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 2741
Topic: Shoulder & Hip Sports
A 21-year-old athlete sustains recurrent anterior shoulder dislocations. Preoperative imaging reveals an "engaging" Hill-Sachs lesion. What specific biomechanical criterion defines this lesion as "engaging"?
Correct Answer & Explanation
. It aligns parallel to the anterior glenoid rim when the shoulder is in abduction and external rotation
Explanation
An "engaging" Hill-Sachs lesion is one whose long axis becomes parallel to the anterior rim of the glenoid when the shoulder is placed in functional abduction and external rotation. This alignment allows the defect to drop over the rim and lever the head out of joint.
Question 2742
Topic: Shoulder & Hip Sports
A 45-year-old male undergoes an open reduction and internal fixation of a proximal humerus fracture via a deltopectoral approach. Postoperatively, he has profound weakness in shoulder abduction and numbness over the lateral aspect of the shoulder. The injured nerve exits the axilla through a specific anatomic space. What are the borders of this space?
Correct Answer & Explanation
. Teres minor (superior), teres major (inferior), long head of triceps (medial), surgical neck of humerus (lateral).
Explanation
Correct Answer: AThe patient has an iatrogenic axillary nerve injury. The axillary nerve and the posterior circumflex humeral artery exit the axilla posteriorly through the quadrilateral space. The borders of the quadrilateral space are: superiorly the teres minor (viewed posteriorly) or subscapularis (viewed anteriorly), inferiorly the teres major, medially the long head of the triceps, and laterally the surgical neck of the humerus.
Question 2743
Topic: Shoulder & Hip Sports
What is the typical characteristic finding on physical examination for a patient with a complete rupture of the pectoralis major tendon?
Correct Answer & Explanation
. Asymmetry of the anterior axillary fold and weakness in adduction/internal rotation.
Explanation
A complete rupture of the pectoralis major tendon typically presents with an asymmetry of the anterior axillary fold (loss of contour on the affected side) and significant weakness in shoulder adduction and internal rotation. A 'Popeye' deformity is characteristic of a biceps brachii rupture. Loss of external rotation is more common with rotator cuff injuries. Inability to abduct past 90 degrees points to rotator cuff or deltoid dysfunction. Deltoid atrophy suggests axillary nerve injury. Therefore, the combination of a visibly flattened axillary fold and functional weakness in its primary actions are key indicators of a pectoralis major rupture.
Question 2744
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. An arthroscopic view from the posterior portal viewing the articular surface of the supraspinatus is shown. The lesion is identified as a partial articular-sided supraspinatus tendon avulsion (PASTA). If this lesion involves greater than 50% of the tendon thickness, which of the following is an accepted surgical management strategy?
Correct Answer & Explanation
. Transtendon arthroscopic repair
Explanation
Correct Answer: Transtendon arthroscopic repairThe images demonstrate a PASTA lesion (Partial Articular-Sided Tendon Avulsion). When a PASTA lesion involves greater than 50% of the tendon footprint thickness, surgical repair is generally indicated. An accepted and common technique is a transtendon arthroscopic repair, which allows the surgeon to secure the articular-sided tear down to the footprint without taking down the intact bursal-sided tissue. This preserves the intact lateral fibers of the rotator cuff while restoring the medial footprint anatomy.
Question 2745
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. MRI and arthroscopic images are provided. The pathology shown is best described as:
Correct Answer & Explanation
. A partial articular-sided supraspinatus tendon avulsion
Explanation
Correct Answer: A partial articular-sided supraspinatus tendon avulsionThe images demonstrate a partial articular surface supraspinatus tear (PASTA lesion). The arthroscopic view from the posterior portal shows the articular surface of the supraspinatus with partial tearing. These tears are a common source of shoulder pain and are often amenable to transtendon arthroscopic repair without detachment of the intact bursal surface.
Question 2746
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. MRI and arthroscopic images are provided. The arthroscopic view from the posterior portal demonstrates a partial articular-sided supraspinatus tendon avulsion (PASTA). Which of the following is an accepted surgical management strategy for this lesion if it involves greater than 50% of the tendon thickness?
Correct Answer & Explanation
. Transtendon arthroscopic repair without detachment of the intact bursal surface
Explanation
Correct Answer: AThe images show a partial articular surface supraspinatus tear (PASTA lesion). When these tears involve greater than 50% of the tendon thickness, surgical repair is often indicated. A common and effective technique is a transtendon arthroscopic repair, which secures the articular-sided avulsion while preserving the intact bursal surface of the tendon. Acromioplasty alone does not address the structural tendon defect.
Question 2747
Topic: Shoulder & Hip Sports
A 45-year-old man sustained a distal radius fracture treated with cast immobilization. He subsequently developed severe shoulder stiffness. After 6 months of physical therapy, his forward elevation is 130 degrees, but external rotation at the side is limited to 5 degrees. Which of the following structures is most likely contracted and requires arthroscopic release?
Correct Answer & Explanation
. Rotator cuff interval (coracohumeral and superior glenohumeral ligaments)
Explanation
Correct Answer: CIsolated or disproportionate loss of external rotation with the arm at the side is the clinical hallmark of a contracted rotator cuff interval, which includes the coracohumeral ligament and the superior glenohumeral ligament. Arthroscopic release of the rotator cuff interval is the treatment of choice when conservative management fails to restore external rotation.
Question 2748
Topic: Shoulder & Hip Sports
An 8-year-old child presents with anterior hip pain and a 'popping' sensation during physical activity. Radiographs are normal. What condition would be least likely in the differential diagnosis given this presentation and age?
Correct Answer & Explanation
. Developmental dysplasia of the hip (presenting with subtle instability)
Explanation
Transient synovitis is common in younger children (ages 3-8, peak at 6), often follows a viral illness, and typically causes acute, painful limp without 'popping' or chronic anterior hip pain over months. While an 8-year-old is within the age range, the chronic nature of the 'popping' and activity-related pain makes other diagnoses more likely. Labral tears, FAI, and iliopectineal bursitis can all cause anterior hip pain and mechanical symptoms like 'popping' in this age group, though FAI is typically more in adolescents. DDH, even if subclinical, can manifest with subtle instability leading to pain and 'popping' in older children.
Question 2749
Topic: Shoulder & Hip Sports
A 70-year-old active gardener develops progressive left shoulder pain and stiffness. Radiographs show joint space narrowing, subchondral sclerosis, and osteophytes. There is also evidence of superior migration of the humeral head and superior glenoid erosion. What is the most likely etiology of his glenohumeral arthritis?
Correct Answer & Explanation
. Rotator cuff arthropathy
Explanation
The combination of superior migration of the humeral head, superior glenoid erosion, and degenerative changes (joint space narrowing, sclerosis, osteophytes) is highly characteristic of rotator cuff arthropathy (RCAT). RCAT results from long-standing, massive, irreparable rotator cuff tears, leading to superior subluxation of the humeral head and subsequent degenerative changes. Primary OA typically presents with concentric narrowing without superior migration unless the rotator cuff is also involved. Post-traumatic arthritis requires a history of significant trauma. Rheumatoid arthritis typically involves symmetric joint destruction, pannus formation, and may present with osteopenia rather than sclerosis, and AVN would show specific changes within the humeral head itself.
Question 2750
Topic: Shoulder & Hip Sports
A 58-year-old female undergoes a shoulder MRI for chronic pain and limited motion. The report describes extensive chondral loss on both the glenoid and humeral head, subchondral edema, and a small full-thickness tear of the supraspinatus tendon. Which of these MRI findings provides the most direct evidence of glenohumeral osteoarthritis?
Correct Answer & Explanation
. Extensive chondral loss on the glenoid and humeral head
Explanation
Extensive chondral loss (cartilage damage) on the articular surfaces of the glenoid and humeral head is the most direct and fundamental MRI finding indicative of glenohumeral osteoarthritis. While the other findings may be associated (subacromial bursitis, rotator cuff tears, labral fraying, and bone marrow edema from stress response or associated pathology), chondral lossisthe defining characteristic of arthritis on imaging. Subacromial bursitis and bone marrow edema in the greater tuberosity often relate to impingement or rotator cuff pathology. Labral fraying can occur in OA but is not the primary diagnostic feature.
Question 2751
Topic: Shoulder & Hip Sports
Which statement regarding the use of computed tomography (CT) scans in the workup of glenohumeral osteoarthritis is most accurate?
Correct Answer & Explanation
. CT provides excellent visualization of glenoid bone loss, version, and subluxation for preoperative planning.
Explanation
CT is particularly valuable for assessing bone morphology, glenoid bone loss, glenoid version (retroversion), and the extent of humeral head subluxation, which are critical parameters for surgical planning, especially for total shoulder arthroplasty. It provides a detailed, three-dimensional view of the bony architecture. MRI is superior for soft tissue evaluation (rotator cuff, labrum, cartilage, marrow edema). While plain radiographs are the initial imaging, CT's utility for detailed bony assessment in advanced OA for surgical planning is distinct and crucial, making the radiation exposure acceptable for specific indications.
Question 2752
Topic: Shoulder & Hip Sports
A 75-year-old patient presents with a history of long-standing, symptomatic glenohumeral osteoarthritis. On examination, you note significant atrophy of the infraspinatus and supraspinatus muscles. Plain radiographs show marked superior migration of the humeral head, severe joint space narrowing, and erosion of the superior glenoid. What is the most likely additional finding on an MRI if performed?
Correct Answer & Explanation
. Large rotator cuff tear
Explanation
The clinical presentation (infraspinatus/supraspinatus atrophy) combined with radiographic findings (superior migration of humeral head, severe joint space narrowing, superior glenoid erosion) are classic indicators of rotator cuff tear arthropathy (RCAT). RCAT is a specific form of shoulder osteoarthritis caused by a chronic, often massive, irreparable rotator cuff tear leading to abnormal biomechanics and superior humeral head migration. Therefore, a large rotator cuff tear would be the most likely additional finding on an MRI, as it is the underlying cause of RCAT. While other pathologies might coexist, the described presentation is directly linked to massive cuff insufficiency.
Question 2753
Topic: Shoulder & Hip Sports
Which of the following physical examination findings would be considered atypical for primary glenohumeral osteoarthritis and would prompt consideration of alternative diagnoses?
Correct Answer & Explanation
. Significant pain with resisted external rotation but full passive external rotation
Explanation
Significant pain with resisted external rotation butfull passive external rotationis highly suggestive of rotator cuff pathology (specifically the infraspinatus and teres minor tendons), rather than glenohumeral osteoarthritis. In OA, both active and passive range of motion would typically be restricted and painful due to capsular contracture and articular cartilage damage. Crepitus, generalized pain with motion, and morning stiffness improving with activity are classic signs of OA. Deltoid atrophy might be present in advanced OA due to disuse, or in RCAT where superior migration impacts the deltoid.
Question 2754
Topic: Shoulder & Hip Sports
A patient with long-standing glenohumeral osteoarthritis describes increasing pain and difficulty with sleeping on the affected side. This is most likely due to:
Correct Answer & Explanation
. Progression of articular cartilage erosion and synovitis
Explanation
Night pain and pain with sleeping on the affected side are very common and often debilitating symptoms in advanced glenohumeral osteoarthritis. This is primarily due to the progression of articular cartilage erosion, leading to increased bone-on-bone friction, inflammation of the synovium, and capsular irritation. The lack of distracting activity at night can make the pain more noticeable. While other conditions can cause night pain, in the context of long-standing OA, direct joint pathology is the most likely cause. Rotator cuff tears, biceps pathology, or nerve compression might contribute but are not themost likelyprimary cause of night pain in progressive OA itself.
Question 2755
Topic: Shoulder & Hip Sports
Which specific type of imaging provides the most accurate and detailed information regarding the extent of articular cartilage damage and bone marrow edema in early glenohumeral osteoarthritis?
Correct Answer & Explanation
. Magnetic Resonance Imaging (MRI)
Explanation
Magnetic Resonance Imaging (MRI) is the gold standard for evaluating soft tissue structures, including articular cartilage, labrum, rotator cuff tendons, and assessing bone marrow edema. While plain radiographs show indirect signs of cartilage loss (joint space narrowing), and CT is excellent for bony morphology, MRI directly visualizes the cartilage layers and bone marrow changes, making it superior for assessing early chondral damage and inflammatory changes like bone marrow edema associated with OA.
Question 2756
Topic: Shoulder & Hip Sports
During the examination of a patient with suspected glenohumeral osteoarthritis, you note significant muscle atrophy. Which muscle group's atrophy is most frequently associated with rotator cuff tear arthropathy?
Correct Answer & Explanation
. Supraspinatus and infraspinatus
Explanation
Rotator cuff tear arthropathy (RCAT) is characterized by massive, irreparable tears of the rotator cuff. The supraspinatus and infraspinatus muscles are critical components of the rotator cuff. Chronic tears of these tendons, particularly the supraspinatus, lead to their disuse and subsequent atrophy, which is a common clinical finding in RCAT. While disuse can lead to general atrophy, specific atrophy of the supraspinatus and infraspinatus is highly indicative of rotator cuff pathology.
Question 2757
Topic: Shoulder & Hip Sports
A patient with long-standing glenohumeral osteoarthritis is found to have a significant loss of active external rotation, but relatively preserved passive external rotation. This specific finding should raise suspicion for what additional pathology?
Correct Answer & Explanation
. Rotator cuff tear involving the external rotators (infraspinatus/teres minor)
Explanation
When active range of motion is significantly limited but passive range of motion is relatively preserved, it suggests a problem with the motor unit (muscle-tendon unit) rather than a fixed capsular or articular restriction. In this scenario, a loss of active external rotation with preserved passive external rotation is a classic sign of a rotator cuff tear affecting the external rotators, primarily the infraspinatus and/or teres minor. Adhesive capsulitis and severe glenoid retroversion would typically limit both active and passive motion. AC joint impingement or biceps tendinitis would present differently.
Question 2758
Topic: Shoulder & Hip Sports
When conducting a physical examination for glenohumeral osteoarthritis, what is the significance of an 'empty can' test that elicits pain but no weakness?
Correct Answer & Explanation
. It suggests subacromial impingement or supraspinatus tendinopathy without a full tear.
Explanation
The 'empty can' (Jobe) test assesses the supraspinatus. If the test elicits pain but no weakness, it suggests irritation or tendinopathy of the supraspinatus tendon, or subacromial impingement, rather than a full-thickness tear where weakness would typically be present. A full-thickness tear would usually result in both pain and weakness (or inability to resist). It is not specific for adhesive capsulitis, deltoid paralysis, or biceps tendinopathy.
Question 2759
Topic: Shoulder & Hip Sports
Which maneuver during a shoulder examination is most useful for assessing the integrity and function of the subscapularis tendon in a patient with suspected rotator cuff tear arthropathy?
Correct Answer & Explanation
. Lift-off test (Gerber's test)
Explanation
The Lift-off test (Gerber's test) is specifically designed to assess the subscapularis tendon. The patient places their hand behind their back and attempts to lift it off their back against resistance. Inability to do so, or weakness, indicates subscapularis pathology. The Empty Can test assesses the supraspinatus. The Hawkins-Kennedy test assesses for subacromial impingement (involving rotator cuff). Speed's test assesses the biceps tendon. The cross-body adduction test assesses the AC joint.
Question 2760
Topic: Shoulder & Hip Sports
What is the primary differentiating factor between a Walch A2 glenoid and a Walch B1 glenoid on imaging?
Correct Answer & Explanation
. The presence and extent of posterior glenoid erosion and retroversion.
Explanation
The key differentiator between Walch A (centralized wear) and Walch B (posterior wear/retroversion) glenoids is the presence and extent of posterior glenoid erosion and retroversion. A2 glenoids have centralized erosion without significant posterior erosion or retroversion. B1 glenoids specifically have posterior glenoid erosion but with less than 25 degrees of retroversion and often a centered humeral head. The degree of humeral head subluxation, while often associated, is a consequence rather than the primary definer of the glenoid type itself. Osteophyte formation and rotator cuff tears are separate pathologies that can coexist.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.