Menu

Shoulder & Hip Sports MCQs

Practice Set 114 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 2261

Topic: Shoulder & Hip Sports

A 22-year-old male athlete presents with recurrent anterior shoulder dislocations. Pre-operative imaging and 3D CT reconstruction indicate an engaging Hill-Sachs lesion and a 26% anterior glenoid bone loss. What is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Coracoid transfer procedure (Latarjet)
. Open inferior capsular shift
. Putti-Platt procedure

Correct Answer & Explanation

. Coracoid transfer procedure (Latarjet)

Explanation

In the setting of recurrent anterior shoulder instability with significant anterior glenoid bone loss (>20-25%), soft tissue stabilization alone (Bankart repair) is associated with an unacceptably high failure rate. Bony augmentation is required. The Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid) provides a 'triple blocking' effect (bone, sling, and capsule) and is the gold standard for significant glenoid bone loss.

Question 2262

Topic: Shoulder & Hip Sports

A 24-year-old male manual laborer presents with recurrent anterior shoulder instability. A 3D CT scan reveals 28% glenoid bone loss and a large, engaging Hill-Sachs lesion. Which of the following surgical procedures is the most appropriate definitive management?

. Arthroscopic Bankart repair alone
. Open Bankart repair with inferior capsular shift
. Arthroscopic remplissage with Bankart repair
. Coracoid transfer (Latarjet procedure)
. Subscapularis advancement (Putti-Platt procedure)

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

Critical glenoid bone loss in anterior shoulder instability is generally accepted to be >20-25%. Soft tissue procedures (Bankart repair, with or without remplissage) have a high failure rate when significant glenoid bone loss is present. The Latarjet procedure (transfer of the coracoid process to the anterior glenoid) provides both a bony block and a dynamic sling effect (via the conjoined tendon) and is the gold standard for instability with >25% glenoid bone loss.

Question 2263

Topic: Shoulder & Hip Sports

A 22-year-old male athlete presents with recurrent anterior shoulder dislocations. A 3D CT scan reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion, indicating an 'off-track' lesion. What is the gold standard surgical intervention to restore stability in this patient?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Putti-Platt procedure
. Humeral head osteochondral allograft

Correct Answer & Explanation

. Latarjet procedure

Explanation

For anterior shoulder instability with critical glenoid bone loss (greater than 20-25%), isolated soft tissue repairs have unacceptably high failure rates. The Latarjet procedure (coracoid transfer) is the standard of care.

Question 2264

Topic: Shoulder & Hip Sports

A 40-year-old male experiences a first-time seizure and subsequently complains of shoulder pain. Radiographs demonstrate a posterior shoulder dislocation with an anteromedial humeral head impression fracture (reverse Hill-Sachs lesion) involving 25% of the articular surface. What is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Open reduction and subscapularis transfer (McLaughlin procedure)
. Latarjet procedure
. Total shoulder arthroplasty
. Hemiarthroplasty

Correct Answer & Explanation

. Open reduction and subscapularis transfer (McLaughlin procedure)

Explanation

A reverse Hill-Sachs lesion involving 20-40% of the articular surface is commonly managed with the McLaughlin procedure (transfer of the subscapularis into the defect) or its modification (lesser tuberosity transfer). This prevents the defect from engaging the posterior glenoid rim.

Question 2265

Topic: Shoulder & Hip Sports

A Bankart lesion is classically described as an avulsion of the anteroinferior labrum and attached capsule from the glenoid rim. What is the associated bony injury resulting from impaction of the humeral head against the anterior glenoid rim?

. Reverse Hill-Sachs lesion
. ALPSA lesion
. GLAD lesion
. Hill-Sachs lesion
. HAGL lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A Hill-Sachs lesion is an osteochondral impaction fracture of the posterosuperior aspect of the humeral head. It occurs when the humeral head dislocates anteriorly and impacts forcefully against the hard cortical bone of the anterior glenoid rim.

Question 2266

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of shoulder weakness. Examination reveals isolated weakness in external rotation with the arm at the side, but full strength in shoulder abduction. Atrophy is noted over the posterior scapula below the spine. Entrapment of the suprascapular nerve at which of the following anatomical locations best explains this specific deficit?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Subcoracoid space

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus (abduction) and infraspinatus (external rotation). If the nerve is entrapped at the suprascapular notch, both muscles are affected. If it is entrapped more distally at the spinoglenoid notch (commonly by a paralabral cyst in overhead athletes), it causes isolated denervation and weakness of the infraspinatus, sparing the supraspinatus.

Question 2267

Topic: Shoulder & Hip Sports

A 13-year-old obese male undergoes in-situ percutaneous pinning for a stable Slipped Capital Femoral Epiphysis (SCFE). Over the next 5 years, he develops progressively worsening anterior hip pain and a decrease in hip internal rotation. What is the most common long-term mechanical complication of an unreduced SCFE pinned in-situ?

. Chondrolysis
. Avascular necrosis of the femoral head
. Subtrochanteric fracture
. Cam-type femoroacetabular impingement (FAI)
. Pincer-type femoroacetabular impingement (FAI)

Correct Answer & Explanation

. Cam-type femoroacetabular impingement (FAI)

Explanation

In-situ pinning of a SCFE arrests slip progression but leaves a residual proximal femoral deformity (the metaphysis remains prominent anteriorly and superiorly). This abnormal morphology frequently results in cam-type femoroacetabular impingement (FAI), causing labral damage and early-onset hip osteoarthritis.

Question 2268

Topic: Shoulder & Hip Sports

When calculating the 'glenoid track' to evaluate a patient with recurrent anterior shoulder instability and an engaging Hill-Sachs lesion, which of the following formulas is used to determine the width of the glenoid track?

. 83% of the intact glenoid width minus the anterior bone loss
. 100% of the intact glenoid width minus the anterior bone loss
. 83% of the intact glenoid width plus the anterior bone loss
. The Hill-Sachs interval divided by the intact glenoid width
. 50% of the intact glenoid width minus the Hill-Sachs depth

Correct Answer & Explanation

. 83% of the intact glenoid width minus the anterior bone loss

Explanation

The glenoid track width is calculated as 83% of the inferior true intact glenoid width minus the width of the anterior glenoid bone defect. If the Hill-Sachs Interval (HSI) is greater than the glenoid track width, the lesion is considered 'off-track' and is at high risk of engaging over the anterior glenoid rim.

Question 2269

Topic: Shoulder & Hip Sports

A 24-year-old rugby player with recurrent anterior shoulder instability is undergoing preoperative evaluation. The 'glenoid track' concept is used to determine his risk of recurrent postoperative dislocation. An 'off-track' Hill-Sachs lesion is best managed by arthroscopic Bankart repair with which concurrent procedure?

. Latarjet coracoid transfer
. Arthroscopic remplissage
. Superior labrum anterior to posterior (SLAP) repair
. Subscapularis peel and advancement
. Proximal biceps tenodesis

Correct Answer & Explanation

. Arthroscopic remplissage

Explanation

An 'off-track' Hill-Sachs lesion indicates that the humeral head defect engages the anterior glenoid rim during abduction and external rotation. To prevent this engagement and recurrent dislocation, a remplissage (filling the defect with the infraspinatus tendon) is performed concurrently with a Bankart repair.

Question 2270

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, the concept of the 'glenoid track' is used to determine surgical management. A Hill-Sachs lesion is designated as 'off-track' when which of the following conditions is met?

. The medial margin of the Hill-Sachs lesion remains lateral to the medial margin of the glenoid track.
. The medial margin of the Hill-Sachs lesion extends medially beyond the medial margin of the glenoid track.
. The defect involves greater than 10% of the humeral head articular surface.
. The glenoid bone loss is less than 5% without any bipolar lesion.
. The Hill-Sachs lesion only engages during internal rotation and adduction.

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion extends medially beyond the medial margin of the glenoid track.

Explanation

A Hill-Sachs lesion is 'off-track' if its medial margin extends further medially than the medial margin of the glenoid track (calculated as 83% of the glenoid width, minus any anterior bone loss). Off-track lesions will engage the anterior glenoid rim during abduction/external rotation, leading to instability, and typically require a Remplissage procedure or bone block in addition to a Bankart repair.

Question 2271

Topic: Shoulder & Hip Sports
A 24-year-old elite baseball pitcher complains of vague, deep shoulder pain and decreased throwing velocity. He has a positive active compression test (O'Brien's). MR arthrogram reveals a Type II SLAP tear. What is the defining anatomical feature of a Type II SLAP tear?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum extending into the biceps tendon
. An anteroinferior labral tear extending superiorly to the biceps anchor

Correct Answer & Explanation

. Detachment of the superior labrum and biceps anchor from the superior glenoid

Explanation

According to Snyder's classification: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

Question 2272

Topic: Shoulder & Hip Sports

A 55-year-old laborer undergoes an arthroscopic massive rotator cuff repair. Six months postoperatively, MRI reveals a retear. Which of the following preoperative MRI findings is most strongly associated with structural failure of rotator cuff healing?

. Age under 60
. Acromioclavicular osteoarthritis
. Goutallier grade 3 or higher fatty infiltration
. Type II acromion
. Subacromial bursitis

Correct Answer & Explanation

. Goutallier grade 3 or higher fatty infiltration

Explanation

Advanced fatty infiltration (Goutallier grade 3 or 4) and muscle atrophy are irreversible changes. They are strongly predictive of poor clinical outcomes and structural failure after rotator cuff repair.

Question 2273

Topic: Shoulder & Hip Sports

In evaluating a patient with recurrent anterior shoulder instability, the concept of the "glenoid track" is utilized to determine the risk of an engaging Hill-Sachs lesion. The glenoid track width is calculated based on which of the following?

. 83% of the intact glenoid width minus the anterior glenoid bone loss
. The full width of the intact glenoid minus the anterior glenoid bone loss
. 83% of the Hill-Sachs lesion width
. The diameter of the humeral head minus the Hill-Sachs depth
. 75% of the intact glenoid width

Correct Answer & Explanation

. 83% of the intact glenoid width minus the anterior glenoid bone loss

Explanation

The glenoid track is approximately 83% of the width of the intact inferior glenoid. To calculate the patient's specific track, the width of the anterior glenoid bone defect is subtracted from this value.

Question 2274

Topic: Shoulder & Hip Sports

A 35-year-old volleyball player presents with isolated weakness in external rotation of the shoulder but normal abduction strength. An MRI shows a paralabral ganglion cyst causing nerve compression. Where is the cyst most likely located?

. Quadrangular space
. Suprascapular notch
. Spinoglenoid notch
. Triangular interval
. Cubital tunnel

Correct Answer & Explanation

. Quadrangular space

Explanation

Isolated weakness of external rotation (infraspinatus) with preserved abduction (supraspinatus) implies compression of the suprascapular nerve after it has innervated the supraspinatus. This occurs at the spinoglenoid notch. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2275

Topic: Shoulder & Hip Sports

The rotator interval is a capsular space in the shoulder that is often implicated in glenohumeral instability and adhesive capsulitis. What are the correct boundaries of the rotator interval?

. Supraspinatus superiorly, subscapularis inferiorly, and the base of the coracoid medially.
. Teres minor superiorly, subscapularis inferiorly, and the glenoid medially.
. Infraspinatus superiorly, supraspinatus inferiorly, and the acromion medially.
. Long head of biceps superiorly, short head of biceps inferiorly, and the transverse humeral ligament laterally.
. Subscapularis superiorly, pectoralis major inferiorly, and the conjoined tendon medially.

Correct Answer & Explanation

. Supraspinatus superiorly, subscapularis inferiorly, and the base of the coracoid medially.

Explanation

The rotator interval is bounded superiorly by the anterior margin of the supraspinatus tendon, inferiorly by the superior margin of the subscapularis tendon, laterally by the transverse humeral ligament, and medially by the base of the coracoid process. It contains the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 2276

Topic: Shoulder & Hip Sports

During closed reduction of a proximal humerus fracture, a patient sustains an iatrogenic injury to the axillary nerve. Which of the following muscles would most likely demonstrate denervation on electromyography?

. Supraspinatus and Infraspinatus
. Teres major and Subscapularis
. Deltoid and Teres minor
. Pectoralis major and Deltoid
. Latissimus dorsi and Teres major

Correct Answer & Explanation

. Supraspinatus and Infraspinatus

Explanation

The axillary nerve is derived from the posterior cord of the brachial plexus (C5-C6). It provides motor innervation to the deltoid and the teres minor muscles, and provides sensation to the lateral aspect of the shoulder via the superior lateral brachial cutaneous nerve.

Question 2277

Topic: Shoulder & Hip Sports

A volleyball player presents with isolated weakness in external rotation of the shoulder but normal abduction initiation. MRI shows a paralabral cyst. Where is the cyst most likely located?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the motor branch to the infraspinatus, causing isolated external rotation weakness. Entrapment at the suprascapular notch would also affect the supraspinatus.

Question 2278

Topic: Shoulder & Hip Sports

A 35-year-old male presents with posterior shoulder pain and numbness over the lateral deltoid. An MRI reveals a space-occupying lesion in the quadrilateral space. Which of the following structures form the superior and inferior borders of this space, respectively?

. Teres minor and Teres major
. Teres major and Teres minor
. Supraspinatus and Infraspinatus
. Teres minor and Latissimus dorsi
. Subscapularis and Teres major

Correct Answer & Explanation

. Teres minor and Teres major

Explanation

The quadrilateral space is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the humeral shaft. It transmits the axillary nerve and posterior circumflex humeral vessels.

Question 2279

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the conjoined tendon is retracted medially. The musculocutaneous nerve typically penetrates the coracobrachialis at what average distance distal to the tip of the coracoid process?

. 1 to 2 cm
. 3 to 8 cm
. 9 to 12 cm
. 13 to 15 cm
. 15 to 20 cm

Correct Answer & Explanation

. 1 to 2 cm

Explanation

The musculocutaneous nerve enters the medial aspect of the coracobrachialis roughly 3 to 8 cm (average 5 cm) distal to the tip of the coracoid process. Vigorous distal or medial retraction of the conjoined tendon can cause severe neuropraxia.

Question 2280

Topic: Shoulder & Hip Sports

A professional volleyball player presents with insidious onset, painless weakness of shoulder external rotation. MRI reveals a paralabral cyst located in the spinoglenoid notch. Which muscle exhibits denervation atrophy?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Supraspinatus

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch spares the supraspinatus but causes isolated infraspinatus denervation.

Test Yourself

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

On this Page