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Upper Extremity Trauma MCQs

Practice Set 21 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 401

Topic: Upper Extremity Trauma

During an open coracoclavicular (CC) ligament reconstruction for a type V acromioclavicular joint separation, the surgeon must be aware of the anatomic orientations of the CC ligaments. Which of the following statements is true regarding the conoid and trapezoid ligaments?

. The trapezoid is medial to the conoid
. The conoid originates posterior to the pectoralis minor insertion and attaches to the conoid tubercle on the posterior-inferior clavicle
. The trapezoid primarily resists superior displacement of the clavicle
. The conoid primarily resists anterior-posterior displacement
. Both ligaments attach onto the superior surface of the coracoid process

Correct Answer & Explanation

. The trapezoid is medial to the conoid

Explanation

The conoid ligament is medial to the trapezoid ligament. It originates on the base of the coracoid (posterior to pec minor) and inserts on the conoid tubercle (posterior-inferior clavicle). The conoid primarily resists superior/inferior translation, while the trapezoid primarily resists horizontal (AP) compression/translation.

Question 402

Topic: Upper Extremity Trauma

In the surgical treatment of high-grade acromioclavicular (AC) joint separations, reconstruction often targets the coracoclavicular (CC) ligaments. Which of the following accurately describes the anatomy of the native CC ligaments?

. The conoid ligament is medial and posterior to the trapezoid ligament.
. The conoid ligament is lateral and anterior to the trapezoid ligament.
. The trapezoid ligament inserts onto the conoid tubercle of the clavicle.
. The trapezoid ligament provides primary restraint to superior translation of the clavicle.
. The conoid ligament provides primary restraint to axial compression of the AC joint.

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 ligament is located posteromedially and is the primary restraint to superior translation. The trapezoid is located anterolaterally and provides primary restraint against axial compression.

Question 403

Topic: Upper Extremity Trauma

During an anatomic coracoclavicular (CC) ligament reconstruction for a chronic Type V acromioclavicular joint separation, bone tunnels are drilled in the clavicle to recreate the native anatomy. What is the approximate anatomical distance from the distal end of the clavicle to the center of the conoid and trapezoid insertions, respectively?

. Conoid 4.5 cm, Trapezoid 3.0 cm
. Conoid 3.0 cm, Trapezoid 4.5 cm
. Conoid 2.0 cm, Trapezoid 1.0 cm
. Conoid 5.5 cm, Trapezoid 2.5 cm
. Conoid 1.5 cm, Trapezoid 3.0 cm

Correct Answer & Explanation

. Conoid 4.5 cm, Trapezoid 3.0 cm

Explanation

The native coracoclavicular ligaments consist of the conoid (medial and posterior) and the trapezoid (lateral and anterior). The center of the trapezoid insertion is approximately 3.0 cm from the distal clavicle, while the center of the conoid insertion is approximately 4.5 cm from the distal end.

Question 404

Topic: Upper Extremity Trauma

In the biomechanics of the acromioclavicular (AC) joint, the coracoclavicular (CC) ligaments provide primary vertical and axial stability. Which of the following statements accurately describes the specific anatomy and function of the CC ligaments?

. The conoid ligament is lateral to the trapezoid and resists anterior translation.
. The trapezoid ligament is medial to the conoid and resists superior translation.
. The conoid ligament is medial to the trapezoid and is the primary restraint to superior displacement of the clavicle.
. The trapezoid ligament is the primary restraint to inferior displacement of the clavicle.
. Both ligaments blend together identically to primarily resist anterior-posterior translation of the clavicle.

Correct Answer & Explanation

. The conoid ligament is lateral to the trapezoid and resists anterior translation.

Explanation

The coracoclavicular complex consists of the conoid and trapezoid ligaments. The conoid ligament is located posteromedially and is the primary restraint to superior translation of the clavicle. The trapezoid ligament is located anterolaterally and primarily restricts axial compression (acromion translating medially beneath the clavicle).

Question 405

Topic: Upper Extremity Trauma

A 42-year-old male sustains a complete distal triceps tendon rupture after a fall on an outstretched hand. During surgical repair using a transosseous cruciate technique, it is crucial to reattach the tendon to its anatomic footprint. Where is the normal anatomic insertion footprint of the triceps tendon?

. Centered exclusively on the absolute tip of the olecranon
. Broadly across the olecranon dome, attaching slightly distal to the articular margin
. Medial to the sublime tubercle of the ulna
. Directly onto the coronoid process
. Along the lateral border of the proximal radius

Correct Answer & Explanation

. Centered exclusively on the absolute tip of the olecranon

Explanation

The triceps tendon inserts over a broad, dome-shaped footprint on the proximal olecranon. It begins slightly distal (1-2 cm) to the articular margin of the olecranon tip and extends distally. The deep medial head fibers insert closer to the joint line, while the lateral and long heads insert more superficially and distally.

Question 406

Topic: Upper Extremity Trauma

A 25-year-old cyclist falls directly onto his shoulder, sustaining a Type V acromioclavicular (AC) joint separation. The surgeon plans a coracoclavicular (CC) ligament reconstruction. Which of the following accurately describes the anatomic insertions of the native CC ligaments on the clavicle?

. Conoid inserts posteromedial, Trapezoid anterolateral
. Conoid inserts anterolateral, Trapezoid posteromedial
. Conoid inserts directly anterior, Trapezoid directly posterior
. Both insert conjointly on the lateral border of the acromion
. Conoid inserts on the coracoid process, Trapezoid on the sternum

Correct Answer & Explanation

. Conoid inserts posteromedial, Trapezoid anterolateral

Explanation

The conoid ligament inserts posteromedially on the conoid tubercle (roughly 45 mm from the distal clavicle), while the trapezoid ligament inserts anterolaterally (roughly 25 mm from the distal clavicle).

Question 407

Topic: Upper Extremity Trauma

An 18-year-old elite baseball pitcher experiences a sudden 'pop' in his medial elbow during a fast pitch, followed by severe pain and an inability to continue throwing. An MRI confirms a complete rupture of the primary restraint to valgus stress. During ulnar collateral ligament (UCL) reconstruction, the surgeon must replicate the exact anatomic footprints of the anterior bundle. Which of the following describes the accurate native attachments of the anterior bundle of the UCL?

. From the lateral epicondyle to the annular ligament
. From the anteroinferior surface of the medial epicondyle to the sublime tubercle on the medial coronoid margin
. From the posterior surface of the medial epicondyle to the tip of the olecranon
. From the medial epicondyle to the center of the radial notch of the ulna
. From the distal humerus supracondylar ridge to the ulnar styloid process

Correct Answer & Explanation

. From the lateral epicondyle to the annular ligament

Explanation

The medial ulnar collateral ligament (UCL) consists of anterior, posterior, and transverse bundles. The anterior bundle is the primary restraint to valgus stress at the elbow during the late cocking and early acceleration phases of throwing. Its anatomical footprint originates on the anteroinferior, undersurface of the medial epicondyle (slightly posterior to the axis of rotation) and inserts distally on the sublime tubercle, which is located on the medial aspect of the coronoid process of the ulna.

Question 408

Topic: Upper Extremity Trauma

A 28-year-old competitive weightlifter feels a sudden 'pop' and sharp pain in his anterior chest wall while performing a heavy bench press. On examination, he has extensive ecchymosis over the anterior axillary fold and weakness in internal rotation and adduction. The vast majority of pectoralis major muscle ruptures occur at which specific anatomical location?

. Musculotendinous junction
. Sternal origin
. Clavicular origin
. Humeral insertion
. Mid-substance of the muscle belly

Correct Answer & Explanation

. Musculotendinous junction

Explanation

The vast majority of pectoralis major ruptures occur at the tendinous insertion onto the proximal humerus, specifically involving the sternocostal head. This injury typically occurs during eccentric loading (e.g., the descent phase of a bench press). Acute surgical repair yields the best functional outcomes for athletes.

Question 409

Topic: Upper Extremity Trauma

A 30-year-old cyclist falls directly onto the point of his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint separation where the clavicle is elevated by 150% relative to the acromion. He is diagnosed with a Rockwood Type V injury. Which of the following structures are disrupted in this specific injury grade?

. Acromioclavicular (AC) ligaments only
. Coracoclavicular (CC) ligaments only
. AC ligaments, CC ligaments, and the deltotrapezial fascia
. AC ligaments and coracoacromial (CA) ligament
. CC ligaments and coracoacromial (CA) ligament

Correct Answer & Explanation

. Acromioclavicular (AC) ligaments only

Explanation

Rockwood Type V AC separations involve disruption of both the AC ligaments and the CC ligaments, along with significant stripping and disruption of the deltotrapezial fascia from the distal clavicle. This extreme displacement (>100% to 300% superiorly) requires surgical reconstruction for optimal functional recovery.

Question 410

Topic: Upper Extremity Trauma
A 25-year-old cyclist crashes and sustains an acromioclavicular (AC) joint injury. Radiographs show the clavicle is displaced superiorly with a coracoclavicular (CC) distance that is 150% of the contralateral 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

A Rockwood Type V AC joint separation is defined by >100% (to 300%) superior displacement of the distal clavicle compared to the contralateral side. This involves disruption of the AC and CC ligaments with significant deltotrapezial fascial stripping.

Question 411

Topic: Upper Extremity Trauma

Following operative fixation of a terrible triad elbow injury involving LCL repair, coronoid fixation, and radial head arthroplasty, what is the most appropriate early postoperative rehabilitation protocol to permit motion while minimizing the risk of subluxation?

. Active extension in supination
. Active extension in pronation
. Passive flexion in supination
. Immobilization in 90 degrees of flexion for 4 weeks
. Immobilization in full extension for 2 weeks

Correct Answer & Explanation

. Active extension in supination

Explanation

Early active range of motion is crucial. Performing extension in pronation tightens the medial structures and relies on the intact medial soft tissue envelope to protect the repaired lateral structures, preventing posterolateral subluxation.

Question 412

Topic: Upper Extremity Trauma

A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion, consistent with a Rockwood Type V injury. Which ligaments must be surgically reconstructed to properly restore superior-inferior stability?

. Acromioclavicular ligaments only
. Coracoclavicular ligaments (conoid and trapezoid)
. Coracoacromial ligament
. Sternoclavicular ligaments
. Superior transverse scapular ligament

Correct Answer & Explanation

. Acromioclavicular ligaments only

Explanation

Rockwood Type V injuries involve severe disruption of both the AC and coracoclavicular (CC) ligaments with >100% superior displacement. Surgical reconstruction primarily targets the conoid and trapezoid (CC) ligaments to restore vertical stability.

Question 413

Topic: Upper Extremity Trauma

During reconstruction of chronic acromioclavicular joint instability, anatomic placement of the coracoclavicular ligament grafts is critical. What are the average distances of the conoid and trapezoid insertions from the distal end of the clavicle?

. Conoid at 1.5 cm, Trapezoid at 3.0 cm
. Conoid at 3.0 cm, Trapezoid at 4.5 cm
. Conoid at 4.5 cm, Trapezoid at 3.0 cm
. Conoid at 2.0 cm, Trapezoid at 5.0 cm
. Conoid at 5.0 cm, Trapezoid at 2.0 cm

Correct Answer & Explanation

. Conoid at 1.5 cm, Trapezoid at 3.0 cm

Explanation

The conoid ligament inserts more medially and posteriorly, averaging 4.5 cm from the distal clavicle. The trapezoid inserts more laterally and anteriorly, averaging 3.0 cm from the distal end.

Question 414

Topic: Upper Extremity Trauma

A 24-year-old man sustains a Grade V acromioclavicular (AC) joint separation. During anatomic coracoclavicular (CC) ligament reconstruction, where should the conoid and trapezoid bone tunnels be sequentially placed on the clavicle relative to the distal end?

. Conoid at 1.5 cm, Trapezoid at 3.0 cm
. Conoid at 4.5 cm, Trapezoid at 3.0 cm
. Conoid at 3.0 cm, Trapezoid at 4.5 cm
. Conoid at 2.5 cm, Trapezoid at 1.5 cm
. Both at 3.5 cm from the AC joint

Correct Answer & Explanation

. Conoid at 1.5 cm, Trapezoid at 3.0 cm

Explanation

The anatomic insertion of the conoid ligament is approximately 4.5 cm medial to the distal clavicle, and the trapezoid ligament is approximately 3.0 cm medial. Accurate tunnel placement is critical for restoring normal AC joint biomechanics.

Question 415

Topic: Upper Extremity Trauma

A 28-year-old cyclist sustains a Grade V acromioclavicular (AC) joint separation. During surgical reconstruction, anatomical restoration of the coracoclavicular ligaments is planned. Which of the following accurately describes the native anatomy of these ligaments?

. The conoid is medial and posterior to the trapezoid
. The conoid is lateral and anterior to the trapezoid
. The trapezoid inserts on the coracoid process base and conoid on the tip
. The conoid and trapezoid both originate from the acromion
. The conoid resists anterior translation while the trapezoid resists superior translation

Correct Answer & Explanation

. The conoid is medial and posterior to the trapezoid

Explanation

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

Question 416

Topic: Upper Extremity Trauma

Recent anatomical studies utilizing gadolinium and quantitative MRI have refined our understanding of the primary arterial blood supply to the proximal humerus. Which of the following vessels provides the majority of the vascularity to the humeral head articular segment?

. Arcuate branch of the anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Thoracoacromial artery
. Subscapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Arcuate branch of the anterior humeral circumflex artery

Explanation

Historically, the anterior humeral circumflex artery (specifically the arcuate branch) was considered the main vascular supply. However, recent studies (e.g., Hettrich et al.) have demonstrated that the posterior humeral circumflex artery supplies the vast majority (approximately 64%) of the blood to the humeral head, particularly the posteromedial and inferior aspects.

Question 417

Topic: Upper Extremity Trauma

A 21-year-old collegiate baseball pitcher undergoes ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. To restore the primary restraint to valgus stress of the elbow between 30 and 120 degrees of flexion, the graft must appropriately reconstruct the anterior bundle. What is the anatomic ulnar insertion of the anterior bundle of the UCL?

. The supinator crest
. The olecranon tip
. The sublime tubercle
. The coronoid tip
. The radial tuberosity

Correct Answer & Explanation

. The supinator crest

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow between 30 and 120 degrees of flexion. It originates on the anterior undersurface of the medial epicondyle and inserts on the sublime tubercle, which is located on the anteromedial aspect of the coronoid process.

Question 418

Topic: Upper Extremity Trauma
A 30-year-old male sustains a direct blow to the point of his shoulder. Radiographs reveal an acromioclavicular (AC) joint injury. The clavicle is significantly displaced posteriorly into or through the trapezius fascia. According to the Rockwood classification, what type of AC injury 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, a Type IV injury is characterized by posterior displacement of the distal clavicle into or through the trapezius muscle/fascia. Type III is 25-100% superior displacement; Type V is >100% superior displacement; Type VI is inferior displacement (subcoracoid).

Question 419

Topic: Upper Extremity Trauma

A 23-year-old professional baseball pitcher presents with posteromedial elbow pain, particularly pronounced during the deceleration phase of throwing. He reports a catching sensation but no instability. Radiographs show a prominent osteophyte on the posteromedial olecranon. MRI shows an intact ulnar collateral ligament (UCL). He is diagnosed with Valgus Extension Overload (VEO). During arthroscopic resection of the osteophyte, what technical error must be strictly avoided?

. Failing to resect the anterior bundle of the UCL
. Over-resection of the posteromedial olecranon by more than 3 mm
. Release of the common extensor origin
. Resection of the radial head
. Debridement of the radiocapitellar joint

Correct Answer & Explanation

. Failing to resect the anterior bundle of the UCL

Explanation

In Valgus Extension Overload (VEO) syndrome, symptomatic posteromedial olecranon osteophytes can be resected arthroscopically. However, over-resection of the posteromedial olecranon (removing more than 2-3 mm of native bone) significantly increases the strain on the native UCL, potentially destabilizing an elbow that was otherwise stable, and leading to iatrogenic valgus instability.

Question 420

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a 100% superior displacement of the distal clavicle relative to the acromion. The coracoclavicular (CC) distance is increased by 50% compared to the contralateral uninjured side. The clinical exam reveals a prominent clavicle, but the deltotrapezial fascia is assessed as intact. According to the Rockwood Classification of acromioclavicular joint injuries, what type is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

In the Rockwood classification, a Type III AC separation is characterized by torn AC ligaments and torn CC ligaments, resulting in 25% to 100% superior translation of the clavicle relative to the acromion. The deltotrapezial fascia remains intact. In contrast, a Type V injury exhibits greater than 100% (often 100-300%) superior displacement and involves disruption of the deltotrapezial fascia.

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