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Upper Extremity Trauma MCQs

Practice Set 1 of 24

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

Question 1

Topic: Upper Extremity Trauma

A patient is diagnosed with compression of the median nerve at the ligament of Struthers. This pathology is invariably associated with an anomalous bony spur located on which of the following structures?

. Medial epicondyle
. Lateral epicondyle
. Anteromedial distal humerus
. Anterolateral distal humerus
. Coronoid process

Correct Answer & Explanation

. Anteromedial distal humerus

Explanation

The ligament of Struthers connects an anomalous supracondylar process (located on the anteromedial aspect of the distal humerus) to the medial epicondyle, which can compress the median nerve and brachial artery.

Question 2

Topic: Upper Extremity Trauma

A 16-year-old elite baseball pitcher presents with posterior elbow pain during the deceleration phase of throwing. Examination demonstrates an extension deficit and pain with forced extension. Radiographs show osteophytes at the posteromedial olecranon tip. What is the underlying pathophysiology?

. Ulnar nerve subluxation
. Valgus extension overload
. Capitellar osteochondritis dissecans
. Ulnar collateral ligament attrition
. Medial epicondyle apophysitis

Correct Answer & Explanation

. Valgus extension overload

Explanation

Valgus extension overload (VEO) syndrome occurs in throwers due to repetitive impingement of the posteromedial olecranon into the olecranon fossa. It is driven by the extreme valgus forces and rapid extension during the throwing motion.

Question 3

Topic: Upper Extremity Trauma

A 48-year-old bodybuilder experiences a painful snap in his posterior elbow while performing heavy bench presses. Physical exam shows a palpable gap proximal to the olecranon and inability to actively extend the elbow against gravity. When performing a primary repair of this acute injury, where is the optimal site for reattachment of the tendon?

. At the articular margin of the olecranon
. Into the triceps footprint, 1-2 cm distal to the olecranon tip
. Into the medial epicondyle
. Into the anconeus aponeurosis
. To the proximal edge of the olecranon fossa

Correct Answer & Explanation

. Into the triceps footprint, 1-2 cm distal to the olecranon tip

Explanation

The normal footprint of the triceps tendon is broad and inserts slightly distal (approx. 1-2 cm) to the tip of the olecranon. Reattaching the tendon anatomically to its footprint provides optimal biomechanical strength and prevents an extension block.

Question 4

Topic: Upper Extremity Trauma

A 35-year-old weightlifter feels a sudden pop in the posterior elbow during a heavy bench press. MRI confirms a complete triceps tendon rupture. During surgical repair, anatomical reattachment should target the normal footprint located:

. On the medial aspect of the olecranon tip
. At the center of the olecranon fossa
. Along the posterior olecranon process, distal to the tip
. At the sublime tubercle
. At the posterolateral radial head

Correct Answer & Explanation

. Along the posterior olecranon process, distal to the tip

Explanation

The anatomic footprint of the triceps tendon is a broad area on the posterior olecranon process, inserting approximately 1 to 2 cm distal to the proximal tip, which is itself covered by a bursa.

Question 5

Topic: Upper Extremity Trauma

The proximal humeral articular surface can be described as a portion of a sphere. The center of this sphere has which of the following anatomic relationships to the long axis of the humerus:

. The center of this sphere lies on the long axis of the humerus.
. The center of this sphere is offset medially with respect to the long axis of the humerus.
. The center of this sphere is offset posteriorly with respect to the long axis of the humerus.
. The center of this sphere is offset anteriorly with respect to the long axis of the humerus.
. The center of this sphere is offset medially and posteriorly with respect to the long axis of the humerus.

Correct Answer & Explanation

. The center of this sphere is offset medially and posteriorly with respect to the long axis of the humerus.

Explanation

Anatomically, a sphere can be fit to the proximal humerus with the articular surface comprising a portion of that spher The center of this sphere is offset 3 mm to 11 mm medially and 1 mm to 6 mm posteriorly with respect to the long axis of the humerus.

Question 6

Topic: Upper Extremity Trauma

A 13-year-old baseball pitcher presents with insidious onset of pain in his throwing shoulder. Radiographs demonstrate widening and irregularity of the proximal humeral physis. What is the most appropriate initial management?

. Corticosteroid injection into the subacromial space
. Immediate operative percutaneous pinning
. Absolute cessation of throwing for 3 months
. Physical therapy focusing on continued throwing with modified mechanics
. Arthroscopic labral debridement

Correct Answer & Explanation

. Absolute cessation of throwing for 3 months

Explanation

Little League shoulder is an overuse epiphysiolysis of the proximal humerus caused by repetitive rotational stresses. The definitive initial treatment is absolute rest from throwing for typically 3 months, followed by a gradual return-to-throwing program.

Question 7

Topic: Upper Extremity Trauma
A rugby player sustains a direct blow to the superior aspect of the shoulder. Radiographs reveal that the distal clavicle is displaced superiorly, and the coracoclavicular distance is increased by 150% compared to the normal contralateral side. According to the Rockwood classification, what type of acromioclavicular (AC) joint injury is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

A Rockwood Type V injury is characterized by a severe superior displacement of the clavicle, with the coracoclavicular (CC) space widened by 100% to 300% relative to the normal side, accompanied by severe disruption of the deltotrapezial fascia.

Question 8

Topic: Upper Extremity Trauma
A 45-year-old non-laborer sustains a Grade III acromioclavicular (AC) joint separation. According to current literature, what is the most widely accepted initial management for this patient?
. Acute surgical reconstruction with coracoclavicular ligaments
. Figure-of-eight bracing for 6 weeks
. Sling immobilization followed by early physical therapy
. Rigid internal fixation with a hook plate
. Primary excision of the distal clavicle

Correct Answer & Explanation

. Sling immobilization followed by early physical therapy

Explanation

Non-operative management consisting of a brief period of sling immobilization and early physical therapy is the standard of care for acute Type III AC joint separations in most patients, yielding excellent functional outcomes.

Question 9

Topic: Upper Extremity Trauma

A 32-year-old bodybuilder feels a tearing sensation in his anterior chest while performing a heavy bench press. Examination reveals an asymmetric loss of the anterior axillary fold. A pectoralis major rupture is suspected. Where does this rupture most commonly occur?

. Sternal origin
. Clavicular origin
. Musculotendinous junction
. Tendon insertion on the humerus
. Intramuscular substance

Correct Answer & Explanation

. Tendon insertion on the humerus

Explanation

Pectoralis major ruptures typically occur during eccentric loading, such as the eccentric phase of a bench press. The most common location for the tear is at or near the tendinous insertion onto the proximal humerus.

Question 10

Topic: Upper Extremity Trauma

Valgus extension overload in baseball pitchers leads to osteophyte formation primarily in which area of the elbow?

. Anteromedial coronoid
. Posteromedial olecranon
. Radial head
. Lateral epicondyle
. Olecranon fossa

Correct Answer & Explanation

. Posteromedial olecranon

Explanation

Valgus extension overload syndrome is characterized by posteromedial olecranon impingement during the deceleration phase of throwing. This repetitive stress causes osteophyte formation on the posteromedial tip of the olecranon.

Question 11

Topic: Upper Extremity Trauma

In evaluating a shoulder with an acromioclavicular (AC) joint injury, a Type V injury according to the Rockwood classification is best defined by which of the following findings?

. Sprain of the AC ligaments only
. Complete tear of the AC ligaments with intact coracoclavicular ligaments
. Superior displacement of the clavicle by 25% to 100% of the normal distance
. Superior displacement of the clavicle >100% of the normal coracoclavicular distance
. Inferior displacement of the clavicle under the coracoid

Correct Answer & Explanation

. Superior displacement of the clavicle >100% of the normal coracoclavicular distance

Explanation

A Rockwood Type V AC joint injury involves complete rupture of the AC and CC ligaments with >100% superior displacement of the clavicle relative to the acromion. This degree of displacement typically necessitates surgical reconstruction.

Question 12

Topic: Upper Extremity Trauma

In Acromioclavicular (AC) joint injuries, the coracoclavicular (CC) ligaments provide the primary vertical stability to the joint. Which of the following accurately describes the anatomical arrangement of the CC ligaments?

. Conoid is medial and trapezoid is lateral
. Conoid is lateral and trapezoid is medial
. Both arise from the acromion directly
. They attach to the lateral aspect of the coracoid process exclusively
. They provide primarily anteroposterior (horizontal) stability

Correct Answer & Explanation

. Conoid is medial and trapezoid is lateral

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid ligaments. The conoid ligament is situated posteromedial, while the trapezoid ligament is positioned anterolateral along the coracoid and clavicle.

Question 13

Topic: Upper Extremity Trauma
In valgus extension overload of the elbow, impingement occurs between which of the following structures:
. Ulnar nerve and ulnar collateral ligament
. Posteromedial olecranon process and posteromedial olecranon fossa
. Posterolateral olecranon process and radial head
. Coronoid process and radial head
. Posteromedial olecranon process and ulnar nerve

Correct Answer & Explanation

. Posteromedial olecranon process and posteromedial olecranon fossa

Explanation

Valgus extension overload is unique to the thrower's elbow. Valgus extension overload of the elbow involves attenuation and creep in the ulnar collateral ligament that transfers compressive forces to the lateral compartment of the elbow at the radiocapitellar joint. In the posterior elbow compartment, the valgus moment creates contact between the posteromedial aspect of the olecranon process and the posteromedial olecranon fossa.

Question 14

Topic: Upper Extremity Trauma

Anteroposterior displacement of the acromion on the clavicle is most strongly resisted by which of the following structures:

. The conoid ligament
. The acromioclavicular ligaments
. The osseous articulation of the acromion on the clavicle
. The acromioclavicular meniscus
. The trapezoid ligament

Correct Answer & Explanation

. The trapezoid ligament

Explanation

During high loads, the coracoclavicular ligaments (conoid and trapezoid ligament) resist vertical and compressive loads across the acromioclavicular joint. The conoid ligament is the strongest ligament resisting downward movement of the scapula relative to the clavicle. The acromioclavicular ligaments maintain alignment of the joint in the axial plane.

Question 15

Topic: Upper Extremity Trauma

An elite weightlifter undergoes surgical repair for a pectoralis major tendon rupture sustained during a heavy bench press. Which anatomical segment of the pectoralis major is most commonly ruptured and typically requires anatomic reattachment?

. Clavicular head at the musculotendinous junction
. Sternal head at its insertion on the proximal humerus
. Clavicular head at its insertion on the coracoid process
. Sternal head at its origin on the ribs
. Abdominal head at its fascial insertion

Correct Answer & Explanation

. Sternal head at its insertion on the proximal humerus

Explanation

Pectoralis major ruptures most commonly involve the sternal head at or near its humeral insertion. The sternal fibers are uniquely stressed during the eccentric phase of heavy bench pressing due to their twisted distal insertion.

Question 16

Topic: Upper Extremity Trauma

In the setting of an acromioclavicular (AC) joint injury, which ligament functions as the primary static restraint to superior translation of the distal clavicle?

. Acromioclavicular ligament
. Coracoacromial ligament
. Trapezoid ligament
. Conoid ligament
. Superior transverse scapular ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid ligament is posteromedial and acts as the primary restraint to superior translation, while the trapezoid is anterolateral and primarily resists axial compression.

Question 17

Topic: Upper Extremity Trauma

A 25-year-old overhead athlete complains of posterior shoulder pain and a subjective feeling of a "dead arm" during the late cocking phase of throwing. Based on the provided MRI finding,

which pathophysiologic mechanism best explains the development of this specific capsulolabral pathology?

. Peel-back mechanism driven by biceps tension in abduction and external rotation
. Subcoracoid impingement due to capsular laxity
. Repetitive microtrauma from isolated internal rotation forces
. Direct direct impact to the lateral acromion
. Degenerative joint disease of the acromioclavicular joint

Correct Answer & Explanation

. Peel-back mechanism driven by biceps tension in abduction and external rotation

Explanation

The clinical scenario and late cocking phase pain are characteristic of a Type II SLAP lesion. In overhead throwers, this is most commonly caused by a "peel-back" mechanism where abduction and external rotation create torsional forces at the biceps anchor.

Question 18

Topic: Upper Extremity Trauma

To permit full active elevation of the arm overhead, the clavicle must undergo complex, coupled movements at the sternoclavicular and acromioclavicular joints. During this full elevation, the clavicle normally undergoes which essential motion?

. Anterior rotation along its longitudinal axis
. Posterior rotation along its longitudinal axis
. Inferior translation of the medial end
. Internal rotation relative to the sternum
. Rigid fixation with zero degrees of rotation

Correct Answer & Explanation

. Posterior rotation along its longitudinal axis

Explanation

During full shoulder elevation, the clavicle must rotate posteriorly approximately 40 to 50 degrees along its longitudinal axis. This motion is dictated by the tensioning of the coracoclavicular ligaments as the scapula upwardly rotates.

Question 19

Topic: Upper Extremity Trauma

During an acromioclavicular joint reconstruction, the surgeon reconstructs the conoid and trapezoid ligaments. The conoid ligament inserts onto the clavicle at what distance from the distal end of the clavicle?

. 1.0 cm
. 3.0 cm
. 4.5 cm
. 6.0 cm
. 8.0 cm

Correct Answer & Explanation

. 4.5 cm

Explanation

The conoid ligament inserts approximately 4.5 cm medial to the distal clavicle. The trapezoid ligament inserts more laterally, about 3.0 cm medial to the distal clavicle.

Question 20

Topic: Upper Extremity Trauma

The coracoclavicular (CC) ligaments provide the primary vertical stability to the acromioclavicular joint. Which of the following accurately describes the anatomic relationship between the two distinct ligaments comprising this complex?

. The conoid is anterolateral to the trapezoid
. The conoid is posteromedial to the trapezoid
. The trapezoid inserts more medially on the clavicle
. Both ligaments insert on the anterior border of the clavicle
. The conoid is the primary restraint to horizontal translation

Correct Answer & Explanation

. The conoid is posteromedial to the trapezoid

Explanation

The coracoclavicular ligament complex consists of the conoid and trapezoid ligaments. The conoid ligament is distinctly located posteromedial to the trapezoid ligament and inserts onto the conoid tubercle of the distal clavicle.

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