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Shoulder & Hip Sports MCQs

Practice Set 35 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 681

Topic: Shoulder & Hip Sports

A 24-year-old professional rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability. Postoperatively, he presents with weakness in elbow flexion and forearm supination, as well as altered sensation over the lateral aspect of the forearm. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Median nerve
. Radial nerve
. Suprascapular nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve courses near the conjoined tendon and is at high risk during the coracoid transfer in a Latarjet procedure. Injury results in biceps and brachialis weakness (elbow flexion/supination) and sensory loss in the lateral antebrachial cutaneous nerve distribution.

Question 682

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability with significant glenoid bone loss, the coracoid process is transferred to the anterior glenoid. The primary dynamic stabilizing effect of this procedure is provided by which of the following mechanisms?

. The osseous block extending the glenoid articular arc
. The sling effect of the conjoint tendon on the inferior subscapularis and anteroinferior capsule
. The repair of the coracoacromial ligament to the glenoid labrum
. The tenodesis of the long head of the biceps to the coracoid
. The tightening of the middle glenohumeral ligament during coracoid transfer

Correct Answer & Explanation

. The osseous block extending the glenoid articular arc

Explanation

The Latarjet procedure provides stability through a 'triple blocking' effect. While the bone block increases the glenoid articular surface (static stability), the primary dynamic stabilizing mechanism is the 'sling effect' created by the conjoint tendon (short head of the biceps and coracobrachialis). In abduction and external rotation, the conjoint tendon tensions across the inferior subscapularis and anteroinferior capsule, preventing anterior humeral translation.

Question 683

Topic: Shoulder & Hip Sports

A 68-year-old male is 6 weeks status-post an anatomic total shoulder arthroplasty using a lesser tuberosity osteotomy approach. He presents with sudden onset of anterior shoulder pain and subjective weakness after attempting to lift a heavy box. On examination, he demonstrates a positive 'belly-press' test and increased passive external rotation compared to the contralateral side. What is the most likely diagnosis?

. Supraspinatus tendon rupture
. Subscapularis failure
. Dislocation of the long head of the biceps
. Aseptic loosening of the glenoid component
. Axillary nerve palsy

Correct Answer & Explanation

. Subscapularis failure

Explanation

Subscapularis failure is a known complication following anatomic total shoulder arthroplasty, particularly when a subscapularis peel, tenotomy, or lesser tuberosity osteotomy is utilized for anterior access. Clinical signs of subscapularis failure include a positive belly-press or lift-off test, weakness in internal rotation, an unexpected increase in passive external rotation, and anterior shoulder pain.

Question 684

Topic: Shoulder & Hip Sports
A 22-year-old collegiate baseball pitcher presents with anterior shoulder pain and a 'dead arm' feeling during the late cocking phase of throwing. MRI arthrogram reveals a SLAP tear. Diagnostic arthroscopy confirms a Type II SLAP tear. Which of the following anatomical findings defines a Type II SLAP tear?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum with extension into the biceps tendon
. An anteroinferior labral detachment with associated capsular stripping

Correct Answer & Explanation

. Detachment of the superior labrum and biceps anchor from the superior glenoid

Explanation

The Snyder classification of SLAP tears is as follows: Type I: Fraying of the superior labrum, biceps anchor intact. Type II: Detachment of the superior labrum and biceps anchor from the glenoid. Type III: Bucket-handle tear of the labrum, biceps anchor intact. Type IV: Bucket-handle tear of the labrum that extends into the biceps tendon. Therefore, Type II is defined by detachment of the labrum and biceps anchor.

Question 685

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with an irreparable massive posterior-superior rotator cuff tear. He has isolated loss of external rotation but intact subscapularis function and forward elevation. He is deemed a candidate for a lower trapezius tendon transfer. The transferred lower trapezius tendon most closely replicates the force vector of which native muscle?

. Supraspinatus
. Infraspinatus
. Teres minor
. Latissimus dorsi
. Posterior deltoid

Correct Answer & Explanation

. Infraspinatus

Explanation

The lower trapezius tendon transfer is increasingly utilized for massive, irreparable posterosuperior rotator cuff tears. Due to its origin, insertion, and line of pull, the lower trapezius muscle most closely replicates the exact force vector of the native infraspinatus. This makes it an excellent option for restoring active external rotation when prolonged by an Achilles tendon or hamstring allograft to reach the greater tuberosity.

Question 686

Topic: Shoulder & Hip Sports
A 48-year-old construction worker presents with deep anterior shoulder pain. An MRI arthrogram demonstrates a Type II SLAP tear. After failing 6 months of conservative management, surgical intervention is planned. Compared to SLAP repair, primary biceps tenodesis in this demographic (workers > 40 years old) is associated with:
. Higher rates of postoperative stiffness
. Lower rates of return to previous work level
. Decreased risk of revision surgery
. Increased risk of cosmetic 'Popeye' deformity compared to tenotomy
. Equivalent functional outcomes but longer rehabilitation time

Correct Answer & Explanation

. Decreased risk of revision surgery

Explanation

In older patients, manual laborers, and those with workman's compensation claims, SLAP repair is associated with a high rate of failure, persistent pain, stiffness, and subsequent revision surgery. Current evidence strongly supports primary biceps tenodesis over SLAP repair in patients over 40 years of age, as it yields lower rates of revision surgery, more reliable pain relief, and excellent return-to-work rates while minimizing postoperative stiffness.

Question 687

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. An MRI arthrogram reveals extravasation of contrast into the axillary pouch with a distinctive 'J-sign', demonstrating an avulsion of the inferior glenohumeral ligament from its anatomic attachment on the humerus. What is the diagnosis?

. Bankart lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion
. Perthes lesion

Correct Answer & Explanation

. HAGL lesion

Explanation

A HAGL (Humeral Avulsion of the Glenohumeral Ligament) lesion occurs when the inferior glenohumeral ligament (IGHL) avulses from its humeral insertion rather than its glenoid origin. On a coronal or oblique MRI arthrogram, the normal U-shape of the axillary recess is lost. Instead, contrast leaks out laterally and inferiorly, converting the U-shape into a characteristic 'J-sign'. Bankart, ALPSA, Perthes, and GLAD lesions all describe pathology at the glenoid attachment side.

Question 688

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. He reports a measurable decrease in throwing velocity. MRI arthrogram is most likely to show which of the following combined pathologic findings?

. Anterior labral tear and subscapularis tendinosis
. Articular-sided partial tear of the supraspinatus/infraspinatus and posterosuperior labral fraying
. Bursal-sided partial tear of the supraspinatus and subacromial bursitis
. Inferior capsular tear and axillary nerve entrapment
. Biceps anchor avulsion and superior glenohumeral ligament tear

Correct Answer & Explanation

. Articular-sided partial tear of the supraspinatus/infraspinatus and posterosuperior labral fraying

Explanation

Internal impingement occurs in overhead athletes during the late cocking phase of throwing (maximum abduction and external rotation). In this position, the greater tuberosity impinges against the posterosuperior glenoid, trapping the posterior supraspinatus and anterior infraspinatus tendons. This causes articular-sided partial rotator cuff tears and posterosuperior labral fraying.

Question 689

Topic: Shoulder & Hip Sports

In a 22-year-old collision athlete undergoing an arthroscopic anterior stabilization for recurrent shoulder instability, which of the following findings is the strongest indication to add an arthroscopic remplissage to the Bankart repair?

. An anterior glenoid bone loss of 25%
. An off-track Hill-Sachs lesion with 10% glenoid bone loss
. An associated Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion
. A concomitant type II SLAP tear
. A partial-thickness subscapularis tendon tear

Correct Answer & Explanation

. An off-track Hill-Sachs lesion with 10% glenoid bone loss

Explanation

An "off-track" Hill-Sachs lesion engages the anterior glenoid rim, significantly increasing the risk of recurrent dislocation. Performing a remplissage (infraspinatus tenodesis into the defect) converts the lesion to an "on-track" state, preventing engagement when glenoid bone loss is subcritical.

Question 690

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is osteotomized and transferred to the anterior glenoid. When retracting the conjoint tendon medially to expose the subscapularis, which nerve is at the highest risk of traction injury?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Long thoracic nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve typically enters the deep surface of the coracobrachialis 5 to 8 cm distal to the coracoid process, though anatomic variations exist. During the Latarjet procedure, aggressive medial retraction of the conjoint tendon (short head of biceps and coracobrachialis) places the musculocutaneous nerve at significant risk for a traction neuropraxia.

Question 691

Topic: Shoulder & Hip Sports

A 65-year-old male presents with severe shoulder weakness. MRI reveals a massive, retracted tear involving the supraspinatus and infraspinatus tendons with grade 3 fatty infiltration. Electromyography (EMG) indicates denervation changes in both muscles. Which anatomical site is the most likely location of secondary nerve tethering and traction injury caused directly by the medial retraction of these tendons?

. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch
. Spiral groove
. Coracoid process

Correct Answer & Explanation

. Suprascapular notch

Explanation

Massive medial retraction of the supraspinatus and infraspinatus muscles can exert a traction force on the suprascapular nerve. Because the nerve is relatively fixed at the suprascapular notch (under the transverse scapular ligament), medial retraction of the muscle belly causes the nerve to be stretched at this proximal anatomical tether point, leading to suprascapular neuropathy.

Question 692

Topic: Shoulder & Hip Sports
In the evaluation of a 22-year-old hockey player with suspected femoroacetabular impingement (FAI), a specialized lateral radiograph of the hip (Dunn view) is obtained. Which of the following radiographic thresholds is generally accepted as diagnostic of a clinically significant Cam-type deformity?
. Center-edge angle of Wiberg > 40 degrees
. Alpha angle > 55 degrees
. Acetabular index < 0 degrees
. Tönnis angle > 15 degrees
. Crossover sign positivity

Correct Answer & Explanation

. Alpha angle > 55 degrees

Explanation

A Cam deformity represents an abnormal morphology of the proximal femur with decreased head-neck offset. The alpha angle, typically measured on a Dunn or cross-table lateral radiograph, quantifies this asphericity. An alpha angle greater than 50-55 degrees is considered diagnostic of a Cam lesion. A center-edge angle >40 degrees or a positive crossover sign suggests Pincer impingement.

Question 693

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 25% anterior glenoid bone loss with a concomitant engaging Hill-Sachs lesion. What is the most appropriate surgical intervention to prevent recurrence?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open Latarjet procedure
. Arthroscopic superior capsular reconstruction
. Putti-Platt procedure

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

Critical anterior glenoid bone loss (generally defined as >20-25%) in a young, contact athlete with recurrent instability is best treated with a bony augmentation procedure. The open Latarjet procedure (coracoid transfer) addresses both the structural glenoid defect and provides a dynamic sling via the conjoint tendon. Arthroscopic Bankart alone has an unacceptably high failure rate in this setting. Remplissage is generally indicated for off-track engaging Hill-Sachs lesions when glenoid bone loss is subcritical (<20%).

Question 694

Topic: Shoulder & Hip Sports

A 55-year-old patient undergoes a lower trapezius tendon transfer for an irreparable posterosuperior rotator cuff tear. To which anatomic footprint is the transferred tendon (or its allograft extension) classically attached to best restore external rotation?

. Lesser tuberosity
. Greater tuberosity (infraspinatus footprint)
. Subscapularis footprint
. Bicipital groove
. Deltoid tuberosity

Correct Answer & Explanation

. Greater tuberosity (infraspinatus footprint)

Explanation

The lower trapezius tendon transfer is increasingly utilized for irreparable posterosuperior rotator cuff tears (involving the supraspinatus and infraspinatus) in patients without advanced arthropathy. Because the line of pull of the lower trapezius mimics that of the infraspinatus, the tendon (often elongated with an Achilles allograft) is attached to the infraspinatus footprint on the greater tuberosity to restore external rotation and assist with forward elevation.

Question 695

Topic: Shoulder & Hip Sports

A 24-year-old male athlete presents with groin pain and is evaluated for femoroacetabular impingement (FAI). Which of the following radiographic findings is most specifically characteristic of Cam-type FAI?

. Coxa profunda
. Alpha angle greater than 55 degrees
. Center-edge angle greater than 40 degrees
. Positive crossover sign
. Prominent ischial spine sign

Correct Answer & Explanation

. Alpha angle greater than 55 degrees

Explanation

Cam-type FAI is caused by an aspherical femoral head-neck junction with loss of the normal waist, leading to abutment against the acetabular rim during flexion and internal rotation. This is quantified by the alpha angle, typically measured on a Dunn or cross-table lateral radiograph. An alpha angle >55 degrees is considered diagnostic for Cam morphology. Coxa profunda, increased center-edge angle, and crossover signs are indicative of Pincer-type FAI (acetabular overcoverage).

Question 696

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, histological examination of the healing tendon-to-bone interface at 12 weeks primarily demonstrates which of the following?
. Direct structural re-establishment of native Sharpey's fibers and uncalcified fibrocartilage
. A dense layer of primarily Type II collagen forming a direct attachment
. A mechanically inferior fibrovascular scar tissue interface consisting predominantly of Type III collagen
. Pure membranous bone formation integrating directly into the tendon fascicles
. Endochondral ossification originating from the underlying cancellous bone bed into the tendon

Correct Answer & Explanation

. A mechanically inferior fibrovascular scar tissue interface consisting predominantly of Type III collagen

Explanation

Unlike the native normal enthesis, which transitions smoothly through four zones (tendon, uncalcified fibrocartilage, calcified fibrocartilage, and bone) relying heavily on Type I collagen and Sharpey's fibers, surgically repaired rotator cuffs heal primarily by the formation of fibrovascular scar tissue. This scar tissue is mechanically inferior and consists predominantly of Type III collagen during the early and intermediate healing phases, which explains the inherent susceptibility to recurrent tears post-surgery.

Question 697

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT evaluation shows 22% anterior glenoid bone loss and a large Hill-Sachs lesion. Applying the glenoid track concept, which of the following confirms that the Hill-Sachs lesion is 'off-track'?

. The Hill-Sachs width is less than the glenoid bone loss.
. The intact medial margin of the Hill-Sachs lesion is medial to the glenoid track.
. The intact medial margin of the Hill-Sachs lesion is lateral to the glenoid track.
. The bipolar bone loss involves only the anterior 10% of the glenoid.
. The coracoid process demonstrates congenital hypoplasia.

Correct Answer & Explanation

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

Explanation

A Hill-Sachs lesion is considered 'off-track' (engaging) when its intact medial margin extends medial to the medial boundary of the glenoid track. This occurs when the combination of glenoid bone loss and the size of the humeral head defect allows the lesion to engage the anterior glenoid rim during abduction and external rotation.

Question 698

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. CT scan reveals anterior glenoid bone loss of 25%. Which procedure provides the lowest recurrence rate for this patient?

. Arthroscopic Bankart repair with superior capsule reconstruction
. Open Bankart repair with capsular shift
. Arthroscopic Remplissage
. Latarjet procedure
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) in a contact athlete is best managed with a bony augmentation procedure like the Latarjet. Soft tissue repairs alone in this setting have an unacceptably high failure rate.

Question 699

Topic: Shoulder & Hip Sports

A 55-year-old female presents with a massive, retracted, immobile tear of the supraspinatus and infraspinatus. Fatty infiltration is Goutallier stage 3. She exhibits pseudoparalysis of elevation. What is the most reliable surgical option to restore active elevation?

. Arthroscopic margin convergence repair
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty
. Superior capsular reconstruction
. Arthroscopic partial repair

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

In an older patient with a massive, irreparable rotator cuff tear, significant fatty infiltration (Goutallier 3), and pseudoparalysis, a reverse total shoulder arthroplasty provides the most reliable functional restoration.

Question 700

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes a reverse total shoulder arthroplasty (rTSA). Preoperatively, he had an irreparable massive rotator cuff tear involving the supraspinatus, infraspinatus, and teres minor, presenting clinically with a positive hornblowers sign. Which of the following concomitant procedures is most appropriate to perform during the rTSA to optimize his postoperative function?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Trapezius transfer
. Subscapularis repair
. Biceps tenodesis

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

Patients with combined loss of active elevation and external rotation (CLEER) and a positive hornblowers sign (teres minor deficiency) benefit from a latissimus dorsi or lower trapezius transfer combined with rTSA to restore external rotation.

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