Menu

Shoulder & Hip Sports MCQs

Practice Set 110 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 2181

Topic: Shoulder & Hip Sports

What is the primary significance of a 'Hill-Sachs lesion' in the context of shoulder dislocation?

. It indicates posterior glenohumeral instability.
. It is an avulsion fracture of the greater tuberosity.
. It is an impaction fracture on the posterior-superior aspect of the humeral head, typically associated with anterior dislocation.
. It signifies an irreparable rotator cuff tear.
. It represents a tear of the superior glenoid labrum.

Correct Answer & Explanation

. It is an impaction fracture on the posterior-superior aspect of the humeral head, typically associated with anterior dislocation.

Explanation

A Hill-Sachs lesion is an impaction fracture on the posterior-superior aspect of the humeral head, caused when the humeral head impacts against the anterior glenoid rim during an anterior dislocation. It is a key indicator of prior anterior dislocation and contributes to recurrent instability. Reverse Hill-Sachs is for posterior. Greater tuberosity is a separate fracture. Rotator cuff tears and labral tears are distinct injuries.

Question 2182

Topic: Shoulder & Hip Sports

When assessing for posterior instability with the patient supine, which test involves applying an axial load while horizontally adducting and internally rotating the arm?

. Apprehension Test
. Relocation Test
. Sulcus Sign
. Jerk Test
. Lift-Off Test

Correct Answer & Explanation

. Jerk Test

Explanation

The Jerk Test (also known as the Posterior Clunk Test or Load and Shift with specific movements) is performed with the patient supine, arm abducted to 90 degrees, and internally rotated. An axial load is applied through the humerus, and the arm is then moved into horizontal adduction. A sudden 'jerk' or clunk as the humeral head subluxates posteriorly indicates a positive test for posterior instability. Apprehension and Relocation tests are for anterior. Sulcus Sign is for inferior. Lift-Off Test is for subscapularis.

Question 2183

Topic: Shoulder & Hip Sports

A patient with a suspected first-time shoulder dislocation is unable to move their arm. Which finding on a pre-reduction X-ray would be a contraindication to closed reduction in the emergency department?

. Large Hill-Sachs lesion
. Bony Bankart lesion
. Fracture of the surgical neck of the humerus
. Greater tuberosity avulsion fracture
. Minor calcification in the rotator cuff tendons

Correct Answer & Explanation

. Fracture of the surgical neck of the humerus

Explanation

A displaced fracture of the surgical neck of the humerus is generally a contraindication to closed reduction in the emergency department, as reduction maneuvers could further displace the fracture or cause neurovascular injury. Such cases often require orthopedic consultation for potential open reduction or different reduction strategies. Hill-Sachs, bony Bankart, and greater tuberosity fractures, while associated, are not absolute contraindications to closed reduction unless they are very large or complex. Minor calcification is irrelevant for acute dislocation management.

Question 2184

Topic: Shoulder & Hip Sports

The 'Drop Arm Test' is positive in a patient with a dislocated shoulder. What associated injury does this MOST likely indicate?

. Axillary nerve palsy
. Complete rotator cuff tear
. Anterior labral avulsion
. Biceps tendon rupture
. Acromioclavicular joint separation

Correct Answer & Explanation

. Complete rotator cuff tear

Explanation

The Drop Arm Test assesses the integrity of the rotator cuff, particularly the supraspinatus. A positive test, where the patient cannot smoothly lower their arm from abduction or the arm 'drops,' suggests a complete rotator cuff tear. While axillary nerve palsy can also cause abduction weakness, the specific 'dropping' often points to the rotator cuff. Labral avulsion, biceps rupture, and AC joint separation have different specific tests.

Question 2185

Topic: Shoulder & Hip Sports

When evaluating a patient for shoulder instability, what is the purpose of assessing the 'apprehension' rather than just pain?

. Apprehension is a more reliable indicator of rotator cuff pathology.
. Apprehension is subjective and less useful than objective pain.
. Apprehension specifically indicates a fear of impending dislocation, suggestive of true instability.
. Pain is always indicative of instability, while apprehension is not.
. Apprehension indicates a biceps tendon injury.

Correct Answer & Explanation

. Apprehension specifically indicates a fear of impending dislocation, suggestive of true instability.

Explanation

In the context of the Apprehension Test, 'apprehension' refers to the patient's subjective feeling of the shoulder 'going out' or impending dislocation, often accompanied by muscle guarding. This is a more specific indicator of true glenohumeral instability (especially anterior) than pain alone, as pain can arise from various shoulder pathologies. A positive apprehension indicates that the position reproduces the sensation of instability, which is distinct from mere pain.

Question 2186

Topic: Shoulder & Hip Sports

A 19-year-old male presents with recurrent anterior shoulder dislocations. On examination, he is found to have a positive 'Kim Test.' What does this test evaluate?

. Anterior labral tear
. Posterior-inferior labral avulsion
. Superior labral tear
. Rotator cuff integrity
. Acromioclavicular joint pathology

Correct Answer & Explanation

. Posterior-inferior labral avulsion

Explanation

The Kim Test is a specific maneuver used to detect a posterior-inferior labral avulsion, which is associated with posterior shoulder instability. It involves the examiner holding the patient's elbow and applying an axial load while elevating the arm to 90 degrees and applying a posteroinferior force to the humeral head. A positive test elicits posterior pain and a clunk. Anterior labral tears (Bankart) are assessed with other tests (e.g., Apprehension/Relocation). SLAP lesions (superior labral) are assessed with tests like Speed's or O'Brien's.

Question 2187

Topic: Shoulder & Hip Sports

A patient with a dislocated shoulder has a suspected Axillary nerve injury. Which muscle should you test to assess its motor function?

. Supraspinatus
. Infraspinatus
. Deltoid
. Biceps brachii
. Subscapularis

Correct Answer & Explanation

. Deltoid

Explanation

The axillary nerve innervates the deltoid and teres minor muscles. Therefore, testing the deltoid (e.g., resisted shoulder abduction) is the primary way to assess the motor function of the axillary nerve. Supraspinatus and Infraspinatus are innervated by the suprascapular nerve. Biceps brachii by the musculocutaneous nerve. Subscapularis by the upper and lower subscapular nerves.

Question 2188

Topic: Shoulder & Hip Sports

A patient presents with a chronic, unreduced posterior shoulder dislocation. Which associated complication is MOST likely to lead to poor long-term outcomes even after successful reduction?

. Axillary nerve neuropraxia
. A small Bankart lesion
. Significant reverse Hill-Sachs lesion (impaction fracture)
. Generalized ligamentous laxity
. Concomitant greater tuberosity fracture

Correct Answer & Explanation

. Significant reverse Hill-Sachs lesion (impaction fracture)

Explanation

Chronic posterior dislocations often lead to a large reverse Hill-Sachs lesion (an impaction fracture on the anterior-medial humeral head). If this defect involves a significant portion of the humeral head articular surface (e.g., >25-40%), it can prevent stable reduction and lead to persistent pain, arthritis, and recurrent instability, even after surgical intervention, significantly impacting long-term outcomes. Axillary nerve neuropraxia often recovers. Small Bankart lesions are associated with anterior instability. Generalized laxity is a predisposing factor but not a direct complication of chronic dislocation. Greater tuberosity fractures are associated with anterior dislocations and are typically managed acutely.

Question 2189

Topic: Shoulder & Hip Sports

In the acute assessment of a dislocated shoulder, what is the MOST reliable way to differentiate between an anterior and posterior dislocation on a single, well-centered AP radiograph, if other views are unavailable?

. The 'light bulb sign' for posterior dislocation
. The presence of a Hill-Sachs lesion for anterior dislocation
. The degree of external rotation of the humeral head for anterior dislocation
. The 'rim sign' for posterior dislocation
. The 'trough line sign' for posterior dislocation

Correct Answer & Explanation

. The 'light bulb sign' for posterior dislocation

Explanation

While several signs can suggest a posterior dislocation on an AP view, the 'light bulb sign' is considered the most reliable. This refers to the appearance of the humeral head as uniformly rounded and internally rotated, obscuring the normal profile of the humeral head (the 'handshake sign' or half-moon sign). Hill-Sachs and Bankart lesions are associated with anterior dislocations. The rim sign (widening of the glenohumeral interval) and trough line sign are also for posterior, but the 'light bulb sign' is a common and distinctive feature on AP. Degree of external rotation is usually lost in posterior, but 'light bulb' describes the specific head shape due to fixed internal rotation.

Question 2190

Topic: Shoulder & Hip Sports

Which test is used to assess the integrity of the subscapularis tendon in a patient with a suspected rotator cuff injury accompanying a dislocation?

. Empty Can Test
. External Rotation Lag Sign
. Internal Rotation Lag Sign (or Lift-Off Test)
. Belly Press Test
. Both C and D

Correct Answer & Explanation

. Both C and D

Explanation

Both the Internal Rotation Lag Sign (which is essentially the Lift-Off Test performed with resistance) and the Belly Press Test are used to assess the subscapularis tendon. The Lift-Off Test is performed with the hand behind the back, asking the patient to lift it off their back against resistance. The Belly Press Test involves the patient pressing their hand into their belly with internal rotation force. Empty Can Test is for supraspinatus. External Rotation Lag Sign is for infraspinatus and teres minor.

Question 2191

Topic: Shoulder & Hip Sports

When evaluating the stability of a reduced shoulder, what is the 'Recurrence Rate' primarily influenced by?

. Patient's age at first dislocation
. Mechanism of injury
. Presence of a Hill-Sachs lesion
. Type of initial reduction maneuver
. All of the above

Correct Answer & Explanation

. Patient's age at first dislocation

Explanation

The patient's age at the time of the first dislocation is the single most significant risk factor for recurrent instability. Younger patients (e.g., teenagers and those in their early 20s) have significantly higher recurrence rates (up to 90%) compared to older patients, largely due to higher activity levels and stronger collagen which makes soft tissue healing less robust compared to bone in younger patients, leading to persistent laxity. While other factors contribute, age at first dislocation is paramount. Presence of a Hill-Sachs lesion increases the risk too, but age at first dislocation is the primary driver of recurrence rates.

Question 2192

Topic: Shoulder & Hip Sports

A patient with a dislocated shoulder is suspected of having an associated Bankart lesion. Which imaging study is BEST for visualizing this injury?

. Plain radiographs (AP, lateral, axillary views)
. CT scan without contrast
. MRI without contrast
. MR arthrogram
. Ultrasound

Correct Answer & Explanation

. MR arthrogram

Explanation

A Bankart lesion is a soft tissue injury (labral avulsion). While a bony Bankart lesion (with a bone fragment) can be seen on plain radiographs or CT, a pure soft tissue Bankart lesion is best visualized with an MR arthrogram. The intra-articular contrast distends the joint capsule and outlines the labrum and glenohumeral ligaments, making tears and avulsions much more apparent than on a standard MRI or CT. Ultrasound has limited utility for labral assessment.

Question 2193

Topic: Shoulder & Hip Sports

A patient reports a 'grinding' or 'catching' sensation in their shoulder, particularly when moving their arm overhead. Which labral injury is MOST likely based on this symptom?

. Anterior Bankart lesion
. Posterior labral tear
. SLAP lesion
. HAGL lesion
. Glenoid rim fracture

Correct Answer & Explanation

. SLAP lesion

Explanation

A 'grinding' or 'catching' sensation, particularly with overhead activities, is a common symptom of a superior labral anterior-posterior (SLAP) lesion, as the biceps anchor (which is part of the superior labrum) can be unstable or irritated. While other labral tears can also cause similar symptoms, SLAP lesions are specifically associated with overhead activity and sometimes 'popping' or 'catching.' Bankart and posterior labral tears are more commonly associated with instability or clunking during specific movements. HAGL and glenoid rim fractures are also distinct pathologies.

Question 2194

Topic: Shoulder & Hip Sports

Which finding during an examination for shoulder instability is MOST consistent with a large Hill-Sachs lesion?

. Increased range of motion in internal rotation
. A palpable defect on the anterior glenoid rim
. Engagement of the humeral head defect against the anterior glenoid during external rotation and abduction
. Pain with resisted elbow flexion
. Scapular dyskinesis

Correct Answer & Explanation

. Engagement of the humeral head defect against the anterior glenoid during external rotation and abduction

Explanation

A large Hill-Sachs lesion, which is an impaction fracture on the posterior-superior humeral head, can 'engage' or 'lock' against the anterior glenoid rim during abduction and external rotation. This engagement contributes significantly to recurrent anterior instability. A palpable defect on the anterior glenoid rim would suggest a Bankart lesion. Pain with resisted elbow flexion suggests biceps pathology. Scapular dyskinesis is a pattern of abnormal scapular movement. Increased internal rotation ROM is generally not associated with Hill-Sachs; rather, limited ER due to engagement.

Question 2195

Topic: Shoulder & Hip Sports

Which of the following is considered a 'red flag' during the initial assessment of a shoulder dislocation, mandating immediate senior orthopedic review?

. First-time dislocation in a 20-year-old
. Associated Hill-Sachs lesion
. Absence of radial pulse and cool, pale hand
. History of seizure causing the dislocation
. Pain not fully controlled by oral analgesics

Correct Answer & Explanation

. Absence of radial pulse and cool, pale hand

Explanation

An absent radial pulse combined with signs of ischemia (cool, pale hand) indicates acute limb-threatening vascular compromise (e.g., axillary artery injury), which is a surgical emergency and mandates immediate senior orthopedic and often vascular surgery review. First-time dislocation, Hill-Sachs, and seizure-induced dislocation are common scenarios. While pain control is important, it is not a 'red flag' signaling immediate limb threat like vascular compromise.

Question 2196

Topic: Shoulder & Hip Sports

What is the primary goal of physical examination after reduction of a shoulder dislocation?

. To assess for the presence of a Hill-Sachs lesion
. To confirm stability and rule out neurovascular compromise
. To determine the long-term prognosis for recurrence
. To initiate rehabilitation exercises immediately
. To quantify the amount of glenohumeral arthritis

Correct Answer & Explanation

. To confirm stability and rule out neurovascular compromise

Explanation

After reduction, the primary goals of the physical exam are to confirm that the shoulder is stably reduced (checking for smooth, pain-free range of motion) and to meticulously re-assess neurovascular status to ensure no new compromise has occurred during the reduction maneuver. Hill-Sachs is an pre-existing bony lesion. Long-term prognosis and arthritis are not immediate post-reduction concerns. Immediate aggressive rehab is not typical.

Question 2197

Topic: Shoulder & Hip Sports

A patient presents with a locked anterior shoulder dislocation that has been unreduced for 3 days. What is the MOST appropriate imaging study prior to attempted reduction?

. Plain radiographs only
. MRI of the shoulder
. CT scan of the shoulder
. Ultrasound of the shoulder
. Nuclear bone scan

Correct Answer & Explanation

. CT scan of the shoulder

Explanation

For a chronic or 'locked' dislocation, particularly one unreduced for several days, there is an increased risk of significant associated bony lesions (e.g., large Hill-Sachs, bony Bankart, surgical neck fracture, or glenoid rim fracture) that can complicate reduction or make closed reduction impossible. A CT scan provides excellent bony detail to assess the size and location of these lesions, which is crucial for planning the safest and most effective reduction strategy. While MRI shows soft tissue, bony detail is paramount here. Plain films may miss subtle but significant fractures. Ultrasound and bone scan are not indicated.

Question 2198

Topic: Shoulder & Hip Sports

A 22-year-old athlete sustains a recurrent anterior shoulder dislocation. Preoperative imaging demonstrates an 'engaging' Hill-Sachs lesion. What specific adjunctive surgical procedure is most commonly performed alongside a Bankart repair to address this lesion?

. Latarjet procedure
. Remplissage procedure
. Putti-Platt procedure
. Eden-Hybinette procedure
. Weaver-Dunn procedure

Correct Answer & Explanation

. Remplissage procedure

Explanation

An engaging Hill-Sachs lesion can lever the humeral head out of the glenoid during abduction and external rotation. The Remplissage procedure addresses this by tenodesing the infraspinatus tendon and posterior capsule into the defect, preventing it from engaging the anterior glenoid rim. Latarjet addresses glenoid bone loss.

Question 2199

Topic: Shoulder & Hip Sports
A 25-year-old rugby player presents with recurrent anterior shoulder dislocations, occurring even with minimal trauma. MRI reveals a large bony Bankart lesion (glenoid bone loss >20%) and an engaging Hill-Sachs lesion. Which surgical procedure is most appropriate to address his instability and prevent recurrence?
. Arthroscopic Bankart repair.
. Open capsular shift.
. Latarjet procedure.
. Remplissage procedure.
. Subscapularis tendon transfer.

Correct Answer & Explanation

. Latarjet procedure.

Explanation

For recurrent anterior shoulder instability, particularly in an active patient (e.g., rugby player) with significant glenoid bone loss (greater than 20-25%) and an engaging Hill-Sachs lesion, a Latarjet procedure is generally considered the gold standard. The Latarjet procedure involves transferring the coracoid process with its attached conjoined tendon to the anterior-inferior glenoid. This addresses the bony defect on the glenoid, provides a 'sling effect' from the conjoined tendon, and helps prevent engagement of the Hill-Sachs lesion. Arthroscopic Bankart repair is suitable for soft tissue Bankart lesions with minimal or no bone loss. Open capsular shift addresses capsular laxity but does not adequately manage significant bone loss. The Remplissage procedure fills the Hill-Sachs defect by tenodesing the infraspinatus and posterior capsule into the defect but does not directly address glenoid bone loss. Subscapularis tendon transfer is not a primary procedure for anterior instability.

Question 2200

Topic: Shoulder & Hip Sports

A 22-year-old competitive dancer presents with chronic, debilitating hip pain unresponsive to physical therapy. MRI reveals a large cam-type femoroacetabular impingement (FAI) deformity, labral tearing, and early chondral damage. Diagnostic intra-articular injection provides significant but temporary relief. The patient desires to return to high-level activity. What is the most appropriate surgical intervention?

. Total hip arthroplasty (THA)
. Open surgical dislocation of the hip with osteochondroplasty and labral repair
. Arthroscopic hip osteochondroplasty and labral repair/reconstruction
. Core decompression for avascular necrosis
. Peri-acetabular osteotomy (PAO)

Correct Answer & Explanation

. Arthroscopic hip osteochondroplasty and labral repair/reconstruction

Explanation

For symptomatic cam-type FAI with associated labral tears and early chondral damage in a young, active patient who has failed conservative treatment, hip arthroscopy is the preferred surgical approach. It allows for osteochondroplasty (re-shaping of the femoral head-neck junction to correct the cam deformity), labral repair or reconstruction, and addressing chondral lesions, all while preserving the native hip joint. This minimally invasive approach facilitates an earlier return to activity compared to open procedures. Open surgical dislocation is a more invasive option usually reserved for complex FAI or when arthroscopic treatment is not feasible. THA is for end-stage arthritis, and PAO is for acetabular dysplasia.

Test Yourself

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

On this Page