Download Case Report #32

CME QUESTIONS
AANEM CASE REPORT #32:
NERVE INJURY ASSOCIATED WITH HIP ARTHROPLASTY
GARY GOLDBERG, MD
HEIDI GOLDSTEIN, MD
For each of the following multiple-choice questions, select the ONE best answer.
1. Following revision of a total hip arthroplasty,
the incidence of nerve injuries is:
A. The same as that seen following initial
arthroplasty.
B. Slightly lower than that seen following
initial arthroplasty.
C. Significantly higher than that seen
following initial arthroplasty.
D. Slightly higher than that seen following
initial arthroplasty.
E. Clearly reduced by somatosensory evoked
potential monitoring of the sciatic nerve.
2. The reasons why the lateral division of the
Sciatic nerve is more susceptible to injury
than the medical division include all of the
following except:
A. The lateral division follows a more oblique
course down the limb.
B. There is more adipose tissue in the
epineurium of the lateral division.
C. The lateral division has fewer, larger
fascicles.
D. The lateral division has less fibrous
connective tissue.
E. The lateral division is tethered to other
Structures
3. Femoral nerve injury is associated with:
A. The use of lateral approach to the hip.
B. The use of posterolateral approach to the
hip.
C. Posterior dislocation of the hip joint.
D. The development of postoperative thrombophlebitis.
E. The use of anterolateral approach to the hip.
4. Using Electrodiagnostic techniques, the incidence of
subclinical gluteal nerve injury following hip
arthroplasty has been reported to be as high as:
A. 12%.
B. 36%.
C. 77%.
D. 88%.
E. 95%.
5. Mechanisms involved in nerve injury during hip
surgery are least likely to involve:
A. Shearing.
B. Ischemia.
C. Neurovascular compromise.
D. Compression.
E. Traction.
6. The presence of abnormal spontaneous potentials,
absent sensory nerve action potentials, and
significantly reduced amplitude of compound
muscle action potentials is associated with:
A. Segmental demyelination.
B. Conduction block.
C. Preserved axonal integrity.
D. Good prognosis for short-term recovery.
E. Poor prognosis for short-term recovery.
7. The incidence of nerve injury can be significantly
reduced by limiting leg lengthening to less than:
A. 2 cm.
B. 3 cm.
C. 4 cm.
D. 5 cm.
E. 6 cm.
8. The deep peronial nerve most commonly
Innervates all of the following muscles
except the:
A. Extensor halluces longus.
B. Extensor digitorum longus.
C. Peroneus tertius.
D. Peroneus brevis.
C. Tibialis anterior.
9. Muscles that lie anterior to the sciatic nerve and
posterior to the hip joint include all of the
following except the:
A. Quadratus femoris.
B. Pififormis.
C. Obturator internus.
D. Obturator externus.
E. The gemelli.
10. All of the following muscles are innervated by
the medial division of the sciatic nerve except the:
A. Long head of the biceps femoris .
B. Semimembranosus.
C. Semitendinosus.
D. Short head of the biceps femoris.
E. Adductor magnus.