Menu

Shoulder & Hip Sports MCQs

Practice Set 33 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 641

Topic: Shoulder & Hip Sports

A 35-year-old male sustains a severely displaced scapular fracture with a fracture line extending deep into the spinoglenoid notch. He complains of persistent shoulder weakness. Which specific physical examination finding is most characteristic of nerve entrapment at this anatomic location?

. Weakness in shoulder abduction and external rotation
. Weakness in shoulder internal rotation
. Numbness over the lateral deltoid
. Weakness in isolated external rotation, with preserved abduction
. Winging of the scapula

Correct Answer & Explanation

. Weakness in shoulder abduction and external rotation

Explanation

The suprascapular nerve innervates the supraspinatus muscle as it passes through the suprascapular notch, and then travels through the spinoglenoid notch to innervate the infraspinatus. Entrapment or injury at the spinoglenoid notch affects only the infraspinatus (causing weakness in external rotation), while sparing the supraspinatus (preserving abduction).

Question 642

Topic: Shoulder & Hip Sports

A 70-year-old female sustains a primary anterior shoulder dislocation. After a successful and atraumatic closed reduction, she demonstrates persistent, profound weakness in active external rotation and active shoulder abduction. However, sensation over the lateral deltoid remains completely intact. What is the most likely etiology of her weakness?

. Axillary nerve palsy
. Suprascapular nerve palsy
. Rotator cuff tear
. Brachial plexus injury
. Deltoid rupture

Correct Answer & Explanation

. Axillary nerve palsy

Explanation

In older adults (particularly those over 40, and risk increases significantly over 60), anterior shoulder dislocations have a high association with massive rotator cuff tears. These tears present with profound weakness that can mimic a nerve palsy. The intact sensation over the deltoid makes an axillary nerve injury less likely, pointing strongly to a structural cuff failure.

Question 643

Topic: Shoulder & Hip Sports
During a posterior approach to the glenoid with retraction as shown in Figure 33, care should be taken during superior retraction to avoid injury to which of the following structures?
. Axillary artery
. Axillary nerve
. Branch of the circumflex scapular artery
. Profunda brachii artery
. Suprascapular nerve and artery

Correct Answer & Explanation

. Suprascapular nerve and artery

Explanation

During a posterior approach to the shoulder for either a scapular fracture, glenoid fracture, or posterior shoulder pathology, the interval between the teres minor and infraspinatus is split. Excessive superior retraction on the infraspinatus, or excessive dissection superomedially under the infraspinatus muscle and tendon can cause injury to the suprascapular nerve and/or artery. During dissection in this interval, the axillary artery and axillary nerve are well protected. A branch of the circumflex scapular artery ascends between the teres minor and infraspinatus muscle, but it is at risk during dissection on the scapula in the mid portion of the interval and not during superior retraction. The profunda brachii artery is not present in this interval.

Question 644

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with chronic groin pain that worsens with deep hip flexion and internal rotation. A standing AP pelvis radiograph demonstrates a 'crossover sign'. A frog-leg lateral radiograph shows an alpha angle of 65 degrees.

Which of the following morphologies is predominantly present?

. Cam morphology only
. Pincer morphology only
. Combined Cam and Pincer morphology
. Developmental dysplasia of the hip
. Perthes-like deformity

Correct Answer & Explanation

. Combined Cam and Pincer morphology

Explanation

The patient exhibits findings of both Cam and Pincer morphology, which is the most common presentation of femoroacetabular impingement (FAI). The 'crossover sign' indicates acetabular retroversion or focal overcoverage (Pincer morphology). An alpha angle greater than 50-55 degrees on a lateral radiograph indicates an aspherical femoral head-neck junction (Cam morphology). Thus, it is a combined FAI.

Question 645

Topic: Shoulder & Hip Sports

A 24-year-old male professional soccer player complains of chronic groin pain exacerbated by kicking. Physical examination reveals a positive impingement test (pain with flexion, adduction, and internal rotation). Radiographs display a "pistol-grip" deformity of the proximal femur and an alpha angle of 68 degrees. What is the primary pathoanatomy responsible for this condition?

. Pincer impingement secondary to focal acetabular retroversion
. Cam impingement due to reduced femoral head-neck offset
. Subspine impingement from a prominent anterior inferior iliac spine
. Ischiofemoral impingement causing quadratus femoris edema
. Internal snapping hip syndrome from the iliopsoas tendon

Correct Answer & Explanation

. Cam impingement due to reduced femoral head-neck offset

Explanation

The clinical picture describes femoroacetabular impingement (FAI). The radiographic findings of a pistol-grip deformity and an elevated alpha angle (>50-55 degrees) are pathognomonic for Cam-type impingement. This is caused by a loss of the normal concave junction between the femoral head and neck (reduced head-neck offset), which creates an aspherical head that abrades the acetabular cartilage during flexion and internal rotation. Pincer impingement is caused by acetabular overcoverage (e.g., coxa profunda, acetabular retroversion, positive crossover sign).

Question 646

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with anterior groin pain worsened by hip flexion, adduction, and internal rotation. Radiographs reveal a "pistol grip" deformity of the proximal femur. An alpha angle is measured on the lateral radiograph to quantify the cam lesion. In the context of Femoroacetabular Impingement (FAI), an alpha angle greater than what value is traditionally considered the threshold for abnormal?

. 30 degrees
. 40 degrees
. 55 degrees
. 75 degrees
. 85 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

An alpha angle greater than 50 to 55 degrees on a lateral radiograph or axial MRI is traditionally considered indicative of a cam deformity. This angle measures the loss of sphericity of the anterior femoral head-neck junction.

Question 647

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 26% anterior glenoid bone loss.

What is the most appropriate surgical intervention to prevent further dislocations in this athlete?

. Arthroscopic Bankart repair with capsular shift
. Open Bankart repair
. Arthroscopic remplissage alone
. Latarjet procedure
. Subscapularis advancement (Putti-Platt)

Correct Answer & Explanation

. Latarjet procedure

Explanation

The Latarjet procedure (coracoid transfer) is the treatment of choice for anterior shoulder instability in the presence of critical anterior glenoid bone loss (>20-25%). Arthroscopic or open Bankart repairs have unacceptably high failure rates in patients with significant bone loss, especially in young contact athletes, because soft tissue repair alone cannot restore the osseous articular arc.

Question 648

Topic: Shoulder & Hip Sports

During a physical examination of the shoulder, a patient is asked to place the palm of their hand on their opposite shoulder, with the elbow kept elevated. The examiner then applies a downward force to the patient's forearm while the patient resists. This test is highly specific for evaluating a tear of which structure?

. Supraspinatus
. Infraspinatus
. Teres minor
. Upper border of the subscapularis
. Long head of the biceps brachii

Correct Answer & Explanation

. Upper border of the subscapularis

Explanation

The physical examination maneuver described is the Bear-Hug test. It is highly sensitive and specific for diagnosing tears of the upper border of the subscapularis. The Belly-Press test is another subscapularis test, but the Bear-Hug test is considered more sensitive for upper subscapularis tears. The Lift-Off test requires internal rotation behind the back, evaluating the lower subscapularis.

Question 649

Topic: Shoulder & Hip Sports

A 25-year-old professional volleyball player presents with insidious onset, painless weakness of the right shoulder. Physical examination reveals isolated atrophy of the infraspinatus fossa, with normal bulk of the supraspinatus. At which anatomic location is the nerve compression most likely occurring?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Isolated atrophy and weakness of the infraspinatus point to compression of the suprascapular nerve at the spinoglenoid notch. The suprascapular nerve innervates the supraspinatus muscle after passing through the suprascapular notch, then travels around the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 650

Topic: Shoulder & Hip Sports

A 22-year-old elite rugby player with recurrent anterior shoulder instability undergoes a Latarjet procedure due to 25% anterior glenoid bone loss. The procedure relies on a "triple blocking" effect. Which of the following provides the most significant contribution to the dynamic stability (the "sling effect") conferred by the Latarjet procedure when the arm is abducted and externally rotated?

. The osseous block of the transferred coracoid process
. The conjoint tendon acting as a sling across the inferior capsule and lower subscapularis
. The repair of the coracoacromial (CA) ligament to the native anterior capsule
. The tenodesis of the long head of the biceps to the coracoid
. The imbrication of the superior glenohumeral ligament (SGHL)

Correct Answer & Explanation

. The conjoint tendon acting as a sling across the inferior capsule and lower subscapularis

Explanation

The Latarjet procedure confers stability through a "triple blocking" mechanism: 1) The osseous block of the coracoid extending the glenoid articular arc; 2) The dynamic "sling effect" of the conjoint tendon (short head of biceps and coracobrachialis) acting on the inferior capsule and lower subscapularis when the arm is in abduction and external rotation; 3) The capsular repair (often using the CA ligament stump). Biomechanical studies show that the dynamic "sling effect" of the conjoint tendon provides 50% to 70% of the stabilizing force.

Question 651

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and weakness. On examination, there is isolated weakness in external rotation with the arm at the side, but abduction is normal. MRI shows a paralabral cyst. Which of the following is true regarding this condition?

. The cyst is likely compressing the nerve at the suprascapular notch
. The patient will likely have atrophy of both the supraspinatus and infraspinatus
. The nerve is accompanied by the suprascapular artery through the spinoglenoid notch
. The sensory branches to the acromioclavicular joint are likely affected
. The condition is often associated with a posterior superior labral tear

Correct Answer & Explanation

. The condition is often associated with a posterior superior labral tear

Explanation

Isolated weakness of the infraspinatus indicates suprascapular nerve entrapment at the spinoglenoid notch. A paralabral cyst in this location is typically associated with a posterosuperior labral tear (SLAP). Entrapment at the suprascapular notch affects both supraspinatus and infraspinatus. The suprascapular artery does not typically pass through the spinoglenoid notch with the nerve (it usually runs superficial to the spinoglenoid ligament).

Question 652

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player undergoes evaluation for recurrent anterior shoulder instability. A 3D CT scan reveals a 20% anterior glenoid bone loss and a Hill-Sachs lesion. According to the 'glenoid track' concept, an 'off-track' Hill-Sachs lesion is defined by which of the following?

. The medial margin of the Hill-Sachs lesion is medial to the glenoid track
. The medial margin of the Hill-Sachs lesion is lateral to the glenoid track
. The lateral margin of the Hill-Sachs lesion is medial to the glenoid track
. The width of the Hill-Sachs lesion is less than the glenoid bone loss
. The Hill-Sachs lesion engages only in adduction and internal rotation

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion is medial to the glenoid track

Explanation

The glenoid track is defined as 83% of the intact glenoid width minus the anterior glenoid bone loss. An 'off-track' Hill-Sachs lesion occurs when the medial margin of the Hill-Sachs lesion extends further medial than the medial boundary of the glenoid track. This indicates that the lesion will 'engage' the anterior rim of the glenoid during abduction and external rotation, increasing the risk of recurrent dislocation. Such lesions typically require a Latarjet procedure or Remplissage.

Question 653

Topic: Shoulder & Hip Sports

A 22-year-old male collegiate wrestler presents with recurrent anterior shoulder instability. Advanced imaging reveals an anterior glenoid bone defect measuring 28% of the glenoid width, along with an engaging Hill-Sachs lesion. Which of the following surgical procedures is most appropriate?

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

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

For patients with critical anterior glenoid bone loss (>20-25%), a soft tissue repair alone (Bankart) has unacceptably high failure rates. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore stability via both the bone block and the sling effect of the conjoint tendon.

Question 654

Topic: Shoulder & Hip Sports

During arthroscopic evaluation of a 22-year-old baseball pitcher, a superior labral anterior-posterior (SLAP) tear is identified with detachment of the biceps anchor. Which of the following physical examination findings was most likely positive preoperatively?

. Lift-off test
. Active compression (O'Brien) test
. Hornblower's sign
. Belly-press test
. Bear-hug test

Correct Answer & Explanation

. Active compression (O'Brien) test

Explanation

The O'Brien (active compression) test is commonly used to evaluate for SLAP tears. Pain deep in the shoulder with internal rotation that is relieved by external rotation is considered a positive result for labral pathology.

Question 655

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Which of the following is the most frequent long-term complication associated with this procedure?

. Coracoid graft nonunion
. Hardware failure
. Development of glenohumeral osteoarthritis
. Recurrent instability
. Musculocutaneous nerve palsy

Correct Answer & Explanation

. Development of glenohumeral osteoarthritis

Explanation

The Latarjet procedure is highly effective for preventing recurrent instability in patients with significant anterior glenoid bone loss. However, long-term follow-up studies have shown a high incidence of glenohumeral osteoarthritis. This is often associated with lateral overhang of the coracoid graft, which causes impingement and wear on the humeral head. Graft nonunion, hardware complications, and nerve injuries occur but at lower rates compared to the long-term development of osteoarthritis.

Question 656

Topic: Shoulder & Hip Sports

An 18-year-old athlete undergoes arthroscopic anterior stabilization for recurrent anterior shoulder instability. Intraoperatively, he is found to have an 'off-track' engaging Hill-Sachs lesion. Which of the following procedures should be added to the Bankart repair?

. Latarjet procedure
. Remplissage
. Subscapularis tenodesis
. Biceps tenodesis
. Glenoid bone grafting

Correct Answer & Explanation

. Latarjet procedure

Explanation

An 'off-track' Hill-Sachs lesion engages the anterior glenoid rim during abduction and external rotation, significantly increasing the risk of recurrent dislocation if treated with a Bankart repair alone. A remplissage procedure (insetting the infraspinatus tendon and capsule into the defect) converts the defect to an extra-articular lesion and prevents engagement.

Question 657

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, which imaging modality is considered the gold standard for quantifying anterior glenoid bone loss?

. AP radiograph of the shoulder
. Stryker notch view radiograph
. MRI arthrogram with axial views
. 3D CT scan with humeral head subtraction
. Ultrasound of the anterior joint capsule

Correct Answer & Explanation

. 3D CT scan with humeral head subtraction

Explanation

3D CT reconstruction with the humeral head digitally subtracted provides the most accurate and reliable quantification of glenoid bone loss. This precise measurement is critical for deciding between a soft tissue stabilization (Bankart) and a bone-grafting procedure (Latarjet).

Question 658

Topic: Shoulder & Hip Sports

Which of the following patients is the most classic and appropriate candidate for a primary Reverse Total Shoulder Arthroplasty (RSA)?

. A 45-year-old laborer with primary osteoarthritis and an intact rotator cuff
. A 70-year-old female with a massive irreparable rotator cuff tear and pseudoparalysis
. A 30-year-old with recurrent anterior instability and severe anterior glenoid bone loss
. A 65-year-old with avascular necrosis of the humeral head and normal cuff function
. A 50-year-old with an isolated subscapularis tear and early joint space narrowing

Correct Answer & Explanation

. A 70-year-old female with a massive irreparable rotator cuff tear and pseudoparalysis

Explanation

RSA is strictly indicated for patients with cuff tear arthropathy or massive irreparable rotator cuff tears with pseudoparalysis. The reverse prosthesis relies on the deltoid muscle for active elevation, effectively bypassing the deficient rotator cuff.

Question 659

Topic: Shoulder & Hip Sports
A 35-year-old male with a history of poorly controlled seizures presents with a locked internal rotation deformity of his right shoulder. A CT scan confirms a posterior shoulder dislocation with an impaction fracture of the anterior humeral head (reverse Hill-Sachs lesion) involving 35% of the articular surface. The dislocation is <3 weeks old. What is the most appropriate surgical management?
. Closed reduction and spica casting
. Arthroscopic posterior Bankart repair
. Open reduction and transfer of the lesser tuberosity into the defect
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

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

Explanation

For a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, the modified McLaughlin procedure (transfer of the lesser tuberosity and subscapularis tendon into the defect) is the recommended treatment to restore stability.

Question 660

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness. Physical exam reveals isolated atrophy of the infraspinatus with preserved supraspinatus bulk. Weakness is noted in external rotation, but abduction is normal. An MRI is most likely to show a paralabral cyst located in which of the following areas?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular space
. Rotator interval

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated atrophy and weakness of the infraspinatus indicate compression of the suprascapular nerve at the spinoglenoid notch, often secondary to a paralabral cyst associated with a posterior or SLAP labral tear. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page