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Upper Extremity Trauma MCQs

Practice Set 12 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 221

Topic: Upper Extremity Trauma
A 32-year-old manual laborer sustains a direct blow to the point of his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion with an increased coracoclavicular distance. What is the most appropriate initial management?
. Open reduction and internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Sling immobilization and early range of motion as tolerated
. Figure-of-eight bracing for 6 weeks
. Distal clavicle excision

Correct Answer & Explanation

. Sling immobilization and early range of motion as tolerated

Explanation

This is a Type III acromioclavicular (AC) joint separation. Initial management for most Type III AC separations, even in heavy laborers, remains non-operative with sling immobilization and early functional rehabilitation.

Question 222

Topic: Upper Extremity Trauma
A 25-year-old professional hockey player sustains a direct downward blow to the point of his right shoulder. Radiographs confirm a Type III acromioclavicular (AC) joint separation (complete disruption of AC and CC ligaments with 100% displacement). According to current literature, what is the most widely accepted initial management for this injury?
. Immediate open reduction and coracoclavicular ligament reconstruction
. Arthroscopic stabilization with a cortical button device
. Non-operative management with a brief period of sling immobilization followed by physical therapy
. Primary distal clavicle excision and Mumford procedure
. Rigid immobilization in an abduction brace for 6 weeks

Correct Answer & Explanation

. Non-operative management with a brief period of sling immobilization followed by physical therapy

Explanation

The standard initial management for Type III AC joint separations is non-operative, as the majority of patients achieve excellent functional outcomes without surgery. Operative intervention is typically reserved for those who remain symptomatic after a trial of conservative management or in highly selected laborers and overhead athletes.

Question 223

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his right shoulder. Radiographs demonstrate 150% superior displacement of the clavicle relative to the acromion, with significant widening of the coracoclavicular distance. The clavicle is not posteriorly displaced into the trapezius. According to the Rockwood classification, what type of injury is this, and what is the typical management?
. Type II; nonoperative management
. Type III; nonoperative management
. Type IV; operative management
. Type V; operative management
. Type VI; nonoperative management

Correct Answer & Explanation

. Type V; operative management

Explanation

A Rockwood Type V injury involves 100% to 300% superior displacement of the clavicle due to complete disruption of the AC and CC ligaments, along with extensive deltotrapezial fascial stripping. Operative reconstruction is typically recommended for these severe displacement injuries.

Question 224

Topic: Upper Extremity Trauma
A 30-year-old manual laborer sustains a Grade III acromioclavicular (AC) joint separation. If surgical reconstruction is eventually required, an understanding of the coracoclavicular ligaments is essential. Which of the following describes the anatomic orientation of these ligaments?
. The conoid ligament is medial and posterior to the trapezoid ligament
. The trapezoid ligament is medial and posterior to the conoid ligament
. The conoid ligament inserts on the superior surface of the clavicle
. Both ligaments originate from the short head of the biceps
. The conoid ligament is primarily responsible for resisting anterior translation

Correct Answer & Explanation

. The conoid ligament is medial and posterior to the trapezoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid is situated medial and posterior to the trapezoid and acts as the primary restraint to superior translation of the clavicle.

Question 225

Topic: Upper Extremity Trauma

During an anatomic reconstruction of the coracoclavicular (CC) ligaments for a chronic Type V acromioclavicular joint separation, the surgeon must recreate the conoid and trapezoid ligaments. Which of the following correctly describes the normal anatomy of these ligaments?

. The conoid is lateral to the trapezoid and inserts on the anterior clavicle
. The conoid is medial to the trapezoid and inserts more posteriorly on the clavicle
. The trapezoid is medial to the conoid and inserts more posteriorly
. Both ligaments insert on the acromion rather than the clavicle
. The trapezoid arises from the base of the coracoid and the conoid from the tip

Correct Answer & Explanation

. The conoid is medial to the trapezoid and inserts more posteriorly on the clavicle

Explanation

The conoid ligament is the more medial of the CC ligaments and inserts more posteriorly onto the conoid tubercle of the clavicle. The trapezoid ligament is lateral and inserts more anteriorly.

Question 226

Topic: Upper Extremity Trauma

A 24-year-old cyclist falls directly onto the point of his shoulder. Radiographs demonstrate a Type V acromioclavicular (AC) joint injury. Which of the following ligaments must be reconstructed to reliably restore superior-inferior stability of the clavicle?

. Coracoacromial ligament
. Acromioclavicular ligament
. Conoid and trapezoid ligaments
. Coracohumeral ligament
. Superior transverse scapular ligament

Correct Answer & Explanation

. Conoid and trapezoid ligaments

Explanation

Type V AC joint injuries involve >100% superior displacement of the clavicle due to complete rupture of both the AC ligaments and the coracoclavicular (CC) ligaments. The CC ligaments (conoid and trapezoid) are the primary restraints against superior clavicular displacement and must be reconstructed.

Question 227

Topic: Upper Extremity Trauma

A 35-year-old man falls onto his shoulder. Radiographs show a 100% to 300% superior displacement of the clavicle relative to the acromion. Which ligaments are disrupted in this classic Type V acromioclavicular injury?

. Acromioclavicular (AC) ligaments only
. Coracoclavicular (CC) ligaments only
. Both AC and CC ligaments along with the deltotrapezial fascia
. Coracoacromial ligament only
. Sternoclavicular ligaments

Correct Answer & Explanation

. Both AC and CC ligaments along with the deltotrapezial fascia

Explanation

A Type V AC joint separation is characterized by severe superior displacement of the distal clavicle. This requires complete disruption of both the AC and CC ligaments, as well as significant tearing of the deltotrapezial fascia.

Question 228

Topic: Upper Extremity Trauma

During the standard deltopectoral approach to the proximal humerus, the cephalic vein is identified. To minimize bleeding and preserve its main venous drainage, the cephalic vein should ideally be retracted in which direction?

. Medially with the pectoralis major
. Laterally with the deltoid
. Superiorly toward the clavicle
. Inferiorly toward the axilla
. It must be ligated in all cases

Correct Answer & Explanation

. Laterally with the deltoid

Explanation

The cephalic vein marks the deltopectoral interval. It is typically retracted laterally with the deltoid muscle to preserve its main venous tributaries from the deltoid, thereby minimizing bleeding.

Question 229

Topic: Upper Extremity Trauma

A 28-year-old competitive weightlifter feels a tearing sensation in his anterior chest while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. Where is the most common anatomic location for this specific tendon rupture?

. Clavicular head at the musculotendinous junction
. Clavicular head at the humeral insertion
. Sternal head at the muscle belly
. Sternal head at the humeral insertion
. Sternal origin at the rib cage

Correct Answer & Explanation

. Sternal head at the humeral insertion

Explanation

Pectoralis major ruptures almost exclusively occur during eccentric loading activities like bench pressing. The most common site of failure is an avulsion of the sternal head tendon from its insertion on the proximal humerus.

Question 230

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate superior displacement of the clavicle relative to the acromion by approximately 150%. Which ligaments are fully disrupted in this Type III acromioclavicular (AC) injury?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Coracoacromial and acromioclavicular ligaments
. Coracoacromial and coracoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

A Type III AC joint separation involves complete disruption of both the acromioclavicular ligaments and the coracoclavicular (conoid and trapezoid) ligaments.

Question 231

Topic: Upper Extremity Trauma

A 35-year-old woman falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. During the standard surgical protocol for this injury, which of the following structures is typically addressed or repaired last?

. Coronoid process
. Radial head
. Lateral collateral ligament (LCL)
. Medial collateral ligament (MCL)
. Common extensor origin

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

The standard surgical algorithm for a terrible triad injury proceeds from deep to superficial and anterior to posterior: coronoid fixation, radial head fixation/replacement, followed by LCL repair. The MCL is typically only addressed if the elbow remains unstable after the lateral and anterior structures are stabilized.

Question 232

Topic: Upper Extremity Trauma

A 29-year-old competitive weightlifter feels a sudden "pop" in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness with internal rotation. MRI confirms a pectoralis major rupture. What is the most common anatomical location of this tear in this patient population?

. Muscle belly
. Sternal origin
. Clavicular origin
. Musculotendinous junction
. Humeral insertion (tendon avulsion)

Correct Answer & Explanation

. Humeral insertion (tendon avulsion)

Explanation

In weightlifters, pectoralis major ruptures almost exclusively occur as avulsions of the tendon from its insertion on the proximal humerus. These injuries typically require surgical repair to restore strength and cosmesis.

Question 233

Topic: Upper Extremity Trauma

A 28-year-old man falls onto his shoulder and is diagnosed with a Type V acromioclavicular (AC) joint injury. Which of the following best describes the anatomic disruption characteristic of this injury type?

. AC ligaments torn, coracoclavicular ligaments intact
. AC and coracoclavicular ligaments torn with <100% superior clavicular displacement
. AC and coracoclavicular ligaments torn with >100% superior clavicular displacement through the deltotrapezial fascia
. AC and coracoclavicular ligaments torn with posterior clavicle displacement into the trapezius
. AC and coracoclavicular ligaments torn with inferior clavicle displacement under the coracoid

Correct Answer & Explanation

. AC and coracoclavicular ligaments torn with >100% superior clavicular displacement through the deltotrapezial fascia

Explanation

A Type V AC joint injury features disruption of both the AC and CC ligaments along with the deltotrapezial fascia, resulting in severe superior displacement of the clavicle by greater than 100% to 300% relative to the acromion.

Question 234

Topic: Upper Extremity Trauma

A 38-year-old bicyclist falls directly onto his shoulder. Clinical examination and standing X-rays demonstrate a Type V acromioclavicular (AC) joint separation, with the distal clavicle elevated 150% above the acromion. Which ligaments are completely disrupted in this injury pattern?

. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Acromioclavicular, coracoclavicular, and coracoacromial ligaments
. Sternoclavicular and acromioclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

A Type V AC joint separation involves severe superior displacement of the clavicle due to complete disruption of both the acromioclavicular (AC) and coracoclavicular (conoid and trapezoid) ligaments, along with disruption of the deltotrapezial fascia.

Question 235

Topic: Upper Extremity Trauma
A 30-year-old right-hand-dominant construction worker sustains a Type III acromioclavicular (AC) joint separation following a direct blow to the shoulder. What is the most widely accepted initial management for this patient?
. Open reduction and hook plate fixation
. Coracoclavicular ligament reconstruction
. Weaver-Dunn procedure
. Nonoperative management with a sling and early range of motion
. Distal clavicle excision

Correct Answer & Explanation

. Nonoperative management with a sling and early range of motion

Explanation

Acute Type III AC joint separations (complete tear of the AC and CC ligaments) are generally treated nonoperatively with a sling and early rehabilitation. Multiple studies have shown that clinical outcomes of nonoperative management are comparable to surgery, with lower complication rates.

Question 236

Topic: Upper Extremity Trauma
A 28-year-old recreational hockey player falls onto the point of his shoulder. Radiographs show a 100% superior displacement of the distal clavicle relative to the acromion. The coracoclavicular distance is increased by 50% compared to the contralateral side. What is the most appropriate initial management?
. Coracoclavicular ligament reconstruction
. Hook plate fixation
. Weaver-Dunn procedure
. Nonoperative management with a sling
. Distal clavicle excision

Correct Answer & Explanation

. Nonoperative management with a sling

Explanation

This is a Type III acromioclavicular (AC) joint separation. Initial management for acute Type III AC separations is generally nonoperative with a short period of sling immobilization, followed by early range of motion.

Question 237

Topic: Upper Extremity Trauma

A 22-year-old rugby player falls directly onto the point of his shoulder and presents with severe pain. Radiographs demonstrate a superiorly displaced distal clavicle. The superior translation is measured at 250% of the normal coracoclavicular (CC) distance. Which of the following accurately describes the ligamentous and fascial pathology in this Type V acromioclavicular (AC) joint injury?

. Intact AC ligaments, torn CC ligaments
. Torn AC ligaments, torn CC ligaments, intact deltotrapezial fascia
. Torn AC ligaments, torn CC ligaments, disrupted deltotrapezial fascia
. Torn AC ligaments, intact CC ligaments, intact deltotrapezial fascia
. Torn CC ligaments, intact AC ligaments, disrupted deltotrapezial fascia

Correct Answer & Explanation

. Torn AC ligaments, torn CC ligaments, disrupted deltotrapezial fascia

Explanation

A Type V acromioclavicular joint injury is characterized by severe superior displacement (>100%). This requires rupture of both the AC and CC ligaments, accompanied by disruption of the stabilizing deltotrapezial fascial envelope.

Question 238

Topic: Upper Extremity Trauma

A 32-year-old bodybuilder felt a sudden tear in his anterior chest wall while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and extensive ecchymosis over the anterior arm. If surgical repair is planned, where is the most common site of failure requiring anatomic reattachment in this specific injury?

. The sternal head origin on the rib cage
. Within the muscle belly itself
. At the musculotendinous junction
. The tendinous insertion onto the proximal humerus
. The clavicular head origin

Correct Answer & Explanation

. The tendinous insertion onto the proximal humerus

Explanation

Pectoralis major ruptures almost exclusively involve the sternal head, typically tearing at the tendinous insertion onto the proximal humerus or the musculotendinous junction. Tears at the tendinous insertion are most amenable to direct surgical repair.

Question 239

Topic: Upper Extremity Trauma
A 28-year-old man falls directly onto the point of his shoulder. Radiographs demonstrate 150% superior displacement of the distal clavicle relative to the acromion. Which ligaments are completely disrupted in this injury?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Both acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligaments only
. Both acromioclavicular and coracoacromial ligaments

Correct Answer & Explanation

. Both acromioclavicular and coracoclavicular ligaments

Explanation

A Type III or higher acromioclavicular (AC) joint separation, characterized by 100% to 300% superior displacement, involves the complete disruption of both the AC ligaments and the coracoclavicular (conoid and trapezoid) ligaments.

Question 240

Topic: Upper Extremity Trauma

A 31-year-old competitive weightlifter feels a tearing sensation in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. The most common site of this specific muscle injury is:

. Muscle belly of the sternal head
. Avulsion of the tendon from the humerus
. Myotendinous junction
. Avulsion from the clavicle
. Sternocostal origin

Correct Answer & Explanation

. Avulsion of the tendon from the humerus

Explanation

Pectoralis major ruptures most commonly occur as an avulsion of the tendon from its insertion on the proximal humerus. They are classic injuries in weightlifters performing bench presses, often requiring surgical repair for optimal return to strength.

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