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Shoulder & Hip Sports MCQs

Practice Set 115 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 2281

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder without any deficit in abduction. At which of the following anatomical locations is the involved nerve compression most likely occurring?

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

Correct Answer & Explanation

. Quadrangular space

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus (abduction) and infraspinatus (external rotation).

Question 2282

Topic: Shoulder & Hip Sports

An Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion differs from a classic Bankart lesion in which of the following ways?

. The ALPSA lesion involves an avulsion of the greater tuberosity.
. In an ALPSA lesion, the anterior labrum remains attached to the periosteum and displaces medially and inferiorly.
. A classic Bankart lesion includes a fracture of the anterior glenoid rim.
. ALPSA lesions only occur with posterior shoulder dislocations.
. ALPSA lesions do not require surgical repair due to their high spontaneous healing rate.

Correct Answer & Explanation

. The ALPSA lesion involves an avulsion of the greater tuberosity.

Explanation

An ALPSA lesion involves the anterior labrum being stripped from the glenoid margin but remaining attached to the intact periosteum of the scapula. It typically rolls medially and inferiorly down the glenoid neck. A classic Bankart lesion is a complete avulsion of the labrum and capsule without intact periosteum.

Question 2283

Topic: Shoulder & Hip Sports

A 22-year-old hockey player presents with groin pain worsened by hip flexion and internal rotation. Radiographs reveal a cam-type deformity. What anatomical location on the proximal femur is most commonly associated with a cam lesion?

. Anteromedial head-neck junction
. Anterolateral head-neck junction
. Posteromedial head-neck junction
. Posterolateral head-neck junction
. Greater trochanter

Correct Answer & Explanation

. Anteromedial head-neck junction

Explanation

Cam impingement is typically caused by an aspherical femoral head with decreased offset, most commonly located at the anterolateral head-neck junction. This causes abutment against the anterosuperior acetabular rim during flexion and internal rotation.

Question 2284

Topic: Shoulder & Hip Sports
During arthroscopic evaluation of a shoulder, the surgeon identifies a tear of the superior third of the subscapularis tendon. According to the Fox/Romeo classification, what type of tear does this represent?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

In the Fox/Romeo classification of subscapularis tears: Type I is a partial thickness tear, Type II is a full-thickness tear of the upper 25% (or upper third), Type III is a full-thickness tear of the upper 50%, Type IV is a full-thickness tear involving the entire tendon with the humeral head centered, and Type V is a complete tear with anterior subluxation of the humeral head.

Question 2285

Topic: Shoulder & Hip Sports

The supraspinatus and infraspinatus tendons insert on the greater tuberosity. Which of the following accurately describes the anatomy of the supraspinatus footprint?

. It is broad anteriorly and tapers posteriorly, inserting on the superior facet.
. It is broad posteriorly and tapers anteriorly, inserting on the middle facet.
. It inserts primarily on the lesser tuberosity.
. It has a larger footprint area than the infraspinatus.
. It inserts exclusively on the inferior facet of the greater tuberosity.

Correct Answer & Explanation

. It is broad anteriorly and tapers posteriorly, inserting on the superior facet.

Explanation

The supraspinatus tendon footprint is described as triangular, being broader anteriorly and tapering posteriorly, and inserts on the superior facet of the greater tuberosity. The infraspinatus has a much larger footprint overall, covering the middle facet and sweeping anteriorly to cover part of the superior facet.

Question 2286

Topic: Shoulder & Hip Sports
A baseball pitcher complains of deep shoulder pain during the cocking phase of throwing. MRI arthrogram suggests a Type II SLAP tear. What is the defining 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 that extends into the biceps tendon
. An anteroinferior labral tear extending superiorly

Correct Answer & Explanation

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

Explanation

The Snyder classification of SLAP tears: Type I is fraying of the labrum with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor from the superior glenoid rim. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear that extends into the long head of the biceps tendon.

Question 2287

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss.

What is the primary dynamic stabilizing mechanism of this procedure?

. The osseous block increasing the anteroposterior diameter of the glenoid
. The capsular repair to the coracoacromial ligament stump
. The sling effect of the conjoint tendon across the anterior-inferior capsule when the arm is abducted and externally rotated
. The tensioning of the subscapularis muscle belly
. The creation of a functional tenodesis of the long head of the biceps

Correct Answer & Explanation

. The osseous block increasing the anteroposterior diameter of the glenoid

Explanation

While the Latarjet provides an osseous block (static), its primary dynamic stabilizing effect is the 'sling effect'. The conjoint tendon tensions across the anterior-inferior capsule during abduction and external rotation, preventing anterior translation.

Question 2288

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. MRI reveals a paralabral cyst compressing a nerve at the spinoglenoid notch. Which muscle(s) will most likely exhibit denervation changes on EMG?

. Supraspinatus only
. Infraspinatus only
. Supraspinatus and Infraspinatus
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Supraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch. Compression at the spinoglenoid notch isolatedly affects the nerve branches to the infraspinatus, causing isolated external rotation weakness.

Question 2289

Topic: Shoulder & Hip Sports

A 25-year-old hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 65 degrees. What is the primary pathomorphologic mechanism of cartilage damage in this condition?

. Contrecoup injury to the posteroinferior labrum
. Delamination of the anterosuperior acetabular cartilage due to a shear force from the femoral neck
. Direct crushing of the anterior labrum between the femoral head and pincer lesion
. Attrition of the ligamentum teres leading to microinstability
. Posterior subluxation of the femoral head causing posterior labral tears

Correct Answer & Explanation

. Contrecoup injury to the posteroinferior labrum

Explanation

An alpha angle >55 degrees is diagnostic of Cam impingement. The non-spherical femoral head exerts severe shear forces on the acetabular rim during flexion, classically causing anterosuperior chondral delamination from the subchondral bone.

Question 2290

Topic: Shoulder & Hip Sports

A 21-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Arthroscopy reveals 'kissing lesions' consisting of fraying of the articular-sided posterior supraspinatus and posterosuperior labrum. This internal impingement pathology is classically associated with which glenohumeral physical exam finding?

. Glenohumeral internal rotation deficit (GIRD)
. Positive belly-press test
. Positive Hornblower's sign
. Increased anterior translation on load and shift test
. Glenohumeral external rotation deficit

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD)

Explanation

Internal impingement in overhead throwers occurs when the articular side of the rotator cuff impinges against the posterosuperior glenoid. It is classically driven by acquired contracture of the posterior capsule, presenting clinically as Glenohumeral Internal Rotation Deficit (GIRD).

Question 2291

Topic: Shoulder & Hip Sports

A 19-year-old collegiate wrestler requires a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. The "sling effect" provided by this procedure is primarily dependent on which of the following structures?

. Coracoacromial ligament
. Pectoralis minor tendon
. Conjoint tendon
. Subscapularis tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Coracoacromial ligament

Explanation

The Latarjet procedure provides stability via a triple blocking effect. The dynamic "sling effect" of the conjoint tendon across the inferior subscapularis when the arm is abducted and externally rotated is a critical component.

Question 2292

Topic: Shoulder & Hip Sports

In the surgical management of Femoroacetabular Impingement (FAI), a cam lesion is typically addressed. This lesion causes cartilage damage primarily through which of the following mechanisms?

. Chondral delamination on the anterosuperior acetabulum via shear forces
. Global pincer-type compression of the labrum
. Impaction of the fovea capitis against the transverse acetabular ligament
. Hypertrophy of the ligamentum teres
. Avulsion of the rectus femoris origin

Correct Answer & Explanation

. Chondral delamination on the anterosuperior acetabulum via shear forces

Explanation

A cam lesion results from decreased femoral head-neck offset. As it enters the joint in flexion, it creates shear forces that lead to classic outside-in chondral delamination and labral tears at the anterosuperior acetabulum.

Question 2293

Topic: Shoulder & Hip Sports

A 20-year-old football player sustains an anterior shoulder dislocation. MRI reveals an "off-track" Hill-Sachs lesion. In addition to an arthroscopic Bankart repair, which procedure is most indicated to prevent recurrent instability?

. Latarjet procedure
. Arthroscopic remplissage
. Coracoid transfer to the lesser tuberosity
. Pectoralis major transfer
. SLAP repair

Correct Answer & Explanation

. Latarjet procedure

Explanation

An "off-track" Hill-Sachs lesion engages the anterior glenoid rim during abduction and external rotation, predicting failure of isolated Bankart repair. Arthroscopic remplissage (capsulotenodesis of the infraspinatus into the defect) effectively converts it to a non-engaging, on-track lesion.

Question 2294

Topic: Shoulder & Hip Sports

When evaluating a patient with a suspected rotator cuff tear, which of the following physical examination tests is most sensitive and specific for identifying an isolated upper subscapularis tendon tear?

. Jobe's (Empty can) test
. Belly-press test
. Lift-off test
. Bear-hug test
. Hornblower's sign

Correct Answer & Explanation

. Jobe's (Empty can) test

Explanation

The Bear-hug test is highly sensitive and specific for upper subscapularis tears. In contrast, the Lift-off test is more specific to the lower portion of the subscapularis tendon.

Question 2295

Topic: Shoulder & Hip Sports

Which of the following statements accurately describes the calculation of the 'Glenoid Track' in evaluating anterior shoulder instability?

. 83% of the inferior glenoid width minus the anterior glenoid bone loss
. 100% of the inferior glenoid width plus the Hill-Sachs width
. The superior-to-inferior diameter of the glenoid minus the bone loss
. 83% of the superior glenoid width minus the posterior glenoid bone loss
. The distance from the bare spot to the anterior rim multiplied by two

Correct Answer & Explanation

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

Explanation

The glenoid track is calculated as 83% of the normal inferior glenoid width subtracted by the amount of anterior glenoid bone loss. A Hill-Sachs lesion wider than this track is considered 'off-track' and carries a higher risk of engagement and recurrent dislocation.

Question 2296

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in shoulder external rotation. MRI reveals a paralabral cyst located at the spinoglenoid notch. Which labral pathology is most commonly associated with this specific finding?

. Anterior Bankart tear
. Anterosuperior labral tear
. Posterior SLAP or posteroinferior labral tear
. Superior labral tear extending into the biceps root
. ALPSA lesion

Correct Answer & Explanation

. Anterior Bankart tear

Explanation

Paralabral cysts at the spinoglenoid notch typically cause isolated suprascapular nerve compression affecting only the infraspinatus. They are highly associated with posterior SLAP or posteroinferior labral tears, which allow synovial fluid to leak and form the cyst.

Question 2297

Topic: Shoulder & Hip Sports

During an interscalene nerve block for a rotator cuff repair, the patient inadvertently receives an intravascular injection of bupivacaine and subsequently develops seizures and ventricular arrhythmias. The toxic mechanism of this drug is primarily due to the blockade of which of the following cellular ion channels?

. Voltage-gated calcium channels
. Ligand-gated chloride channels
. Voltage-gated sodium channels
. ATP-sensitive potassium channels
. NMDA receptors

Correct Answer & Explanation

. Voltage-gated calcium channels

Explanation

Local anesthetics like bupivacaine act by binding to the intracellular portion of voltage-gated sodium channels, preventing sodium influx and thus inhibiting action potential propagation. Systemic toxicity (LAST) primarily affects the CNS and myocardium through this same massive sodium channel blockade.

Question 2298

Topic: Shoulder & Hip Sports

The coracoacromial arch is an important anatomical restraint that prevents superior translation of the humeral head and is often implicated in subacromial impingement syndrome. The coracoacromial ligament attaches to which two osseous structures?

. Coracoid process and greater tuberosity
. Coracoid process and lesser tuberosity
. Coracoid process and anterior undersurface of the acromion
. Acromion and distal clavicle
. Coracoid process and proximal clavicle

Correct Answer & Explanation

. Coracoid process and greater tuberosity

Explanation

The coracoacromial ligament forms the roof of the subacromial space. It attaches medially to the lateral border of the coracoid process and laterally to the anterior undersurface of the acromion. Thickening of this ligament or acromial osteophytes can lead to impingement of the underlying rotator cuff.

Question 2299

Topic: Shoulder & Hip Sports

When reviewing an MRI for a patient with suprascapular neuropathy, a cyst is identified at the spinoglenoid notch. Which of the following clinical findings is most likely associated with compression at this specific anatomical location?

. Isolated weakness in external rotation
. Weakness in both internal and external rotation
. Isolated weakness in arm abduction
. Weakness in arm abduction and external rotation
. Loss of sensation over the lateral deltoid

Correct Answer & Explanation

. Isolated weakness in external rotation

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. A cyst exclusively at the spinoglenoid notch causes isolated infraspinatus weakness.

Question 2300

Topic: Shoulder & Hip Sports

A 24-year-old overhead athlete presents with painless weakness of external shoulder rotation. MRI demonstrates a paralabral cyst causing compression at the spinoglenoid notch. Which of the following represents the expected clinical and anatomical findings?

. Isolated atrophy of the infraspinatus with intact sensation
. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the teres minor with numbness over the lateral deltoid
. Atrophy of the supraspinatus with preserved infraspinatus function
. Weakness of external rotation with sensory loss over the posterior scapula

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus with intact sensation

Explanation

The suprascapular nerve gives off its motor branch to the supraspinatus before passing through the spinoglenoid notch. Compression at the spinoglenoid notch therefore causes isolated infraspinatus weakness and atrophy, without sensory deficits.

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