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Shoulder & Hip Sports MCQs

Practice Set 101 of 142

This practice set contains high-yield board review questions covering key concepts in Shoulder & Hip Sports. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2001

Topic: Shoulder & Hip Sports

A 32-year-old elite volleyball player presents with isolated weakness in external rotation of the dominant shoulder. Physical examination reveals isolated atrophy of the infraspinatus with no supraspinatus involvement. Where is the most likely location of nerve compression?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branches to the infraspinatus, sparing the supraspinatus. Compression at the suprascapular notch would affect both muscles.

Question 2002

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Physical examination demonstrates a 20-degree glenohumeral internal rotation deficit (GIRD) compared to the contralateral shoulder.

What is the primary pathomechanical cause of this patient's internal impingement?

. Contracture of the anterior joint capsule
. Contracture of the posterior band of the inferior glenohumeral ligament
. Anterosuperior humeral head escape
. Primary subcoracoid impingement
. Suprascapular neuropathy

Correct Answer & Explanation

. Contracture of the posterior band of the inferior glenohumeral ligament

Explanation

Internal impingement in overhead athletes is primarily driven by a contracture of the posterior band of the inferior glenohumeral ligament (IGHL). This contracture leads to a posterosuperior shift of the humeral head during maximum abduction and external rotation, trapping the posterosuperior rotator cuff against the labrum.

Question 2003

Topic: Shoulder & Hip Sports

Following an arthroscopic repair of a full-thickness supraspinatus tear, the tendon undergoes a complex biological healing process.

How does the healed tendon-to-bone interface typically present histologically?

. Regeneration of the native four-zone fibrocartilage transition
. Formation of a fibrovascular scar tissue interface
. Direct endochondral ossification
. Intramembranous ossification
. Primary cortical bone healing

Correct Answer & Explanation

. Formation of a fibrovascular scar tissue interface

Explanation

Unlike native tendon insertions which feature a complex four-zone fibrocartilaginous transition, healing following rotator cuff repair typically results in a mechanically inferior fibrovascular scar tissue interface. It does not regenerate the native enthesis.

Question 2004

Topic: Shoulder & Hip Sports

A 45-year-old recreational tennis player has persistent deep shoulder pain. MRI shows an isolated Type II Superior Labrum Anterior Posterior (SLAP) tear. He undergoes arthroscopic evaluation. What is the most reliable predictor of failure if a primary SLAP repair is performed in this patient instead of a biceps tenodesis?

. Age greater than 40 years
. Concomitant Bankart lesion
. Dominant arm involvement
. History of subacromial steroid injections
. Overhead sport participation

Correct Answer & Explanation

. Age greater than 40 years

Explanation

In patients over the age of 40, primary repair of a Type II SLAP tear has a significantly high failure rate and frequently results in postoperative stiffness. Biceps tenodesis is generally the preferred surgical treatment in this demographic.

Question 2005

Topic: Shoulder & Hip Sports

A 20-year-old rugby player presents with his third anterior shoulder dislocation. A CT scan with 3D reconstruction is obtained.

Measurements indicate a 25% anterior glenoid bone loss. What is the most appropriate surgical intervention to minimize the risk of recurrent instability?

. Arthroscopic Bankart repair with capsulorrhaphy
. Arthroscopic Bankart repair with Remplissage
. Coracoid process transfer (Latarjet procedure)
. Open Bankart repair
. Subscapularis advancement (Putti-Platt procedure)

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

Critical glenoid bone loss exceeding 20-25% in a contact athlete is a strong indication for a bony augmentation procedure, such as the Latarjet procedure. Soft tissue Bankart repairs have unacceptably high failure rates in the setting of significant bone loss.

Question 2006

Topic: Shoulder & Hip Sports

A 24-year-old competitive rugby player sustains his third anterior shoulder dislocation. A pre-operative CT scan demonstrates 28% anterior glenoid bone loss. Which of the following surgical interventions is most appropriate?

. Arthroscopic Bankart repair with Remplissage
. Arthroscopic Bankart repair alone
. Open Bankart repair
. Coracoid transfer (Latarjet procedure)
. Overtightening of the anterior capsule

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

The Latarjet procedure (coracoid transfer) is the gold standard for anterior shoulder instability in the presence of critical anterior glenoid bone loss (>20-25%). Arthroscopic soft tissue repairs alone have an unacceptably high failure rate in this setting.

Question 2007

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he presents with an inability to actively flex his elbow or supinate his forearm. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at high risk during the Latarjet procedure due to its proximity to the coracoid process and conjoint tendon, which are retracted during exposure. Injury results in weakness of elbow flexion and forearm supination.

Question 2008

Topic: Shoulder & Hip Sports

A 25-year-old hockey player presents with anterior hip pain exacerbated by hip flexion, adduction, and internal rotation. Radiographs reveal a crossover sign and an alpha angle of 65 degrees. What is the most likely combination of pathomorphologies?

. Cam impingement only
. Pincer impingement only
. Mixed Cam and Pincer impingement
. Developmental dysplasia of the hip
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Mixed Cam and Pincer impingement

Explanation

An alpha angle greater than 55 degrees indicates a Cam deformity (femoral head-neck junction abnormality). The crossover sign on an AP pelvis radiograph indicates cranial retroversion of the acetabulum, typical of Pincer impingement. Together, they represent mixed femoroacetabular impingement (FAI).

Question 2009

Topic: Shoulder & Hip Sports

A 60-year-old male presents with a massive, irreparable posterosuperior rotator cuff tear. He has an intact subscapularis, no glenohumeral arthritis (Hamada grade 1), but demonstrates a positive hornblower's sign. Which of the following joint-preserving procedures is most indicated to restore active external rotation?

. Superior capsular reconstruction
. Latissimus dorsi tendon transfer
. Pectoralis major tendon transfer
. Arthroscopic partial repair with margin convergence
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Latissimus dorsi tendon transfer

Explanation

In an active patient with an irreparable posterosuperior rotator cuff tear and severe active external rotation weakness, a latissimus dorsi tendon transfer is indicated. Superior capsular reconstruction improves superior stability but does not actively restore external rotation.

Question 2010

Topic: Shoulder & Hip Sports

A 48-year-old recreational tennis player presents with vague anterior shoulder pain. An MRI arthrogram reveals a Type II SLAP tear. He has failed 6 months of nonoperative management. What is the currently recommended surgical intervention for this specific demographic?

. Arthroscopic SLAP repair with suture anchors
. Biceps tenodesis
. Coracoid transfer (Latarjet)
. Anterior capsulolabral reconstruction
. Arthroscopic debridement only

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In older patients (typically >40 years) with a symptomatic Type II SLAP tear, primary biceps tenodesis is strongly preferred. SLAP repair in this older demographic is associated with higher rates of postoperative stiffness, persistent pain, and revision surgery.

Question 2011

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability. Postoperatively, he presents with numbness over the lateral aspect of his forearm and weakness in elbow flexion. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at high risk during the Latarjet procedure due to its proximity to the conjoint tendon and coracoid process. Vigorous medial retraction of the conjoint tendon places traction on this nerve, causing lateral forearm numbness and biceps weakness.

Question 2012

Topic: Shoulder & Hip Sports

A 21-year-old collegiate rugby player presents with recurrent anterior shoulder instability. CT scan demonstrates 28% anterior glenoid bone loss. What is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open Bankart repair
. Latarjet procedure
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure

Explanation

In contact athletes with critical glenoid bone loss (typically >20-25%), a Latarjet procedure (coracoid transfer) is indicated. Arthroscopic soft tissue repairs alone have an unacceptably high failure rate in this setting.

Question 2013

Topic: Shoulder & Hip Sports

A 28-year-old rock climber presents with chronic shoulder pain. An MRI reveals a type II SLAP lesion. He fails conservative management and undergoes arthroscopic repair. Postoperatively, what is the most common complication following SLAP repair in this patient demographic?

. Recurrent instability
. Postoperative stiffness
. Axillary nerve injury
. Rotator cuff tear
. Hardware migration

Correct Answer & Explanation

. Postoperative stiffness

Explanation

Postoperative stiffness, particularly a loss of external rotation, is the most common complication following SLAP repair. This risk is minimized by avoiding overtensioning of the capsulolabral complex.

Question 2014

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, a massive, retracted, U-shaped tear involving the supraspinatus and infraspinatus is identified. Margin convergence sutures are utilized. What is the primary biomechanical goal of margin convergence?

. To medialize the footprint for easier reach
. To reduce strain on the repair at the greater tuberosity
. To stimulate biologic healing at the tendon-tendon interface
. To prevent suprascapular nerve stretch
. To convert a U-shaped tear into a V-shaped tear

Correct Answer & Explanation

. To reduce strain on the repair at the greater tuberosity

Explanation

Margin convergence side-to-side suturing acts to close a U-shaped tear into a more manageable crescent shape. Biomechanically, this significantly reduces tension and strain at the tendon-to-bone repair site on the greater tuberosity.

Question 2015

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. Advanced imaging reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion.

Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic remplissage alone
. Open Bankart repair with capsular shift
. Latarjet procedure (coracoid transfer)
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

The Latarjet procedure is indicated for recurrent anterior shoulder instability associated with critical glenoid bone loss (>20-25%). Soft tissue repairs alone in this setting have an unacceptably high failure rate.

Question 2016

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player is diagnosed with a posterior labral tear and an associated paralabral cyst located strictly at the spinoglenoid notch. Which of the following clinical exam findings is most expected?

. Isolated weakness in internal rotation
. Weakness in both shoulder abduction and external rotation
. Isolated weakness in external rotation
. Loss of active forward elevation
. Sensory deficit over the lateral deltoid

Correct Answer & Explanation

. Isolated weakness in external rotation

Explanation

A paralabral cyst at the spinoglenoid notch selectively compresses the distal suprascapular nerve branch to the infraspinatus. This spares the supraspinatus (innervated prior to the notch), resulting in isolated external rotation weakness.

Question 2017

Topic: Shoulder & Hip Sports

A 24-year-old hockey player presents with chronic groin pain. Imaging reveals femoroacetabular impingement (FAI) with a cam lesion. Which radiographic view is best utilized to measure the alpha angle to quantify the cam deformity?

. AP Pelvis
. False profile view
. Dunn lateral view
. Inlet view
. Outlet view

Correct Answer & Explanation

. Dunn lateral view

Explanation

The Dunn lateral or cross-table lateral views provide the best visualization of the anterolateral femoral head-neck junction, which is where cam deformities most commonly occur and the alpha angle is most accurately measured.

Question 2018

Topic: Shoulder & Hip Sports

A 20-year-old female dancer complains of a deep, audible clicking in her groin area when she brings her hip from flexion into extension. The phenomenon is reproducible and mildly painful. This specific form of 'snapping hip' syndrome involves which of the following structures?

. Iliotibial band snapping over the greater trochanter
. Gluteus maximus tendon snapping over the ischial tuberosity
. Iliopsoas tendon snapping over the iliopectineal eminence
. Rectus femoris tendon snapping over the anterior inferior iliac spine
. Biceps femoris tendon snapping over the fibular head

Correct Answer & Explanation

. Iliopsoas tendon snapping over the iliopectineal eminence

Explanation

Internal snapping hip syndrome (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the femoral head during hip extension.

Question 2019

Topic: Shoulder & Hip Sports

A 24-year-old male presents with recurrent anterior shoulder instability. CT scan with 3D reconstruction reveals a 25% anteroinferior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Arthroscopic SLAP repair
. Open inferior capsular shift
. Latarjet procedure
. Remplissage procedure alone

Correct Answer & Explanation

. Latarjet procedure

Explanation

In patients with recurrent anterior shoulder instability and significant glenoid bone loss (typically >20-25%), isolated soft-tissue repair (Bankart) has an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the standard of care for restoring stability.

Question 2020

Topic: Shoulder & Hip Sports

A 45-year-old tennis player presents with shoulder pain. MRI shows a partial articular-sided supraspinatus tendon avulsion (PASTA) involving 60% of the tendon thickness. What is the recommended surgical management if conservative treatment fails?

. Arthroscopic debridement of the tendon without repair
. Takedown of the remaining tendon and formal repair
. Subacromial decompression alone
. Latissimus dorsi tendon transfer
. Open reduction and internal fixation

Correct Answer & Explanation

. Takedown of the remaining tendon and formal repair

Explanation

For partial articular-sided rotator cuff tears involving greater than 50% of the tendon thickness, standard treatment involves taking down the remaining intact tendon and performing a formal full-thickness repair, or completing a transtendon (in situ) repair.

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