Menu

Upper Extremity Trauma MCQs

Practice Set 17 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 321

Topic: Upper Extremity Trauma

A 45-year-old man falls directly onto his shoulder. Clinical examination and weight-bearing radiographs reveal a Type V acromioclavicular (AC) joint separation with 150% superior displacement of the clavicle relative to the acromion. What is the most appropriate management?

. Sling immobilization for 6 weeks followed by physical therapy
. Closed reduction and figure-of-eight bracing
. Coracoclavicular (CC) ligament reconstruction
. Distal clavicle excision alone
. Acromioplasty and subacromial decompression

Correct Answer & Explanation

. Coracoclavicular (CC) ligament reconstruction

Explanation

Type V AC separations represent severe displacement (>100-300%) due to disruption of both the AC and CC ligaments, along with stripping of the deltotrapezial fascia. Surgical reconstruction of the CC ligaments is the standard of care.

Question 322

Topic: Upper Extremity Trauma
A 28-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint injury with 50% superior displacement of the clavicle relative to the acromion. How is this injury classified according to Rockwood?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

A Rockwood Type III injury involves complete disruption of both the AC and coracoclavicular (CC) ligaments, resulting in 25% to 100% superior displacement of the distal clavicle compared to the contralateral side.

Question 323

Topic: Upper Extremity Trauma
A 26-year-old cyclist sustains an injury to his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint separation where the distal clavicle is displaced superiorly by 150% relative to the acromion. The coracoclavicular distance is more than doubled compared to the contralateral side. What is the Rockwood classification of this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

Rockwood Type V AC joint injuries are characterized by 100% to 300% superior displacement of the distal clavicle with severe disruption of the coracoclavicular ligaments and the deltotrapezial fascia.

Question 324

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Clinical exam shows severe prominence of the distal clavicle. Radiographs reveal a Type V acromioclavicular (AC) joint injury with >100% superior displacement. Surgical reconstruction of the coracoclavicular (CC) ligaments is planned. What are the names and typical medial-to-lateral orientation of the native CC ligaments?
. Conoid is medial, trapezoid is lateral
. Trapezoid is medial, conoid is lateral
. Coracoacromial is medial, conoid is lateral
. Conoid is medial, coracoacromial is lateral
. Superior AC is medial, trapezoid is lateral

Correct Answer & Explanation

. Conoid is medial, trapezoid is lateral

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid (medial) and trapezoid (lateral) ligaments. The conoid primarily prevents superior translation, while the trapezoid resists axial compression of the AC joint.

Question 325

Topic: Upper Extremity Trauma
A 27-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a displaced acromioclavicular joint injury with 150% superior displacement of the clavicle relative to the acromion. What is the classification of this injury and the standard recommended treatment?
. Type III; Nonoperative management initially
. Type III; Immediate operative reconstruction
. Type IV; Nonoperative management initially
. Type V; Immediate operative reconstruction
. Type V; Nonoperative management initially

Correct Answer & Explanation

. Type V; Immediate operative reconstruction

Explanation

A Type V AC joint injury involves 100% to 300% superior displacement of the clavicle with severe disruption of the deltotrapezial fascia. Treatment for Type V injuries is generally operative reconstruction of the coracoclavicular ligaments.

Question 326

Topic: Upper Extremity Trauma
A 28-year-old cyclist falls directly onto his shoulder point. Clinical exam shows a highly prominent clavicle. Radiographs reveal 150% superior displacement of the distal clavicle relative to the acromion. Which type of acromioclavicular (AC) joint separation has occurred and what is the standard primary recommendation?
. Type II; Nonoperative management
. Type III; Operative repair
. Type III; Nonoperative management
. Type V; Operative repair
. Type V; Nonoperative management

Correct Answer & Explanation

. Type V; Operative repair

Explanation

A Type V AC joint injury involves 100-300% superior displacement of the clavicle due to disruption of the AC ligaments, coracoclavicular ligaments, and the deltotrapezial fascia. Operative reconstruction is generally recommended for Type V injuries to restore mechanics.

Question 327

Topic: Upper Extremity Trauma

A 19-year-old collegiate baseball pitcher requires ulnar collateral ligament reconstruction. The primary restraint to valgus stress at 30 to 90 degrees of elbow flexion is the anterior bundle. Where does this bundle anatomically originate?

. Posterior aspect of the medial epicondyle
. Anterior undersurface of the medial epicondyle
. Coronoid process
. Sublime tubercle
. Olecranon process

Correct Answer & Explanation

. Anterior undersurface of the medial epicondyle

Explanation

The anterior bundle of the medial ulnar collateral ligament originates from the anterior undersurface of the medial epicondyle. It inserts distally on the sublime tubercle of the coronoid process.

Question 328

Topic: Upper Extremity Trauma

During a modified Weaver-Dunn procedure for acromioclavicular joint separation, the coracoacromial (CA) ligament is transferred to the distal clavicle. Which anatomic structure attaches to the medial border of the coracoid process?

. Conjoined tendon
. Coracoacromial ligament
. Pectoralis minor tendon
. Trapezoid ligament
. Conoid ligament

Correct Answer & Explanation

. Pectoralis minor tendon

Explanation

The pectoralis minor inserts on the medial border and superior surface of the coracoid process. The conjoined tendon inserts at the tip, while the coracoclavicular ligaments attach to the base.

Question 329

Topic: Upper Extremity Trauma

The coracoclavicular (CC) ligaments provide the primary vertical stability to the acromioclavicular joint. Which of the following describes the anatomical position of the conoid ligament relative to the trapezoid ligament?

. Posteromedial
. Anterolateral
. Directly superior
. Directly anterior
. Posterolateral

Correct Answer & Explanation

. Posteromedial

Explanation

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

Question 330

Topic: Upper Extremity Trauma

During reconstruction of an acromioclavicular joint separation, anatomic reduction of the coracoclavicular ligaments is desired. Which of the following statements accurately describes the anatomy of the conoid and trapezoid ligaments?

. The conoid is lateral and inserts on the inferior clavicle
. The trapezoid is medial and inserts on the superior clavicle
. The conoid is medial and inserts on the conoid tubercle of the posterior clavicle
. The trapezoid is medial and inserts on the anterior clavicle
. Both ligaments originate from the acromion

Correct Answer & Explanation

. The conoid is medial and inserts on the conoid tubercle of the posterior clavicle

Explanation

The conoid ligament is the more medial of the two coracoclavicular ligaments and inserts onto the conoid tubercle on the posterior aspect of the clavicle. The trapezoid is located more laterally and inserts anterolaterally on the trapezoid line.

Question 331

Topic: Upper Extremity Trauma

An overhead throwing athlete sustains a tear of the ulnar collateral ligament (UCL) of the elbow. The anterior bundle of the UCL is the primary restraint to valgus stress. Where does the anterior bundle insert on the ulna?

. Tip of the olecranon
. Base of the coronoid process
. Sublime tubercle
. Radial notch
. Supinator crest

Correct Answer & Explanation

. Sublime tubercle

Explanation

The anterior bundle of the ulnar collateral ligament originates on the anterior undersurface of the medial epicondyle and inserts on the sublime tubercle at the medial margin of the coronoid process.

Question 332

Topic: Upper Extremity Trauma

A 30-year-old cyclist sustains a Type V acromioclavicular (AC) joint injury. During open reduction and reconstruction, the surgeon focuses on restoring the primary restraint to superior clavicular translation.

Which ligament acts as this primary restraint?

. Superior AC ligament
. Inferior AC ligament
. Coracoacromial ligament
. Conoid ligament
. Trapezoid ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The conoid ligament, which is the more medial of the two coracoclavicular (CC) ligaments, is the primary restraint to superior translation of the clavicle. The trapezoid ligament provides primary resistance to axial compression.

Question 333

Topic: Upper Extremity Trauma

A 20-year-old collegiate baseball pitcher presents with medial elbow pain and decreased pitching velocity. The moving valgus stress test is positive. MRI confirms a full-thickness tear of the anterior bundle of the ulnar collateral ligament (UCL). During reconstruction, where must the graft be secured on the ulna to recreate the native anterior bundle insertion?

. Olecranon tip
. Base of the coronoid process (sublime tubercle)
. Radial notch of the ulna
. Supinator crest
. Medial epicondyle

Correct Answer & Explanation

. Base of the coronoid process (sublime tubercle)

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow. It originates on the anteroinferior surface of the medial epicondyle and inserts on the sublime tubercle at the base of the coronoid process.

Question 334

Topic: Upper Extremity Trauma

During anatomical reconstruction of the coracoclavicular (CC) ligaments for a high-grade acromioclavicular joint separation, proper graft placement requires knowledge of the native footprint. The conoid ligament footprint on the clavicle is located:

. Posteromedial to the trapezoid ligament
. Anterolateral to the trapezoid ligament
. Directly anterior to the trapezoid ligament
. Directly lateral to the trapezoid ligament
. At the distal end of the acromion

Correct Answer & Explanation

. Posteromedial to the trapezoid ligament

Explanation

The conoid ligament attaches to the conoid tubercle of the clavicle, which is located posteromedial to the attachment of the trapezoid ligament. The conoid is the primary restraint to superior clavicular translation.

Question 335

Topic: Upper Extremity Trauma
A 29-year-old male cyclist falls on his shoulder. Radiographs show superior displacement of the clavicle with a coracoclavicular (CC) distance increased by 120% compared to the contralateral side. What Rockwood classification does this represent and what is the typical management?
. Type II, non-operative
. Type III, always operative
. Type V, operative reconstruction
. Type VI, closed reduction
. Type IV, non-operative

Correct Answer & Explanation

. Type V, operative reconstruction

Explanation

A CC distance increased by 100-300% denotes a Rockwood Type V acromioclavicular joint injury. Because this severe disruption includes the deltotrapezial fascia, surgical reconstruction of the CC ligaments is typically indicated.

Question 336

Topic: Upper Extremity Trauma
A 28-year-old construction worker falls directly onto his shoulder and sustains a Type III acromioclavicular (AC) joint separation. Which ligament acts as the primary restraint to superior translation of the distal clavicle?
. Superior acromioclavicular ligament
. Conoid ligament
. Trapezoid ligament
. Coracoacromial ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments provide vertical stability to the AC joint. The conoid ligament is the primary restraint to superior translation, while the trapezoid ligament is the primary restraint to posterior translation of the distal clavicle.

Question 337

Topic: Upper Extremity Trauma
A 24-year-old cyclist falls directly onto his shoulder. Radiographs show 100% superior displacement of the clavicle relative to the acromion, with a coracoclavicular distance increased by 50% compared to the contralateral side. The deltotrapezial fascia remains intact. This represents which Rockwood classification type?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type III

Explanation

A Rockwood Type III AC joint separation involves rupture of both the AC and coracoclavicular (CC) ligaments, leading to 25% to 100% superior displacement of the clavicle. The deltotrapezial fascia is intact, distinguishing it from a Type V injury (which has >100% displacement and stripped fascia).

Question 338

Topic: Upper Extremity Trauma
A 30-year-old mountain biker falls directly onto his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion, and the coracoclavicular distance is doubled compared to the contralateral side. What type of acromioclavicular (AC) joint injury is this, and what is the standard management?
. Type II, non-operative management
. Type III, routine operative management
. Type IV, non-operative management
. Type V, operative management
. Type VI, non-operative management

Correct Answer & Explanation

. Type V, operative management

Explanation

A Type V AC joint injury is defined by superior displacement of the distal clavicle between 100% and 300%. These injuries severely disrupt the deltotrapezial fascia and typically require surgical reconstruction.

Question 339

Topic: Upper Extremity Trauma
A 28-year-old cyclist fell onto his shoulder point. Radiographs reveal a Type III acromioclavicular (AC) joint injury (100% superior translation of the clavicle). What is the consensus regarding initial management?
. Immediate hook plate fixation
. Nonoperative management with a sling and early range of motion
. Coracoclavicular ligament reconstruction using a semitendinosus autograft
. Arthroscopic tight-rope fixation
. Distal clavicle excision

Correct Answer & Explanation

. Nonoperative management with a sling and early range of motion

Explanation

The initial management for uncomplicated Type III AC joint injuries is nonoperative, focusing on brief sling immobilization and early range of motion. Surgery is generally reserved for patients who remain symptomatic after conservative care.

Question 340

Topic: Upper Extremity Trauma
A 30-year-old cyclist falls directly onto his shoulder. Radiographs show 150% superior displacement of the distal clavicle relative to the acromion. Which ligaments are disrupted?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament only
. Sternoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

Displacement greater than 100% indicates a high-grade acromioclavicular joint injury (Type III or V). This requires complete disruption of both the acromioclavicular (AC) and coracoclavicular (CC) ligament complexes.

Test Yourself

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

On this Page