21. The cruciate ligaments are important knee structures which lie:
A) Inside the joint capsule, and within the synovial cavity as well
B) Outside the synovial cavity but within the fi brous joint capsule
C) Outside the fi brous joint capsule
D) Outside the synovial cavity and fibrous joint capsule
22. What is a sign that the stellate ganglion was successfully blocked?
A) Ipsilateral Horner’s syndrome
B) Increased paresthesias
C) Anesthesia in the limb
D) Increased pain symptoms
23. What is a Smith’s fracture?
A) Fracture of the distal radius with dorsal displacement
B) Fracture of the distal ulna with dorsal displacement
C) Fracture of the distal radius with volar displacement
D) Fracture of the distal ulna with volar displacement
Musculoskeletal quiz online Q & A-2
24. Which position should be avoided after total hip arthroplasty using an anterior approach?
A) Bridging
B) Adduction crossing midline
C) Sitting on regular toilet seat
D) Cross legs
25. Which condition/injury is not considered an absolute contraindication for return to play?
A) Atlantoaxial instability noted on lateral flexion-extension x-rays
B) Fused C1 to C2 segments
C) A two- to three-level spinal fusion with normal exam
D) An acute spinal fracture
26. What is the most common cause of nontraumatic elbow joint destruction?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Repetitive valgus stress injury
D) Gout
27. Intrinsic factors contributing to the development of tendinitis include all of the following except:
A) Age
B) Genetic predisposition
C) Poor training technique
D) Muscle imbalance/weakness
28. The articulations of the elbow joint:
A) Allow 3 degrees of freedom
B) Allow 2 degrees of freedom
C) Allow normal range of motion (ROM) of −10° extension to 120° flexion
D) Allow 30° to 40° of pronation
29. Which of the following is not true regarding steroid injection for carpal tunnel syndrome (CTS)?
A) It is indicated for mild to moderate CTS
B) It can be used in conjunction with splinting and physical therapy
C) Caution should be used when injecting patients with diabetes
D) Is preferable to surgery in patients with severe CTS
30. Identify the final treatment phase of sports rehabilitation:
A) Resolving pain and infl ammation
B) Restoring range of motion (ROM)
C) Strengthening
D) Sports/task-specific activities
Musculoskeletal quiz online Q & A-2
31. What is the usual mechanism of a scaphoid fracture?
A) Axial compression and hyperextension of the wrist
B) Fall onto outstretched hands
C) Direct blow to the scaphoid bone
D) End-on blow of the fist, as in boxing
32. Hill-Sachs lesion of the shoulder:
A) May be associated with posterior dislocations
B) May cause shoulder instability if it accounts for 10% of the articular surface
C) Is a compression fracture of the posterolateral aspect of humeral head caused by abutment gainst the anterior rim of the glenoid fossa
D) Is evaluated by Speed’s test
33. The diagnosis of aseptic noninflammatory olecranon bursitis:
A) Is based on plain radiographs, demonstrating an olecranon spur in all cases
B) Requires aspiration of bursal fluid in all cases
C) Is usually straightforward and based on characteristic appearance on physical examination
D) Is made only with MRI
34. What structures are found within the quadrangular space?
A) The circumflex scapular artery
B) The femoral nerve, artery, and vein
C) Processus vaginalis, spermatic cord, and ilioinguinal nerve
D) Axillary nerve, posterior circumflex artery, and humeral artery
35. Internal snapping hip syndrome is caused by:
A) A tight iliopsoas tendon snapping over the lesser trochanter
B) A tight iliotibial band snapping over the greater trochanter
C) A tight gluteus maximus snapping over the greater trochanter
D) An acetabular labral tear or loose body in the hip joint
36. The rotator cuff muscles include all of the following except:
A) Teres minor
B) Supraspinatus
C) Rhomboids
D) Infraspinatus
37. What is the Adson’s test used for?
A) To detect thoracic outlet syndrome
B) To check for adequate blood perfusion to the hand
C) To detect anterior instability of the shoulder joint
D) To detect symptoms of carpal tunnel syndrome (CTS)
38. The glenohumeral joint (shoulder girdle complex) involves articulation of the humeral head with the glenoid fossa and the labrum. Approximately what percentage of the humeral head articulates with the glenoid fossa?
A) 15
B) 30
C) 50
D) 70
39. De Quervain’s stenosing tenosynovitis is inflammation of the first dorsal compartment, which includes which of the following?
A) Abductor pollicis longus and opponens pollicis
B) Extensor pollicis brevis and opponens pollicis
C) Abductor pollicis longus and extensor pollicis brevis
D) Adductor pollicis longus and opponens pollicis
40. A finger locked in flexion, especially in the morning, is typical of which condition?
A) Trigger finger
B) Mallet finger
C) Jersey finger
D) Boutonnière deformity
Musculoskeletal quiz online Q & A-2 ( 21 to 40 Questions and Answers )
Musculoskeletal quiz online Q & A-2
Answers
- B) The cruciate ligaments lie outside the synovial cavity but within the fibrous joint capsule.
- A) Ipsilateral Horner’s syndrome (dropping eye, pupillary constriction, and increased skin temperature or flushing) indicates that the block was adequate.
- C) Smith’s fracture is when the distal radius becomes fractured and the distal fragment is displaced toward the palm (volar). It is also called a reverse Colle’s fracture because in a Colle’s fracture the distal radial fragment is displaced dorsally.
- A) The anterior hip dislocation precautions are different from the posterior hip dislocation precautions: no hip extension, bridging, prone lying, or hip external rotation beyond neutral. When the patient is supine, keep the hip flexed to approximately 30° by placing a pillow under the patient’s knees or by raising the head of the bed.
- C) Answers A, B, and D are all absolute contraindications to return to play. A two- to three-level spinal fusion with normal exam is considered a relative contraindication. A one-level fusion with normal alignment and physical exam has no restriction whereas a fusion extending more than three levels is an absolute contraindication for return to play.
- B) Rheumatoid arthritis is the most common cause of elbow joint destruction and occurs in most patients who have polyarticular involvement.
- C) Age, muscle imbalance (weakness), anatomic malalignment, and genetic predisposition are all intrinsic factors that contribute to the development of tendinitis. Extrinsic variables include training errors, environmental factors, and equipment.
- B) The elbow articulations allow the elbow two degrees of freedom: flexion-extension and pronation-supination. The normal elbow moves from 0° (full extension) to 135° to 150° of flexion. Pronation is approximately 70° to 90°, and supination is approximately 80° to 90°.
- D) Steroid injection can be considered in patients diagnosed (by nerve conduction studies [NCV]/electromyogram [EMG]) with mild to moderate CTS. Care is taken to avoid piercing the median nerve. The needle is directed at an angle of 30°. Surgery is usually required in severe CTS, especially if abnormal spontaneous potentials are noted in the abductor pollicis brevis (APB) muscle.
- D) There are five treatment phases in sports rehabilitation: the first phase is to resolve the pain and inflammation; the second phase is to restore ROM; the third phase is to strengthen; the fourth phase is proprioceptive training; and the last phase involves sports/task-specific activities.
- B) Scaphoid fractures are the most common carpal bone fractures. The usual mechanism of injury (as is the case with most carpal fractures) is a fall on outstretched hands. Patients will have tenderness in the anatomical “snuffbox” area and decreased range of motion (ROM). Fracture of the middle 1/3 of the scaphoid bone (known as the waist) is most common. This bone has retrograde blood supply, making it particularly susceptible to malunion or avascular necrosis following a fracture. It is for this reason that a low threshold of suspicion is maintained for scaphoid fractures, and immobilization is usually initially prescribed if there is high clinical suspicion (despite negative x-rays).
- C) Anterior glenohumeral stability is evaluated by the apprehension test. Hill-Sachs lesion accounting for greater than 30% of the articular surface may cause shoulder instability. A notch occurs in the posterior lateral aspect of humeral head owing to recurrent impingement. I
- C) Additional studies are not usually necessary. If crystal-induced or septic bursitis is suspected, aspiration of the bursal fl uid is usually indicated. Plain radiographs may demonstrate an olecranon spur in about 1/3 of cases.
- D) The quadrangular space of the shoulder is bordered by the teres minor, teres major, long head of the triceps muscle, and medial border of the humerus. It is an area of potential compression of the posterior humeral circumflex artery or axillary nerve, especially in athletes who engage in overhead activities (throwing athletes, tennis players, swimmers). Patients will present with pain and paresthesias of the posterior lateral shoulder.
- D) Internal snapping hip syndrome is caused by a tight iliopsoas tendon snapping over the iliopectineal prominence of the pelvis, or less commonly, acetabular labral tear or loose body in the hip joint. A tight iliotibial band or gluteus maximus snapping over the greater trochanter causes external snapping hip syndrome.
- C) The rotator cuff muscles include the teres minor, supraspinatus, infraspinatus, and subscapularis muscles. These muscles are dynamic stabilizers of the shoulder.
- A) Adson’s test is performed by locating the radial pulse of the affected arm and asking the patient to turn their head toward the affected shoulder. The arm may be abducted and externally rotated as part of the maneuver. If the radial pulse diminishes on the affected side, this is positive for possible thoracic outlet syndrome. Thoracic outlet syndrome is the compression of the neurovascular structures in the neck, usually by a cervical rib or first rib and scalene muscles.
- B) Approximately 30% of the humeral head articulates directly with the glenoid fossa. A fibro cartilaginous complex called the labrum surrounds the glenoid fossa, effectively increasing the total contact of the humeral head with the glenoid to 70%. This allows for the stabilization of the glenohumeral joint and prevents anterior and posterior humeral head dislocation.
- C) De Quervain’s affects the abductor pollicis longus and extensor pollicis brevis tendons. It can be seen with overuse in sports with gripped equipment such as golf and racquet sports. The patient usually has pain with resisted thumb extension. Finkelstein’s test can be positive.
- A) Individual flexor tendons for each digit of the hand are housed within a flexor tendon sheath. The tendon sheath has areas of thickening called annular and cruciate pulleys that function to stabilize the tendon. In stenosing tenosynovitis (trigger finger), the proximal pulley becomes inflamed and thickened with concurrent nodular enlargement of the tendon itself. As the inflamed tendon passes through the thickened pulley, it occasionally becomes stuck, locking the finger in flexion. This condition usually affects the middle or ring fingers. Therapy includes local steroid injection or surgery.