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Shoulder & Hip Sports MCQs

Practice Set 32 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 621

Topic: Shoulder & Hip Sports

A 27-year-old woman underwent shoulder arthroscopy for multidirectional instability 3 years ago. She was unable to regain shoulder range of motion despite therapy and has had progressively worsening pain. A current axillary radiograph is shown in Figure 100. In reviewing the medical records from the index procedure, what factor may be significant in contributing to her current condition? Review Topic

. Subsequent development of a supraspinatus tear
. Subscapularis tendon dehiscence
. Coagulation of the anterior humeral circumflex artery
. Use of monopolar radiofrequency thermal capsulorrhaphy
. Lack of compliance with postoperative therapy program

Correct Answer & Explanation

. Subsequent development of a supraspinatus tear

Explanation

Reports from several centers suggest the potential to develop glenohumeral chondrolysis because of the heat production associated with use of radiofrequency or laser thermal capsulorrhaphy. A tear of the supraspinatus may lead to poor function and progression to rotator cuff tear arthropathy with superior humeral head migration. Subscapularis dehiscence is a risk in open surgery through a deltopectoral approach and can lead to anterior instability. The anterior humeral circumflex artery is the main supply to the humeral head and its coagulation can lead to osteonecrosis. Whereas a lack of postoperative therapy can lead to unresolved pain and stiffness, chondrolysis is not reported.

Question 622

Topic: Shoulder & Hip Sports

A 19-year-old rugby player is evaluated for recurrent anterior shoulder instability. A 3D CT reconstruction of the shoulder demonstrates anterior glenoid bone loss estimated at 28%. Which of the following is the most appropriate surgical treatment to prevent further recurrence?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure (coracoid transfer)
. Putti-Platt procedure
. Arthroscopic capsular plication

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

Critical anterior glenoid bone loss (generally >20-25%) results in a high failure rate if treated with isolated soft-tissue procedures (Bankart repair). A bony augmentation procedure, such as the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid), is required to restore glenohumeral stability.

Question 623

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast presents with bilateral shoulder pain and a sensation of 'slipping.' Examination reveals a positive sulcus sign that does not decrease with external rotation, and a positive apprehension test without distinct trauma. What is the most appropriate initial management?

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Arthroscopic capsular plication
. A comprehensive physical therapy program focused on periscapular and rotator cuff strengthening
. Subacromial corticosteroid injection

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

The patient's presentation (bilateral symptoms, positive sulcus sign, atraumatic) is classic for multidirectional instability (MDI). The gold standard initial management for MDI is a minimum of 6 months of physical therapy emphasizing periscapular stabilizer and rotator cuff strengthening. Surgery (e.g., capsular shift) is reserved for patients who fail an extensive course of targeted therapy.

Question 624

Topic: Shoulder & Hip Sports

A 60-year-old male with a massive, retracted posterosuperior rotator cuff tear complains of pronounced weakness in external rotation. MRI reveals that fatty infiltration is most severe in the infraspinatus. Entrapment of the suprascapular nerve as a result of profound tendon retraction would most likely occur at which of the following anatomic locations?

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

Correct Answer & Explanation

. Quadrilateral space

Explanation

Massive retraction of the supraspinatus and infraspinatus tendons can place extreme traction on the suprascapular nerve. The nerve is most vulnerable to tethering and entrapment at the spinoglenoid notch due to the direct medial pull of the retracted infraspinatus muscle belly. Entrapment here causes isolated infraspinatus denervation.

Question 625

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a cam-type femoroacetabular impingement (FAI). This specific morphology is best described by which of the following anatomic abnormalities?

. Acetabular retroversion
. Coxa profunda
. Decreased alpha angle
. Aspherical femoral head-neck junction
. Protrusio acetabuli

Correct Answer & Explanation

. Acetabular retroversion

Explanation

Cam-type FAI is caused by an aspherical contour of the femoral head-neck junction, often described as a 'pistol grip' deformity or an osseous bump on the anterosuperior neck. This is quantified by an increased alpha angle. Pincer-type FAI is characterized by acetabular overcoverage, such as acetabular retroversion, coxa profunda, or protrusio acetabuli.

Question 626

Topic: Shoulder & Hip Sports

A 24-year-old rugby player presents with recurrent anterior shoulder instability. An MRI arthrogram reveals an abnormal contour of the inferior glenohumeral ligament (IGHL) with a 'J-sign' and contrast extravasation into the axillary pouch, but the anterior labrum remains attached to the glenoid. What is the most likely diagnosis?

. ALPSA lesion
. GLAD lesion
. HAGL lesion
. SLAP tear
. Kim lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

A HAGL (Humeral Avulsion of the Glenohumeral Ligament) lesion occurs when the IGHL is avulsed from its humeral attachment. On coronal MRI arthrogram, the normal U-shape of the axillary recess is lost and appears as a 'J-sign' due to the dropping down of the torn ligament, allowing contrast to extravasate into the axillary tissues. It is an important cause of recurrent instability without a Bankart lesion.

Question 627

Topic: Shoulder & Hip Sports

A 22-year-old collegiate hockey player is diagnosed with symptomatic femoroacetabular impingement (FAI), Cam type. He has an alpha angle of 75 degrees. During hip arthroscopy, which of the following intra-articular pathologies is most classically encountered as a direct biomechanical result of this specific femoral deformity?

. Chondral delamination at the anterosuperior acetabulum
. Rupture of the ligamentum teres
. Ossification of the reflected head of the rectus femoris
. Posteroinferior labral tear
. Dysplastic, shallow acetabulum with global labral hypertrophy

Correct Answer & Explanation

. Chondral delamination at the anterosuperior acetabulum

Explanation

Cam-type FAI is characterized by an aspherical femoral head-neck junction (high alpha angle) that acts like a cam, forcefully jamming into the anterosuperior acetabulum during hip flexion and internal rotation. This causes excessive shear forces across the articular cartilage, classically resulting in anterosuperior chondral delamination and separation of the labrum from the adjacent articular cartilage.

Question 628

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague dominant shoulder pain. Physical examination reveals a glenohumeral internal rotation deficit (GIRD). Which of the following examination findings defines a 'pathologic' GIRD that warrants intervention rather than an expected anatomic adaptation to overhead throwing?

. Loss of >10 degrees of internal rotation with symmetric external rotation compared to the contralateral side
. Loss of >20 degrees of internal rotation with a >5 degree loss of total arc of motion compared to the contralateral side
. Loss of >5 degrees of internal rotation with a compensatory 10 degree gain in external rotation
. A total arc of motion >180 degrees with internal rotation restricted to 45 degrees
. Symmetric internal rotation but >15 degrees greater external rotation compared to the contralateral side

Correct Answer & Explanation

. Loss of >10 degrees of internal rotation with symmetric external rotation compared to the contralateral side

Explanation

Overhead throwing athletes frequently develop an adaptive loss of internal rotation with a compensatory gain in external rotation, resulting in an unaltered total arc of motion compared to the non-dominant arm. This is a physiologic adaptation (anatomic GIRD) primarily due to osseous humeral retroversion. 'Pathologic GIRD' is defined clinically as a loss of >20 degrees of internal rotation associated with a loss of >5 degrees in the total arc of motion compared to the contralateral side. Pathologic GIRD is associated with posterior capsule contracture and an increased risk of SLAP tears and internal impingement.

Question 629

Topic: Shoulder & Hip Sports

A 26-year-old male ice hockey player is diagnosed with symptomatic cam-type femoroacetabular impingement (FAI). He elects to undergo hip arthroscopy for osteochondroplasty of the femoral head-neck junction. During diagnostic arthroscopy, the surgeon evaluates the acetabular labrum and articular cartilage. Which region of the acetabulum is most likely to exhibit articular cartilage delamination secondary to this specific impingement morphology?

. Anteroinferior
. Posterosuperior
. Posteroinferior
. Anterosuperior
. Directly at the fovea capitis

Correct Answer & Explanation

. Anteroinferior

Explanation

Cam impingement occurs due to a loss of sphericity of the femoral head (decreased head-neck offset), creating an 'aspherical' cam lesion typically on the anterosuperior aspect of the head-neck junction. During hip flexion and internal rotation, this cam lesion engages the anterosuperior acetabular rim. The outside-in shear forces generated by the cam lesion cause separation of the articular cartilage from the subchondral bone, presenting clinically and arthroscopically as chondral delamination or the 'wave sign' predominantly in the anterosuperior acetabulum.

Question 630

Topic: Shoulder & Hip Sports

A 19-year-old football player presents with recurrent anterior shoulder instability. CT imaging reveals a 28% anterior glenoid bone defect. Which of the following procedures is most appropriate to restore stability and prevent recurrence?

. Arthroscopic Bankart repair with capsular plication
. Open Bankart repair
. Coracoid process transfer (Latarjet procedure)
. Remplissage procedure alone
. Arthroscopic labral repair with bioabsorbable anchors

Correct Answer & Explanation

. Arthroscopic Bankart repair with capsular plication

Explanation

In the setting of anterior shoulder instability with critical glenoid bone loss (typically >20-25%), soft tissue stabilization alone is inadequate. A bony augmentation procedure, such as the Latarjet coracoid transfer, is required.

Question 631

Topic: Shoulder & Hip Sports
The posterior circumflex humeral artery and the axillary nerve usually lie in a space bordered superiorly by the
. teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major.
. teres major, medially by the humerus, and inferiorly by the teres minor.
. supraspinatus, inferiorly by the infraspinatus, and posterior to the scapular body.
. supraspinatus, inferiorly by the scapular body, and covered by the superior transverse scapular ligament.
. infraspinatus, inferiorly by the teres minor, and laterally by the long head of the triceps.

Correct Answer & Explanation

. teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major.

Explanation

The quadrangular space is bordered superiorly by the teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major. The posterior circumflex humeral artery and the axillary nerve lie in this space.

Question 632

Topic: Shoulder & Hip Sports
A 58-year-old man has persistent pain and weakness of his right shoulder after undergoing primary rotator cuff repair 1 year ago. A clinical photograph is shown in Figure 11. Which of the following factors might make functional improvement problematic with revision rotator cuff surgery?
. Patient’s age
. Patient’s gender
. Number of prior surgical procedures
. Detachment of the deltoid
. Duration of the rotator cuff tear

Correct Answer & Explanation

. Detachment of the deltoid

Explanation

Functional improvement after revision rotator cuff surgery is most likely to occur in patients with an intact deltoid, good-quality rotator cuff tissue, preoperative active elevation alone to 90 degrees, and only one prior rotator cuff repair. In this patient, the compromised deltoid origin might make functional improvement less likely.

Question 633

Topic: Shoulder & Hip Sports
A 25-year-old carpenter falls on his outstretched arm. What physical finding best correlates with the lesion seen on the MRI scan shown in Figure 3?
. Weakness in external rotation
. Weakness in abduction
. Positive lift-off test
. Loss of biceps contour
. Deltoid atrophy

Correct Answer & Explanation

. Positive lift-off test

Explanation

The MRI scan shows disruption of the subscapularis muscle. Subscapularis rupture is associated with weakness in internal rotation as shown with a positive lift-off test as described by Gerber and Krushell. The belly press test also has been shown to be a useful clinical test for this problem. Weakness in external rotation and abduction is more consistent with supraspinatus and infraspinatus tears. Deltoid atrophy is associated with an axillary nerve injury. Loss of biceps contour is associated with rupture of the long head of the biceps.

Question 634

Topic: Shoulder & Hip Sports
Figures 49a and 49b show MRI scans of the shoulder. What is the most likely diagnosis?
. Rotator cuff tear
. Normal anatomic variant
. Stage II impingement
. Bankart lesion
. Acromioclavicular grade II sprain

Correct Answer & Explanation

. Rotator cuff tear

Explanation

The supraspinatus tendon shows clear detachment and retraction from its greater tuberosity attachment by the absence of the normal dark subacromial signal extending to the attachment on the greater tuberosity. There is no anterior inferior glenoid labral detachment that usually is seen in a Bankart lesion. The acromioclavicular joint shows no evidence of separation. The humeral head is migrated cranially, indicating a chronic rotator cuff tear.

Question 635

Topic: Shoulder & Hip Sports

A 25-year-old professional hockey player presents with chronic, deep groin pain exacerbated by hip flexion and internal rotation.

Imaging demonstrates a classic pistol-grip deformity. Which of the following represents the primary mechanism of articular cartilage damage in this condition?

. Chondral delamination of the anterosuperior acetabulum from the subchondral bone.
. Linear wear of the posteroinferior acetabular cartilage.
. Global thinning of the femoral head articular cartilage.
. Crushing injury to the base of the labrum without cartilage involvement.
. Hypertrophy of the ligamentum teres causing foveal wear.

Correct Answer & Explanation

. Chondral delamination of the anterosuperior acetabulum from the subchondral bone.

Explanation

The scenario describes Cam-type femoroacetabular impingement (FAI), characterized by a non-spherical femoral head-neck junction (pistol-grip deformity). As the hip goes into flexion and internal rotation, this aspherical head engages the anterosuperior acetabular rim. The shear forces generated cause an outside-in separation (delamination) of the acetabular cartilage from the subchondral bone, often leaving the labrum partially intact initially, unlike Pincer impingement where the primary failure is a crushing of the labrum.

Question 636

Topic: Shoulder & Hip Sports

A 22-year-old collegiate hockey player presents with chronic, insidious onset groin pain exacerbated by hip flexion and internal rotation.

Radiographs demonstrate an aspherical femoral head-neck junction with an alpha angle of 65 degrees. He is diagnosed with Cam-type femoroacetabular impingement (FAI). During hip arthroscopy, which pattern of intra-articular damage is most characteristically observed in isolated Cam FAI?

. Posteroinferior acetabular cartilage delamination with an intact anterior labrum
. Global full-thickness acetabular cartilage loss resembling inflammatory arthritis
. Anterosuperior acetabular cartilage delamination (often with a relatively intact overlying labrum initially)
. Fraying and tearing of the ligamentum teres with a normal chondrolabral junction
. Linear, full-thickness fissuring strictly on the femoral head articular cartilage

Correct Answer & Explanation

. Posteroinferior acetabular cartilage delamination with an intact anterior labrum

Explanation

Cam-type FAI is caused by a loss of sphericity at the anterolateral femoral head-neck junction (decreased offset). During hip flexion and internal rotation, this prominent cam lesion engages the anterosuperior acetabulum. The shear forces generated typically cause the articular cartilage to delaminate from the subchondral bone at the anterosuperior chondrolabral junction. Often, in early stages, the overlying labrum remains relatively intact or detaches from the articular cartilage (the 'carpet delamination' sign), unlike Pincer impingement where the labrum itself is crushed first.

Question 637

Topic: Shoulder & Hip Sports

Which of the following best describes the pathomechanics of pincer-type femoroacetabular impingement (FAI)?

. An aspherical femoral head engaging the anterosuperior acetabulum in flexion
. Decreased femoral head-neck offset causing shear forces on the labrum
. Acetabular overcoverage causing linear impact and crushing of the labrum against the femoral neck
. Slipped capital femoral epiphysis leading to posterior impingement
. Chondral delamination occurring before labral pathology

Correct Answer & Explanation

. An aspherical femoral head engaging the anterosuperior acetabulum in flexion

Explanation

Pincer FAI is caused by local or global acetabular overcoverage. The femoral neck abuts the overhanging acetabular rim, causing linear contact that crushes the labrum and can lead to secondary contrecoup cartilage lesions.

Question 638

Topic: Shoulder & Hip Sports
A 39-year-old man has anterior shoulder pain after landing on his abducted left shoulder while playing softball. Examination reveals a stable glenohumeral joint, pain on passive external rotation of greater than 25 degrees, and pain and weakness on belly press (Napoleon’s) test. An MRI scan is shown. To provide maximum pain relief and return of function, management should include
. physical therapy to restore range of motion and rotator cuff strength.
. repair of the supraspinatus and biceps tenotomy.
. repair of the supraspinatus and biceps tenodesis.
. repair of the subscapularis and biceps tenotomy.
. repair of the subscapularis and biceps tenodesis.

Correct Answer & Explanation

. repair of the subscapularis and biceps tenodesis.

Explanation

The examination and MRI scan confirm a subscapularis rupture and dislocation of the long head of the biceps tendon. The greatest return of function will result from repair of the subscapularis and tenodesis of the biceps tendon. Physical therapy alone will result in inadequate healing of the subscapularis and will not address the biceps tendon. While biceps tenotomy is an option, it will not provide the same level of pain relief and return of function as a tenodesis in a young, active man. There is no evidence for a supraspinatus tear.

Question 639

Topic: Shoulder & Hip Sports

A 45-year-old man sustains a comminuted fracture of the scapular body that extends into the spinoglenoid notch.

If the nerve passing through this specific notch is entrapped by fracture callus, which of the following physical examination findings would be exclusively expected?

. Weakness of both shoulder abduction and external rotation.
. Isolated weakness of external rotation with completely preserved shoulder abduction.
. Loss of sensation over the lateral aspect of the deltoid.
. Scapular winging prominent with forward elevation of the arm.
. Weakness of internal rotation of the shoulder.

Correct Answer & Explanation

. Isolated weakness of external rotation with completely preserved shoulder abduction.

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. It passes first through the suprascapular notch (giving motor branches to the supraspinatus) and then continues through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch results in isolated infraspinatus weakness (weak external rotation), while supraspinatus function (initiation of abduction) remains intact.

Question 640

Topic: Shoulder & Hip Sports

A 25-year-old male presents with an anterior shoulder dislocation following a rugby tackle. Post-reduction, he reports numbness over the lateral aspect of his shoulder. If this nerve injury persists, which muscle's function will most likely demonstrate profound weakness on subsequent examination?

. Supraspinatus
. Pectoralis major
. Subscapularis
. Infraspinatus
. Teres minor

Correct Answer & Explanation

. Supraspinatus

Explanation

The patient has an axillary nerve palsy, which is the most common nerve injury associated with anterior shoulder dislocations. The axillary nerve innervates the deltoid and the teres minor. The teres minor is an external rotator of the shoulder. The supraspinatus and infraspinatus are innervated by the suprascapular nerve, while the subscapularis is innervated by the upper and lower subscapular nerves.

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