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Upper Extremity Trauma MCQs

Practice Set 20 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 381

Topic: Upper Extremity Trauma
A 26-year-old cyclist falls directly onto his shoulder. Radiographs reveal a Type V acromioclavicular (AC) joint injury. Which of the following strict criteria distinguishes a Type V injury from a Type III injury?
. Complete rupture of the AC ligaments with intact CC ligaments
. Posterior displacement of the clavicle into the trapezius
. Inferior displacement of the clavicle under the coracoid process
. Greater than 100% superior displacement of the clavicle with detachment of the deltotrapezial fascia
. 25-100% superior displacement of the clavicle with an intact deltotrapezial fascia

Correct Answer & Explanation

. Greater than 100% superior displacement of the clavicle with detachment of the deltotrapezial fascia

Explanation

A Type V AC joint injury is characterized by severe superior displacement (>100% to 300% compared to the contralateral side). This massive displacement occurs because the deltotrapezial fascia is extensively stripped from the distal clavicle.

Question 382

Topic: Upper Extremity Trauma

In the surgical treatment of a high-grade acromioclavicular (AC) joint separation, reconstruction of the coracoclavicular (CC) ligaments is planned. What is the normal anatomic orientation of the native conoid and trapezoid ligaments?

. Conoid is lateral and anterior; trapezoid is medial and posterior
. Conoid is medial and anterior; trapezoid is lateral and posterior
. Conoid is medial and posterior; trapezoid is lateral and anterior
. Conoid is lateral and posterior; trapezoid is medial and anterior
. Both ligaments insert at the exact same location on the distal clavicle

Correct Answer & Explanation

. Conoid is lateral and anterior; trapezoid is medial and posterior

Explanation

The coracoclavicular ligament complex consists of the conoid and trapezoid. The conoid is situated medial and posterior, while the trapezoid is lateral and anterior. Anatomic reconstruction aims to replicate these specific footprint locations.

Question 383

Topic: Upper Extremity Trauma

When reconstructing the coracoclavicular (CC) ligaments for a chronic acromioclavicular (AC) joint dislocation, anatomic graft placement is crucial. Which of the following accurately describes the anatomic insertions of the native CC ligaments on the undersurface of the clavicle?

. The conoid ligament inserts anterolaterally, while the trapezoid ligament inserts posteromedially.
. The conoid ligament inserts posteromedially, while the trapezoid ligament inserts anterolaterally.
. Both ligaments insert on the identical footprint centrally.
. The conoid is strictly medial and the trapezoid is strictly posterior.
. The conoid inserts at the AC joint capsule while the trapezoid inserts on the coracoid base.

Correct Answer & Explanation

. The conoid ligament inserts anterolaterally, while the trapezoid ligament inserts posteromedially.

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid and trapezoid ligaments. The conoid ligament inserts posteromedially on the conoid tubercle of the clavicle, whereas the trapezoid ligament inserts anterolaterally on the trapezoid line.

Question 384

Topic: Upper Extremity Trauma

The coracoclavicular (CC) ligaments are key stabilizers of the acromioclavicular joint. Which of the following best describes their anatomic orientation and primary biomechanical functions?

. Trapezoid is medial and primarily resists superior translation
. Trapezoid is lateral and primarily resists horizontal compression; Conoid is medial and primarily resists superior translation
. Conoid is lateral and primarily resists superior translation
. Conoid is medial and primarily resists horizontal translation
. Both insert on the acromion and equally resist superior translation

Correct Answer & Explanation

. Trapezoid is medial and primarily resists superior translation

Explanation

The conoid ligament is posteromedial and is the primary restraint to superior translation of the clavicle. The trapezoid ligament is anterolateral and primarily resists horizontal (axial) compression towards the acromion.

Question 385

Topic: Upper Extremity Trauma

In Acromioclavicular (AC) joint reconstructions, reconstructing the coracoclavicular (CC) ligaments anatomically is vital. Which of the following accurately describes the anatomical orientation and footprint of the CC ligaments on the clavicle?

. The conoid is anterolateral and the trapezoid is posteromedial
. The conoid is posteromedial and the trapezoid is anterolateral
. Both ligaments attach directly to the anterior edge of the clavicle
. The trapezoid attaches to the superior surface while the conoid attaches inferiorly
. The conoid is purely lateral to the trapezoid ligament

Correct Answer & Explanation

. The conoid is anterolateral and the trapezoid is posteromedial

Explanation

The coracoclavicular ligaments consist of the conoid and trapezoid. The conoid ligament inserts posteromedially on the conoid tubercle, while the trapezoid ligament inserts anterolaterally on the trapezoid line.

Question 386

Topic: Upper Extremity Trauma

In the surgical management of a Type V acromioclavicular (AC) joint dislocation, reconstructing the coracoclavicular (CC) ligaments is prioritized.

What is the precise anatomic orientation and insertion of the native conoid and trapezoid ligaments on the clavicle?

. Conoid is posteromedial; Trapezoid is anterolateral
. Conoid is anterolateral; Trapezoid is posteromedial
. Conoid is strictly anterior; Trapezoid is strictly posterior
. Conoid is strictly lateral; Trapezoid is strictly medial
. Both ligaments originate from the acromion and insert medially on the clavicle

Correct Answer & Explanation

. Conoid is posteromedial; Trapezoid is anterolateral

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid ligament inserts on the conoid tubercle of the clavicle, which is located posteromedial to the trapezoid insertion. The trapezoid ligament inserts more anterolaterally. The conoid is the primary restraint to superior translation.

Question 387

Topic: Upper Extremity Trauma
A 40-year-old male falls directly onto his shoulder point. Radiographs show an acromioclavicular (AC) joint separation with 150% superior displacement of the clavicle relative to the acromion. There is no disruption of the deltotrapezial fascia. Based on the Rockwood classification, what type of injury is this, and what is the generally recommended treatment for this specific grade?
. Type III; non-operative management initially
. Type V; operative surgical reconstruction
. Type IV; non-operative management
. Type III; immediate operative surgical reconstruction
. Type II; brief sling followed by early ROM

Correct Answer & Explanation

. Type V; operative surgical reconstruction

Explanation

A Rockwood Type V AC joint injury involves disruption of the AC and coracoclavicular (CC) ligaments, with superior displacement of the clavicle >100% to 300% of the normal contralateral side. The deltotrapezial fascia is severely stripped. Unlike Type III injuries, which are controversially managed but often treated non-operatively, Type V injuries generally require operative reconstruction to restore shoulder biomechanics and relieve skin tension.

Question 388

Topic: Upper Extremity Trauma

During an anatomic reconstruction of the coracoclavicular (CC) ligaments for a high-grade acromioclavicular (AC) joint separation, the surgeon must drill clavicular and coracoid tunnels to recreate the conoid and trapezoid ligaments. Which of the following statements accurately describes their native anatomical relationship?

. The conoid is medial and posterior to the trapezoid
. The conoid is lateral and anterior to the trapezoid
. Both ligaments originate from the acromion
. The trapezoid is the primary restraint to superior displacement, while the conoid resists horizontal compression
. The conoid attaches to the lateral-most edge of the clavicle

Correct Answer & Explanation

. The conoid is medial and posterior to the trapezoid

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. Anatomically, the conoid is located medial and posterior to the trapezoid. The conoid is shaped like a cone and is the primary restraint to superior translation of the clavicle. The trapezoid is anterolateral and primarily resists axial compression of the clavicle.

Question 389

Topic: Upper Extremity Trauma

A 21-year-old collegiate baseball pitcher reports medial elbow pain during the late cocking and early acceleration phases of throwing. MRI confirms a full-thickness tear of the anterior bundle of the ulnar collateral ligament (UCL). To correctly reconstruct this ligament, where must the ulnar tunnel be primarily centered?

. Olecranon tip
. Sublime tubercle
. Coronoid base
. Lateral epicondyle
. Radial tuberosity

Correct Answer & Explanation

. Olecranon tip

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow, and it inserts distally on the sublime tubercle of the proximal ulna.

Question 390

Topic: Upper Extremity Trauma
A 25-year-old rugby player sustains a Type V acromioclavicular (AC) joint separation, characterized by >100% superior displacement of the clavicle into the trapezius fascia. What is the most widely accepted surgical approach for this severe injury?
. Isolated repair of the acromioclavicular capsule
. Distal clavicle excision alone
. Surgical reconstruction of the coracoclavicular (CC) ligaments
. Closed reduction and percutaneous pinning of the AC joint
. Observation and physical therapy

Correct Answer & Explanation

. Surgical reconstruction of the coracoclavicular (CC) ligaments

Explanation

Type IV, V, and VI AC separations are indications for operative management due to severe displacement and soft tissue disruption. This requires robust reconstruction of the coracoclavicular (CC) ligaments.

Question 391

Topic: Upper Extremity Trauma

A 15-year-old boy presents with shoulder pain. Radiographs reveal a well-circumscribed, lytic lesion in the epiphysis of the proximal humerus with a thin sclerotic margin. Histological examination shows mononuclear cells with grooved nuclei and areas of 'chicken-wire' calcification. Which specific genetic mutation drives this neoplasm?

. H3F3A (G34W)
. H3F3B (K36M)
. IDH1 (R132C)
. GNAS (R201H)
. BRAF (V600E)

Correct Answer & Explanation

. H3F3A (G34W)

Explanation

The clinical presentation and histology (chicken-wire calcification) are diagnostic of a chondroblastoma. Chondroblastomas are uniquely driven by a specific K36M mutation in the H3F3B histone gene.

Question 392

Topic: Upper Extremity Trauma
A 35-year-old male falls directly onto the point of his shoulder. Radiographs show a 150% superior displacement of the distal clavicle relative to the acromion, and the coracoclavicular distance is increased by 50% compared to the normal side. According to the Rockwood classification, what type of injury is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

In Rockwood Type V AC joint injuries, the distal clavicle is displaced superiorly by 100% to 300% relative to the acromion, often stripping or piercing the deltotrapezial fascia. Type III is up to 100% superior displacement. Type IV is posterior displacement into or through the trapezius.

Question 393

Topic: Upper Extremity Trauma

During an anatomic coracoclavicular (CC) ligament reconstruction for a chronic type V acromioclavicular joint dislocation, the surgeon plans to drill the clavicle to recreate the conoid and trapezoid ligaments. Which of the following accurately describes the anatomic relationship of these ligaments?

. The conoid is anterolateral to the trapezoid
. The conoid is posteromedial to the trapezoid
. The conoid inserts 25 mm from the distal clavicle
. The trapezoid is a cord-like structure while the conoid is flat and broad
. Both ligaments originate from the medial aspect of the coracoid process

Correct Answer & Explanation

. The conoid is anterolateral to the trapezoid

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid ligaments. The conoid is the posteromedial structure, inserting roughly 45 mm from the distal clavicle. The trapezoid is anterolateral to the conoid and inserts roughly 25 mm from the distal end of the clavicle. Knowledge of this anatomy is crucial for anatomic tunnel placement during reconstruction.

Question 394

Topic: Upper Extremity Trauma
A 22-year-old football player sustains a direct blow to the point of his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint injury. The clavicle is displaced posteriorly into or through the trapezius fascia, with normal coracoclavicular distance on the AP view but obvious posterior displacement on the axillary lateral view. Which Rockwood classification type is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type IV

Explanation

In the Rockwood classification of AC joint injuries, Type IV is characterized by posterior displacement of the distal clavicle into or through the trapezius muscle/fascia. This may not be obvious on a standard AP radiograph, making the axillary lateral view crucial. Type V is severe superior displacement (>100%), and Type VI is inferior displacement (subcoracoid).

Question 395

Topic: Upper Extremity Trauma

Recent anatomic studies have challenged historical teachings regarding the vascularity of the proximal humerus. Based on current evidence, which of the following arteries provides the predominant blood supply to the humeral head?

. Ascending branch of the anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Thoracoacromial artery
. Deep brachial artery
. Suprascapular artery

Correct Answer & Explanation

. Ascending branch of the anterior humeral circumflex artery

Explanation

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

Question 396

Topic: Upper Extremity Trauma
A patient sustains a Type III acromioclavicular (AC) joint separation. The coracoclavicular (CC) ligaments are ruptured. Which CC ligament originates from the base of the coracoid and inserts onto the conoid tubercle of the clavicle?
. Trapezoid ligament
. Conoid ligament
. Coracoacromial ligament
. Superior AC ligament
. Acromioclavicular ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid and trapezoid ligaments. The conoid ligament is the more medial and posterior of the two, originating at the base of the coracoid and inserting on the conoid tubercle. The trapezoid ligament is more lateral and anterior.

Question 397

Topic: Upper Extremity Trauma
In the setting of a Type III acromioclavicular (AC) joint separation, both the AC ligaments and coracoclavicular (CC) ligaments are torn. Which of the following structures acts as the primary restraint to superior translation of the distal clavicle?
. Conoid ligament
. Trapezoid ligament
. Acromioclavicular capsular ligaments
. Coracoacromial ligament
. Superior transverse scapular ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid and trapezoid ligaments. Biomechanical studies have demonstrated that the conoid ligament (which is located posteromedially) is the primary restraint to superior translation of the distal clavicle. The trapezoid ligament (located anterolaterally) serves primarily to resist axial compression of the AC joint. The AC capsular ligaments primarily resist anterior-posterior translation.

Question 398

Topic: Upper Extremity Trauma

A 28-year-old professional pitcher presents with medial elbow pain during the late cocking phase of throwing. MRI confirms a full-thickness tear of the anterior bundle of the ulnar collateral ligament (UCL). Where is the typical anatomic insertion of this crucial stabilizing bundle on the ulna?

. Sublime tubercle
. Olecranon tip
. Coronoid tip
. Supinator crest
. Radial notch

Correct Answer & Explanation

. Sublime tubercle

Explanation

The anterior bundle of the medial UCL inserts on the sublime tubercle, located at the anteromedial margin of the coronoid process. This bundle is the primary restraint to valgus stress at the elbow during the throwing motion.

Question 399

Topic: Upper Extremity Trauma
A 32-year-old cyclist falls onto the point of his shoulder. Radiographs reveal a 150% superior displacement of the clavicle relative to the acromion, and the coracoclavicular interval measures 28 mm. According to the Rockwood classification, what is the injury type and optimal management?
. Type III, non-operative management
. Type III, operative management
. Type V, non-operative management
. Type V, operative management
. Type IV, non-operative management

Correct Answer & Explanation

. Type V, operative management

Explanation

Displacement of the clavicle between 100% and 300% characterizes a Rockwood Type V injury. This high-grade acromioclavicular joint separation typically requires operative management to restore anatomy and biomechanics.

Question 400

Topic: Upper Extremity Trauma
A 28-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion with no posterior displacement on the axillary view. Which ligaments/structures are disrupted in this injury?
. Acromioclavicular (AC) ligaments only.
. Coracoclavicular (CC) ligaments only.
. Both AC and CC ligaments, with intact deltotrapezial fascia.
. Both AC and CC ligaments, with disruption of the deltotrapezial fascia.
. Coracoacromial (CA) ligament and AC ligaments.

Correct Answer & Explanation

. Both AC and CC ligaments, with disruption of the deltotrapezial fascia.

Explanation

A Type V AC joint injury involves >100% (often up to 300%) superior displacement of the clavicle. This degree of displacement requires disruption of the AC ligaments, CC ligaments, and the stabilizing deltotrapezial fascia. Type III involves up to 100% displacement, where AC and CC are torn, but the deltotrapezial fascia is largely intact.

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