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Shoulder & Hip Sports MCQs

Practice Set 135 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 2681

Topic: Shoulder & Hip Sports
In a patient undergoing surgical repair for a Rockwood Type III AC joint injury, what type of sling or brace is typically used post-operatively to support the arm and protect the repair?
. Figure-of-eight clavicle brace.
. Gunslinger brace.
. Shoulder immobilizer with an abduction pillow.
. Standard arm sling or a sling with a waist strap.
. Dynamic shoulder orthosis.

Correct Answer & Explanation

. Standard arm sling or a sling with a waist strap.

Explanation

Following surgical repair of an AC joint injury, a standard arm sling or a sling with a waist strap is typically used for comfort and to protect the repair by limiting abduction and rotation. A figure-of-eight brace is for clavicle shaft fractures. A gunslinger brace is for certain glenohumeral injuries. An abduction pillow immobilizer is commonly used after rotator cuff repair or shoulder instability surgery. Dynamic orthoses are for complex rehab. The key is protection without excessive immobility.

Question 2682

Topic: Shoulder & Hip Sports
A 35-year-old weightlifter presents with chronic pain and clicking at his right AC joint following an untreated Rockwood Type III injury 2 years prior. He has significant distal clavicle prominence and pain with overhead pressing. What salvage procedure might be considered for his symptoms?
. Acute CC ligament reconstruction.
. Arthroscopic Bankart repair.
. Distal clavicle excision (Mumford procedure).
. Total shoulder arthroplasty.
. Rotator cuff repair.

Correct Answer & Explanation

. Distal clavicle excision (Mumford procedure).

Explanation

For chronic, symptomatic AC joint injuries, particularly those with persistent pain, clicking, or degenerative changes often leading to impingement after a previous dislocation, distal clavicle excision (Mumford procedure) is a common salvage procedure. This involves resecting a small portion of the distal clavicle to create space and alleviate pain, typically performed either open or arthroscopically. Acute CC ligament reconstruction is for acute instability. Other options are for different pathologies.

Question 2683

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness in external rotation. Exam reveals normal internal rotation and abduction strength. MRI demonstrates a paralabral cyst located strictly in the spinoglenoid notch. Which muscle is predominantly affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Infraspinatus

Explanation

A cyst in the spinoglenoid notch compresses the distal suprascapular nerve, specifically and exclusively affecting the infraspinatus muscle. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2684

Topic: Shoulder & Hip Sports

A 32-year-old male presents with a locked posterior shoulder dislocation and a 30% reverse Hill-Sachs defect following an unprovoked seizure. What is the most appropriate surgical treatment to address the humeral head defect and prevent recurrent instability?

. Arthroscopic Bankart repair
. Latarjet procedure
. Transfer of the subscapularis tendon into the defect (McLaughlin procedure)
. Remplissage procedure
. Hemiarthroplasty

Correct Answer & Explanation

. Transfer of the subscapularis tendon into the defect (McLaughlin procedure)

Explanation

For reverse Hill-Sachs defects between 20-40% associated with posterior shoulder instability, transferring the lesser tuberosity or the subscapularis tendon into the defect (McLaughlin or modified McLaughlin procedure) is indicated. Defects >40-50% typically require arthroplasty.

Question 2685

Topic: Shoulder & Hip Sports

A 21-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% anterior glenoid bone loss. Postoperatively, he exhibits weakness in elbow flexion and decreased sensation over the lateral forearm. Which nerve was most likely injured during the procedure?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Suprascapular nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis approximately 3-8 cm distal to the coracoid process. It is at significant risk during coracoid osteotomy, mobilization, and transfer in the Latarjet procedure.

Question 2686

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 28% anterior glenoid bone loss and a significant engaging Hill-Sachs lesion. Which of the following procedures is most appropriate to restore stability?

. Arthroscopic Bankart repair
. Open capsular shift
. Arthroscopic Remplissage alone
. Latarjet procedure
. Subscapularis advancement

Correct Answer & Explanation

. Latarjet procedure

Explanation

The Latarjet procedure (coracoid transfer) is indicated for recurrent anterior shoulder instability with critical glenoid bone loss (>20-25%). It provides stability via the triple-blocking effect: bone block, sling effect of the conjoined tendon, and capsular repair.

Question 2687

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. CT imaging reveals a 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Coracoid transfer (Latarjet procedure)
. Open inferior capsular shift

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

Critical anterior glenoid bone loss (>20-25%) in a young, high-demand collision athlete is an absolute indication for a bony augmentation procedure like the Latarjet. Soft tissue stabilization alone (Bankart repair) in this scenario has an unacceptably high recurrence rate.

Question 2688

Topic: Shoulder & Hip Sports

A 50-year-old laborer presents with pseudoparalysis of external rotation due to a massive, irreparable tear of the supraspinatus and infraspinatus. His subscapularis is intact, and he has no glenohumeral arthritis. Which of the following is the most appropriate tendon transfer?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Either Latissimus dorsi or Lower trapezius transfer

Correct Answer & Explanation

. Either Latissimus dorsi or Lower trapezius transfer

Explanation

Latissimus dorsi and lower trapezius tendon transfers are both indicated to restore active external rotation and forward elevation in young patients with massive, irreparable posterosuperior rotator cuff tears without arthropathy. Pectoralis major transfer is indicated for irreparable subscapularis tears.

Question 2689

Topic: Shoulder & Hip Sports

During an anatomic Total Shoulder Arthroplasty (TSA), which surgical management of the subscapularis has been biomechanically shown to provide the highest rate of structural healing?

. Subscapularis tenotomy
. Subscapularis peel from the lesser tuberosity
. Lesser tuberosity osteotomy (LTO)
. Z-lengthening of the subscapularis tendon

Correct Answer & Explanation

. Lesser tuberosity osteotomy (LTO)

Explanation

A lesser tuberosity osteotomy (LTO) utilizes bone-to-bone healing, which provides the strongest and most reliable structural healing of the subscapularis footprint. Soft tissue healing in tenotomy or peel techniques has historically shown higher rates of failure and subsequent subscapularis insufficiency.

Question 2690

Topic: Shoulder & Hip Sports

A 55-year-old male presents with severe anterior shoulder pain and internal rotation weakness following a fall on the ice. Which of the following physical exam findings is most specific for a full-thickness tear of the upper border of the subscapularis?

. Positive Jobe's test
. Positive Hornblower's sign
. Positive Bear Hug test
. Positive O'Brien's test

Correct Answer & Explanation

. Positive Bear Hug test

Explanation

The Bear Hug test and the Belly Press test are specific clinical maneuvers designed to evaluate the integrity of the subscapularis. A positive test indicates subscapularis weakness or tearing. Hornblower's assesses the teres minor.

Question 2691

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is transferred to the anterior glenoid neck. Which anatomical structures make up the 'conjoined tendon' that provides the dynamic sling effect in this transfer?

. Short head of the biceps and coracobrachialis
. Long head of the biceps and coracobrachialis
. Pectoralis minor and short head of the biceps
. Short head of the biceps and brachialis

Correct Answer & Explanation

. Short head of the biceps and coracobrachialis

Explanation

The conjoined tendon attached to the tip of the coracoid consists of the short head of the biceps brachii and the coracobrachialis. When transferred through the subscapularis split in a Latarjet, these muscles create a dynamic sling that reinforces the anterior inferior capsule when the arm is abducted and externally rotated.

Question 2692

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. A preoperative 3D CT scan reveals a 28% anteroinferior glenoid bone defect. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with remplissage
. Arthroscopic thermal capsulorrhaphy
. Latarjet procedure
. Putti-Platt procedure
. Open Bankart repair without bone grafting

Correct Answer & Explanation

. Latarjet procedure

Explanation

Anteroinferior glenoid bone loss exceeding 20-25% is a critical defect that typically results in the failure of soft-tissue only stabilization. A bone block augmentation procedure, such as the Latarjet (coracoid transfer), is indicated to restore glenohumeral stability.

Question 2693

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. MRI reveals a paralabral cyst in the spinoglenoid notch. Which physical exam finding is most likely present?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the infraspinatus
. Positive lift-off test
. Scapular winging with forward flexion against resistance
. Complete loss of active forward elevation

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch selectively affects the infraspinatus muscle, leading to isolated atrophy and external rotation weakness. Proximal compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 2694

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with a massive, irreparable posterosuperior rotator cuff tear. He has no significant glenohumeral osteoarthritis. A latissimus dorsi tendon transfer is being considered. Which of the following is an absolute prerequisite for a successful functional outcome following this procedure?

. Intact coracoacromial ligament
. Intact subscapularis function
. Complete tear of the teres minor
. Preoperative forward flexion of at least 150 degrees
. Advanced fatty infiltration of the subscapularis

Correct Answer & Explanation

. Intact subscapularis function

Explanation

A latissimus dorsi transfer requires an intact and functioning subscapularis (as well as an intact deltoid) to provide an anterior counterforce for the transferred tendon. Subscapularis deficiency is a contraindication to this procedure.

Question 2695

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher presents with posterior shoulder pain. Examination reveals a significant glenohumeral internal rotation deficit (GIRD) of his throwing shoulder compared to the contralateral side. What is the initial treatment of choice?

. Posterior capsular stretching program
. Arthroscopic posterior capsular release
. Arthroscopic SLAP repair
. Anterior capsuloplication
. Open anterior capsular shift

Correct Answer & Explanation

. Posterior capsular stretching program

Explanation

GIRD is caused by contracture of the posterior inferior capsule and is initially treated with a targeted posterior capsular stretching program (e.g., sleeper stretches). Surgical intervention is reserved for refractory cases.

Question 2696

Topic: Shoulder & Hip Sports

The Latarjet procedure provides anterior shoulder stability through a "triple blocking" effect. Which of the following provides the dynamic sling effect when the arm is abducted and externally rotated?

. The coracoacromial ligament
. The conjoint tendon
. The inferior glenohumeral ligament
. The subscapularis muscle
. The long head of the biceps

Correct Answer & Explanation

. The conjoint tendon

Explanation

The dynamic stabilization (sling effect) in the Latarjet procedure is provided by the conjoint tendon acting across the anteroinferior capsule when the arm is placed in abduction and external rotation.

Question 2697

Topic: Shoulder & Hip Sports

A 23-year-old overhead athlete presents with recurrent anterior shoulder instability. Advanced imaging is obtained.

The concept of the 'glenoid track' is utilized to evaluate his bipolar bone loss. Which of the following defines an 'off-track' Hill-Sachs lesion?

. The medial margin of the Hill-Sachs lesion remains lateral to the glenoid track during abduction and external rotation.
. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating it will engage the anterior glenoid rim.
. The lateral margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating an intact capsular attachment.
. The subchondral bone of the humerus is entirely intact without impaction.
. The glenoid bone loss is greater than 25% but the humerus is entirely normal.

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating it will engage the anterior glenoid rim.

Explanation

The glenoid track is the contact zone of the glenoid on the humeral head during shoulder abduction and external rotation. If the medial margin of a Hill-Sachs lesion extends further medially than the medial border of the glenoid track, it is considered 'off-track'. This means the lesion will slide over and 'engage' the anterior glenoid rim, causing a dislocation. Such lesions require specific treatment (like a remplissage or Latarjet) in addition to an anterior stabilization.

Question 2698

Topic: Shoulder & Hip Sports

During the arthroscopic repair of a massive rotator cuff tear, preserving the 'suspensory cable' of the shoulder is deemed critical for mechanical function. The rotator cable is a thick, fibrous bundle that extends primarily between which two structures?

. Coracoid process and the greater tuberosity
. Biceps brachii long head tendon and the inferior glenohumeral ligament
. Coracohumeral ligament and the triceps tendon
. Anterior aspect of the supraspinatus and the inferior aspect of the infraspinatus
. Acromion and the lesser tuberosity

Correct Answer & Explanation

. Anterior aspect of the supraspinatus and the inferior aspect of the infraspinatus

Explanation

The rotator cable is a thick bundle of fibers running perpendicular to the rotator cuff tendon fibers. It acts like a suspension bridge, shielding the thinner, avascular 'crescent' region from excess stress. It spans from anterior to the biceps tendon (anterior margin of the supraspinatus) to the inferior margin of the infraspinatus tendon.

Question 2699

Topic: Shoulder & Hip Sports

In the preoperative evaluation of recurrent anterior shoulder instability, the 'glenoid track' concept is utilized to predict failure of isolated soft tissue stabilization. A bipolar bone loss lesion is considered 'off-track' if which of the following is true?

. The Hill-Sachs lesion is narrower than the intact glenoid articular track
. The Hill-Sachs lesion engages the anterior rim of the glenoid when the arm is positioned in abduction and external rotation
. The glenoid bone loss alone exceeds 25% of the inferior glenoid diameter
. The Hill-Sachs lesion is completely covered by the intact posterior rotator cuff footprint
. The defect primarily involves the posterior superior labrum without bony avulsion

Correct Answer & Explanation

. The Hill-Sachs lesion engages the anterior rim of the glenoid when the arm is positioned in abduction and external rotation

Explanation

An 'off-track' Hill-Sachs lesion extends medially past the medial margin of the glenoid track. Clinically and biomechanically, this means the lesion will engage the anterior rim of the glenoid in functional positions (abduction/external rotation), thereby predicting a high failure rate for an isolated Bankart repair. Such cases usually require a Remplissage procedure or a bony augmentation (e.g., Latarjet).

Question 2700

Topic: Shoulder & Hip Sports

In a patient with a massive rotator cuff tear, superior migration of the humeral head indicates disruption of the coronal plane force couple. Which two muscle groups primarily constitute this force couple?

. Subscapularis and Infraspinatus
. Deltoid and the inferior rotator cuff (infraspinatus, subscapularis, teres minor)
. Supraspinatus and Deltoid
. Pectoralis major and Latissimus dorsi
. Teres major and Coracobrachialis

Correct Answer & Explanation

. Deltoid and the inferior rotator cuff (infraspinatus, subscapularis, teres minor)

Explanation

The coronal plane force couple involves the deltoid pulling superiorly and the inferior rotator cuff (infraspinatus, subscapularis, teres minor) providing a compressive, inferiorly directed force. When the cuff fails, the deltoid acts unopposed, causing superior humeral migration.

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