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Shoulder & Hip Sports MCQs

Practice Set 141 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 2801

Topic: Shoulder & Hip Sports

A surgeon is performing an open posterior bone block procedure for a patient with recurrent posterior shoulder instability and significant posterior glenoid bone loss. The surgical approach involves an incision over the posterior shoulder. To safely access the posterior joint capsule, the surgeon must develop an internervous plane. Which of the following describes the correct internervous plane for the classic posterior approach to the shoulder?

. Between the supraspinatus and infraspinatus
. Between the infraspinatus and teres minor
. Between the teres minor and teres major
. Between the deltoid and triceps
. Between the infraspinatus and teres major

Correct Answer & Explanation

. Between the infraspinatus and teres minor

Explanation

Correct Answer: Between the infraspinatus and teres minorThe classic posterior approach to the shoulder utilizes the internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). This plane allows safe access to the posterior glenoid and capsule without denervating the posterior rotator cuff musculature. Care must be taken to avoid injuring the axillary nerve and posterior circumflex humeral artery as they exit the quadrangular space inferior to the teres minor.

Question 2802

Topic: Shoulder & Hip Sports

A physical therapist is designing a rehabilitation protocol for a patient with posterior shoulder instability. The protocol heavily focuses on the infraspinatus muscle. In addition to providing external rotation, what is the primary biomechanical function of the infraspinatus during active shoulder elevation?

. Superior translation of the humeral head
. Anterior translation of the humeral head
. Depression and compression of the humeral head into the glenoid
. Internal rotation of the humerus
. Protraction of the scapula

Correct Answer & Explanation

. Depression and compression of the humeral head into the glenoid

Explanation

Correct Answer: Depression and compression of the humeral head into the glenoidThe rotator cuff muscles, including the infraspinatus, function as dynamic stabilizers of the glenohumeral joint. During active shoulder elevation, the deltoid exerts a strong superior shear force on the humerus. The infraspinatus, along with the subscapularis and teres minor, acts to depress the humeral head and compress it firmly into the glenoid concavity (concavity compression). This force couple is essential for maintaining the center of rotation of the humeral head and preventing superior migration or instability.

Question 2803

Topic: Shoulder & Hip Sports

A 24-year-old offensive lineman presents with recurrent posterior shoulder instability. He is undergoing a nonoperative rehabilitation program. Which of the following muscles acts as the primary dynamic posterior stabilizer of the glenohumeral joint and should be the primary focus of his strengthening program?

. Supraspinatus
. Infraspinatus
. Pectoralis major
. Subscapularis
. Latissimus dorsi

Correct Answer & Explanation

. Infraspinatus

Explanation

Correct Answer: B (Infraspinatus)The infraspinatus and teres minor are the primary dynamic stabilizers against posterior glenohumeral translation. Conservative management of recurrent unidirectional posterior shoulder instability heavily emphasizes the strengthening of the infraspinatus, teres minor, and posterior deltoid. The subscapularis, pectoralis major, and latissimus dorsi are internal rotators and anterior stabilizers, while the supraspinatus primarily assists in abduction and superior stability.

Question 2804

Topic: Shoulder & Hip Sports

A 32-year-old male presents to the emergency department with severe right shoulder pain and an inability to externally rotate his arm after a generalized tonic-clonic seizure. Radiographs reveal a posterior shoulder dislocation. Which of the following best explains the mechanism of this specific injury pattern during a seizure?

. Overpowering of the external rotators by the stronger internal rotators
. Direct blunt trauma to the anterior aspect of the shoulder
. Hyper-external rotation and abduction of the arm
. Overpowering of the internal rotators by the stronger external rotators
. Sudden contraction of the deltoid and trapezius muscles

Correct Answer & Explanation

. Overpowering of the external rotators by the stronger internal rotators

Explanation

Correct Answer: A (Overpowering of the external rotators by the stronger internal rotators)Posterior shoulder dislocations classically occur during seizures or electrical shock. This is due to the massive, simultaneous tetanic contraction of the shoulder musculature. The strong internal rotators (latissimus dorsi, pectoralis major, and subscapularis) overpower the relatively weaker external rotators (infraspinatus and teres minor), forcefully driving the humeral head posteriorly out of the glenoid fossa.

Question 2805

Topic: Shoulder & Hip Sports

A 21-year-old collegiate weightlifter complains of deep posterior shoulder pain with bench pressing. On examination, the patient is seated with the arm abducted to 90 degrees and internally rotated. The examiner applies an axial load to the humerus while horizontally adducting the arm, which produces a sudden clunk and pain. Which of the following is the most likely diagnosis?

. Anterior shoulder instability
. Superior labrum anterior to posterior (SLAP) tear
. Posterior shoulder instability
. Subacromial impingement
. Acromioclavicular joint separation

Correct Answer & Explanation

. Posterior shoulder instability

Explanation

Correct Answer: C (Posterior shoulder instability)The vignette describes the Jerk test, which is highly specific for posterior shoulder instability and posterior labral tears. A positive test occurs when a posterior subluxation (clunk) is felt as the arm is horizontally adducted under an axial load, and a second clunk may be felt as the arm is returned to the starting position (reduction). This test places maximal stress on the posterior band of the inferior glenohumeral ligament and the posterior labrum.

Question 2806

Topic: Shoulder & Hip Sports

A 28-year-old male presents with recurrent posterior shoulder instability. Magnetic resonance arthrography (MRA) demonstrates an incomplete and concealed avulsion of the posteroinferior labrum. The articular cartilage is intact, and there is no retroversion of the glenoid. Which of the following eponyms best describes this lesion?

. Bankart lesion
. ALPSA lesion
. GLAD lesion
. Kim's lesion
. HAGL lesion

Correct Answer & Explanation

. Kim's lesion

Explanation

Correct Answer: D (Kim's lesion)A Kim's lesion is defined as an incomplete and concealed avulsion of the posteroinferior labrum. It is a hallmark pathoanatomic finding in posterior shoulder instability. Unlike a reverse Bankart lesion, where the labrum is completely detached from the glenoid rim, a Kim's lesion involves a deep incomplete tear between the labrum and the glenoid cartilage, often requiring probing during arthroscopy to identify.

Question 2807

Topic: Shoulder & Hip Sports

A 26-year-old male requires an open posterior stabilization for refractory posterior shoulder instability. The surgeon utilizes a classic posterior approach to the shoulder. Which of the following describes the correct internervous plane utilized in this approach?

. Between the supraspinatus and infraspinatus
. Between the infraspinatus and teres minor
. Between the teres minor and teres major
. Between the deltoid and pectoralis major
. Between the trapezius and latissimus dorsi

Correct Answer & Explanation

. Between the infraspinatus and teres minor

Explanation

Correct Answer: B (Between the infraspinatus and teres minor)The classic posterior approach to the shoulder utilizes the internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). This plane allows safe access to the posterior glenohumeral joint capsule and labrum without denervating the posterior rotator cuff musculature.

Question 2808

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a locked posterior shoulder dislocation that occurred 3 weeks ago. A CT scan reveals an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 35% of the articular surface. Which of the following is the most appropriate surgical management for this bony defect?

. Arthroscopic posterior labral repair
. Latarjet procedure
. McLaughlin procedure or modification
. Remplissage procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. McLaughlin procedure or modification

Explanation

Correct Answer: C (McLaughlin procedure or modification)A reverse Hill-Sachs lesion involving 20-40% of the articular surface is typically managed with a McLaughlin procedure (transfer of the subscapularis tendon into the defect) or its Neer modification (transfer of the lesser tuberosity with the attached subscapularis into the defect). This prevents the defect from engaging the posterior glenoid rim. Defects >40-50% typically require arthroplasty, while defects <20% may be managed with closed reduction and stabilization alone.

Question 2809

Topic: Shoulder & Hip Sports

The primary muscle targeted in the conservative management of recurrent posterior shoulder instability is innervated by a nerve that passes through which of the following anatomic structures?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: E (Spinoglenoid notch)The primary muscle targeted in the conservative management of posterior instability is the infraspinatus. The infraspinatus is innervated by the suprascapular nerve. After passing through the suprascapular notch (where it innervates the supraspinatus), the nerve travels around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus.

Question 2810

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer is diagnosed with recurrent posterior shoulder subluxation. She is prescribed a physical therapy program. In addition to strengthening the infraspinatus and posterior deltoid, she is advised to avoid positions that place the posterior capsule under maximal stress. Which of the following positions should she avoid?

. Abduction and external rotation
. Flexion, adduction, and internal rotation
. Extension and external rotation
. Abduction and internal rotation
. Extension, adduction, and external rotation

Correct Answer & Explanation

. Flexion, adduction, and internal rotation

Explanation

Correct Answer: B (Flexion, adduction, and internal rotation)The posterior capsule and labrum are placed under maximal tension when the shoulder is in flexion, adduction, and internal rotation. This is the classic provocative position for posterior instability (and the position used in the Jerk test). Patients with posterior instability should avoid this position during rehabilitation and daily activities to prevent recurrent subluxation.

Question 2811

Topic: Shoulder & Hip Sports

A 22-year-old male with recurrent posterior shoulder instability undergoes advanced imaging. Which of the following anatomic variants of the glenoid is most strongly associated with an increased risk of posterior shoulder instability?

. Increased glenoid anteversion
. Increased glenoid retroversion
. Glenoid hypoplasia
. Increased superior tilt of the glenoid
. Coracoid hypoplasia

Correct Answer & Explanation

. Increased glenoid retroversion

Explanation

Correct Answer: B (Increased glenoid retroversion)Increased glenoid retroversion (excessive posterior tilt of the glenoid articular surface) is a well-recognized anatomic risk factor for posterior shoulder instability. Normal glenoid version is typically neutral to slightly retroverted (around 1-2 degrees). Excessive retroversion (e.g., >7-10 degrees) significantly increases the risk of posterior subluxation or dislocation by reducing the bony restraint against posterior translation.

Question 2812

Topic: Shoulder & Hip Sports

A 22-year-old collegiate offensive lineman presents with recurrent posterior shoulder instability. He has not had any frank dislocations but experiences a "clunking" sensation when pass blocking. Physical examination reveals a positive Jerk test. Radiographs and MRI show no significant bone loss or labral tearing. He wishes to pursue nonoperative management. A physical therapy program should primarily focus on strengthening which of the following muscle groups to provide dynamic stability against posterior humeral head translation?

. Subscapularis and pectoralis major
. Infraspinatus and teres minor
. Supraspinatus and biceps brachii
. Serratus anterior and trapezius
. Latissimus dorsi and teres major

Correct Answer & Explanation

. Infraspinatus and teres minor

Explanation

Correct Answer: Infraspinatus and teres minorConservative management of recurrent unidirectional posterior shoulder instability heavily emphasizes strengthening the dynamic posterior stabilizers of the glenohumeral joint. The primary muscles responsible for resisting posterior translation of the humeral head are the infraspinatus, teres minor, and the posterior head of the deltoid. Strengthening the anterior structures (such as the subscapularis and pectoralis major) can actually exacerbate posterior instability by creating an imbalance that pulls the humeral head posteriorly.

Question 2813

Topic: Shoulder & Hip Sports

A 28-year-old weightlifter presents with vague posterior shoulder pain and weakness in external rotation. He has a history of recurrent posterior shoulder subluxations. Physical examination demonstrates atrophy of the infraspinatus fossa but normal bulk of the supraspinatus. MRI reveals a posterior labral tear with an associated paralabral cyst. At which of the following anatomic locations is the cyst most likely compressing the affected nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: Spinoglenoid notchPosterior labral tears can allow synovial fluid to leak and form paralabral cysts. These cysts frequently extend into the spinoglenoid notch. The suprascapular nerve passes through the suprascapular notch (innervating the supraspinatus) and then travels through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch results in isolated infraspinatus weakness and atrophy, while sparing the supraspinatus. Compression at the suprascapular notch would affect both muscles. The quadrilateral space contains the axillary nerve, which innervates the deltoid and teres minor.

Question 2814

Topic: Shoulder & Hip Sports

A 40-year-old man presents with a locked posterior shoulder dislocation following an electrocution injury 3 weeks ago. A CT scan demonstrates an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 25% of the articular surface. The glenoid is intact. Which of the following is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Arthroscopic posterior labral repair
. Open reduction and transfer of the lesser tuberosity into the defect
. Open reduction and structural allograft reconstruction of the glenoid
. Total shoulder arthroplasty

Correct Answer & Explanation

. Open reduction and transfer of the lesser tuberosity into the defect

Explanation

Correct Answer: Open reduction and transfer of the lesser tuberosity into the defectA reverse Hill-Sachs lesion is an anteromedial impaction fracture of the humeral head caused by the posterior glenoid rim during a posterior dislocation. The treatment depends on the size of the defect. Defects less than 20% can often be managed nonoperatively or with simple reduction if stable. Defects between 20% and 40% are at high risk for engaging the posterior glenoid and causing recurrent instability. These are best treated with a McLaughlin procedure (transfer of the subscapularis tendon into the defect) or a modified McLaughlin procedure (transfer of the lesser tuberosity with the attached subscapularis into the defect). Defects greater than 40-50% typically require hemiarthroplasty or total shoulder arthroplasty.

Question 2815

Topic: Shoulder & Hip Sports

A surgeon is performing an open posterior approach to the shoulder for a posterior bone block procedure to address recurrent posterior instability. After incising the deltoid in line with its fibers, an internervous plane is utilized to access the posterior joint capsule. This plane is located between which of the following two muscles?

. Infraspinatus and teres minor
. Teres minor and teres major
. Supraspinatus and infraspinatus
. Deltoid and triceps
. Infraspinatus and subscapularis

Correct Answer & Explanation

. Infraspinatus and teres minor

Explanation

Correct Answer: Infraspinatus and teres minorThe classic open posterior approach to the shoulder utilizes the internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). This plane allows safe access to the posterior capsule and glenoid. Care must be taken not to extend the dissection too far inferiorly to avoid injury to the axillary nerve as it exits the quadrilateral space just inferior to the teres minor.

Question 2816

Topic: Shoulder & Hip Sports

A 20-year-old female gymnast presents with bilateral shoulder pain and a feeling of her shoulders "slipping out of place." She can voluntarily subluxate her shoulders posteriorly. Physical exam reveals a positive sulcus sign of 3 cm bilaterally that does not reduce with external rotation. She has generalized ligamentous laxity with a Beighton score of 7/9. What is the most appropriate initial management for this patient's posterior instability?

. Arthroscopic posterior capsulolabral repair
. Open inferior capsular shift
. Aggressive physical therapy focusing on periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy
. Posterior bone block procedure

Correct Answer & Explanation

. Aggressive physical therapy focusing on periscapular and rotator cuff strengthening

Explanation

Correct Answer: Aggressive physical therapy focusing on periscapular and rotator cuff strengtheningThis patient presents with multidirectional instability (MDI), characterized by generalized laxity, voluntary subluxation, and a positive sulcus sign that persists in external rotation (indicating rotator interval incompetence). The hallmark of MDI treatment is a prolonged, dedicated course of physical therapy (typically at least 6 months) focusing on strengthening the dynamic stabilizers, specifically the rotator cuff and periscapular muscles. Operative intervention (such as an inferior capsular shift) is strictly reserved for patients who fail extensive conservative management, and voluntary dislocators often have poor surgical outcomes.

Question 2817

Topic: Shoulder & Hip Sports

A 35-year-old electrician presents to the emergency department after sustaining a high-voltage electrical shock. His right arm is locked in internal rotation and he resists any external rotation. A CT scan confirms a posterior shoulder dislocation. The classic bony defect associated with this injury is located on which aspect of the humerus?

. Anteromedial humeral head
. Anterolateral humeral head
. Posteromedial humeral head
. Posterolateral humeral head
. Superior humeral head

Correct Answer & Explanation

. Anteromedial humeral head

Explanation

A reverse Hill-Sachs lesion is an impaction fracture located on the anteromedial aspect of the humeral head. It occurs when the anteromedial humeral head impacts the posterior glenoid rim during a posterior dislocation.

Question 2818

Topic: Shoulder & Hip Sports

During a physical examination for suspected posterior shoulder instability, the examiner performs the Jerk test. The patient is seated, and the arm is placed in 90 degrees of forward flexion and internal rotation. While applying an axial load to the humerus, the examiner moves the arm in which of the following directions to elicit a clunk?

. Horizontal adduction
. Horizontal abduction
. Vertical extension
. External rotation
. Vertical flexion

Correct Answer & Explanation

. Horizontal adduction

Explanation

The Jerk test is performed by placing the arm in 90 degrees of forward flexion and internal rotation, applying an axial load, and moving the arm into horizontal adduction. A sudden clunk indicates posterior subluxation of the humeral head off the glenoid.

Question 2819

Topic: Shoulder & Hip Sports

A 42-year-old male presents with a locked posterior shoulder dislocation following a seizure 3 weeks ago. Imaging reveals a reverse Hill-Sachs defect that involves 30% of the articular surface. He is highly active and wishes to retain his native joint. Which of the following is the most appropriate surgical intervention?

. Arthroscopic posterior labral repair
. Transfer of the lesser tuberosity into the defect
. Latarjet procedure
. Total shoulder arthroplasty
. Arthroscopic remplissage

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect

Explanation

For reverse Hill-Sachs lesions involving 20-40% of the articular surface, a modified McLaughlin procedure (transfer of the lesser tuberosity with the attached subscapularis) is indicated. This provides a bone-to-bone healing surface and mechanically prevents the defect from engaging the posterior glenoid.

Question 2820

Topic: Shoulder & Hip Sports

A 27-year-old rugby player presents with recurrent posterior shoulder instability. Advanced imaging reveals a posterior glenoid bone loss of 25%. Soft tissue structures are relatively preserved. What is the most appropriate surgical management to prevent recurrent instability?

. Arthroscopic posterior labral repair with capsular shift
. Subscapularis tendon transfer
. Posterior bone block augmentation (e.g., iliac crest)
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Posterior bone block augmentation (e.g., iliac crest)

Explanation

In the setting of posterior glenoid bone loss exceeding 15-20%, soft tissue repairs alone have an unacceptably high failure rate. A posterior bone block augmentation (using iliac crest or distal tibia allograft) is indicated to restore the articular arc.

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