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Shoulder & Hip Sports MCQs

Practice Set 109 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 2161

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with painless weakness of the shoulder. Examination reveals isolated atrophy of the infraspinatus with preserved supraspinatus bulk and strength. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2162

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player is undergoing an open Latarjet procedure for recurrent anterior shoulder instability associated with 25% glenoid bone loss. During the procedure, the coracoid process is osteotomized and transferred to the anterior glenoid. To create the dynamic "sling effect" that contributes to the stability provided by this procedure, the coracoid and its attached conjoint tendon are passed through a split in which of the following structures?

. Pectoralis major tendon
. Pectoralis minor tendon
. Subscapularis muscle
. Anterior capsule
. Coracoacromial ligament

Correct Answer & Explanation

. Subscapularis muscle

Explanation

Correct Answer: CThe Latarjet procedure provides stability through a "triple effect": 1) the bony augmentation of the anterior glenoid defect, 2) the dynamic "sling effect" of the conjoint tendon (short head of biceps and coracobrachialis), and 3) the repair of the capsule to the stump of the coracoacromial ligament. To achieve the sling effect, the coracoid and conjoint tendon are passed through a horizontal split made in the subscapularis muscle (typically between its superior two-thirds and inferior one-third). When the arm is abducted and externally rotated (the position of vulnerability), the conjoint tendon acts as a dynamic sling across the anterior-inferior capsule, preventing anterior translation of the humeral head.

Question 2163

Topic: Shoulder & Hip Sports

A 26-year-old professional volleyball player presents with painless weakness in his dominant right shoulder. Physical examination reveals normal 5/5 strength in supraspinatus testing (empty can test), but isolated 3/5 strength in external rotation with the arm at the side. There is visible atrophy of the infraspinatus fossa. Where is the most likely anatomical site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch.

Explanation

Correct Answer: BThe patient presents with isolated weakness and atrophy of the infraspinatus muscle, which is innervated by the suprascapular nerve. The suprascapular nerve passes through the suprascapular notch (where it innervates the supraspinatus) and then courses around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch (e.g., by the transverse scapular ligament) typically causes weakness in BOTH the supraspinatus and infraspinatus. Compression at the spinoglenoid notch (often due to a paralabral cyst associated with a posterior labral tear in overhead athletes) results in isolated infraspinatus weakness, as the motor branches to the supraspinatus have already branched off proximally. The quadrilateral space contains the axillary nerve.

Question 2164

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player with recurrent anterior shoulder instability and 25% anterior glenoid bone loss undergoes an open Latarjet procedure. During the transfer of the coracoid process through the split in the subscapularis muscle, retractors are placed medially under the conjoint tendon. Which of the following nerves is at greatest risk of iatrogenic injury during this specific step of the procedure?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Long thoracic nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

Correct Answer: CDuring the Latarjet procedure, the coracoid process (with the attached conjoint tendon—short head of the biceps and coracobrachialis) is transferred to the anterior glenoid. The musculocutaneous nerve typically enters the coracobrachialis muscle approximately 3 to 8 cm distal to the tip of the coracoid process. When retracting the conjoint tendon medially to expose the anterior glenoid and subscapularis, aggressive or deep retractor placement can stretch or directly compress the musculocutaneous nerve. The axillary nerve (Option A) is at risk inferiorly during capsular release and glenoid preparation. The suprascapular nerve (Option B) is posterior and superior, not typically at risk during the anterior coracoid transfer. The radial nerve (Option D) is posterior to the humerus. The long thoracic nerve (Option E) is medial on the chest wall.

Question 2165

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, the surgeon aims to restore the native tendon-to-bone insertion (enthesis) to optimize healing. In a normal, healthy direct tendon insertion, the transition from tendon to bone occurs through four distinct histological zones. Which zone lies immediately superficial to the "tidemark"?

. Mineralized bone
. Calcified fibrocartilage
. Uncalcified fibrocartilage
. Parallel collagen fibers of the tendon
. Loose areolar connective tissue

Correct Answer & Explanation

. Uncalcified fibrocartilage

Explanation

Correct Answer: CA direct tendon insertion (enthesis), such as the rotator cuff footprint, consists of four distinct histological zones that transition mechanical stress from the compliant tendon to the rigid bone. From superficial to deep, these zones are: 1) Tendon (parallel collagen fibers), 2) Uncalcified fibrocartilage, 3) Calcified fibrocartilage, and 4) Bone. The "tidemark" is a distinct basophilic line that separates the uncalcified fibrocartilage from the calcified fibrocartilage. Therefore, the zone immediately superficial to the tidemark is the uncalcified fibrocartilage. Understanding this anatomy is crucial because surgical repair often results in healing via a fibrovascular scar rather than regeneration of this complex 4-zone enthesis, which contributes to the risk of re-tear.

Question 2166

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. The success of this procedure relies on a "triple blocking" effect. Which of the following muscles constitutes the dynamic "sling effect" across the anterior-inferior capsule when the arm is in the abducted and externally rotated position?

. Short head of the biceps and coracobrachialis
. Long head of the biceps and pectoralis minor
. Subscapularis and pectoralis major
. Coracobrachialis and pectoralis minor
. Short head of the biceps and subscapularis

Correct Answer & Explanation

. Short head of the biceps and coracobrachialis

Explanation

Correct Answer: A (Short head of the biceps and coracobrachialis)The Latarjet procedure involves transferring the coracoid process, along with its attached conjoint tendon, to the anterior-inferior glenoid neck. The "triple blocking" effect consists of: 1) a bony block from the transferred coracoid, 2) a dynamic "sling effect" from the conjoint tendon, and 3) capsular repair (often using the coracoacromial ligament stump). The conjoint tendon is composed of the short head of the biceps brachii and the coracobrachialis. When the arm is placed in the vulnerable position of abduction and external rotation, these muscles contract and act as a dynamic sling across the anterior-inferior capsule, preventing anterior translation of the humeral head. The pectoralis minor inserts on the medial aspect of the coracoid and is typically released during the procedure. The long head of the biceps originates from the supraglenoid tubercle.

Question 2167

Topic: Shoulder & Hip Sports

A 26-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness in his dominant arm. Physical examination reveals normal strength in forward elevation and abduction, but 3/5 strength in external rotation with the arm at the side. There is noticeable atrophy of the infraspinatus fossa, but the supraspinatus fossa appears normal. At which of the following anatomic locations is the affected nerve most likely compressed?

. Suprascapular notch.
. Spinoglenoid notch.
. Quadrilateral space.
. Spiral groove.
. Cubital tunnel.

Correct Answer & Explanation

. Spinoglenoid notch.

Explanation

Correct Answer: Spinoglenoid notch.The patient presents with isolated weakness and atrophy of the infraspinatus muscle, indicating an entrapment of the suprascapular nerve at the spinoglenoid notch. The suprascapular nerve branches off the upper trunk of the brachial plexus, passes through the suprascapular notch (under the transverse scapular ligament) where it innervates the supraspinatus muscle. It then courses around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch would result in weakness ofboththe supraspinatus (abduction) and infraspinatus (external rotation). Compression at the spinoglenoid notch, often seen in overhead athletes due to repetitive stretching or paralabral cysts, results in isolated infraspinatus weakness. The quadrilateral space contains the axillary nerve; the spiral groove contains the radial nerve; the cubital tunnel contains the ulnar nerve.

Question 2168

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with chronic posterior shoulder pain. An MRI arthrogram reveals a partial articular-sided supraspinatus tendon avulsion (PASTA lesion) and posterosuperior labral fraying. The treating physician diagnoses internal impingement. This specific pathology is most likely exacerbated by the impingement of the rotator cuff and labrum against the posterosuperior glenoid rim during which phase of the throwing motion?

. Wind-up.
. Early cocking.
. Late cocking / maximal external rotation.
. Acceleration.
. Follow-through.

Correct Answer & Explanation

. Late cocking / maximal external rotation.

Explanation

Correct Answer: Late cocking / maximal external rotation.Internal impingement (posterosuperior impingement) is a pathological condition commonly seen in overhead athletes, particularly baseball pitchers. It occurs when the arm is placed in extreme abduction and maximal external rotation—the classic position of the 'late cocking' phase of throwing. In this position, the articular surface of the posterior rotator cuff (supraspinatus and infraspinatus) becomes pinched between the greater tuberosity of the humerus and the posterosuperior glenoid rim and labrum. Over time, this repetitive microtrauma leads to articular-sided rotator cuff tears (like PASTA lesions) and posterosuperior labral fraying or tears. The acceleration phase involves rapid internal rotation, and the follow-through phase involves deceleration and cross-body adduction, neither of which produces this specific posterosuperior pinch.

Question 2169

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. CT scan with 3D reconstruction reveals an inverted pear-shaped glenoid with 28% anterior glenoid bone loss. He undergoes a Latarjet procedure. Biomechanically, what is the primary mechanism by which this procedure confers stability in abduction and external rotation?

. Restoration of the anterior glenoid articular arc length
. Sling effect of the conjoint tendon on the inferior subscapularis and capsule
. Re-tensioning of the coracoacromial ligament
. Dynamic tensioning of the pectoralis minor
. Prevention of Hill-Sachs engagement via cam effect

Correct Answer & Explanation

. Sling effect of the conjoint tendon on the inferior subscapularis and capsule

Explanation

The Latarjet procedure provides stability through three main mechanisms. The most significant stabilizing factor in the abducted and externally rotated position is the 'sling effect' of the conjoint tendon compressing the inferior subscapularis and anterior capsule.

Question 2170

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. Advanced imaging demonstrates an engaging Hill-Sachs lesion and 25% anterior glenoid bone loss. Which of the following surgical interventions is most appropriate to restore stability and prevent recurrence?

. Arthroscopic Bankart repair with remplissage
. Open Bankart repair with inferior capsular shift
. Coracoid transfer to the anterior glenoid (Latarjet procedure)
. Arthroscopic capsular plication
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Coracoid transfer to the anterior glenoid (Latarjet procedure)

Explanation

In the setting of significant anterior glenoid bone loss (>20-25%), soft tissue stabilization alone has unacceptably high failure rates. The Latarjet procedure provides a triple blocking effect (bone, sling, and capsule) to definitively restore stability in these high-risk patients.

Question 2171

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. CT scan shows 25% anterior glenoid bone loss. He undergoes a Latarjet procedure. Which of the following describes the primary stabilizing biomechanical "sling" effect of this procedure?

. Conjoined tendon tensioning across the inferior subscapularis
. Coracoacromial ligament transfer to the anterior capsule
. Bony block increasing the glenoid articular arc
. Dynamic tensioning of the long head of the biceps
. Static tensioning of the middle glenohumeral ligament

Correct Answer & Explanation

. Conjoined tendon tensioning across the inferior subscapularis

Explanation

The Latarjet procedure provides stability primarily through the dynamic sling effect of the conjoined tendon on the lower subscapularis and anteroinferior capsule. This effect is most pronounced when the arm is in the vulnerable abducted and externally rotated position. The bony block and capsular repair play secondary stabilizing roles.

Question 2172

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst at the spinoglenoid notch. Which of the following associated intra-articular pathologies is most likely responsible for this cyst?

. Anterior Bankart tear
. SLAP tear extending anteriorly
. Posterior labral tear
. Superior capsular defect
. Subscapularis tendon tear

Correct Answer & Explanation

. Posterior labral tear

Explanation

Paralabral cysts at the spinoglenoid notch typically arise from a one-way valve effect caused by a posterior or posterosuperior labral tear. These cysts selectively compress the suprascapular nerve after it has already innervated the supraspinatus, leading to isolated infraspinatus atrophy and external rotation weakness.

Question 2173

Topic: Shoulder & Hip Sports

A patient describes a sensation of the shoulder 'slipping out' when reaching across the body to perform a task like fastening a seatbelt. This mechanism is suggestive of which type of instability?

. Anterior instability
. Posterior instability
. Inferior instability
. Multidirectional instability
. Rotator cuff impingement

Correct Answer & Explanation

. Posterior instability

Explanation

Reaching across the body (horizontal adduction and internal rotation) is a classic position for posterior subluxation or dislocation. Anterior instability typically occurs with abduction and external rotation. Inferior instability is less position-specific but involves inferior translation. Multidirectional instability would involve multiple directions. Rotator cuff impingement causes pain with certain movements but not a 'slipping out' sensation.

Question 2174

Topic: Shoulder & Hip Sports

In assessing a patient for multidirectional instability (MDI), which of the following signs would be most indicative?

. A positive Apprehension Test with external rotation
. A positive Jerk Test with horizontal adduction
. A positive Sulcus Sign with inferior traction
. All of the above combined with generalized ligamentous laxity
. Isolated pain with resisted internal rotation

Correct Answer & Explanation

. All of the above combined with generalized ligamentous laxity

Explanation

Multidirectional instability (MDI) implies instability in at least two, but typically three, directions (anterior, posterior, and inferior). Therefore, a patient with MDI would likely exhibit positive findings on tests for anterior instability (Apprehension Test), posterior instability (Jerk Test), and inferior instability (Sulcus Sign). Generalized ligamentous laxity (e.g., Beighton score) often predisposes to MDI. Isolated pain with resisted internal rotation suggests rotator cuff pathology.

Question 2175

Topic: Shoulder & Hip Sports

A patient presents with a superior labral anterior-posterior (SLAP) lesion. Which physical exam maneuver is MOST likely to elicit pain?

. Neer Impingement Test
. Hawkins-Kennedy Impingement Test
. Speed's Test
. Empty Can Test
. Cross-Body Adduction Test

Correct Answer & Explanation

. Speed's Test

Explanation

Speed's Test (or Biceps Load Test II) is specifically designed to test for SLAP lesions, assessing pain with resisted shoulder flexion while the elbow is extended and forearm supinated. Neer and Hawkins-Kennedy are for impingement, Empty Can for supraspinatus, and Cross-Body Adduction for AC joint pathology. While impingement tests can sometimes be positive with SLAP, Speed's test is more specific for biceps/labral irritation.

Question 2176

Topic: Shoulder & Hip Sports

What is the primary purpose of obtaining an axillary view radiograph in a patient with a suspected shoulder dislocation?

. To assess for a Hill-Sachs lesion
. To visualize a bony Bankart lesion
. To differentiate between anterior and posterior dislocations
. To evaluate for rotator cuff tears
. To measure the critical shoulder angle

Correct Answer & Explanation

. To differentiate between anterior and posterior dislocations

Explanation

The axillary view (or Velpeau view if unable to abduct) is crucial for differentiating between anterior and posterior dislocations, as it provides a true lateral view of the glenohumeral joint and shows the relationship of the humeral head to the glenoid. An AP view alone can sometimes be misleading, especially with posterior dislocations. While it can also show bony Bankart lesions, its primary utility is differentiation of dislocation type. Hill-Sachs can be seen on AP or West Point axillary. It does not directly evaluate rotator cuff tears or measure the critical shoulder angle (which is for impingement/arthritis risk).

Question 2177

Topic: Shoulder & Hip Sports

When performing the Load and Shift test, what does excessive posterior translation of the humeral head indicate?

. Anterior capsular laxity
. Posterior capsular laxity
. Inferior glenohumeral ligament incompetence
. Superior labral tear
. Rotator cuff tear

Correct Answer & Explanation

. Posterior capsular laxity

Explanation

The Load and Shift test assesses glenohumeral translation in anterior and posterior directions. Excessive posterior translation indicates posterior capsular laxity, a hallmark of posterior glenohumeral instability. Anterior capsular laxity would manifest as excessive anterior translation. Inferior glenohumeral ligament incompetence would contribute to inferior instability. Labral or rotator cuff tears are structural injuries, not directly measured by generalized capsular laxity translation tests.

Question 2178

Topic: Shoulder & Hip Sports

In a patient presenting with an acute shoulder dislocation, a palpable clunk or grind during gentle rotation of the arm post-reduction could indicate:

. Successful reduction and stability
. Recurrent dislocation
. Intra-articular loose body or labral injury
. Axillary nerve recovery
. Musculocutaneous nerve injury

Correct Answer & Explanation

. Intra-articular loose body or labral injury

Explanation

A palpable clunk or grind post-reduction, especially with specific movements, can indicate an intra-articular loose body (e.g., osteochondral fragment, bony Bankart fragment) or a labral tear (e.g., Bankart lesion). It suggests continued pathology within the joint despite reduction. Successful reduction implies smooth, pain-free motion. Recurrence would be a complete dislocation. Nerve recovery/injury is unrelated to mechanical clunking.

Question 2179

Topic: Shoulder & Hip Sports

When examining a patient with recurrent anterior shoulder instability, what is the significance of a 'Bankart lesion'?

. It describes an impaction fracture of the posterior-superior humeral head
. It refers to an avulsion of the anterior-inferior labrum and glenohumeral ligaments from the glenoid rim
. It is a fracture of the greater tuberosity of the humerus
. It indicates a tear of the supraspinatus tendon
. It represents a defect in the articular cartilage of the humeral head

Correct Answer & Explanation

. It refers to an avulsion of the anterior-inferior labrum and glenohumeral ligaments from the glenoid rim

Explanation

A Bankart lesion is a specific injury to the anterior-inferior glenoid labrum and the attached inferior glenohumeral ligament, caused by the humeral head forcefully impacting the glenoid rim during an anterior dislocation. It is a critical lesion contributing to recurrent anterior instability. Option A describes a Hill-Sachs lesion. Options C, D, and E describe other distinct injuries.

Question 2180

Topic: Shoulder & Hip Sports

A 45-year-old male sustains a fall onto his abducted arm. Radiographs confirm an anterior shoulder dislocation. Which associated fracture is most likely due to impaction of the posterior-superior humeral head against the anterior glenoid rim?

. Reverse Hill-Sachs lesion
. Bony Bankart lesion
. Greater tuberosity fracture
. Surgical neck fracture
. Clavicle fracture

Correct Answer & Explanation

. Bony Bankart lesion

Explanation

A Bony Bankart lesion is an avulsion fracture of the anterior-inferior glenoid rim, occurring when the humeral head dislocates anteriorly and impacts the glenoid. A Reverse Hill-Sachs lesion is associated with posterior dislocations. Greater tuberosity and surgical neck fractures are also associated but are different mechanisms. Clavicle fractures are less directly associated with the dislocation mechanism itself.

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