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Nerve & Tendon MCQs

Practice Set 45 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 881

Topic: Nerve & Tendon

When evaluating a patient for cubital tunnel syndrome, the examiner asks the patient to hold a piece of paper tightly between the thumb and index finger while the examiner pulls it away. The patient compensates by flexing the interphalangeal (IP) joint of the thumb. What is this sign called and what muscle weakness does it indicate?

. Wartenberg's sign; Abductor digiti minimi
. Froment's sign; Adductor pollicis
. Egawa's sign; Dorsal interossei
. Jeanne's sign; Flexor pollicis brevis
. Tinel's sign; First dorsal interosseous

Correct Answer & Explanation

. Wartenberg's sign; Abductor digiti minimi

Explanation

Froment's sign occurs when a patient pinches a piece of paper between the thumb and index finger. If the adductor pollicis (innervated by the ulnar nerve) is weak, the patient compensates by firing the flexor pollicis longus (innervated by the anterior interosseous nerve/median nerve), leading to hyperflexion of the thumb IP joint.

Question 882

Topic: Nerve & Tendon

A patient with severe cubital tunnel syndrome undergoes surgical decompression. The surgeon traces the ulnar nerve proximally to distally. What is the most common site of ulnar nerve compression in this condition?

. Arcade of Struthers
. Medial intermuscular septum
. Osborne's ligament (FCU aponeurosis)
. Deep flexor pronator aponeurosis
. Guyon's canal

Correct Answer & Explanation

. Arcade of Struthers

Explanation

The most common site of ulnar nerve compression at the elbow is between the two heads of the flexor carpi ulnaris (FCU), which are connected by the cubital tunnel retinaculum, also known as Osborne's ligament.

Question 883

Topic: Nerve & Tendon

During surgical decompression for cubital tunnel syndrome, which of the following structures represents a potential site of ulnar nerve compression located approximately 8 cm proximal to the medial epicondyle?

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

Correct Answer & Explanation

. Osborne's ligament

Explanation

The Arcade of Struthers is a fascial band located about 8 cm proximal to the medial epicondyle that can compress the ulnar nerve. The Ligament of Struthers, by contrast, compresses the median nerve.

Question 884

Topic: Nerve & Tendon

A 21-year-old baseball pitcher presents with posteromedial elbow pain that occurs specifically during the deceleration phase of throwing. Physical examination reveals a 10-degree loss of terminal elbow extension and a positive valgus overpressure test. What is the most likely diagnosis?

. Ulnar collateral ligament (UCL) complete rupture
. Valgus extension overload syndrome
. Little leaguer's elbow
. Flexor-pronator mass strain
. Cubital tunnel syndrome

Correct Answer & Explanation

. Ulnar collateral ligament (UCL) complete rupture

Explanation

Valgus extension overload (VEO) syndrome occurs in overhead throwing athletes due to repetitive valgus stress and extreme extension during the deceleration and follow-through phases. This causes impingement of the posteromedial olecranon tip against the olecranon fossa, leading to osteophyte formation, loose bodies, posteromedial pain, and a mechanical loss of terminal extension.

Question 885

Topic: Nerve & Tendon

During a medial ulnar collateral ligament (UCL) reconstruction on a 21-year-old baseball pitcher using the modified Jobe technique, a muscle-splitting approach through the flexor-pronator mass is planned. To prevent painful postoperative neuroma formation, the surgeon must carefully identify and protect the medial antebrachial cutaneous nerve (MACN). What is the typical anatomic course of the MACN in this operative field?

. It courses posterior to the medial epicondyle within the cubital tunnel alongside the ulnar nerve.
. It crosses the operative field from anterior to posterior, typically 2 to 3 cm distal to the medial epicondyle.
. It crosses the operative field running parallel to the ulnar nerve directly over the medial epicondyle.
. It courses deep to the flexor pronator mass and is only at risk during the subperiosteal elevation of the origin.
. It lies entirely within the brachialis muscle belly and is rarely encountered during UCL reconstruction.

Correct Answer & Explanation

. It courses posterior to the medial epicondyle within the cubital tunnel alongside the ulnar nerve.

Explanation

The medial antebrachial cutaneous nerve (MACN) runs anterior to the medial epicondyle and sends branches that cross the standard UCL incision from anterior to posterior. These branches are typically found in the subcutaneous tissue approximately 2 to 3 cm distal to the medial epicondyle. Careful superficial dissection is mandatory to avoid cutting these branches, which leads to highly symptomatic neuromas in throwing athletes.

Question 886

Topic: Nerve & Tendon

A 45-year-old female undergoes an open carpal tunnel release. During the procedure, the incision is inadvertently placed too far ulnar to the axis of the ring finger. Which of the following structures is most at immediate risk?

. Recurrent motor branch of the median nerve
. Superficial palmar arch
. Palmar cutaneous branch of the median nerve
. Ulnar nerve and artery
. Flexor pollicis longus tendon

Correct Answer & Explanation

. Recurrent motor branch of the median nerve

Explanation

During an open carpal tunnel release, placing the incision too far ulnar (ulnar to the ring finger axis) places the contents of Guyon's canal (the ulnar nerve and artery) at risk. The incision is typically made in line with the radial border of the ring finger to safely avoid the palmar cutaneous branch of the median nerve radially and the ulnar neurovascular bundle ulnarly.

Question 887

Topic: Nerve & Tendon

A 29-year-old rugby player injures his ring finger. Examination reveals inability to actively flex the distal interphalangeal (DIP) joint. Radiographs are negative. MRI shows the flexor digitorum profundus (FDP) tendon is retracted into the palm. What is the optimal timeframe for surgical repair?

. Within 24 hours
. Within 7-10 days
. Within 3-4 weeks
. Within 6-8 weeks
. Delayed reconstruction with tendon graft at 3 months

Correct Answer & Explanation

. Within 24 hours

Explanation

This is a Zone 1 FDP avulsion (Jersey finger) retracted into the palm (Leddy-Packer Type 1). The vincula are torn, compromising blood supply, so repair must be performed within 7-10 days to prevent tendon necrosis and irreversible contracture.

Question 888

Topic: Nerve & Tendon

During a volar (Henry) approach to the proximal radius, the supinator muscle must be reflected to safely expose the radial shaft while protecting the posterior interosseous nerve (PIN). The PIN enters the supinator through a fibrous arch. What is the name of this anatomical structure?

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

Correct Answer & Explanation

. Arcade of Struthers

Explanation

The Arcade of Frohse is the proximal fibrous edge of the superficial head of the supinator muscle and is the most common site of PIN compression. The Arcade of Struthers is located in the arm (ulnar nerve compression), the Lacertus fibrosus (bicipital aponeurosis) covers the median nerve/brachial artery, the Ligament of Struthers connects a supracondylar process to the medial epicondyle (median nerve compression), and Osborne's fascia bridges the two heads of the FCU at the cubital tunnel.

Question 889

Topic: Nerve & Tendon

During surgical exploration of the anterior elbow for a suspected neurovascular injury, the contents of the cubital fossa are assessed. From lateral to medial, what is the normal sequence of the primary structures crossing the elbow joint within this fossa?

. Median nerve, Brachial artery, Biceps tendon
. Biceps tendon, Median nerve, Brachial artery
. Brachial artery, Biceps tendon, Median nerve
. Biceps tendon, Brachial artery, Median nerve
. Median nerve, Biceps tendon, Brachial artery

Correct Answer & Explanation

. Median nerve, Brachial artery, Biceps tendon

Explanation

The primary structures in the cubital fossa from lateral to medial are the biceps Tendon, the brachial Artery, and the median Nerve. A common mnemonic for this sequence is TAN (Tendon, Artery, Nerve).

Question 890

Topic: Nerve & Tendon

A patient experiences a severe traction injury to the brachial plexus. An electromyogram (EMG) reveals intact function of the musculocutaneous and median nerves, but complete denervation of the latissimus dorsi. The thoracodorsal nerve, which innervates the latissimus dorsi, arises as a direct branch of which cord of the brachial plexus?

. Lateral cord
. Medial cord
. Posterior cord
. Anterior cord
. Superior trunk

Correct Answer & Explanation

. Lateral cord

Explanation

The thoracodorsal nerve (middle subscapular nerve) arises directly from the posterior cord of the brachial plexus (C6, C7, C8 roots) to innervate the latissimus dorsi muscle. Other branches of the posterior cord include the upper and lower subscapular nerves, as well as the axillary and radial terminal branches.

Question 891

Topic: Nerve & Tendon

A cyclist presents with weakness in finger adduction and abduction but intact sensation over the hypothenar eminence and volar ulnar digits. An MRI shows a ganglion cyst compressing the ulnar nerve in Zone 2 of Guyon's canal. Which of the following describes the contents of Zone 2?

. The bifurcation of the ulnar nerve into superficial and deep branches
. The deep motor branch of the ulnar nerve only
. The superficial sensory branch of the ulnar nerve only
. The ulnar artery and superficial sensory branch
. The palmar cutaneous branch of the ulnar nerve

Correct Answer & Explanation

. The bifurcation of the ulnar nerve into superficial and deep branches

Explanation

Guyon's canal is divided into three zones. Zone 1 contains the mixed motor and sensory nerve prior to bifurcation. Zone 2 contains the deep motor branch only. Zone 3 contains the superficial sensory branch only. Compression in Zone 2 results in pure motor deficits (weakness of interossei and hypothenar muscles) with spared sensation.

Question 892

Topic: Nerve & Tendon

During an in situ ulnar nerve decompression at the elbow, the surgeon divides Osborne's ligament. This structure anatomically represents the:

. Floor of the cubital tunnel composed of the medial collateral ligament
. Fascial band spanning from the medial epicondyle to the olecranon, forming the roof of the cubital tunnel
. Ligament connecting the lateral epicondyle to the radial head
. Dynamic stabilizer formed by the flexor carpi radialis
. Ligament of Struthers associated with median nerve compression

Correct Answer & Explanation

. Floor of the cubital tunnel composed of the medial collateral ligament

Explanation

Osborne's ligament (or the cubital tunnel retinaculum) forms the roof of the cubital tunnel. It is a fascial band that spans from the medial epicondyle to the olecranon process. It is a primary site of ulnar nerve compression at the elbow.

Question 893

Topic: Nerve & Tendon

The lumbrical muscles of the hand are unique because they originate from tendons and insert onto tendons. Which of the following accurately describes the anatomy of the lumbrical muscles?

. All four are bipennate muscles
. They originate from the flexor digitorum superficialis tendons
. The first and second lumbricals are typically innervated by the ulnar nerve
. They insert onto the radial aspect of the extensor expansions
. The third and fourth lumbricals are unipennate

Correct Answer & Explanation

. All four are bipennate muscles

Explanation

The lumbricals originate from the Flexor Digitorum Profundus (FDP) tendons. The 1st and 2nd are unipennate and innervated by the median nerve, while the 3rd and 4th are bipennate and innervated by the ulnar nerve. They uniformly insert onto the radial lateral bands of the extensor expansions, allowing them to flex the MCP joints and extend the PIP and DIP joints.

Question 894

Topic: Nerve & Tendon

When approaching the cubital fossa to repair a ruptured distal biceps tendon, understanding the mediolateral arrangement of the deep structures is essential. From medial to lateral, what is the correct order of structures within the cubital fossa?

. Median nerve, Brachial artery, Biceps tendon, Radial nerve
. Brachial artery, Median nerve, Biceps tendon, Radial nerve
. Median nerve, Biceps tendon, Brachial artery, Radial nerve
. Radial nerve, Biceps tendon, Brachial artery, Median nerve
. Radial nerve, Brachial artery, Biceps tendon, Median nerve

Correct Answer & Explanation

. Median nerve, Brachial artery, Biceps tendon, Radial nerve

Explanation

The structures in the cubital fossa from medial to lateral are the Median nerve, Brachial artery, Biceps tendon, and Radial nerve (mnemonic: MBBR). The pronator teres forms the medial border, and the brachioradialis forms the lateral border.

Question 895

Topic: Nerve & Tendon

A 6-year-old girl sustains a severely displaced extension-type supracondylar humerus fracture. Upon examination in the emergency department, she is unable to flex the interphalangeal joint of her thumb and the distal interphalangeal joint of her index finger. Which nerve is most likely injured?

. Posterior interosseous nerve
. Ulnar nerve
. Radial nerve
. Anterior interosseous nerve
. Musculocutaneous 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 (FPL) and flexor digitorum profundus (FDP) to the index and middle fingers. Injury results in the inability to make an 'A-OK' sign.

Question 896

Topic: Nerve & Tendon

A 4-year-old child sustains a displaced lateral condyle fracture of the humerus that is left untreated. Years later, the patient develops a progressive deformity and neurological symptoms. What is the most likely late neurological complication?

. Median nerve palsy
. Anterior interosseous nerve syndrome
. Tardy ulnar nerve palsy
. Radial nerve palsy
. Axillary nerve neurapraxia

Correct Answer & Explanation

. Median nerve palsy

Explanation

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

Question 897

Topic: Nerve & Tendon

A 5-year-old girl is treated non-operatively for a lateral condyle fracture of the humerus that was displaced 3 mm. She subsequently develops a symptomatic nonunion. Which of the following long-term complications is most directly associated with this condition?

. Progressive cubitus varus
. Tardy ulnar nerve palsy
. Anterior interosseous nerve palsy
. Avascular necrosis of the trochlea
. Proximal radioulnar synostosis

Correct Answer & Explanation

. Progressive cubitus varus

Explanation

Nonunion of a pediatric lateral condyle fracture typically results in a progressive cubitus valgus deformity. Over several years, this valgus angulation stretches the ulnar nerve, leading to tardy ulnar nerve palsy.

Question 898

Topic: Nerve & Tendon

A 5-year-old boy sustains a minimally displaced lateral condyle fracture of the humerus. Which of the following is the most likely long-term complication if this fracture goes on to nonunion?

. Cubitus varus and median nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Volkmann ischemic contracture
. Premature physeal closure with arm shortening
. Avascular necrosis of the trochlea

Correct Answer & Explanation

. Cubitus varus and median nerve palsy

Explanation

Nonunion of a lateral condyle fracture typically results in progressive cubitus valgus deformity. This valgus angulation stretches the ulnar nerve, often leading to a tardy ulnar nerve palsy years later.

Question 899

Topic: Nerve & Tendon
A 25-year-old rugby player is unable to actively flex the distal interphalangeal (DIP) joint of his ring finger after aggressively grabbing an opponent's jersey during a tackle. Ultrasound shows the flexor digitorum profundus (FDP) tendon stump retracted to the level of the lumbrical origin in the palm. According to the Leddy-Packer classification, what type of injury is this and what is the required timeframe for primary repair?
. Type I, requiring repair within 7-10 days
. Type I, safely repairable up to 3-4 weeks
. Type II, requiring repair within 7-10 days
. Type II, safely repairable up to 3-4 weeks
. Type III, requiring repair within 7-10 days

Correct Answer & Explanation

. Type I, requiring repair within 7-10 days

Explanation

This is a Type I Leddy-Packer jersey finger injury. The FDP tendon retracts into the palm (zone III), rupturing both vincula. This severely compromises the tendon's blood supply. To avoid tendon necrosis and contracture, surgical repair must be performed acutely, ideally within 7 to 10 days.

Question 900

Topic: Nerve & Tendon

A patient presents to the clinic unable to form a perfect 'OK' sign with their thumb and index finger, instead flattening the pinch by using the pulps of the digits. Which nerve is predominantly affected, and which specific muscle function is lost?

. Anterior interosseous nerve; loss of flexor pollicis longus and flexor digitorum profundus to the index finger
. Posterior interosseous nerve; loss of extensor pollicis longus and extensor indicis proprius
. Median nerve at the carpal tunnel; loss of abductor pollicis brevis
. Ulnar nerve at the cubital tunnel; loss of adductor pollicis
. Ulnar nerve in Guyon's canal; loss of the first dorsal interosseous

Correct Answer & Explanation

. Anterior interosseous nerve; loss of flexor pollicis longus and flexor digitorum profundus to the index finger

Explanation

The anterior interosseous nerve (AIN) is a pure motor branch of the median nerve innervating the flexor pollicis longus (FPL), the flexor digitorum profundus (FDP) to the index and middle fingers, and the pronator quadratus. Loss of FPL and FDP prevents terminal flexion of the thumb and index finger, leading to a positive 'OK' sign (Kiloh-Nevin sign) where the patient pinches with flattened pulps.

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