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Shoulder & Hip Sports MCQs

Practice Set 3 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 41

Topic: Shoulder & Hip Sports

Which radiographic measurement on a Dunn lateral radiograph is most indicative of Cam-type femoroacetabular impingement (FAI)?

. Lateral center-edge angle > 40 degrees
. Alpha angle > 55 degrees
. Tonnis angle < 0 degrees
. Crossover sign
. Posterior wall sign

Correct Answer & Explanation

. Alpha angle > 55 degrees

Explanation

An alpha angle greater than 50-55 degrees on a lateral hip radiograph indicates a decreased anterior head-neck offset, which is characteristic of Cam-type FAI.

Question 42

Topic: Shoulder & Hip Sports

What is the primary pathophysiology behind Pincer-type femoroacetabular impingement (FAI)?

. Aspherical femoral head
. Slipped capital femoral epiphysis
. Acetabular overcoverage
. Femoral retroversion
. Coxa valga

Correct Answer & Explanation

. Acetabular overcoverage

Explanation

Pincer FAI is caused by focal or global acetabular overcoverage (e.g., retroversion, coxa profunda), leading to impingement of the femoral neck against the prominent acetabular rim.

Question 43

Topic: Shoulder & Hip Sports

A patient with suspected athletic pubalgia undergoes a diagnostic local anesthetic injection. Which anatomical structure is typically targeted to confirm the diagnosis of a rectus abdominis/adductor longus aponeurotic plate injury?

. Ischial tuberosity
. Pubic symphysis cleft
. Acetabular joint
. Greater trochanteric bursa
. Sacroiliac joint

Correct Answer & Explanation

. Pubic symphysis cleft

Explanation

A diagnostic injection into the pubic cleft or the rectus/adductor aponeurosis can help localize the pain generator in suspected athletic pubalgia, confirming the diagnosis if symptoms temporarily resolve.

Question 44

Topic: Shoulder & Hip Sports

During surgical intervention for recalcitrant external snapping hip syndrome, what structure is typically lengthened or released?

. Iliopsoas tendon
. Rectus femoris
. Iliotibial band
. Gluteus medius
. Tensor fasciae latae muscle belly

Correct Answer & Explanation

. Iliotibial band

Explanation

External snapping hip is caused by the iliotibial band (or anterior border of the gluteus maximus) snapping over the greater trochanter. Surgical treatment involves IT band lengthening, such as a Z-plasty or crucial release.

Question 45

Topic: Shoulder & Hip Sports

Which of the following physical exam findings is considered the most sensitive test for anterior femoroacetabular impingement and labral pathology?

. Flexion, Abduction, External Rotation (FABER)
. Flexion, Adduction, Internal Rotation (FADIR)
. Log roll test
. Scour test
. Ober test

Correct Answer & Explanation

. Flexion, Adduction, Internal Rotation (FADIR)

Explanation

The FADIR (Flexion, Adduction, Internal Rotation) test is highly sensitive for anterior intra-articular hip pathology, including anterior FAI and labral tears, as it provokes mechanical impingement.

Question 46

Topic: Shoulder & Hip Sports

A 19-year-old female dancer complains of a painful clunking sensation deep in her anterior groin when extending her hip from a flexed, abducted, and externally rotated position. Ultrasound shows sudden tendon displacement. Which anatomic structure is most likely involved?

. Iliotibial band over the greater trochanter
. Gluteus maximus over the ischial tuberosity
. Iliopsoas tendon over the iliopectineal eminence
. Rectus femoris over the anterior inferior iliac spine
. Sartorius over the anterior superior iliac spine

Correct Answer & Explanation

. Iliopsoas tendon over the iliopectineal eminence

Explanation

Internal snapping hip (coxa saltans) is caused by the iliopsoas tendon snapping over the iliopectineal eminence or femoral head. It is characteristically reproduced by moving the hip from a flexed, abducted, and externally rotated position into extension.

Question 47

Topic: Shoulder & Hip Sports

A 28-year-old marathon runner presents with lateral hip pain and a palpable snap when walking. The Ober test is strongly positive. If extensive non-operative management fails, what surgical intervention is most appropriate?

. Iliopsoas tendon release
. Gluteus medius repair
. Iliotibial band lengthening or Z-plasty
. Trochanteric bursectomy alone
. Osteochondroplasty of the femoral head-neck junction

Correct Answer & Explanation

. Iliotibial band lengthening or Z-plasty

Explanation

External snapping hip is caused by a tight iliotibial band (ITB) slipping over the greater trochanter. Refractory cases that fail physical therapy and injections are treated with ITB lengthening, Z-plasty, or crucial release.

Question 48

Topic: Shoulder & Hip Sports

A 24-year-old hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 65 degrees on the lateral view. What is the primary pathophysiologic mechanism of his joint damage?

. Linear contact between the acetabular rim and femoral neck
. Shear forces causing delamination of the anterosuperior acetabular cartilage
. Primary degeneration of the ligamentum teres
. Global overcoverage of the femoral head
. Dysplastic shallow acetabulum causing edge loading

Correct Answer & Explanation

. Shear forces causing delamination of the anterosuperior acetabular cartilage

Explanation

Cam impingement (alpha angle >55 degrees) features an aspherical femoral head that enters the joint in flexion, creating massive shear forces. This directly leads to anterosuperior acetabular cartilage delamination and labral tears.

Question 49

Topic: Shoulder & Hip Sports

Internal impingement of the shoulder between the posterosuperior glenoid rim and the rotator cuff occurs in which phase of throwing:

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

Internal impingement of the shoulder occurs with the arm in the abducted, externally rotated, and extended position that corresponds with the late cocking phase of throwing. Internal impingement is responsible for shoulder pain commonly occurring in overhead and throwing athletes. Initial treatment is focused on therapy that strengthens the anterior structures, stretches the posterior structures, and controls the scapular position in space. If nonoperative treatment fails, arthroscopic debridement, thermal capsular shrinkage, and humeral derotational osteotomy have been used with varying degrees of success.

Question 50

Topic: Shoulder & Hip Sports
When performing a Latarjet coracoid transfer for anterior shoulder instability with bony anterior glenoid rim insufficiency, the glenoid surface of the coracoid transfer must be positioned:
. Flush with the glenoid rim
. 5 mm medial to the glenoid rim
. 10 mm medial to the glenoid rim
. 5 mm lateral to the glenoid rim
. 10 mm lateral to the glenoid rim

Correct Answer & Explanation

. Flush with the glenoid rim

Explanation

Allain and colleagues have clearly demonstrated that a coracoid transfer overhanging laterally to the glenoid rim is associated with the development of arthritis. One of the functions of the coracoid transfer is to increase the anteroposterior diameter of the glenoid, not to serve as a bone block.

Question 51

Topic: Shoulder & Hip Sports

An arthroscopic photo (Slide) looking from the posterior portal is presented. Identify the torn structure:

. Middle glenohumeral ligament
. Inferior glenohumeral ligament
. Subscapularis tendon
. Infraspinatus tendon
. Ligamentous pulley of long head biceps

Correct Answer & Explanation

. Ligamentous pulley of long head biceps

Explanation

This photo demonstrates a torn ligamentous pulley that has possibly resulted in an unstable biceps tendon. Pathology of the ligamentous pulley is often associated with rotator cuff pathology.

Question 52

Topic: Shoulder & Hip Sports

A 22-year-old hockey player presents with anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an increased alpha angle, consistent with femoroacetabular impingement (FAI). This morphological abnormality (Cam lesion) is typically located in which quadrant of the femoral head-neck junction?

. Anterosuperior
. Anteroinferior
. Posterosuperior
. Posteroinferior

Correct Answer & Explanation

. Anterosuperior

Explanation

A Cam lesion is characterized by a loss of spherical concavity at the femoral head-neck junction, resulting in an increased alpha angle (typically >55 degrees). It is most commonly located in the anterosuperior quadrant of the proximal femur.

Question 53

Topic: Shoulder & Hip Sports

A 22-year-old professional football player sustains recurrent anterior shoulder dislocations. Advanced imaging reveals a 25% bony Bankart lesion of the anterior glenoid rim. What is the most appropriate surgical intervention to prevent recurrence?

. Arthroscopic Bankart repair with suture anchors
. Latarjet procedure
. Open inferior capsular shift
. Remplissage procedure alone
. Superior capsular reconstruction

Correct Answer & Explanation

. Latarjet procedure

Explanation

For critical anterior glenoid bone loss (>20-25%), arthroscopic soft tissue stabilization has an unacceptably high failure rate. A bone-block augmentation procedure, most commonly the Latarjet (coracoid transfer), is required to restore glenoid width and stability.

Question 54

Topic: Shoulder & Hip Sports

A ballet dancer complains of a deep "snapping" sensation in her anterior groin when extending her hip from a flexed and abducted position. There is no pain over the greater trochanter. What is the anatomical structure causing this internal snapping hip syndrome?

. Iliotibial band snapping over the greater trochanter
. Gluteus maximus snapping over the greater trochanter
. Iliopsoas tendon snapping over the iliopectineal eminence
. Rectus femoris snapping over the anterior inferior iliac spine
. Hamstring origin snapping over the ischial tuberosity

Correct Answer & Explanation

. Iliopsoas tendon snapping over the iliopectineal eminence

Explanation

Internal snapping hip syndrome (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the femoral head during hip extension. External snapping hip involves the IT band or gluteus maximus snapping over the greater trochanter.

Question 55

Topic: Shoulder & Hip Sports

A 20-year-old baseball pitcher presents with a SLAP tear. During which phase of throwing does a type II SLAP tear most commonly become symptomatic due to the peel-back mechanism?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The "peel-back" mechanism of the superior labrum occurs in the late cocking phase of throwing, when the shoulder is in maximal abduction and external rotation.

Question 56

Topic: Shoulder & Hip Sports

A 26-year-old rugby player has recurrent anterior shoulder instability. CT scan shows a 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Remplissage procedure
. Latarjet procedure
. Putti-Platt procedure
. Capsular shift

Correct Answer & Explanation

. Latarjet procedure

Explanation

For patients with significant anterior glenoid bone loss (>20-25%), a Latarjet procedure (coracoid transfer) is indicated to restore the glenoid arc and provide a sling effect, reducing recurrence rates.

Question 57

Topic: Shoulder & Hip Sports
The infraspinatus is strengthened best by which exercise:
. External rotation at 70° of elevation
. Internal rotation at 70° of elevation
. External rotation at 0° of elevation
. Internal rotation at 0° of elevation
. Scapular elevation with internal humeral rotation

Correct Answer & Explanation

. External rotation at 0° of elevation

Explanation

The infraspinatus is primarily responsible for external rotation, humeral head depression, and posterior approximation at lower elevations, whereas the teres minor functions at higher elevations. Therefore, external rotation with the arm near the side of the body is optimal for strengthening the infraspinatus. External rotation at approximately 70° is more appropriate for strengthening the teres minor.

Question 58

Topic: Shoulder & Hip Sports

A 35-year-old professional volleyball player presents with painless weakness in external rotation of his right shoulder. MRI reveals a paralabral cyst located strictly in the spinoglenoid notch. Which muscle or muscles are most likely affected by this specific nerve entrapment?

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

Correct Answer & Explanation

. Infraspinatus only

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Entrapment at the more proximal suprascapular notch affects both the supraspinatus and the infraspinatus.

Question 59

Topic: Shoulder & Hip Sports

A 65-year-old female undergoes arthroscopic repair for a massive, retracted supraspinatus and infraspinatus tear. To minimize the risk of postoperative retear, which biomechanical principle is most critical?

. Using a single-row repair to preserve the lateral footprint blood supply
. Minimizing tension on the repair by maximizing footprint coverage
. Creating a high-tension double-row repair to ensure gap closure
. Utilizing non-absorbable sutures to bridge the gap without tissue reduction
. Relying on isolated margin convergence without bone anchor fixation

Correct Answer & Explanation

. Minimizing tension on the repair by maximizing footprint coverage

Explanation

Minimizing tension on the repair site is the single most critical factor for biological healing in massive rotator cuff tears. Over-tensioning compromises blood flow and significantly increases the risk of structural failure.

Question 60

Topic: Shoulder & Hip Sports

Which of the following describes the correct relationship between the suprascapular nerve and the suprascapular vessels as they pass through the suprascapular notch:

. The suprascapular nerve, artery, and vein all pass below the transverse scapular ligament.
. The suprascapular nerve, artery, and vein all pass superficially to the transverse scapular ligament.
. The suprascapular nerve passes superficially to the transverse scapular ligament while the artery and vein pass deep to it.
. The suprascapular nerve and artery pass deep to the transverse scapular ligament while the suprascapular vein passes superficially to it.
. The suprascapular nerve passes deep to the transverse scapular ligament while the suprascapular artery and vein pass above it.

Correct Answer & Explanation

. The suprascapular nerve passes deep to the transverse scapular ligament while the suprascapular artery and vein pass above it.

Explanation

The suprascapular nerve is a branch of the upper trunk of the brachial plexus at Erbs point. The suprascapular nerve receives branches primarily from the fifth cervical nerve root. The nerve follows the omohyoid muscle laterally and passes beneath the anterior border of the trapezius muscle to the upper border of the scapula where it joins the suprascapular artery. It passes through the suprascapular notch deep to the transverse scapular ligament. The artery and vein pass superficial to the ligament and join the nerve distally in the suprascapular fossa. After innervating the supraspinatus muscle, the nerve passes around the lateral free margin of the scapular spine (spinoglenoid notch) to innervate the infraspinatus muscle.

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