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Question 5621

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 5622

Topic: Knee Sports

The meniscofemoral ligaments of the knee are anatomically associated with the posterior cruciate ligament (PCL). What is the specific anatomic course of the ligament of Wrisberg?

. It passes anterior to the PCL
. It passes posterior to the PCL
. It passes anterior to the ACL
. It passes posterior to the ACL
. It connects the anterior horns of the medial and lateral menisci

Correct Answer & Explanation

. It passes posterior to the PCL


Explanation

The ligament of Wrisberg passes posterior to the posterior cruciate ligament (PCL). The ligament of Humphry passes anterior to the PCL.

Question 5623

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which bundle provides the primary restraint to anterior tibial translation when the knee is in 90 degrees of flexion?

. Anteromedial bundle
. Posterolateral bundle
. Intermediate bundle
. Posterior oblique ligament
. Ligament of Wrisberg

Correct Answer & Explanation

. Anteromedial bundle


Explanation

The anteromedial (AM) bundle of the ACL tightens in flexion, making it the primary restraint to anterior translation at 90 degrees. The posterolateral (PL) bundle is tightest in extension and provides rotational stability.

Question 5624

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 5625

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner of the knee, a surgeon isolates the fibular collateral ligament (FCL). What is the anatomic relationship of the FCL femoral attachment relative to the popliteus tendon femoral attachment?

. 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 epicondyle, the attachment of the fibular collateral ligament (FCL) is located proximal and posterior to the attachment of the popliteus tendon. Identifying this relationship is crucial for anatomic reconstruction of the posterolateral corner.

Question 5626

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 5627

Topic: Knee Sports

A 22-year-old football player sustains a direct blow to the anteromedial tibia. Clinical examination reveals increased external tibial rotation at 30 degrees of knee flexion but symmetrical rotation at 90 degrees. Which of the following structures is the primary restraint to external tibial rotation at 30 degrees?

. Anterior cruciate ligament
. Popliteofibular ligament
. Lateral collateral ligament
. Posterior cruciate ligament
. Popliteus tendon

Correct Answer & Explanation

. Popliteofibular ligament


Explanation

The popliteofibular ligament (PFL) is a key component of the posterolateral corner. It acts as the primary restraint to external tibial rotation when the knee is flexed to 30 degrees.

Question 5628

Topic: Knee Sports

During a knee reconstruction for a multi-ligamentous injury, the surgeon isolates the primary stabilizer to external tibial rotation at 30 degrees of knee flexion. Which of the following structures is being evaluated?

. Anterior cruciate ligament
. Fibular collateral ligament
. Popliteus tendon
. Popliteofibular ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Popliteofibular ligament


Explanation

The popliteofibular ligament is a primary stabilizer to external tibial rotation. The fibular collateral ligament (LCL) is the primary restraint to varus stress.

Question 5629

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 5630

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 5631

Topic: 5. Sports Medicine

A 22-year-old athlete undergoes an arthroscopic medial meniscal repair. Healing is most favorable in the peripheral third of the meniscus. The vascular supply to this region is primarily derived from which of the following?

. Middle genicular artery
. Superior genicular arteries
. Inferior genicular arteries
. Popliteal artery penetrating branches
. Descending genicular artery

Correct Answer & Explanation

. Inferior genicular arteries


Explanation

The peripheral 10-30% of the meniscus is vascularized by the perimeniscal capillary plexus, which arises from the medial and lateral inferior genicular arteries. The central avascular portion relies on diffusion from synovial fluid.

Question 5632

Topic: Knee Sports

When evaluating a patient with a suspected posterolateral corner (PLC) knee injury, understanding the femoral attachments is crucial for reconstruction. Where does the fibular collateral ligament (FCL) attach on the lateral femoral condyle relative to the popliteus tendon insertion?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly inferior

Correct Answer & Explanation

. Proximal and posterior


Explanation

The FCL originates on the lateral femoral condyle proximal and posterior to the popliteus tendon insertion. Recognizing this anatomic relationship is critical for ensuring isometric graft placement during PLC reconstruction.

Question 5633

Topic: Knee Sports
A surgeon is evaluating a patient with recurrent lateral patellar instability and plans to reconstruct the medial patellofemoral ligament (MPFL). Where is the anatomic femoral origin of the MPFL located?
. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the medial epicondyle
. Directly on the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle


Explanation

The femoral footprint of the MPFL is located in a saddle-like depression situated between the medial epicondyle and the adductor tubercle. Accurate identification of this point (Schรถttle's point) is required to prevent non-isometric graft behavior.

Question 5634

Topic: Knee Sports

Which of the following accurately describes the anatomy and biomechanical properties of the medial meniscus compared to the lateral meniscus?

. It is more mobile than the lateral meniscus
. It covers a larger articular surface area than the lateral meniscus
. It is perfectly circular (O-shaped)
. It has firmer attachments to the joint capsule
. It shares an insertion site with the anterior cruciate ligament

Correct Answer & Explanation

. It has firmer attachments to the joint capsule


Explanation

The medial meniscus is C-shaped, covers less articular surface area, and has firmer attachments to the deep medial collateral ligament and joint capsule. This decreased mobility makes it more prone to tearing than the O-shaped lateral meniscus.

Question 5635

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 5636

Topic: Knee Sports

A 22-year-old soccer player ruptures her anterior cruciate ligament (ACL). The ACL is composed of two primary bundles. In which position is the anteromedial (AM) bundle of the ACL most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. Internal rotation in extension

Correct Answer & Explanation

. 90 degrees of flexion


Explanation

The anteromedial (AM) bundle is most taut in flexion (optimally tested at 90 degrees with the anterior drawer test), whereas the posterolateral (PL) bundle is most taut in extension. They are named for their tibial footprint insertions.

Question 5637

Topic: Knee Sports

A 25-year-old professional rugby player undergoes posterolateral corner reconstruction of the knee. The surgeon identifies the popliteofibular ligament (PFL) as a critical structure to reconstruct for rotational stability. What is the correct anatomical origin and insertion of the native PFL?

. Popliteus musculotendinous junction to the posteromedial aspect of the fibular styloid
. Lateral femoral condyle to the lateral aspect of the fibular head
. Popliteus tendon insertion to the anterior aspect of the fibular head
. Popliteus musculotendinous junction to the lateral tibial plateau
. Posterior horn of the lateral meniscus to the fibular styloid

Correct Answer & Explanation

. Popliteus musculotendinous junction to the posteromedial aspect of the fibular styloid


Explanation

The popliteofibular ligament (PFL) originates from the musculotendinous junction of the popliteus and inserts on the posteromedial aspect of the fibular styloid. It acts as a primary static stabilizer against external tibial rotation in the posterolateral corner of the knee.

Question 5638

Topic: 5. Sports Medicine

A 30-year-old overhead throwing athlete presents with vague posterior shoulder pain. An MRI reveals isolated atrophy of the teres minor. Compression of the axillary nerve within the quadrilateral space is suspected. What are the true anatomical borders of this space?

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

Correct Answer & Explanation

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


Explanation

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

Question 5639

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 5640

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).