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Nerve & Tendon MCQs

Practice Set 2 of 53

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

Question 21

Topic: Nerve & Tendon

When creating the posteromedial portal for elbow arthroscopy, the portal is typically placed superior to the olecranon tip and medial to the triceps tendon. Which nerve is at the greatest risk of injury during the establishment of this portal?

. Radial nerve
. Ulnar nerve
. Median nerve
. Anterior interosseous nerve
. Medial antebrachial cutaneous nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

The ulnar nerve resides posterior to the medial epicondyle. The posteromedial portal must be created carefully with a 'nick and spread' technique, remaining close to the olecranon to avoid ulnar nerve injury.

Question 22

Topic: Nerve & Tendon

Which nerve is most commonly injured in a distal humerus fracture?

. Radial nerve
. Median nerve
. Axillary nerve
. Ulnar nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

The ulnar nerve runs posterior to the medial epicondyle and is vulnerable to injury in distal humerus fractures, particularly supracondylar fractures.

Question 23

Topic: Nerve & Tendon

Which structure is commonly entrapped in a supracondylar humerus fracture in children?

. Brachial artery
. Radial nerve
. Ulnar nerve
. Median nerve
. Cephalic vein

Correct Answer & Explanation

. Brachial artery

Explanation

The brachial artery and median nerve are most at risk for injury or entrapment in displaced supracondylar humerus fractures, potentially leading to Volkmann's ischemic contracture.

Question 24

Topic: Nerve & Tendon

A magnetic resonance image (MRI) of the dominant elbow of a 19-year-old minor league baseball pitcher is presented (pic). He has been unable to pitch for the past 6 weeks secondary to pain. The recommended treatment includes:

. Physical therapy for triceps strengthening
. Physical therapy for pronator strengthening
. Ulnar nerve transpostion
. Radial collateral ligament reconstruction
. Ulnar collateral ligament reconstruction

Correct Answer & Explanation

. Ulnar collateral ligament reconstruction

Explanation

The MRI shows a disruption of the humeral attachment of the ulnar collateral ligament. The ulnar collateral ligament of the elbow is the most frequently observed ligamentous elbow injury in baseball pitchers. Recommended treatment in the throwing athlete is reconstruction of the ulnar collateral ligament with an autogenous palmaris longus graft.

Question 25

Topic: Nerve & Tendon

In a high-level baseball pitcher undergoing ulnar collateral ligament (UCL) reconstruction, which nerve is most intimately at risk of injury and often requires careful decompression or transposition?

. Median nerve
. Radial nerve
. Ulnar nerve
. Musculocutaneous nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Ulnar nerve

Explanation

The ulnar nerve passes directly behind the medial epicondyle through the cubital tunnel, placing it at high risk during UCL (Tommy John) reconstruction. Surgeons must carefully protect it, and many routinely perform a subcutaneous or submuscular ulnar nerve transposition.

Question 26

Topic: Nerve & Tendon

A 32-year-old male sustains a complete distal biceps tendon rupture. During surgical repair using a single-incision anterior approach, which nerve is at the highest risk of injury?

. Median nerve
. Ulnar nerve
. Lateral antebrachial cutaneous nerve
. Poster interosseous nerve
. Superficial radial nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single-incision anterior approach for distal biceps repair due to its superficial location and proximity to the surgical field.

Question 27

Topic: Nerve & Tendon

A 28-year-old rugby player grabs an opponent's jersey and feels a sudden "snap" in his ring finger. He is unable to actively flex the DIP joint. What is the most likely diagnosis?

. FDS tendon rupture
. FDP tendon rupture
. A2 pulley rupture
. Central slip rupture
. Sagittal band rupture

Correct Answer & Explanation

. FDP tendon rupture

Explanation

Jersey finger is an avulsion of the Flexor Digitorum Profundus (FDP) tendon. It occurs during forced extension of a flexed DIP joint, leading to an inability to actively flex the DIP.

Question 28

Topic: Nerve & Tendon

A 21-year-old collegiate baseball pitcher undergoes ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. Which of the following technical factors is most associated with postoperative ulnar neuropathy?

. Routine submuscular ulnar nerve transposition
. Use of a figure-of-eight graft weave
. Drilling the ulnar tunnel anterior to the sublime tubercle
. Failure to address the medial antebrachial cutaneous nerve
. Over-tensioning of the graft at 90 degrees of flexion

Correct Answer & Explanation

. Routine submuscular ulnar nerve transposition

Explanation

Routine ulnar nerve transposition during UCL reconstruction increases the risk of postoperative ulnar neuropathy compared to in situ decompression. Current trends favor leaving the nerve undisturbed unless significant preoperative neuropathy exists.

Question 29

Topic: Nerve & Tendon

When evaluating the biomechanical constructs for Ulnar Collateral Ligament (UCL) reconstruction of the elbow, the "docking" technique compared to the traditional figure-of-eight technique has been shown to:

. Require a larger ulnar bone tunnel
. Have an increased risk of ulnar nerve injury
. Result in inferior maximum load to failure
. Reduce the number of holes drilled in the medial epicondyle to one
. Decrease the tension on the flexor-pronator mass

Correct Answer & Explanation

. Reduce the number of holes drilled in the medial epicondyle to one

Explanation

The docking technique simplifies humeral fixation by using a single main tunnel in the medial epicondyle where the graft ends are "docked" and tied over a bone bridge, thereby reducing stress risers.

Question 30

Topic: Nerve & Tendon

A 16-year-old male high school football player was making a tackle when he felt sudden pain in his right long finger. He has swelling and tenderness along the volar aspect of the injured digit. He is unable to actively flex the distal interphalangeal joint of the injured digit. Radiographs are negative for fracture. Recommended treatment should include:

. Observation
. Splinting of the distal interphalangeal joint in extension
. Splinting of the distal interphalangeal joint in flexion
. Immediate active range of motion exercises
. Surgical repair

Correct Answer & Explanation

. Observation

Explanation

Avulsion of the flexor digitorum profundus, or "jersey finger," is a common injury in football. Appropriate treatment includes surgical repair.

Question 31

Topic: Nerve & Tendon

A 50-year-old woman presents with numbness in her ring and small fingers. Examination reveals a positive Froment sign when asked to pinch a piece of paper. Which of the following muscles is actively compensating to cause the typical interphalangeal flexion seen in a positive Froment sign?

. Adductor pollicis
. Flexor pollicis brevis
. Flexor pollicis longus
. Abductor pollicis brevis
. Extensor pollicis longus

Correct Answer & Explanation

. Flexor pollicis longus

Explanation

A positive Froment sign indicates ulnar nerve palsy affecting the adductor pollicis. To maintain pinch grip, the patient compensates by firing the anterior interosseous nerve (AIN)-innervated flexor pollicis longus (FPL), resulting in hyperflexion of the thumb interphalangeal joint.

Question 32

Topic: Nerve & Tendon

Which of the following nerve roots supplies motor innervation to the flexor digitorum superficialis (FDS):

. C 5
. C 6
. C 7
. C 8
. T1

Correct Answer & Explanation

. C 8

Explanation

The FDS flexes the proximal interphalangeal joint and is innervated by the C 8 cervical spine nerve root. The FDS is innervated peripherally by the median nerve. The flexor digitorum profundus flexes the distal interphalangeal joint and is also innervated by the C 8 cervical spine nerve root. The middle and index fingers are supplied by the median nerve, and the ring and little fingers are supplied by the ulnar nerve.

Question 33

Topic: Nerve & Tendon

A 7-year-old boy presents with an established nonunion of a lateral condyle fracture of the humerus

that occurred 3 years ago. Which of the following nerve palsies is he at greatest risk of developing?

. Median nerve palsy
. Anterior interosseous nerve palsy
. Radial nerve palsy
. Ulnar nerve palsy
. Musculocutaneous nerve palsy

Correct Answer & Explanation

. Ulnar nerve palsy

Explanation

Lateral condyle nonunions often lead to progressive cubitus valgus deformities. This valgus stretch pulls the ulnar nerve behind the medial epicondyle, classically causing tardy ulnar nerve palsy.

Question 34

Topic: Nerve & Tendon

A 4-year-old child presents with an elbow injury. Radiographs reveal a displaced lateral condyle fracture.

If this fracture goes on to nonunion, which of the following long-term complications is most likely to develop?

. Cubitus varus and median nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Volkmann ischemic contracture
. Premature closure of the entire distal humeral physis
. Posterior interosseous nerve syndrome

Correct Answer & Explanation

. Cubitus valgus and tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle fracture typically results in a progressive cubitus valgus deformity due to loss of the lateral column support. Over years, this stretching of the ulnar nerve behind the medial epicondyle can lead to tardy ulnar nerve palsy.

Question 35

Topic: Nerve & Tendon

A 5-year-old boy sustains a lateral condyle fracture of the humerus.

If left untreated, leading to nonunion and progressive deformity, what late neurological complication is he at highest risk of developing?

. Median nerve palsy
. Tardy ulnar nerve palsy
. Radial nerve palsy
. Anterior interosseous nerve syndrome
. Posterior interosseous nerve syndrome

Correct Answer & Explanation

. Tardy ulnar nerve palsy

Explanation

Untreated or nonunited lateral condyle fractures often lead to progressive cubitus valgus deformity. This chronic stretching of the ulnar nerve over the medial epicondyle results in tardy ulnar nerve palsy years later.

Question 36

Topic: Nerve & Tendon

In a pediatric patient with a displaced lateral condyle humerus fracture, which of the following is the most significant clinical risk if the fracture fails to unite?

. Progressive cubitus varus
. Premature closure of the medial epicondyle
. Tardy ulnar nerve palsy
. Acute radial nerve palsy
. Volkmann ischemic contracture

Correct Answer & Explanation

. Tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle fracture typically leads to progressive cubitus valgus deformity. Over time, this valgus angulation chronically stretches the ulnar nerve, potentially resulting in tardy ulnar nerve palsy.

Question 37

Topic: Nerve & Tendon

Which of the following is an absolute indication for operative intervention in a pediatric medial epicondyle fracture?

. Displacement greater than 2 mm
. Displacement greater than 5 mm
. Ulnar nerve neurapraxia
. Incarceration of the fragment in the joint
. High-level overhead throwing athlete

Correct Answer & Explanation

. Incarceration of the fragment in the joint

Explanation

Incarceration of the medial epicondyle fragment within the elbow joint block is an absolute indication for surgical extraction and fixation. Other parameters, such as displacement >5 mm or ulnar nerve symptoms, are considered relative indications.

Question 38

Topic: Nerve & Tendon

A 6-year-old child sustains a posteromedially displaced supracondylar fracture of the humerus. Which nerve is most frequently injured due to this specific displacement pattern?

. Median nerve
. Anterior interosseous nerve
. Radial nerve
. Ulnar nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

Posteromedial displacement of the distal fragment causes the proximal fracture spike to displace anterolaterally. This uniquely places the radial nerve at the greatest risk of injury.

Question 39

Topic: Nerve & Tendon

A 4-year-old child sustains a lateral condyle fracture of the humerus. The fracture is displaced by 4 mm. If left untreated, what is the most common long-term clinical deformity and potential neurological complication?

. Cubitus varus and median nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Cubitus varus and radial nerve palsy
. Extension deficit and AIN palsy
. Flexion deficit and musculocutaneous nerve palsy

Correct Answer & Explanation

. Cubitus valgus and tardy ulnar nerve palsy

Explanation

Displaced lateral condyle fractures have a high rate of nonunion if not fixed properly. This can lead to progressive cubitus valgus deformity, which stretches the ulnar nerve over time, causing tardy ulnar nerve palsy.

Question 40

Topic: Nerve & Tendon

A 2-year-old child presents with a right thumb that is locked in flexion at the interphalangeal joint. A nodule is palpable at the volar aspect of the MCP joint. What is the recommended initial management?

. Immediate surgical release of the A1 pulley
. Corticosteroid injection into the tendon sheath
. Observation and passive stretching exercises
. Splinting in full extension for 6 weeks
. Surgical release of the A2 pulley

Correct Answer & Explanation

. Observation and passive stretching exercises

Explanation

Pediatric trigger thumb resolves spontaneously in approximately 30% of cases within the first few years of life. Initial management is observation and stretching; A1 pulley release is reserved for cases failing to resolve by age 2 to 3.

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