Menu

Upper Extremity Trauma MCQs

Practice Set 13 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 241

Topic: Upper Extremity Trauma

The anterior bundle of the ulnar collateral ligament (UCL) of the elbow is the primary restraint to valgus stress. Where is its primary anatomical insertion on the ulna?

. Tip of the olecranon
. Sublime tubercle
. Supinator crest
. Coronoid tip
. Radial notch

Correct Answer & Explanation

. Tip of the olecranon

Explanation

The anterior bundle of the UCL originates on the anteroinferior surface of the medial epicondyle. It inserts on the sublime tubercle of the proximal ulna.

Question 242

Topic: Upper Extremity Trauma

A 30-year-old competitive weightlifter feels a "pop" in his chest while performing a heavy bench press. He presents with bruising over the anterior axillary fold and a loss of the normal axillary contour. Regarding the anatomy and pathology of this injury, which of the following statements is true?

. The clavicular head is most commonly ruptured.
. The sternal head typically tears from its humeral insertion.
. Nonoperative management is the standard of care for young athletes.
. The tendon is typically repaired to the coracoid process.
. Tears most commonly occur during the concentric phase of the lift.

Correct Answer & Explanation

. The clavicular head is most commonly ruptured.

Explanation

Pectoralis major ruptures classicly occur during the eccentric (lowering) phase of a bench press. The sternal head is most commonly involved, typically avulsing from its insertion on the proximal humerus.

Question 243

Topic: Upper Extremity Trauma
A 28-year-old avid cyclist falls directly on the point of his shoulder. Radiographs demonstrate a Type III acromioclavicular (AC) joint separation (100% to 200% superior displacement of the clavicle). According to current evidence-based guidelines, what is the most appropriate initial management?
. Coracoclavicular (CC) ligament reconstruction using an allograft
. Hook plate fixation
. Nonoperative management with a brief period in a sling followed by early range of motion
. Modified Weaver-Dunn procedure
. Primary acromioclavicular joint arthrodesis

Correct Answer & Explanation

. Nonoperative management with a brief period in a sling followed by early range of motion

Explanation

Acute Type III AC joint separations are generally managed nonoperatively with a sling and early rehabilitation. Multiple studies have shown similar functional outcomes between operative and nonoperative treatment, but higher complication rates and delayed return to work with surgery.

Question 244

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs show 150% superior displacement of the clavicle relative to the acromion (Type III acromioclavicular joint separation). What is the general consensus regarding initial management in this athletic population?
. Acute surgical reconstruction is mandatory
. Nonoperative management with a sling and early rehabilitation
. Primary excision of the distal clavicle
. Acromioclavicular joint pinning
. Coracoclavicular ligament repair without graft augmentation

Correct Answer & Explanation

. Nonoperative management with a sling and early rehabilitation

Explanation

Uncomplicated Type III AC joint separations are generally treated nonoperatively with a sling and early physical therapy. Surgical intervention is typically reserved for patients who fail conservative management, those with severe superior displacement (Type V), or those with specific high-demand overhead requirements.

Question 245

Topic: Upper Extremity Trauma
A 21-year-old collegiate hockey player sustains a direct blow to the superior aspect of the shoulder. Radiographs demonstrate a Type III acromioclavicular (AC) joint separation (100% to 200% displacement). What is the most appropriate initial management for this in-season athlete?
. Open reduction internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Sling immobilization for comfort and early physical therapy
. Weaver-Dunn procedure
. Distal clavicle excision

Correct Answer & Explanation

. Sling immobilization for comfort and early physical therapy

Explanation

Initial management for an acute Type III AC joint separation in most athletes is nonoperative, focusing on brief sling immobilization for comfort followed by early range of motion. Surgery is generally reserved for chronic symptomatic cases or severe higher-grade (IV-VI) injuries.

Question 246

Topic: Upper Extremity Trauma

A 28-year-old hockey player takes a severe hit into the boards, landing directly on his lateral shoulder. Examination reveals a prominent distal clavicle. Radiographs show a Type III acromioclavicular (AC) joint separation. What is the standard initial treatment?

. Surgical reconstruction of the coracoclavicular ligaments
. Hook plate fixation of the AC joint
. Nonoperative management with a sling for comfort
. Distal clavicle excision

Correct Answer & Explanation

. Surgical reconstruction of the coracoclavicular ligaments

Explanation

Type III AC joint separations (complete rupture of AC and CC ligaments) are generally treated nonoperatively with a brief period of sling immobilization, early range of motion, and physical therapy. Surgery is reserved for patients who fail conservative management or specific high-level overhead laborers.

Question 247

Topic: Upper Extremity Trauma

A 25-year-old hockey player sustains a direct blow to the point of his shoulder. Radiographs reveal an acromioclavicular (AC) joint separation with the distal clavicle displaced posteriorly into the trapezius fascia. What is the Rockwood classification type of this injury?

. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type II

Explanation

In the Rockwood classification of AC joint injuries, a Type IV injury is characterized by posterior displacement of the distal clavicle into or through the trapezius muscle/fascia. This injury generally requires surgical stabilization.

Question 248

Topic: Upper Extremity Trauma

A 30-year-old weightlifter feels a 'tear' in his anterior chest while performing a heavy bench press. Examination reveals an asymmetric chest wall and a palpable defect in the anterior axillary fold. The vast majority of these pectoralis major injuries occur at which anatomic location?

. Muscle belly
. Musculotendinous junction
. Tendon insertion on the humerus
. Clavicular head origin
. Sternal head origin

Correct Answer & Explanation

. Muscle belly

Explanation

Pectoralis major ruptures most commonly occur in weightlifters performing bench presses. The most frequent site of rupture is an avulsion of the tendon directly from its insertion on the proximal humerus lateral to the bicipital groove.

Question 249

Topic: Upper Extremity Trauma
A 30-year-old recreational cyclist falls directly onto his right shoulder. Clinical examination and radiographs demonstrate 100% superior displacement of the clavicle relative to the acromion, with an increased coracoclavicular distance compared to the normal side. The deltotrapezial fascia appears clinically intact based on the reducible nature of the joint. What is the most widely recommended initial treatment for this Grade III acromioclavicular (AC) joint separation?
. Immediate open reduction and internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Brief period of sling immobilization followed by early active range of motion
. Figure-of-eight bracing for 6 weeks
. Distal clavicle excision (Mumford procedure)

Correct Answer & Explanation

. Brief period of sling immobilization followed by early active range of motion

Explanation

For standard, non-laboring or non-overhead athletic patients, acute Grade III AC joint separations are best managed non-operatively. Initial treatment consists of a brief period in a sling for comfort followed by early range of motion and physical therapy.

Question 250

Topic: Upper Extremity Trauma
A 7-year-old boy sustains a forearm injury. Radiographs show a plastic deformation of the ulna and an anterior dislocation of the radial head. According to the Bado classification, what type of Monteggia lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Galeazzi equivalent

Correct Answer & Explanation

. Type I

Explanation

A Bado Type I Monteggia fracture involves an anterior dislocation of the radial head with a fracture (or plastic deformation in children) of the ulnar diaphysis. It is the most common type of Monteggia lesion in the pediatric population.

Question 251

Topic: Upper Extremity Trauma

Historically, the anterior humeral circumflex artery was believed to be the primary blood supply to the humeral head. Recent anatomic studies have demonstrated that the primary arterial supply to the proximal humerus actually arises from which of the following vessels?

. Thoracoacromial artery
. Posterior humeral circumflex artery
. Suprascapular artery
. Circumflex scapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Thoracoacromial artery

Explanation

Recent quantitative perfusion studies have overturned historical teaching, proving that the posterior humeral circumflex artery provides the vast majority (up to 64%) of the blood supply to the humeral head.

Question 252

Topic: Upper Extremity Trauma

A 21-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction. The primary medial restraint to valgus stress of the elbow, which is targeted for reconstruction, has its distal insertion on which of the following anatomic structures?

. The radial neck
. The sublime tubercle of the ulna
. The olecranon tip
. The lesser sigmoid notch
. The anular ligament

Correct Answer & Explanation

. The radial neck

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow from 30 to 120 degrees of flexion. It originates on the anteroinferior medial epicondyle and inserts on the sublime tubercle of the coronoid process of the ulna.

Question 253

Topic: Upper Extremity Trauma

A patient with an Essex-Lopresti injury has longitudinal radioulnar dissociation. Which component of the interosseous membrane (IOM) of the forearm provides the greatest longitudinal stability and must be considered during reconstruction?

. Proximal oblique cord
. Distal oblique bundle
. Central band
. Dorsal oblique accessory cord
. Transverse radioulnar band

Correct Answer & Explanation

. Proximal oblique cord

Explanation

The central band of the interosseous membrane is the thickest and most crucial component for longitudinal stability of the forearm. It originates proximally on the radius and courses distally and ulnarly to insert on the ulna.

Question 254

Topic: Upper Extremity Trauma

A 35-year-old laborer falls directly on the lateral aspect of his shoulder and is diagnosed with a grade III acromioclavicular (AC) joint separation. Which ligaments are completely disrupted in this injury?

. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Both acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament
. Sternoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular ligaments only

Explanation

A Rockwood grade III AC joint separation involves complete disruption of both the acromioclavicular (AC) and coracoclavicular (CC) ligaments. This results in superior displacement of the clavicle by 25-100%.

Question 255

Topic: Upper Extremity Trauma

A 29-year-old cyclist falls directly onto his shoulder point. Radiographs confirm a 150% superior displacement of the distal clavicle relative to the acromion, and the coracoclavicular distance is increased by 150% compared to the contralateral side. This represents which type of acromioclavicular (AC) joint injury according to the Rockwood classification?

. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type II

Explanation

A Rockwood Type V AC joint injury is characterized by >100% to 300% superior displacement of the clavicle relative to the acromion. This involves severe disruption of the AC ligaments, coracoclavicular (CC) ligaments, and the deltotrapezial fascia.

Question 256

Topic: Upper Extremity Trauma

A 32-year-old manual laborer falls directly onto the tip of his shoulder. Radiographs demonstrate a 100% superior displacement of the distal clavicle relative to the acromion, with the coracoclavicular distance increased by 50% compared to the uninjured side. The most appropriate initial management is:

. Nonoperative management with a sling and early ROM
. Clavicle hook plate fixation
. Coracoclavicular ligament reconstruction
. Weaver-Dunn procedure
. Primary acromioclavicular joint repair

Correct Answer & Explanation

. Nonoperative management with a sling and early ROM

Explanation

The patient has a Type III acromioclavicular (AC) joint separation. Despite being a manual laborer, literature supports an initial trial of nonoperative management with a sling and physical therapy, as most patients achieve satisfactory functional outcomes without surgery.

Question 257

Topic: Upper Extremity Trauma

A 25-year-old cyclist sustains a direct blow to the point of his shoulder. Radiographs demonstrate a Type V acromioclavicular (AC) joint injury. Which of the following correctly describes the fascial disruption distinguishing a Type V from a Type III AC joint injury?

. Disruption of the acromioclavicular ligaments only
. Disruption of the coracoclavicular ligaments only
. Disruption of the deltotrapezial fascia
. Disruption of the coracoacromial ligament
. Avulsion of the conjoined tendon

Correct Answer & Explanation

. Disruption of the acromioclavicular ligaments only

Explanation

A Type V AC joint injury involves disruption of the AC ligaments, CC ligaments, and the deltotrapezial fascia, resulting in >100% superior displacement of the clavicle. Type III injuries have intact deltotrapezial fascia.

Question 258

Topic: Upper Extremity Trauma

A 26-year-old cyclist falls directly onto his right shoulder. Radiographs show superior displacement of the clavicle relative to the acromion, with an 80% increase in the coracoclavicular distance compared to the uninjured side. The deltotrapezial fascia remains structurally intact. This represents which Rockwood classification of acromioclavicular (AC) joint separation?

. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type II

Explanation

Rockwood Type III injuries involve complete disruption of both the AC and CC ligaments, with 25-100% superior displacement of the clavicle. The deltotrapezial fascia remains intact, unlike in Type V injuries where it is stripped and displacement is >100%.

Question 259

Topic: Upper Extremity Trauma

A 42-year-old heavy laborer sustains an acromioclavicular (AC) joint injury. Radiographs reveal a 150% superior displacement of the clavicle relative to the acromion with significant posterior displacement into the trapezius fascia. Based on the Rockwood classification, what is the injury type and optimal management?

. Type III; non-operative management with a sling
. Type III; acute surgical reconstruction
. Type IV; acute surgical reconstruction
. Type V; acute surgical reconstruction
. Type VI; non-operative management

Correct Answer & Explanation

. Type III; non-operative management with a sling

Explanation

A Rockwood Type IV AC joint separation is characterized by posterior displacement of the distal clavicle into or through the trapezius fascia. Unlike many Type III injuries, Type IV injuries typically require surgical reconstruction due to significant functional impairment and pain.

Question 260

Topic: Upper Extremity Trauma

A 28-year-old male falls directly onto the point of his shoulder while cycling. Radiographs demonstrate a Type III acromioclavicular (AC) joint separation. Based on the Rockwood classification, what is the status of the supporting ligaments?

. AC ligaments sprained, CC ligaments intact
. AC ligaments torn, CC ligaments sprained
. AC ligaments torn, CC ligaments torn
. AC ligaments intact, CC ligaments torn
. Only the conoid ligament is torn

Correct Answer & Explanation

. AC ligaments sprained, CC ligaments intact

Explanation

A Rockwood Type III AC joint injury involves complete rupture of both the acromioclavicular (AC) and coracoclavicular (CC) ligaments, resulting in 25% to 100% superior translation of the distal clavicle.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page