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Upper Extremity Trauma MCQs

Practice Set 10 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 181

Topic: Upper Extremity Trauma

A patient with an acromioclavicular dislocation has a very prominent distal clavicle. Examination reveals that the deformity increases rather than reduces with an isometric shoulder shrug. Which of the following structures is most likely intact?

Anatomy 2002 Practice Questions: Set 1 (Solved) - Figure 8

. Trapezoid ligament
. Conoid ligament
. Acromioclavicular ligament
. Deltoid muscle origin
. Trapezius muscle insertion

Correct Answer & Explanation

. Deltoid muscle origin

Explanation

Severely displaced acromioclavicular injuries disrupt the deltotrapezial fascia and muscular origin in addition to the ligaments (acromioclavicular and coracoclavicular or trapezoid and conoid). When the deltoid is still attached to the clavicle, an isometric shoulder shrug will tend to reduce the displacement. When the deltoid is detached but the trapezius is attached, this manuever will increase the deformity and surgery may be indicated.

Question 182

Topic: Upper Extremity Trauma

Figure 7 shows the radiograph of an 18-year-old hockey player who sustained a shoulder injury during a fall into the side boards. Examination reveals a significant prominence at the acromioclavicular joint. Management should consist of

Sports Medicine 2001 Practice Questions: Set 1 (Solved) - Figure 22

. a figure-of-8 clavicle strap.
. a sling for comfort, followed by early range-of-motion and strengthening exercises.
. open reduction and stabilization.
. immobilization in a spica cast.
. resection of the distal clavicle.

Correct Answer & Explanation

. open reduction and stabilization.

Explanation

The radiograph shows a type V acromioclavicular separation with greater than 100% superior elevation of the clavicle. This finding implies detachment of the deltoid and trapezius from the distal clavicle. Because of severe compromise of function and potential compromise to the overlying skin, surgery is the treatment of choice for type V acromioclavicular separations. During reduction and repair, meticulous repair of the deltotrapezial fascia will also aid in securing the repair. Nuber GW, Bowen MK: Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 1997;5:11-18.

Question 183

Topic: Upper Extremity Trauma
A 29-year-old quarterback falls onto his dominant shoulder and sustains the injury shown in Figures 14a and 14b. Management should consist of
. an arm sling.
. nonsteroidal anti-inflammatory drugs and a rapid return to activity.
. arthroscopic partial claviculectomy.
. acromioclavicular joint reduction and stabilization.
. acromionectomy.

Correct Answer & Explanation

. acromioclavicular joint reduction and stabilization.

Explanation

Type V acromioclavicular dislocations are characterized by elevation of the clavicle of 100% to 300% and involve extensive soft-tissue stripping. The treatment of choice is surgical reduction of the acromioclavicular joint and some type of stabilization.

Question 184

Topic: Upper Extremity Trauma
A 21-year-old football player had severe pain and immediate swelling in the left anteromedial chest wall while bench pressing near maximal weights several days ago. Examination at the time of injury revealed a mass on the anteromedial chest wall. Follow-up examination now reveals decreased swelling, and axillary webbing is observed. The patient has weakness to adduction and forward flexion. The injured muscle originates from the
. proximal clavicle and sternocostal margin.
. proximal humerus.
. coracoid process.
. distal clavicle and acromion.
. anterior scapula.

Correct Answer & Explanation

. proximal humerus.

Explanation

The patient has a pectoralis major rupture. The pectoralis major originates from the proximal clavicle and the border of the sternum, including ribs two through six.

Question 185

Topic: Upper Extremity Trauma

A 12-year-old boy falls from a bicycle. A radiograph of his injured shoulder is shown in Figure 41. What is the optimal method of treatment?

General Orthopedics Board Review 2026: High-Yield MCQs (Set 16) - Figure 15

. Suture of the coracoclavicular ligament
. Temporary plate fixation across the acromioclavicular joint
. Immobilization in a shoulder spica cast
. Sling immobilization
. Reduction and temporary intramedullary fixation across the acromioclavicular joint

Correct Answer & Explanation

. Sling immobilization

Explanation

The radiograph reveals a distal clavicle fracture. In children, a periosteal sleeve will remain attached to the intact coracoclavicular ligament, and as such, remodeling can be expected. Therefore, nonsurgical management with a sling is preferred. Surgical treatment is not necessary, and a shoulder spica cast offers no advantage over a simple sling.

Question 186

Topic: Upper Extremity Trauma

A 46-year-old woman fell from her bicycle and sustained the injury shown in Figure 24. Which of the following ligaments has been disrupted?

Sports Medicine Board Review 2007: High-Yield MCQs (Set 4) - Figure 5

. Acromioclavicular
. Acromioclavicular and coracoclavicular
. Coracoclavicular
. Coracoacromial and sternoclavicular
. Sternoclavicular

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular

Explanation

The radiograph shows a type V acromioclavicular joint injury. Type V injuries involve disruption of the acromioclavicular and coracoclavicular ligaments. Type I injuries involve a sprain of the acromioclavicular joint ligaments. Type II injuries involve disruption of the acromioclavicular joint ligaments; the coracoclavicular ligaments are partially injured. Sternoclavicular ligaments stabilize the medial clavicle and the sternum; they are not damaged with acromioclavicular joint dislocations. Fukuda K, Craig EV, An KN, et al: Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 1986;68:434-439.

Question 187

Topic: Upper Extremity Trauma

A 52-year-old man who was a former high school pitcher now reports loss of elbow flexion and extension with pain at the extremes of motion. Nonsurgical management has failed to provide relief. Examination reveals movement from 50 degrees to 110 degrees and is painful only at the limits of motion. A radiograph is shown in Figure 12. Treatment should consist of

Shoulder 2002 Practice Questions: Set 1 (Solved) - Figure 29

. excision of the osteophytes and loose bodies and anterior and posterior capsular releases.
. removal of the loose bodies.
. anterior capsular release.
. anterior and posterior capsular releases.
. interposition arthroplasty.

Correct Answer & Explanation

. excision of the osteophytes and loose bodies and anterior and posterior capsular releases.

Explanation

Based on the history, examination, and radiograph, the patient has typical degenerative arthritis of the elbow. This condition is found almost exclusively in men, and there is almost universally a history of repetitive heavy use or overuse of the elbow. Patients report pain at terminal extension and usually have a flexion contracture. Radiographs reveal osteophytes on the coronoid and olecranon and in the coronoid and olecranon fossae. The osteophytes are often associated with loose bodies that sometimes are attached to the soft tissues. Treatment should consist of removal of all loose bodies and impinging osteophytes using open technique or by arthroscopy. The capsular contractures should be released at the same time. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 283-294. Morrey BF: Primary degenerative arthritis of the elbow: Treatment by ulnohumeral arthroplasty. J Bone Joint Surg Br 1992;74:409-413. Redden JF, Stanley D: Arthroscopic fenestration of the olecranon fossa in the treatment of osteoarthritis of the elbow. Arthroscopy 1993;9:14-16.

Question 188

Topic: Upper Extremity Trauma

A 27-year-old professional baseball pitcher who underwent arthroscopic olecranon debridement continues to have medial-sided elbow pain during late cocking. Physical examination reveals laxity and pain with valgus stress testing. What is the most likely cause of his pain?

. Ulnar neuritis
. Excessive olecranon resection
. Osteochondritis dissecans of the capitellum
. Olecranon stress fracture
. Valgus extension overload

Correct Answer & Explanation

. Excessive olecranon resection

Explanation

Both the medial collateral ligament and the olecranon contribute to valgus stability of the elbow. Excessive olecranon resection increases the demand placed on the medial collateral ligament in resisting valgus forces during throwing. Bone removal from the olecranon should be limited to osteophytes. Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 101-111.

Question 189

Topic: Upper Extremity Trauma

Figure 17 shows the radiograph of a 25-year-old professional football player who has superior shoulder pain that prevents him from sports participation. History reveals that he sustained a shoulder injury that was treated with closed reduction and temporary pinning 3 years ago. The best course of action should be

Shoulder Board Review 2002: High-Yield MCQs (Set 2) - Figure 4

. no further participation in contact sports.
. open reduction of the acromioclavicular joint and coracoclavicular screw stabilization.
. open repair of the coracoclavicular ligaments.
. Weaver-Dunn reconstruction and coracoclavicular reconstruction.
. excision of the distal clavicle.

Correct Answer & Explanation

. Weaver-Dunn reconstruction and coracoclavicular reconstruction.

Explanation

The radiograph shows a complete acromioclavicular separation. Because the patient is a professional athlete who is unable to participate, surgery is indicated. Chronic separations, especially those with previous trauma from joint pinning, should be treated with resection of the distal clavicle and stabilization to the coracoid. Some type of biologic reconstruction of the coracoclavicular ligaments is generally recommended. Open repair of the ligaments is generally not possible in such a delayed fashion. Screw fixation alone will not provide a lasting solution as the screws usually need to be removed, leaving no fixation in place. Reconstruction using the coracoacromial ligament is generally recommended with coracoclavicular fixation to protect the repair while it heals. Nuber GW, Bowen MK: Disorders of the acromioclavicular joint: Pathophysiology, diagnosis and management, in Iannotti JP, Williams GR (eds): Disorders of the Shoulder: Diagnosis and Management. Philadelphia, PA, Lippincott Williams and Wilkins, 1999.

Question 190

Topic: Upper Extremity Trauma

Figure 35 shows the radiograph of a 35-year-old weightlifter who has had pain with overhead lifts for the past 7 months. Cortisone injections in the acromioclavicular joint provided only temporary relief. A bone scan reveals increased activity of the acromioclavicular joint. Treatment should now consist of

Sports Medicine Board Review 2004: High-Yield MCQs (Set 4) - Figure 5

. rotator cuff interval closure.
. distal clavicle excision.
. superior labrum anterior and posterior repair.
. biceps tenodesis.
. thermal capsulorrhaphy.

Correct Answer & Explanation

. distal clavicle excision.

Explanation

Osteolysis of the distal clavicle is common in weightlifters; therefore, distal clavicle excision is the treatment of choice. A subacromial decompression alone would not alleviate the acromioclavicular joint symptoms. Interval closure, biceps degeneration, and superior labrum anterior and posterior repair would limit superior migration but would not explain the abnormal bone scan. Thermal capsular shrinkage does not have a role here. Flatow EL, Cordasco FA, McCluskey GM, Bigliani LU: Arthroscopic resection of the distal clavicle via a superior portal: A critical quantitative radiographic assessment of bone removal. Arthroscopy 1990;6:153-154.

Question 191

Topic: Upper Extremity Trauma
The use of a screw between the clavicle and the coracoid process to maintain the clavicle and acromioclavicular (AC) joint in a reduced position is a treatment option for AC joint separations. Screw removal is generally recommended after soft-tissue healing. What effect does this rigid coracoclavicular fixation have on shoulder kinematics?
. Significant limitation of humeral elevation
. Significant limitation of shoulder abduction
. Significant loss of motion in all directions
. Little to no limitation of shoulder range of motion
. Limitation of humeral rotation

Correct Answer & Explanation

. Little to no limitation of shoulder range of motion

Explanation

This issue has been debated since Inman published his classic study on clavicular rotation in 1944. Subsequently, it has been shown by several authors that the clinical evaluation of patients with either coracoclavicular screws in place or with arthrodesis of the coracoclavicular reveals little to no loss of shoulder motion. This is most likely the result of synchronous motion of the scapula and clavicle in shoulder movements.

Question 192

Topic: Upper Extremity Trauma

According to recent quantitative anatomical studies utilizing MRI and gadolinium, which of the following vessels provides the principal intraosseous blood supply to the humeral head, challenging historical teachings regarding proximal humerus vascularity?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Suprascapular artery
. Thoracoacromial artery
. Circumflex scapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Historically, the anterior humeral circumflex artery (via its arcuate branch) was thought to be the primary blood supply to the humeral head. However, modern quantitative studies (e.g., Hettrich et al.) have demonstrated that the posterior humeral circumflex artery provides the vast majority (approximately 64%) of the intraosseous blood supply to the humeral head.

Question 193

Topic: Upper Extremity Trauma
A 45-year-old male sustains a fall directly onto the tip of his right shoulder. He presents with severe pain, a visible deformity, and tenderness over the acromioclavicular (AC) joint. On examination, there is a prominent distal clavicle and positive cross-body adduction test. Radiographs show complete disruption of both the AC and coracoclavicular (CC) ligaments, with significant superior displacement of the clavicle relative to the acromion. Which Rockwood classification type BEST describes this injury?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type V

Explanation

This patient's injury, with complete disruption of both AC and CC ligaments and significant superior displacement of the clavicle, fits the description of a Rockwood Type V AC joint injury. Type I involves a sprain of the AC ligaments with intact CC ligaments. Type II involves disruption of the AC ligaments with intact CC ligaments. Type III involves complete disruption of AC and CC ligaments, with clavicle displacement of 25-100% of the acromion width. Type IV involves posterior displacement of the clavicle into the trapezius muscle. Type V involves severe superior displacement of the clavicle, often 100-300% of the acromion width, through the deltotrapezial fascia. Type VI involves inferior displacement of the clavicle, which is rare.

Question 194

Topic: Upper Extremity Trauma
A 70-year-old female presents with persistent pain, limited range of motion, and a visible step-off deformity at her right acromioclavicular (AC) joint following a fall 3 months ago. Radiographs show a Rockwood Type III AC joint injury. She has significant discomfort with overhead activities and reaching across her body. What is the MOST appropriate management?
. Continued non-operative management with physical therapy
. Corticosteroid injection into the AC joint
. AC joint arthrodesis
. Surgical reconstruction of the coracoclavicular ligaments
. Distal clavicle excision (Mumford procedure)

Correct Answer & Explanation

. Surgical reconstruction of the coracoclavicular ligaments

Explanation

For symptomatic chronic Rockwood Type III AC joint injuries that have failed conservative management, surgical reconstruction of the coracoclavicular ligaments (often combined with AC ligament repair or reconstruction) is the most appropriate treatment to restore stability and reduce pain. This aims to restore the anatomical relationship and kinematics. Continued non-operative management is unlikely to resolve chronic symptoms in this active patient. Corticosteroid injections are temporary. AC joint arthrodesis is an option but less common than reconstruction. Distal clavicle excision (Mumford procedure) addresses AC joint pain from arthritis or impingement but does not restore stability to a Type III injury.

Question 195

Topic: Upper Extremity Trauma

A 32-year-old competitive weightlifter feels a sudden 'pop' in his anterior chest while performing a bench press. He presents with bruising and weakness in shoulder internal rotation. If a complete pectoralis major rupture is present, which anatomical location is most commonly involved?

. Muscle belly of the clavicular head
. Musculotendinous junction of the clavicular head
. Avulsion of the sternal head tendon from the humerus
. Origin of the sternal head at the sternum
. Coracoid process avulsion

Correct Answer & Explanation

. Avulsion of the sternal head tendon from the humerus

Explanation

Pectoralis major ruptures most frequently occur at the tendinous insertion of the sternal head onto the proximal humerus, particularly during eccentric loading exercises like the bench press.

Question 196

Topic: Upper Extremity Trauma
Goss introduced the concept of the 'superior suspensory shoulder complex' (SSSC) as a bone-and-soft-tissue ring crucial for understanding the stability of 'floating shoulder' injuries. Which of the following structures acts as an inferior strut rather than a constituent part of the SSSC ring itself?
. Glenoid process
. Coracoid process
. Distal clavicle
. Acromial process
. Scapular spine

Correct Answer & Explanation

. Scapular spine

Explanation

The SSSC consists of a continuous ring of bone and soft tissue: the glenoid process, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromial process. This ring is suspended by the middle clavicle (superior strut) and supported inferiorly by the lateral scapular body and the scapular spine (inferior strut). Therefore, the scapular spine is a strut supporting the ring, not part of the ring itself.

Question 197

Topic: Upper Extremity Trauma

During an olecranon osteotomy for open reduction and internal fixation of an intra-articular distal humerus fracture (AO/OTA 13-C3), the osteotomy should be directed to enter the joint at which of the following landmarks?

. Through the center of the coronoid process
. Into the deepest, non-articular portion of the trochlear notch (bare area)
. Proximal to the sublime tubercle
. Through the olecranon tip 5 mm from the insertion of the triceps tendon
. Distal to the attachment of the brachialis muscle

Correct Answer & Explanation

. Into the deepest, non-articular portion of the trochlear notch (bare area)

Explanation

An olecranon osteotomy is typically performed as a chevron osteotomy directed into the 'bare area' of the greater sigmoid (trochlear) notch. This bare area is devoid of articular cartilage and represents the deepest portion of the notch. Entering the joint here minimizes damage to the articular surface of the proximal ulna and facilitates an anatomic reduction upon repair.

Question 198

Topic: Upper Extremity Trauma

Historically, the arcuate artery (ascending branch of the anterior humeral circumflex artery) was considered the primary blood supply to the humeral head. However, recent quantitative cadaveric and MRI studies have demonstrated that the principal arterial supply to the humeral head actually arises from which of the following?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Thoracoacromial artery
. Subscapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent anatomic and MRI studies (e.g., Hettrich et al.) have redefined the vascular anatomy of the proximal humerus, demonstrating that the posterior humeral circumflex artery (PHCA) provides approximately 64% of the blood supply to the humeral head. This paradigm shift highlights the importance of the PHCA, though preserving both vessels when possible during proximal humerus surgery remains ideal.

Question 199

Topic: Upper Extremity Trauma

A 14-year-old boy who is right handed reports right shoulder pain. Radiographs show a lucent lesion of the proximal humeral epiphysis with a narrow zone of transition. Results of an open biopsy confirm the presence of a chondroblastoma. Based on these findings, the next most appropriate step in management should consist of

Orthopedic Surgery Board Review 2026 | High-Yield MCQs - Set 6 - Figure 24

. intralesional curettage and bone grafting.
. intra-articular resection of the proximal humerus and endoprosthetic replacement.
. intra-articular resection of the proximal humerus and osteoarticular allograft reconstruction.
. extra-articular resection of the proximal humerus and allograft arthrodesis of the shoulder.
. observation and serial radiographs.

Correct Answer & Explanation

. intralesional curettage and bone grafting.

Explanation

The patient has a chondroblastoma of the proximal humerus; therefore, the treatment of choice is curettage and bone grafting. Surgical resection of the proximal humerus is not indicated in the initial treatment of an intraosseous chondroblastoma. Mirra JM: Bone Tumors: Clinical, Radiologic, and Pathologic Correlations. Philadelphia, PA, Lea and Febiger, 1989, pp 589-623.

Question 200

Topic: Upper Extremity Trauma

A 22-year-old motorcycle rider is ejected and sustains a massive traction injury to his right upper extremity. Physical examination reveals a completely flail, anesthetic right arm, and severe swelling over the shoulder girdle. Radiographs show significant lateral displacement of the scapula relative to the spinous processes, an intact clavicle, and disruption of the acromioclavicular joint. What is the most likely associated limb-threatening vascular injury?

. Axillary artery transection
. Subclavian artery disruption
. Brachial artery thrombosis
. Thoracoacromial trunk avulsion
. Internal thoracic artery rupture

Correct Answer & Explanation

. Subclavian artery disruption

Explanation

Scapulothoracic dissociation is a high-energy closed traction injury characterized by complete disruption of the scapulothoracic articulation. It is often accompanied by devastating injuries to the brachial plexus and the subclavian or axillary vessels. The subclavian artery is particularly vulnerable as it is tethered over the first rib and under the clavicle, making it the most common critical vascular injury associated with this pattern.

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