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Shoulder & Hip Sports MCQs

Practice Set 113 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 2241

Topic: Shoulder & Hip Sports

During a deltopectoral approach for open reduction and internal fixation of a proximal humerus fracture, the surgeon encounters the 'three sisters'. These structures consist of two venae comitantes and which of the following arteries?

. Thoracoacromial artery
. Posterior circumflex humeral artery
. Anterior circumflex humeral artery
. Acromial branch of the suprascapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Anterior circumflex humeral artery

Explanation

The 'three sisters' refer to the anterior circumflex humeral artery and its two accompanying veins. They are consistently found running transversely across the inferior border of the subscapularis muscle and often require ligation to mobilize the subscapularis.

Question 2242

Topic: Shoulder & Hip Sports

In a displaced surgical neck fracture of the humerus, the proximal shaft is typically displaced anteromedially. Which muscle is the primary deforming force responsible for this specific displacement?

. Deltoid
. Latissimus dorsi
. Pectoralis major
. Subscapularis
. Biceps brachii

Correct Answer & Explanation

. Pectoralis major

Explanation

In surgical neck fractures, the pectoralis major acts as the primary deforming force on the humeral shaft, pulling it medially and anteriorly. Meanwhile, the proximal fragment remains neutral or abducted due to the balanced pull of the rotator cuff muscles.

Question 2243

Topic: Shoulder & Hip Sports

An 80-year-old female presents with an anterior shoulder dislocation and an expanding axillary hematoma. A traction injury to the axillary artery is suspected. The axillary artery is formally divided into three distinct anatomical parts by which of the following structures?

. Pectoralis major
. Pectoralis minor
. Teres major
. Subscapularis
. Clavicle

Correct Answer & Explanation

. Pectoralis minor

Explanation

The axillary artery is anatomically divided into three segments based on its relationship to the pectoralis minor muscle. The first part is medial, the second part lies posterior, and the third part lies lateral to the pectoralis minor.

Question 2244

Topic: Shoulder & Hip Sports

Which of the following is the most sensitive test for subacromial impingement syndrome?

. Cross-body adduction test
. Speed's test
. Hawkins-Kennedy test
. Empty Can test
. Drop arm test

Correct Answer & Explanation

. Hawkins-Kennedy test

Explanation

The Hawkins-Kennedy test is considered one of the most sensitive tests for subacromial impingement syndrome. It involves internally rotating the arm with the shoulder flexed to 90 degrees and the elbow flexed to 90 degrees, which causes the supraspinatus tendon to impinge under the coracoacromial arch. The Empty Can test and Drop Arm test are more specific for rotator cuff tears, particularly the supraspinatus. Speed's test is for biceps pathology. Cross-body adduction test is for AC joint pathology.

Question 2245

Topic: Shoulder & Hip Sports

Which muscle is primarily responsible for the initiation of shoulder abduction in the first 15-30 degrees?

. Deltoid
. Pectoralis major
. Latissimus dorsi
. Supraspinatus
. Teres major

Correct Answer & Explanation

. Supraspinatus

Explanation

The supraspinatus muscle is primarily responsible for initiating shoulder abduction (first 15-30 degrees) before the deltoid muscle takes over for the remainder of the range. The deltoid is a powerful abductor but is less efficient at initiation. Pectoralis major and latissimus dorsi are adductors and internal rotators. Teres major is an adductor and internal rotator.

Question 2246

Topic: Shoulder & Hip Sports

Which rotator cuff muscle is primarily responsible for internal rotation of the shoulder?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Subscapularis

Explanation

The subscapularis muscle is the primary internal rotator of the shoulder and is one of the four rotator cuff muscles. The supraspinatus is responsible for abduction. The infraspinatus and teres minor are external rotators. The deltoid is a major abductor and flexor/extensor, but not a rotator cuff muscle.

Question 2247

Topic: Shoulder & Hip Sports

What is the primary function of the subscapularis tendon in the shoulder?

. Abduction
. External rotation
. Internal rotation
. Adduction
. Flexion

Correct Answer & Explanation

. Internal rotation

Explanation

The subscapularis is one of the four rotator cuff muscles and is the primary internal rotator of the shoulder. It also contributes to shoulder adduction. The supraspinatus is an abductor, and the infraspinatus and teres minor are external rotators. The deltoid is a major abductor.

Question 2248

Topic: Shoulder & Hip Sports

What is the primary goal of conservative management for rotator cuff tendinopathy without a full-thickness tear?

. Eliminate all shoulder pain permanently
. Avoid all overhead activities indefinitely
. Improve rotator cuff strength and scapular mechanics
. Initiate corticosteroid injections early
. Prepare for inevitable surgical repair

Correct Answer & Explanation

. Improve rotator cuff strength and scapular mechanics

Explanation

The primary goal of conservative management for rotator cuff tendinopathy is to improve rotator cuff strength, restore proper scapular mechanics, and optimize neuromuscular control of the shoulder. This addresses underlying biomechanical deficits that contribute to impingement and tendon overload. While pain reduction is a goal, complete elimination of pain may not always be achievable, and the focus is on functional restoration. Avoidance of overhead activities is temporary, not indefinite. Corticosteroid injections offer short-term relief but do not address the root cause and are not always initiated early. Surgical repair is typically reserved for failed conservative management or full-thickness tears.

Question 2249

Topic: Shoulder & Hip Sports

A 38-year-old male presents with chronic insidious onset of groin pain, worse with activity and prolonged sitting. He denies trauma. Physical exam reveals pain with FADIR (flexion-adduction-internal rotation) and FABER (flexion-abduction-external rotation) tests. Radiographs show a prominent anterior inferior iliac spine (AIIS) and an alpha angle of 70 degrees. What is the most likely diagnosis?

. Osteoarthritis of the hip.
. Femoroacetabular impingement (FAI), cam type.
. Femoroacetabular impingement (FAI), pincer type.
. Sports hernia (athletic pubalgia).
. Stress fracture of the femoral neck.

Correct Answer & Explanation

. Femoroacetabular impingement (FAI), cam type.

Explanation

The clinical presentation of chronic groin pain, positive FADIR and FABER tests, and a high alpha angle (70 degrees) are classic for femoroacetabular impingement (FAI), specifically the cam type. A cam deformity describes an aspherical femoral head-neck junction that abuts the acetabular rim during hip flexion and internal rotation. A prominent anterior inferior iliac spine (AIIS) can contribute to a form of extra-articular impingement (subspine impingement) which sometimes coexists with pincer or cam morphology, but the elevated alpha angle is the defining radiographic feature of cam-type FAI. Osteoarthritis is typically a consequence of long-standing FAI, not the primary diagnosis in a 38-year-old with these specific findings. Sports hernia is an athletic pubalgia, which presents differently, primarily with lower abdominal or adductor pain. Stress fractures usually have a more acute onset and distinct radiographic findings.

Question 2250

Topic: Shoulder & Hip Sports

Which of the following conditions is an indication for surgical management of an acute rotator cuff tear?

. Small, partial-thickness tear in an elderly, sedentary patient.
. Full-thickness tear (>1 cm) in a young, active patient with acute trauma and significant weakness.
. Chronic, asymptomatic full-thickness tear.
. Degenerative full-thickness tear with minimal pain and good function.
. Impingement syndrome without a documented tear.

Correct Answer & Explanation

. Full-thickness tear (>1 cm) in a young, active patient with acute trauma and significant weakness.

Explanation

Surgical repair of an acute rotator cuff tear is strongly indicated in a young, active patient who sustains a full-thickness tear (especially greater than 1 cm) from acute trauma and experiences significant weakness. In this demographic and tear pattern, surgical repair offers the best chance for restoring function, preventing tear enlargement, and avoiding future degenerative changes. Small, partial tears, or tears in elderly/sedentary patients, or chronic asymptomatic/degenerative tears are often managed conservatively first. Impingement syndrome without a tear is also managed conservatively.

Question 2251

Topic: Shoulder & Hip Sports

Which of the following tendons forms part of the 'rotator cuff' of the shoulder?

. Long head of the biceps brachii
. Pectoralis major
. Deltoid
. Supraspinatus
. Teres major

Correct Answer & Explanation

. Supraspinatus

Explanation

The rotator cuff is composed of four muscles and their tendons: supraspinatus, infraspinatus, teres minor, and subscapularis (SITS muscles). The supraspinatus is one of these four. The long head of the biceps brachii passes through the rotator cuff but is not part of it. Pectoralis major, deltoid, and teres major are not rotator cuff muscles.

Question 2252

Topic: Shoulder & Hip Sports

A 65-year-old female presents with chronic shoulder pain, weakness, and difficulty lifting her arm above her head. Physical examination reveals atrophy of the supraspinatus and infraspinatus muscles, a positive 'drop arm' test, and significant weakness with external rotation. Which of the following is the most likely diagnosis?

. Adhesive capsulitis.
. Subacromial impingement syndrome.
. Glenohumeral osteoarthritis.
. Massive rotator cuff tear.
. Bicipital tendinopathy.

Correct Answer & Explanation

. Massive rotator cuff tear.

Explanation

The combination of chronic pain, weakness, difficulty with overhead motion, atrophy of specific rotator cuff muscles (supraspinatus, infraspinatus), and a positive 'drop arm' test (inability to smoothly lower the arm from abduction) is highly indicative of a massive rotator cuff tear, often involving multiple tendons. Adhesive capsulitis primarily causes global stiffness. Impingement syndrome is typically painful arc syndrome without significant weakness or muscle atrophy. Glenohumeral osteoarthritis causes pain and stiffness, but rotator cuff signs are not primary. Bicipital tendinopathy causes anterior shoulder pain.

Question 2253

Topic: Shoulder & Hip Sports

A 58-year-old female presents with sudden onset of severe right shoulder pain and an inability to actively abduct or externally rotate her arm after lifting a heavy box. On examination, she has a positive 'hook test' and a visible 'Popeye' deformity in her upper arm. Which tendon is most likely injured?

. Supraspinatus tendon.
. Infraspinatus tendon.
. Subscapularis tendon.
. Long head of biceps tendon.
. Teres minor tendon.

Correct Answer & Explanation

. Long head of biceps tendon.

Explanation

The sudden onset of shoulder pain, inability to abduct/externally rotate (suggesting rotator cuff involvement), and specifically the 'Popeye' deformity (a bulge in the distal upper arm) along with a positive 'hook test' (for biceps pathology) are classic signs of a rupture of the long head of the biceps tendon. While rotator cuff injury is also likely, the 'Popeye' sign is pathognomonic for biceps rupture. Supraspinatus, infraspinatus, subscapularis, and teres minor are rotator cuff muscles but do not present with a 'Popeye' deformity upon rupture.

Question 2254

Topic: Shoulder & Hip Sports

A 30-year-old male presents with recurrent episodes of shoulder dislocation. Examination reveals anterior apprehension with the arm in abduction and external rotation, and a palpable defect on the posterior aspect of the humeral head on MRI. This defect is known as a:

. Bankart lesion.
. SLAP lesion.
. Hill-Sachs lesion.
. Reverse Bankart lesion.
. Os acromiale.

Correct Answer & Explanation

. Hill-Sachs lesion.

Explanation

The scenario describes recurrent anterior shoulder dislocation with an anterior apprehension sign. The defect on the posterior aspect of the humeral head, caused by impaction against the anterior inferior glenoid rim during dislocation, is known as a Hill-Sachs lesion. A Bankart lesion is an injury to the anterior inferior labrum and glenoid rim. A SLAP (Superior Labrum Anterior to Posterior) lesion involves the superior labrum. A reverse Bankart lesion is a posterior inferior labrum tear associated with posterior dislocation. Os acromiale is an unfused acromial apophysis.

Question 2255

Topic: Shoulder & Hip Sports

A 50-year-old construction worker complains of right shoulder pain, especially when lifting his arm overhead. He describes a 'catching' sensation and weakness with abduction. Physical exam reveals a positive Neer's and Hawkins' test. Resisted external rotation is weak. What is the most likely diagnosis?

. Adhesive capsulitis.
. Glenohumeral osteoarthritis.
. Rotator cuff tear.
. Bicipital tendinitis.
. Acromioclavicular joint arthritis.

Correct Answer & Explanation

. Rotator cuff tear.

Explanation

The patient's symptoms of pain with overhead activity, weakness with abduction and external rotation, and positive impingement signs (Neer's and Hawkins' tests) are highly suggestive of a rotator cuff tear. Resisted external rotation weakness specifically points to involvement of the supraspinatus or infraspinatus, both part of the rotator cuff. Adhesive capsulitis presents with global stiffness. Glenohumeral osteoarthritis typically causes grinding and limited range of motion, often in older patients. Bicipital tendinitis causes anterior shoulder pain. AC joint arthritis causes localized pain at the top of the shoulder.

Question 2256

Topic: Shoulder & Hip Sports

Which of the following describes the most common type of rotator cuff tear and its anatomical location?

. Subscapularis tear at its insertion on the lesser tuberosity.
. Infraspinatus tear at its musculotendinous junction.
. Supraspinatus tear at its insertion on the greater tuberosity.
. Teres minor tear at its insertion on the greater tuberosity.
. Biceps tendon tear in the bicipital groove.

Correct Answer & Explanation

. Supraspinatus tear at its insertion on the greater tuberosity.

Explanation

The supraspinatus tendon is the most commonly torn rotator cuff tendon, and tears most frequently occur at its insertion on the greater tuberosity. This area is vulnerable due to its location under the acromion, making it susceptible to impingement and wear. The other options describe less common sites or different tendons/structures.

Question 2257

Topic: Shoulder & Hip Sports

A patient with a traumatic brachial plexus injury presents with a 'waiter's tip' posture (shoulder adducted and internally rotated, elbow extended, forearm pronated, wrist flexed). Which nerve roots are most likely affected?

. C8-T1
. C7-C8
. C5-C6
. T1-T2
. C6-C7

Correct Answer & Explanation

. C5-C6

Explanation

The 'waiter's tip' posture is characteristic of an Erb's palsy, which results from injury to the upper trunk of the brachial plexus, primarily involving the C5 and C6 nerve roots. This affects muscles innervated by these roots, including the deltoid, supraspinatus, infraspinatus, biceps, and brachialis, leading to the described posture. C8-T1 injuries cause Klumpke's palsy, affecting intrinsic hand muscles.

Question 2258

Topic: Shoulder & Hip Sports

A 25-year-old male sustains a traumatic anterior shoulder dislocation. After successful closed reduction, what is the most important imaging study to obtain if he reports recurrent instability?

. Standard shoulder radiographs (AP, scapular Y, axillary views)
. CT scan with 3D reconstruction
. MRI with intravenous contrast (arthrogram)
. Ultrasound of the rotator cuff
. Nerve conduction studies

Correct Answer & Explanation

. MRI with intravenous contrast (arthrogram)

Explanation

For recurrent shoulder instability, particularly after a traumatic dislocation, an MRI with intravenous contrast (arthrogram) is the most important imaging study. It provides the best visualization of soft tissue injuries associated with instability, such as a Bankart lesion (labral tear), Hill-Sachs lesion (osseous defect on the humeral head), HAGL lesion, or capsular laxity. Standard radiographs are good for initial diagnosis and bony lesions but lack soft tissue detail. CT scans are excellent for bony defects but less so for labral tears. Ultrasound is primarily for rotator cuff tears. Nerve conduction studies are for neurological deficits.

Question 2259

Topic: Shoulder & Hip Sports

A 40-year-old male presents with lateral hip pain, worse with walking, lying on the affected side, and prolonged sitting. Physical examination reveals tenderness over the greater trochanter and pain reproduction with resisted hip abduction. Radiographs are normal. What is the most likely diagnosis?

. Trochanteric bursitis
. Gluteus medius tear
. Femoral neck stress fracture
. Labral tear of the hip
. Osteoarthritis of the hip

Correct Answer & Explanation

. Gluteus medius tear

Explanation

The symptoms of lateral hip pain, tenderness over the greater trochanter, and pain with resisted hip abduction are classic for pathology involving the gluteus medius or minimus tendons, collectively known as 'greater trochanteric pain syndrome.' While 'trochanteric bursitis' is a common historical term, current understanding suggests that abductor tendinopathy (tear or degeneration) is the primary pathology in most cases, often accompanied by bursitis. Gluteus medius tear is a specific and accurate diagnosis within this spectrum. Femoral neck stress fracture would cause deep groin/hip pain, worse with impact, and often show signs on advanced imaging. Labral tears cause anterior hip or groin pain, often with clicking. Osteoarthritis of the hip causes deep groin pain, stiffness, and restricted range of motion.

Question 2260

Topic: Shoulder & Hip Sports

Which of the following is a classic finding on physical examination for a patient with a complete rupture of the pectoralis major tendon?

. Winged scapula.
. Pain and weakness with internal rotation of the humerus.
. Lack of palpable tendon with a 'divot' or defect in the anterior axillary fold.
. Positive Hawkins' sign.
. Inability to abduct the arm beyond 90 degrees.

Correct Answer & Explanation

. Lack of palpable tendon with a 'divot' or defect in the anterior axillary fold.

Explanation

A complete rupture of the pectoralis major tendon (typically at the humeral insertion) is characterized by a lack of a palpable tendon and a 'divot' or defect in the anterior axillary fold. The muscle belly may also retract medially, creating an asymmetry compared to the contralateral side. Patients experience pain and weakness, particularly with resisted adduction and internal rotation. Winged scapula is associated with serratus anterior or trapezius palsy. Positive Hawkins' sign is for subacromial impingement. Inability to abduct the arm beyond 90 degrees can be due to rotator cuff tears or severe impingement, not specific to pectoralis major rupture.

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