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Shoulder & Hip Sports MCQs

Practice Set 132 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 2621

Topic: Shoulder & Hip Sports

Which finding on a shoulder X-ray of an 84-year-old is most indicative of early post-traumatic changes following a shoulder dislocation, rather than chronic instability?

. Large Hill-Sachs lesion
. Bony Bankart lesion
. A small glenohumeral joint effusion
. Superior migration of the humeral head
. Glenoid osteophytes

Correct Answer & Explanation

. A small glenohumeral joint effusion

Explanation

A small glenohumeral joint effusion (fluid in the joint space) can be an acute sign of trauma, including dislocation. Large Hill-Sachs and bony Bankart lesions suggest more significant or recurrent trauma. Superior migration of the humeral head indicates chronic rotator cuff deficiency. Glenoid osteophytes are a sign of chronic degenerative change.

Question 2622

Topic: Shoulder & Hip Sports

Which radiographic sign is often observed in the late stages of rotator cuff arthropathy, indicating severe joint destruction?

. Inferior glenohumeral osteophytes
. Widening of the acromioclavicular joint
. Severe superior migration of the humeral head with glenoid erosion
. Absence of a bicipital groove
. Scapular body fracture

Correct Answer & Explanation

. Severe superior migration of the humeral head with glenoid erosion

Explanation

Severe superior migration of the humeral head leading to direct articulation with the acromion, causing both acromial and glenoid erosion, is characteristic of late-stage rotator cuff arthropathy. This indicates extensive loss of the rotator cuff's stabilizing function. Inferior osteophytes are typical of primary OA. AC joint widening implies dislocation. Bicipital groove presence is normal. Scapular body fractures are traumatic.

Question 2623

Topic: Shoulder & Hip Sports

You are asked about the 'Latarjet procedure'. Which specific type of shoulder instability is it primarily indicated for?

. Multidirectional instability.
. Posterior glenohumeral instability.
. Anterior glenohumeral instability with significant glenoid bone loss.
. Superior labrum anterior and posterior (SLAP) tears.
. Rotator cuff tear arthropathy.

Correct Answer & Explanation

. Anterior glenohumeral instability with significant glenoid bone loss.

Explanation

The Latarjet procedure is a bone block procedure primarily indicated for recurrent anterior glenohumeral instability, especially in cases with significant anterior glenoid bone loss (e.g., >20-25% of the inferior glenoid diameter) or in high-demand contact athletes. The transferred coracoid process acts as a bony buttress and has a sling effect on the subscapularis tendon, preventing further anterior dislocation. It is not indicated for the other conditions listed.

Question 2624

Topic: Shoulder & Hip Sports

When interpreting plain radiographs for a patient with shoulder pain, which view is most essential for assessing the acromial morphology and identifying a potential os acromiale?

. AP internal rotation view.
. AP external rotation view.
. Axillary lateral view.
. Scapular Y view.
. Supraspinatus outlet view.

Correct Answer & Explanation

. Supraspinatus outlet view.

Explanation

The Supraspinatus Outlet View (or 'Y' view in some contexts when evaluating the acromial undersurface projection) is specifically designed to visualize the relationship between the humeral head, glenoid, and acromion, providing an excellent profile of the acromion. It's crucial for assessing acromial morphology (e.g., curved, hooked acromion) and detecting an os acromiale, which is a common cause of impingement. The Axillary lateral view is also good for bony anatomy and glenoid version, but the outlet view is superior for acromial shape and os acromiale.

Question 2625

Topic: Shoulder & Hip Sports

You are asked about pain generators in subacromial impingement syndrome. Which structure is generally considered the primary source of pain in most cases?

. The deltoid muscle.
. The articular cartilage of the humeral head.
. The inflamed subacromial bursa and rotator cuff tendons.
. The glenoid labrum.
. The biceps tendon within the bicipital groove.

Correct Answer & Explanation

. The inflamed subacromial bursa and rotator cuff tendons.

Explanation

In subacromial impingement syndrome, the primary pain generators are the inflamed subacromial bursa and the irritated/damaged rotator cuff tendons (supraspinatus, infraspinatus, teres minor, subscapularis). These structures are compressed between the humeral head and the coracoacromial arch during overhead movements, leading to inflammation and pain. While the biceps tendon can be involved (secondary impingement), the bursa and cuff are the most common primary sources of pain.

Question 2626

Topic: Shoulder & Hip Sports

You are asked to distinguish between a Type II SLAP tear and a superior rotator cuff tear during an oral examination. What physical examination maneuver would be most helpful in differentiating these two conditions?

. Apprehension test.
. Neer impingement sign.
. Obrien's Test (Active Compression Test).
. Empty Can Test.
. External Rotation Lag Sign.

Correct Answer & Explanation

. Obrien's Test (Active Compression Test).

Explanation

O'Brien's Test (Active Compression Test) is often used to detect SLAP lesions, with pain during internal rotation and relief with external rotation. While not perfectly specific, it is specifically designed to stress the superior labrum. Neer and Empty Can tests primarily assess rotator cuff pathology/impingement. Apprehension tests instability, and the External Rotation Lag Sign assesses infraspinatus/teres minor. Therefore, O'Brien's is the most helpful differentiator for SLAP vs. RC tears in this context.

Question 2627

Topic: Shoulder & Hip Sports

An examiner asks about the 'painful arc' sign. What is its typical presentation and what pathology does it most commonly suggest?

. Pain during the first 30 degrees of abduction, suggesting adhesive capsulitis.
. Pain during the last 30 degrees of abduction, suggesting AC joint pathology.
. Pain between 60 and 120 degrees of abduction, suggesting subacromial impingement or rotator cuff pathology.
. Pain during resisted external rotation, suggesting infraspinatus tendinopathy.
. Pain with internal rotation and adduction, suggesting posterior impingement.

Correct Answer & Explanation

. Pain between 60 and 120 degrees of abduction, suggesting subacromial impingement or rotator cuff pathology.

Explanation

The 'painful arc' sign is characterized by pain occurring specifically between 60 and 120 degrees of active abduction, which then subsides with further elevation. This finding is highly suggestive of subacromial impingement syndrome or rotator cuff pathology (tendinopathy or partial tear) because the rotator cuff tendons are compressed under the acromion during this arc of motion. Pain at other arcs suggests different pathologies.

Question 2628

Topic: Shoulder & Hip Sports

When discussing imaging for a suspected anterior labral tear in a patient with recurrent instability, what characteristic finding on MRI is highly suggestive of a Bankart lesion?

. Fluid signal within the subacromial bursa.
. Edema within the greater tuberosity.
. Separation of the anterior-inferior labrum from the glenoid rim.
. Thickening of the superior glenohumeral ligament.
. Cystic changes at the inferior glenoid.

Correct Answer & Explanation

. Separation of the anterior-inferior labrum from the glenoid rim.

Explanation

A Bankart lesion is a traumatic avulsion of the anterior-inferior labrum from the glenoid rim, often associated with a tear of the anterior-inferior glenohumeral ligament. On MRI, this presents as a separation or detachment of the labrum from the glenoid, often with surrounding fluid or edema. Fluid in the bursa suggests impingement, greater tuberosity edema can be from contusion or RC tear, and other options are less specific to Bankart.

Question 2629

Topic: Shoulder & Hip Sports

An examiner asks about a patient with a neglected posterior shoulder dislocation. What is the most significant concern regarding reduction in such a case?

. Increased risk of brachial plexus injury.
. Difficulty in achieving reduction due to muscle contracture.
. High likelihood of avascular necrosis of the humeral head following reduction.
. Increased risk of iatrogenic fracture of the humeral head during reduction.
. Increased risk of recurrent dislocation after reduction.

Correct Answer & Explanation

. Increased risk of iatrogenic fracture of the humeral head during reduction.

Explanation

In a neglected posterior shoulder dislocation (typically beyond 3 weeks), the most significant concern during attempted closed reduction is the increased risk of iatrogenic fracture of the humeral head (especially if there's a large reverse Hill-Sachs lesion) due to the humeral head being locked on the posterior glenoid. Avascular necrosis is also a concern, but the acute risk during reduction is fracture. The difficulty in reduction is true, but the primary complication to prevent is bony damage. Recurrence is more an issue of stability after reduction.

Question 2630

Topic: Shoulder & Hip Sports

When discussing the choice between open and arthroscopic repair for a traumatic Bankart lesion in a young, active athlete with recurrent dislocations but minimal bone loss, what is a key advantage of the arthroscopic approach you would highlight?

. Lower recurrence rate compared to open repair.
. Stronger repair construct.
. Better visualization of posterior pathology.
. Less post-operative stiffness.
. Avoidance of subscapularis detachment and potentially faster return to sport.

Correct Answer & Explanation

. Avoidance of subscapularis detachment and potentially faster return to sport.

Explanation

A key advantage of arthroscopic Bankart repair, especially when comparing it to traditional open Bankart repair, is the avoidance of subscapularis detachment. This theoretically leads to less post-operative pain, potentially faster rehabilitation, and an earlier return to sport, as the subscapularis is a critical anterior stabilizer and external rotator. While recurrence rates can be similar in experienced hands with appropriate patient selection, the avoidance of muscle detachment is a clear technical advantage. Less post-operative stiffness is a potential benefit, but avoidance of subscapularis compromise is a more direct advantage.

Question 2631

Topic: Shoulder & Hip Sports

You are asked about the typical presentation of a patient with a full-thickness rotator cuff tear (not acute traumatic). What is the most characteristic finding on physical examination?

. Severe limitation of passive range of motion.
. Gross instability with apprehension tests.
. Weakness and pain with active elevation, especially against resistance.
. Localized tenderness over the bicipital groove.
. Significant crepitus on shoulder circumduction.

Correct Answer & Explanation

. Weakness and pain with active elevation, especially against resistance.

Explanation

For a full-thickness rotator cuff tear, the most characteristic finding on physical examination is weakness and pain with active elevation, particularly against resistance (e.g., positive Empty Can, Jobe's test, or weakness in external rotation against resistance). While pain is common, true weakness in active motion out of proportion to pain is a strong indicator of a tear. Limitation of passive ROM suggests adhesive capsulitis, instability suggests instability, and bicipital groove tenderness suggests biceps pathology.

Question 2632

Topic: Shoulder & Hip Sports

An examiner asks about the appropriate immobilization following a surgical repair of a large rotator cuff tear. What is the generally recommended position and duration for initial immobilization?

. Sling with arm internally rotated for 2 weeks.
. Sling with arm in neutral rotation for 6-8 weeks.
. Abduction pillow sling with arm in slight external rotation for 4-6 weeks.
. Shoulder brace allowing full range of motion immediately.
. Sling without restriction for 1 week.

Correct Answer & Explanation

. Abduction pillow sling with arm in slight external rotation for 4-6 weeks.

Explanation

Following repair of a large rotator cuff tear, immobilization in an abduction pillow sling (or similar device) with the arm in slight abduction and external rotation for 4-6 weeks is a common and generally recommended protocol. This position helps reduce tension on the repair site. While specific protocols vary, prolonged immobilization (e.g., 6-8 weeks in neutral) can lead to stiffness, and insufficient immobilization can jeopardize the repair. Immediate full ROM or internal rotation are generally contraindicated.

Question 2633

Topic: Shoulder & Hip Sports

You are discussing a patient with chronic shoulder pain and a positive 'drop arm test'. What does this test specifically indicate, and what type of pathology is it highly suggestive of?

. Bicipital tendinopathy.
. Glenohumeral instability.
. Full-thickness rotator cuff tear, particularly supraspinatus.
. Adhesive capsulitis.
. Acromioclavicular joint injury.

Correct Answer & Explanation

. Full-thickness rotator cuff tear, particularly supraspinatus.

Explanation

The Drop Arm Test is highly indicative of a full-thickness tear of the rotator cuff, most commonly the supraspinatus tendon. A positive test occurs when the patient cannot smoothly lower their arm from a position of 90 degrees of abduction (after the examiner passively places it there) and the arm 'drops' uncontrollably. It signifies an inability to maintain active abduction against gravity. The other conditions are not primarily assessed by this test.

Question 2634

Topic: Shoulder & Hip Sports

An examiner asks you about the optimal approach for assessing glenoid bone loss in a patient with recurrent anterior shoulder instability. Which imaging modality and specific measurement technique would you recommend?

. Plain AP radiograph with the 'perfect circle' technique.
. MRI with 3D reconstruction using a bone defect angle measurement.
. CT scan with 3D reconstruction using the 'inverted pear' or 'glenoid track' concept.
. Ultrasound with dynamic assessment.
. Plain axillary lateral radiograph to estimate glenoid width.

Correct Answer & Explanation

. CT scan with 3D reconstruction using the 'inverted pear' or 'glenoid track' concept.

Explanation

A CT scan with 3D reconstruction is the gold standard for accurately assessing glenoid bone loss in anterior shoulder instability. Techniques like the 'inverted pear' sign, which compares the width of the inferior glenoid to the mid-glenoid, or direct measurements of the bone defect area on an en face view, and the 'glenoid track' concept, are used to quantify bone loss and guide surgical decision-making. While MRI can show bone loss, CT is superior for precise quantification of bony defects.

Question 2635

Topic: Shoulder & Hip Sports

An examiner asks you about the primary anatomical structure involved in 'Os Acromiale' and its clinical significance.

. A fracture of the acromion.
. A non-union of the coracoid process.
. A failure of fusion of the acromial apophysis.
. An accessory ossicle within the supraspinatus tendon.
. A congenital anomaly of the glenoid.

Correct Answer & Explanation

. A failure of fusion of the acromial apophysis.

Explanation

An os acromiale is a failure of fusion of one or more of the four ossification centers of the acromion, resulting in a separate bone segment. This unfused segment can be mobile and impinge on the rotator cuff, causing subacromial impingement syndrome and predisposing to rotator cuff tears. It is not a fracture, nor is it related to the coracoid, supraspinatus, or glenoid.

Question 2636

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. An MRI shows an engaging Hill-Sachs lesion. According to the glenoid track concept, which of the following best describes the criteria for an 'off-track' Hill-Sachs lesion?

. The Hill-Sachs interval (HSI) is less than the glenoid track width.
. The Hill-Sachs interval (HSI) is greater than the glenoid track width.
. The glenoid bone loss is greater than 10% of the native glenoid width.
. The Hill-Sachs lesion involves the anterior 20% of the humeral head.
. The width of the glenoid track is greater than the bare area of the glenoid.

Correct Answer & Explanation

. The Hill-Sachs interval (HSI) is greater than the glenoid track width.

Explanation

According to the glenoid track concept described by Di Giacomo et al., if the Hill-Sachs interval (HSI) - defined as the width of the Hill-Sachs lesion plus the intact anterior bone bridge - is greater than the glenoid track width (which is 83% of the intact glenoid width minus any anterior bone loss), the lesion will engage the anterior glenoid rim. This is termed an 'off-track' lesion.

Question 2637

Topic: Shoulder & Hip Sports

A 29-year-old male volleyball player presents with isolated weakness in external rotation of the right shoulder. Forward elevation strength is 5/5. MRI reveals a paralabral cyst. At which anatomical location is the cyst most likely compressing the suprascapular nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus muscle and then passes through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (commonly by a paralabral cyst associated with a posterior labral tear) causes isolated infraspinatus weakness (external rotation deficit). Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2638

Topic: Shoulder & Hip Sports

A 24-year-old rugby player has recurrent anterior shoulder instability. CT evaluation demonstrates an engaging Hill-Sachs lesion ('off-track') with 10% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Open Bankart repair with inferior capsular shift
. Humeral head structural allograft reconstruction

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

In the setting of recurrent anterior instability with 'subcritical' glenoid bone loss (typically <15-20%) but an off-track (engaging) Hill-Sachs lesion, arthroscopic Bankart repair combined with a Remplissage procedure (infraspinatus tenodesis and capsulodesis into the defect) effectively converts the lesion to 'on-track' and prevents engagement. Latarjet is generally reserved for critical bone loss (>20%).

Question 2639

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with painless weakness of her dominant shoulder. Physical examination reveals isolated atrophy of the infraspinatus with normal supraspinatus bulk and strength. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. Compression at the suprascapular notch affects both muscles. However, as the nerve traverses the spinoglenoid notch, it innervates only the infraspinatus. Therefore, a lesion at the spinoglenoid notch (commonly a paralabral cyst associated with a posterior labral tear) results in isolated infraspinatus atrophy and weakness.

Question 2640

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer with an irreparable posterosuperior rotator cuff tear is evaluated for a latissimus dorsi tendon transfer. He has intact forward elevation to 100 degrees but persistent pain and severe external rotation weakness. Which of the following preoperative findings is a recognized contraindication to a successful latissimus dorsi transfer?

. Gouty arthropathy of the acromioclavicular joint
. An intact teres minor
. Infraspinatus atrophy (Goutallier stage 3)
. An irreparable tear of the subscapularis
. Mild glenohumeral osteoarthritis

Correct Answer & Explanation

. An irreparable tear of the subscapularis

Explanation

A successful latissimus dorsi transfer for a massive posterosuperior cuff tear relies on an intact force couple in the transverse plane. An irreparable subscapularis tear compromises the anterior aspect of this force couple, making a latissimus dorsi transfer functionally ineffective and historically a strict contraindication. Advanced age, deltoid deficiency, and pseudoparalysis are also contraindications.

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