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Nerve & Tendon MCQs

Practice Set 44 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 861

Topic: Nerve & Tendon

A 32-year-old male bodybuilder complains of medial elbow pain and an audible, palpable snapping sensation when performing triceps extensions. Examination reveals a 'double snap' over the medial epicondyle as the elbow is moved from extension into flexion. Which two anatomical structures are most likely subluxating over the medial epicondyle?

. Ulnar nerve and medial head of the triceps
. Ulnar nerve and lateral head of the triceps
. Ulnar nerve and common flexor tendon
. Median nerve and medial head of the triceps
. Median nerve and brachialis tendon

Correct Answer & Explanation

. Ulnar nerve and medial head of the triceps

Explanation

Snapping triceps syndrome typically involves the dynamic subluxation of the ulnar nerve followed by the medial head of the triceps over the medial epicondyle during elbow flexion. This creates a distinct 'double snap' on examination. Treatment often requires ulnar nerve transposition and concurrent resection or management of the prominent medial head of the triceps.

Question 862

Topic: Nerve & Tendon

A 35-year-old male presents with a rigidly stiff elbow 5 months after suffering a traumatic brain injury and prolonged ICU stay.

Radiographs confirm extensive bridging heterotopic ossification (HO) anteriorly. He is neurologically intact. Regarding the surgical excision of this HO, which of the following statements reflects the most currently accepted treatment principle?

. Surgery must be delayed until at least 12-18 months post-injury to prevent recurrence.
. Early excision (at 4-6 months) can be performed safely once the ossification appears radiographically mature with clear trabeculations.
. A preoperative bone scan and normalization of alkaline phosphatase are strict prerequisites for excision.
. Post-operative immobilization in a cast for 6 weeks is mandatory to prevent hematoma and recurrence.
. The ulnar nerve is typically protected by the anterior HO mass and rarely requires neurolysis.

Correct Answer & Explanation

. Surgery must be delayed until at least 12-18 months post-injury to prevent recurrence.

Explanation

Current evidence suggests that waiting 12-18 months or for normal alkaline phosphatase levels is unnecessary and prolongs disability. Early excision (around 4-6 months) is safe and effective as long as the HO demonstrates radiographic maturity (sharp margins and trabecular pattern). Early mobilization, not prolonged immobilization, is crucial postoperatively. Ulnar neurolysis is frequently required due to the global capsular release often needed.

Question 863

Topic: Nerve & Tendon

A 42-year-old bodybuilder undergoes a single-incision anterior repair for a distal biceps tendon rupture. Postoperatively, he complains of numbness along the radial aspect of his forearm. Which nerve was most likely injured during the surgical approach?

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

Correct Answer & Explanation

. Superficial radial nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) exits between the biceps and brachialis and is the most commonly injured nerve during a single-incision anterior distal biceps repair due to lateral retraction.

Question 864

Topic: Nerve & Tendon

While evaluating a patient with a suspected nerve palsy, the examiner asks the patient to firmly grasp a piece of paper between the thumb and the index finger. As the examiner pulls the paper away, the patient's thumb interphalangeal (IP) joint hyperflexes. This compensatory maneuver is known as Froment's sign. Which muscle is compensating for the underlying deficit?

. Adductor pollicis
. Flexor pollicis longus
. Abductor pollicis brevis
. First dorsal interosseous
. Opponens pollicis

Correct Answer & Explanation

. Adductor pollicis

Explanation

Froment's sign evaluates ulnar nerve function. The adductor pollicis is paralyzed (ulnar nerve), so the patient compensates by firing the flexor pollicis longus (innervated by the anterior interosseous nerve branch of the median nerve) to hold the paper, causing marked thumb IP joint flexion.

Question 865

Topic: Nerve & Tendon

A 40-year-old new mother presents with radial-sided wrist pain. During physical examination, the physician grasps the patient's thumb and sharply ulnar deviates the wrist, eliciting severe pain over the first dorsal compartment. Which specific eponym correctly identifies this provocative maneuver?

. Finkelstein's test
. Eichhoff's test
. Wartenberg's sign
. Phalen's maneuver
. Tinel's sign

Correct Answer & Explanation

. Finkelstein's test

Explanation

Grasping the thumb and ulnar deviating the wrist is the true Finkelstein's test. Eichhoff's test involves the patient clenching their thumb inside their fist, followed by the examiner passively ulnar deviating the wrist. Although Eichhoff's is often mistakenly called Finkelstein's in practice, the original description of Finkelstein's specifically mentions the examiner grasping the thumb.

Question 866

Topic: Nerve & Tendon

A 50-year-old female presents with weakness in her hand. The examiner observes that the patient's small finger remains in an abducted posture and she is unable to actively adduct it. This finding (Wartenberg's sign) is caused by the unopposed action of which muscle, and what is its innervation?

. Abductor digiti minimi; Ulnar nerve
. Extensor digiti minimi; Radial nerve
. Third palmar interosseous; Ulnar nerve
. Extensor digitorum communis; Posterior interosseous nerve
. Lumbrical to the fifth digit; Median nerve

Correct Answer & Explanation

. Abductor digiti minimi; Ulnar nerve

Explanation

Wartenberg's sign is seen in ulnar neuropathy. The ulnar-innervated palmar interossei (responsible for adduction) are paralyzed. The small finger is pulled into abduction by the unopposed action of the extensor digiti minimi (EDM), which is innervated by the radial nerve via the posterior interosseous nerve (PIN).

Question 867

Topic: Nerve & Tendon

A patient presents with persistent abduction posturing of the small finger. This finding (Wartenberg's sign) is caused by unopposed action of which muscle, and what is the underlying nerve injury?

. Extensor digiti minimi; Radial nerve palsy
. Abductor digiti minimi; Ulnar nerve palsy
. Extensor digiti minimi; Ulnar nerve palsy
. Abductor digiti minimi; Median nerve palsy
. Flexor digiti minimi; Ulnar nerve palsy

Correct Answer & Explanation

. Extensor digiti minimi; Radial nerve palsy

Explanation

Wartenberg's sign is the abducted posture of the small finger due to the unopposed action of the extensor digiti minimi, which is innervated by the radial nerve. It manifests when the ulnar nerve-innervated palmar interossei (specifically the 3rd palmar interosseous) are weak or paralyzed.

Question 868

Topic: Nerve & Tendon

A patient with a documented ulnar nerve neuropathy exhibits a persistent abduction posture of the small finger at rest (Wartenberg's sign). Which intact muscle is responsible for this unopposed abduction?

. Extensor digiti minimi
. Abductor digiti minimi
. Third palmar interosseous
. Fourth dorsal interosseous
. Flexor digiti minimi

Correct Answer & Explanation

. Extensor digiti minimi

Explanation

Wartenberg's sign is an abduction deformity of the small finger due to ulnar nerve palsy. It results from weakness of the third palmar interosseous muscle and unopposed abduction by the radial nerve-innervated extensor digiti minimi.

Question 869

Topic: Nerve & Tendon

A patient presents with persistent numbness in their ring and small fingers. Upon observation, the examiner notes that the patient's small finger rests in an abducted position. This finding (Wartenberg's sign) is due to unopposed action of which muscle?

. Extensor digiti minimi
. Abductor digiti minimi
. Third palmar interosseous
. Fourth dorsal interosseous
. Flexor digiti minimi

Correct Answer & Explanation

. Extensor digiti minimi

Explanation

Wartenberg's sign is the abducted resting posture of the small finger resulting from ulnar nerve palsy. The intact radially innervated extensor digiti minimi pulls the finger into abduction, overcoming the paralyzed ulnarly innervated third palmar interosseous muscle.

Question 870

Topic: Nerve & Tendon

A patient presents with generalized arm pain and weakness. The examiner asks the patient to resist bilateral internal rotation of the shoulders. The examiner then lightly strokes the skin over the patient's cubital tunnel and immediately asks the patient to resist internal rotation again. A sudden, momentary loss of resistance is noted. What does this signify?

. Psychogenic weakness
. Cervical myelopathy
. Ulnar nerve entrapment at the elbow
. Medial epicondylitis
. Thoracic outlet syndrome

Correct Answer & Explanation

. Psychogenic weakness

Explanation

The scratch collapse test is a highly sensitive provocative test for peripheral nerve entrapment. Stroking the skin over a site of nerve compression (such as the ulnar nerve at the cubital tunnel) triggers a brief inhibitory spinal reflex, causing transient loss of motor tone.

Question 871

Topic: Nerve & Tendon

A 6-year-old child sustains a displaced extension-type supracondylar humerus fracture. Upon clinical examination, the child is unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger (unable to make an 'OK' sign). Which nerve branch is most likely injured?

. Posterior interosseous nerve
. Anterior interosseous nerve
. Recurrent motor branch of the median nerve
. Deep branch of the ulnar nerve
. Superficial radial nerve

Correct Answer & Explanation

. Posterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures. It innervates the flexor pollicis longus and the flexor digitorum profundus to the index finger.

Question 872

Topic: Nerve & Tendon
During an open carpal tunnel release, the surgeon must carefully identify and protect the recurrent motor branch of the median nerve. This specific nerve branch innervates all of the following muscles EXCEPT the:
. Opponens pollicis
. Abductor pollicis brevis
. Superficial head of the flexor pollicis brevis
. Adductor pollicis
. None of the above

Correct Answer & Explanation

. Adductor pollicis

Explanation

The recurrent motor branch of the median nerve innervates the thenar musculature (opponens pollicis, abductor pollicis brevis, and superficial head of the flexor pollicis brevis). The adductor pollicis is innervated by the deep branch of the ulnar nerve.

Question 873

Topic: Nerve & Tendon
A 28-year-old carpenter suffers a deep laceration to the volar aspect of his index finger. Surgical exploration reveals complete transection of both the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons within the fibro-osseous sheath, between the proximal edge of the A1 pulley and the FDS insertion. This injury is located in which flexor tendon zone?
. Zone I
. Zone II
. Zone III
. Zone IV
. Zone V

Correct Answer & Explanation

. Zone II

Explanation

Flexor tendon Zone II, historically called 'no man's land' due to the poor surgical outcomes of the past, extends from the proximal edge of the A1 pulley to the insertion of the FDS tendon on the middle phalanx. Both the FDS and FDP travel tightly together within the fibro-osseous sheath in this zone.

Question 874

Topic: Nerve & Tendon

During the surgical decompression of the ulnar nerve for cubital tunnel syndrome, multiple potential sites of anatomic compression must be addressed. Which of the following represents the most proximal potential site of ulnar nerve entrapment in the arm?

. Osborne's ligament
. Arcade of Struthers
. Medial intermuscular septum
. Aponeurosis of the flexor carpi ulnaris (FCU)
. Ligament of Struthers

Correct Answer & Explanation

. Osborne's ligament

Explanation

The Arcade of Struthers is a thin fascial band extending from the medial head of the triceps to the medial intermuscular septum, located approximately 8 cm proximal to the medial epicondyle. It represents the most proximal potential site of ulnar nerve compression. Note: The Ligament of Struthers is a distinct structure associated with the supracondylar process that can compress the median nerve, not the ulnar nerve.

Question 875

Topic: Nerve & Tendon

Which structure forms the roof of the cubital tunnel and is implicated as the primary site of ulnar nerve compression in most cases of cubital tunnel syndrome?

. Arcade of Struthers
. Osborne's ligament
. Medial intermuscular septum
. Aponeurosis of the flexor carpi radialis
. Lacertus fibrosus

Correct Answer & Explanation

. Arcade of Struthers

Explanation

Osborne's ligament (the cubital tunnel retinaculum) bridges the two heads of the flexor carpi ulnaris. It forms the roof of the cubital tunnel and is the most common site of ulnar nerve compression at the elbow.

Question 876

Topic: Nerve & Tendon

A 52-year-old female undergoes an anterior subcutaneous transposition of the ulnar nerve for severe cubital tunnel syndrome. During the proximal dissection, a fascial band located roughly 8 cm proximal to the medial epicondyle must be meticulously released to prevent kinking of the transposed nerve. What is this structure called?

. Ligament of Struthers
. Arcade of Frohse
. Arcade of Struthers
. Lacertus fibrosus
. Osborne's ligament

Correct Answer & Explanation

. Ligament of Struthers

Explanation

The Arcade of Struthers is a fascial band bridging the medial intermuscular septum to the medial head of the triceps, located about 8 cm proximal to the medial epicondyle. It is a critical potential site of ulnar nerve compression that must be released during an anterior transposition.

Question 877

Topic: Nerve & Tendon

A patient with severe carpal tunnel syndrome exhibits profound thenar atrophy. Which of the following muscles is primarily innervated by the recurrent motor branch of the median nerve and is expected to be most atrophied?

. Adductor pollicis
. Opponens pollicis
. Deep head of the flexor pollicis brevis
. First dorsal interosseous
. Palmaris brevis

Correct Answer & Explanation

. Adductor pollicis

Explanation

The recurrent motor branch of the median nerve innervates the Opponens pollicis, Abductor pollicis brevis, and the superficial head of the Flexor pollicis brevis. The adductor pollicis and the deep head of the flexor pollicis brevis are typically innervated by the ulnar nerve.

Question 878

Topic: Nerve & Tendon

A 6-year-old boy sustains a completely displaced supracondylar humerus fracture. Radiographs reveal the distal fragment is displaced posterolaterally. Based on this displacement pattern, which nerve is at the highest risk of injury?

. Radial nerve
. Anterior interosseous nerve
. Ulnar nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

In a posterolaterally displaced supracondylar fracture, the proximal fragment is driven anteromedially, placing the median nerve (specifically the anterior interosseous nerve branch) at greatest risk. Posteromedial displacement places the radial nerve at risk, while flexion-type fractures risk ulnar nerve injury.

Question 879

Topic: Nerve & Tendon

In surgical decompression of the ulnar nerve for cubital tunnel syndrome, which structure forms the roof of the cubital tunnel and represents a common site of primary compression?

. Struthers' ligament
. Osborne's ligament (fascia)
. The aponeurosis of the flexor carpi radialis
. The intermuscular septum
. The anconeus epitrochlearis

Correct Answer & Explanation

. Struthers' ligament

Explanation

The cubital tunnel is bordered anteriorly by the medial epicondyle, laterally by the olecranon, and its floor is the MCL. The roof is formed by Osborne's ligament (the arcuate ligament or fascia), which connects the two heads of the flexor carpi ulnaris (FCU). This is a primary site of compression for the ulnar nerve at the elbow.

Question 880

Topic: Nerve & Tendon

In evaluating a patient with a severe closed traction injury to the brachial plexus, which of the following electrodiagnostic or clinical findings is MOST indicative of a preganglionic nerve root avulsion rather than a postganglionic lesion?

. Absent sensory nerve action potentials (SNAPs)
. Preserved sensory nerve action potentials (SNAPs) in an anesthetic dermatome
. Denervation potentials in the deltoid and biceps muscles
. Presence of a Tinel's sign in the supraclavicular fossa
. Recovery of motor function following neurolysis

Correct Answer & Explanation

. Absent sensory nerve action potentials (SNAPs)

Explanation

In a preganglionic root avulsion, the dorsal root ganglion (DRG) remains intact and attached to the peripheral nerve. Therefore, the peripheral sensory axons do not undergo Wallerian degeneration, and SNAPs remain normal or preserved, even though the patient has no sensation in that dermatome (because the connection to the spinal cord is severed). In postganglionic injuries, the lesion is distal to the DRG, leading to Wallerian degeneration and absent SNAPs.

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