shaft (lateral)
. Teres minor (superior), Infraspinatus (inferior), Lateral head of triceps (medial), Humeral shaft (lateral)
. Teres major (superior), Teres minor (inferior), Long head of triceps (medial), Coracobrachialis (lateral)

Correct Answer & Explanation

. Teres minor (superior), Teres major (inferior), Long head of triceps (medial), Humeral shaft (lateral)


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 contains the axillary nerve and the posterior circumflex humeral artery.

Question 3209

Topic: Shoulder & Hip Sports

A patient has isolated weakness in external rotation of the shoulder but demonstrates normal active abduction. An MRI reveals a paralabral cyst. In which anatomical location is the cyst most likely compressing the affected nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

The suprascapular nerve innervates the supraspinatus (abduction) before passing through the spinoglenoid notch to innervate the infraspinatus (external rotation). Compression at the spinoglenoid notch selectively impairs the infraspinatus while sparing the supraspinatus.

Question 3210

Topic: Knee Sports

A surgeon is reconstructing the posterolateral corner of the knee. The fibular collateral ligament (FCL) and the popliteus tendon (PT) both insert on the lateral femoral epicondyle. What is the spatial relationship of the FCL footprint relative to the PT footprint on the femur?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior


Explanation

On the lateral femoral condyle, the origin of the fibular collateral ligament (FCL) is located proximal and posterior to the origin of the popliteus tendon.

Question 3211

Topic: 5. Sports Medicine

A 28-year-old overhead throwing athlete presents with posterior shoulder pain and teres minor atrophy on MRI. Entrapment of the axillary nerve in the quadrilateral space is suspected. What are the boundaries of this anatomical space?

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

Correct Answer & Explanation

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


Explanation

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

Question 3212

Topic: Knee Sports

A surgeon is reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability. Anatomically, the femoral origin of the native MPFL is located in a saddle-like depression between which two osseous landmarks?

. Adductor tubercle and medial epicondyle
. Gastrocnemius tubercle and adductor tubercle
. Medial epicondyle and medial tibial plateau
. Medial epicondyle and Blumensaat's line
. Adductor tubercle and the medial collateral ligament insertion

Correct Answer & Explanation

. Adductor tubercle and medial epicondyle


Explanation

The femoral origin of the MPFL lies in a saddle-shaped depression located between the medial epicondyle (distally) and the adductor tubercle (proximally). Finding this isometric point is critical for avoiding abnormal graft tension during knee flexion.

Question 3213

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. MRI reveals a paralabral cyst compressing a nerve at the spinoglenoid notch. Which physical examination finding corresponds to this specific level of entrapment?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the supraspinatus
. Isolated atrophy of the infraspinatus
. Weakness in both abduction and external rotation
. Sensory loss over the lateral deltoid

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch selectively denervates the infraspinatus, causing isolated external rotation weakness without abduction deficit.

Question 3214

Topic: Knee Sports

The posterolateral corner (PLC) of the knee provides primary restraint to varus stress and posterolateral rotation. Which of the following structures is considered one of the three major static stabilizers of the PLC?

. Biceps femoris tendon
. Lateral gastrocnemius tendon
. Popliteofibular ligament
. Iliotibial band
. Arcuate ligament

Correct Answer & Explanation

. Popliteofibular ligament


Explanation

The three primary static stabilizers of the posterolateral corner of the knee are the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. The biceps femoris and iliotibial band provide dynamic, rather than static, stability.

Question 3215

Topic: 5. Sports Medicine

What fibers of the anterior cruciate ligament tighten with extension of the knee?

. Anterolateral
. Anteromedial
. Posterolateral
. Posteromedial
. Posterior oblique

Correct Answer & Explanation

. Posterolateral


Explanation

The anterior cruciate ligament consists of two functional bundles: anteromedial and posterolateral. During extension of the knee, the posterolateral bundle becomes taut. In flexion, the anteromedial bundle is tight and the posterolateral bundle relaxes. Traditionally, anterior cruciate ligament reconstruction primarily recreates the anteromedial bundle. Recently, techniques for double bundle reconstruction have been described to recreate the normal anatomic relationship of the two bundles. Girgis FG, Marshall JL, Monajem AS: The cruciate ligaments of the knee joint: Anatomical, functional and experimental analysis. Clin Orthop Relat Res 1975;106:216-231. Cha PS, Brucker PU, West RV, et al: Arthroscopic double-bundle anterior cruciate ligament reconstruction: An anatomic approach. Arthroscopy 2005;21:1275.

Question 3216

Topic: Knee Sports

Figure 51 shows an arthroscopic view of the patellofemoral joint from an inferolateral portal. The arrow points to which of the following structures?

. Loose body
. Plica
. Displaced meniscus tear
. Torn retinaculum
. Osteochondral defect

Correct Answer & Explanation

. Plica


Explanation

Synovial folds or plicae are the result of incomplete or partial resorption of the synovial membranes during fetal development of the knee. The arthroscopic view shows a medial patellar plica, which has been noted in 5% to 55% of all individuals but becomes symptomatic in only a small number of patients. Symptoms may include crepitus, pain, snapping, and swelling and often respond to nonsurgical management. Clarke HD, Scott WN, Insall JN: Anatomic aberrations, in Insall JN, Scott WN (eds): Surgery of the Knee, ed 4. Philadelphia, PA, Churchill Livingstone, 2006, vol 1, pp 67-85.

Question 3217

Topic: 5. Sports Medicine

A 45-year-old overhead athlete presents with deep posterior shoulder pain and weakness in external rotation. Abduction strength is symmetric. MRI reveals a paralabral cyst. The cyst is most likely located in which of the following anatomic locations?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Isolated infraspinatus weakness (diminished external rotation) with normal supraspinatus function (intact abduction) suggests distal suprascapular nerve compression at the spinoglenoid notch. A cyst at the suprascapular notch would typically affect both muscles.

Question 3218

Topic: 5. Sports Medicine

A 24-year-old athlete sustains a posterolateral corner (PLC) knee injury. Surgical reconstruction involves repairing the structure that inserts onto the fibular head and is the primary restraint to varus opening at 30 degrees of knee flexion. What is this structure?

. Lateral collateral ligament (LCL)
. Popliteofibular ligament
. Popliteus tendon
. Anterolateral ligament
. Biceps femoris tendon

Correct Answer & Explanation

. Lateral collateral ligament (LCL)


Explanation

The Lateral Collateral Ligament (LCL) inserts on the fibular head and is the primary restraint to varus stress at 30 degrees of knee flexion. The popliteofibular ligament and popliteus tendon primarily control external tibial rotation.

Question 3219

Topic: Knee Sports

A surgeon is performing a posterolateral corner reconstruction of the knee and must drill tunnels for the anatomic femoral attachments of the fibular collateral ligament (FCL) and the popliteus tendon. What is the typical anatomic relationship of the popliteus femoral footprint relative to the FCL footprint?

. Proximal and posterior
. Proximal and anterior
. Distal and anterior
. Distal and posterior
. Directly superficial

Correct Answer & Explanation

. Distal and anterior


Explanation

The popliteus tendon inserts on the femur at the anterior aspect of the popliteal sulcus. This footprint is located just distal and anterior (typically 18.5 mm) to the femoral attachment of the fibular collateral ligament.

Question 3220

Topic: 5. Sports Medicine

A 28-year-old overhead athlete presents with isolated weakness in shoulder external rotation. Abduction is full and painless. Magnetic resonance imaging reveals a paralabral cyst. Compression of the nerve at which of the following locations is most likely responsible for this specific physical examination finding?

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

A cyst at the spinoglenoid notch compresses the terminal branch of the suprascapular nerve, resulting in isolated infraspinatus weakness (external rotation). Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.