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Shoulder & Hip Sports MCQs

Practice Set 37 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 721

Topic: Shoulder & Hip Sports

In cases of recurrent anterior shoulder instability, a Hill-Sachs lesion is a common bony defect resulting from an impaction fracture on the:

. Anteromedial aspect of the humeral head
. Posterosuperior aspect of the humeral head
. Anterolateral aspect of the humeral head
. Posteroinferior aspect of the humeral head
. Superior aspect of the greater tuberosity

Correct Answer & Explanation

. Posterosuperior aspect of the humeral head

Explanation

A Hill-Sachs lesion is a cortical depression in the posterosuperior lateral aspect of the humeral head. It occurs when the humeral head dislocates anteriorly and impacts against the firm anterior glenoid rim.

Question 722

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. MRI arthrogram reveals a SLAP tear and partial articular-sided supraspinatus tendon avulsion (PASTA). What is the primary pathomechanical etiology of this injury?

. Subcoracoid impingement
. Glenohumeral internal rotation deficit (GIRD) leading to peel-back
. Primary external impingement against the coracoacromial arch
. Anterior capsular laxity causing excessive external rotation
. Posterior capsular redundancy leading to obligate anterior translation

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD) leading to peel-back

Explanation

Internal impingement in overhead throwers is driven by repetitive late-cocking motions causing a tight posterior capsule (GIRD). This leads to a posterosuperior shift of the humeral head, pinching the rotator cuff and peeling back the superior labrum.

Question 723

Topic: Shoulder & Hip Sports

A 65-year-old patient with a massive, chronic, retracted rotator cuff tear involving the supraspinatus and infraspinatus develops fatty infiltration and marked atrophy. EMG studies show denervation changes in the infraspinatus only. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Isolated denervation of the infraspinatus indicates compression at the spinoglenoid notch, often by a paralabral cyst.

Question 724

Topic: Shoulder & Hip Sports

Which of the following radiographic parameters is considered an established indication for operative intervention in the management of a displaced extra-articular scapular body/neck fracture?

. Glenopolar angle greater than 45 degrees
. Glenopolar angle less than 22 degrees
. Medial displacement of the glenoid of 5 mm
. Angulation of the scapular body of 15 degrees
. Inferior displacement of the glenoid of 2 mm

Correct Answer & Explanation

. Glenopolar angle less than 22 degrees

Explanation

Surgical indications for extra-articular scapular neck and body fractures include a glenopolar angle (GPA) of < 22 degrees (normal is 30-45 degrees), medial-lateral displacement > 20 mm, and angulation > 45 degrees. A severely decreased GPA alters the resting length and vectors of the rotator cuff, leading to poor functional outcomes if treated nonoperatively.

Question 725

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball catcher has posterior shoulder pain and severe external rotation weakness with the arm in adduction. Radiographs are normal. MRI scans are shown in Figures 15a through 15c. Management should consist of Review Topic

. aspiration and steroid injection.
. rest.
. acromioplasty.
. arthroscopic repair and decompression.
. rehabilitation.

Correct Answer & Explanation

. arthroscopic repair and decompression.

Explanation

The MRI scans reveal a large posterior paralabral cyst associated with a posterior-superior labral tear. The cyst appears as a well-defined, smoothly marginated mass with low signal intensity on T1-weighted MRI scans and with high signal intensity on T2-weighted MRI scans. MRI also reveals changes in the supraspinatus and infraspinatus muscles secondary to denervation, including decreased muscle bulk and fatty infiltration. MRI has the added advantage, compared with other imaging modalities, of detecting intra-articular lesions, such as labral tears, which are frequently associated with ganglion cysts of the shoulder. In this case of a professional baseball player with a space-occupying lesion causing nerve compression with an associated labral tear, the treatment of choice is arthroscopic decompression of the cyst and repair of the tear. Acromioplasty would not address the primary pathology in this patient.

Question 726

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, the 'glenoid track' concept is applied. A Hill-Sachs lesion is considered 'off-track' and at high risk for engagement if it:

. Remains engaged over the anterior glenoid rim during abduction and internal rotation
. Is entirely covered by the intact articular surface of the glenoid
. Extends medial to the medial margin of the glenoid track
. Involves less than 20% of the humeral head diameter
. Is associated with an isolated soft tissue Bankart lesion

Correct Answer & Explanation

. Extends medial to the medial margin of the glenoid track

Explanation

An 'off-track' Hill-Sachs lesion extends medial to the margin of the glenoid track. Because it is wider than the track provided by the glenoid, it will engage the anterior glenoid rim during abduction and external rotation, often necessitating a remplissage or Latarjet procedure.

Question 727

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player with recurrent anterior shoulder instability undergoes a preoperative 3D CT scan. The 'bare spot' or 'best-fit circle' method is utilized to assess anterior glenoid bone loss. Which of the following thresholds of anterior glenoid bone loss is classically accepted as an absolute indication for a bony augmentation procedure (e.g., Latarjet) rather than an isolated arthroscopic Bankart repair?

. Greater than 5%
. Greater than 10%
. Greater than 15%
. Greater than 20-25%
. Greater than 40%

Correct Answer & Explanation

. Greater than 20-25%

Explanation

The classic threshold for critical anterior glenoid bone loss, which serves as an absolute indication for a bony augmentation procedure (such as the Latarjet procedure), is generally accepted as > 20-25%. While recent literature discusses 'subcritical' bone loss (13.5-15%) in high-demand contact athletes where bone block may be considered, > 20-25% remains the definitive, historically validated cut-off for critical bone loss where soft tissue repair alone has an unacceptably high failure rate.

Question 728

Topic: Shoulder & Hip Sports

A 24-year-old male undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness with elbow flexion and forearm supination, as well as numbness over the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure, particularly during the coracoid osteotomy and the retraction of the conjoint tendon. Injury to this nerve results in weakness of the biceps and brachialis (elbow flexion and supination) and sensory deficits in the lateral antebrachial cutaneous nerve distribution (lateral forearm).

Question 729

Topic: Shoulder & Hip Sports

A 60-year-old male presents with a massive, chronically retracted tear involving both the supraspinatus and infraspinatus tendons. Due to the medial retraction of these specific tendons, at which anatomical site is the suprascapular nerve most vulnerable to traction injury or tethering?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates the supraspinatus and infraspinatus. With massive, retracted tears of the supraspinatus, the nerve can be placed under significant traction and tethered at the suprascapular notch (proximal to its innervation of the supraspinatus). While retraction of the infraspinatus alone might tether the nerve at the spinoglenoid notch, medial retraction of massive tears (involving supraspinatus) primarily threatens the nerve at the suprascapular notch.

Question 730

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT scan demonstrates 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. He undergoes a Latarjet procedure. During the coracoid transfer, which nerve is at greatest risk of injury if retractors are placed too vigorously on the medial aspect of the conjoint tendon?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

During the Latarjet procedure, the musculocutaneous nerve is at high risk of iatrogenic injury. It typically penetrates the coracobrachialis muscle approximately 5 to 8 cm distal to the coracoid tip but can enter much closer in anatomic variants. Vigorous medial retraction of the conjoint tendon can stretch or compress this nerve.

Question 731

Topic: Shoulder & Hip Sports

A 28-year-old male volleyball player presents with insidious onset posterior shoulder pain and weakness in external rotation. Exam reveals atrophy of the infraspinatus with a normal appearing supraspinatus. MRI demonstrates a paralabral cyst. At which of the following anatomical locations is the cyst most likely compressing the suprascapular nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated atrophy and weakness of the infraspinatus indicate compression of the suprascapular nerve after it has innervated the supraspinatus. This occurs at the spinoglenoid notch. Compression at the more proximal suprascapular notch would cause weakness and atrophy in both the supraspinatus and infraspinatus. Paralabral cysts associated with posterior labral tears frequently track into the spinoglenoid notch.

Question 732

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic shoulder pain and weakness. Clinical examination demonstrates a positive external rotation lag sign and a positive Hornblower's sign. MRI reveals a massive, irreparable tear of the posterosuperior rotator cuff with significant fatty infiltration of the infraspinatus and teres minor. The subscapularis is intact. If a tendon transfer is planned, which of the following provides the most biomechanically appropriate line of pull to restore external rotation in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Levator scapulae transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

A lower trapezius transfer, often augmented with an Achilles tendon allograft, most closely replicates the anatomic vector of the infraspinatus. It is highly effective for restoring external rotation in patients with irreparable posterosuperior cuff tears and an intact subscapularis, especially when there is a pronounced external rotation deficit (positive lag and Hornblower's signs). While latissimus dorsi transfers are also used for massive posterosuperior tears, its vector is less parallel to the infraspinatus compared to the lower trapezius.

Question 733

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals an 'inverted pear' glenoid with 28% anterior inferior bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with capsular plication
. Arthroscopic Remplissage procedure
. Latarjet procedure (coracoid transfer)
. Open inferior capsular shift
. Superior capsular reconstruction

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Anterior glenoid bone loss exceeding 20-25% ('inverted pear' glenoid) is an absolute indication for a bone block augmentation procedure, as soft tissue repairs (like an arthroscopic Bankart) have unacceptably high failure rates in this setting. The Latarjet procedure (transferring the coracoid process with the attached conjoint tendon to the anterior glenoid) provides a triple blocking effect (bone block, sling effect of the conjoint tendon, and capsular repair) and is the treatment of choice.

Question 734

Topic: Shoulder & Hip Sports
A 24-year-old collegiate baseball pitcher presents with 'dead arm' syndrome and posterior shoulder pain during the late cocking phase of throwing. MRI reveals a Snyder Type II SLAP tear. What is the defining pathoanatomic feature of a Type II SLAP lesion?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and the long head of the biceps anchor from the glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum that extends into the biceps tendon
. Avulsion of the anterior-inferior labrum with a periosteal sleeve

Correct Answer & Explanation

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

Explanation

According to the Snyder classification: Type I is degenerative fraying; Type II is detachment of the superior labrum and biceps anchor from the superior glenoid tubercle; Type III is a bucket-handle tear of the labrum with an intact biceps anchor; Type IV is a bucket-handle tear that extends into the long head of the biceps tendon.

Question 735

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with vague posterior shoulder pain and isolated weakness in external rotation. Physical examination reveals noticeable atrophy of the infraspinatus fossa, while the supraspinatus fossa appears completely normal. At which anatomic location is the nerve most likely entrapped?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus muscle after passing through the suprascapular notch, and then travels through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (commonly by a paralabral cyst in overhead athletes) results in isolated infraspinatus weakness and atrophy, sparing the supraspinatus.

Question 736

Topic: Shoulder & Hip Sports

A 26-year-old man presents with recurrent anterior shoulder instability. An MRI arthrogram reveals a HAGL lesion. What is the specific pathoanatomy defining this lesion?

. Avulsion of the middle glenohumeral ligament from the anterior glenoid rim
. Avulsion of the inferior glenohumeral ligament complex from the anatomical neck of the humerus
. A superior labral tear extending from anterior to posterior
. A bony avulsion fracture of the anterior inferior glenoid rim
. An intrasubstance tear of the upper subscapularis tendon

Correct Answer & Explanation

. Avulsion of the inferior glenohumeral ligament complex from the anatomical neck of the humerus

Explanation

HAGL stands for Humeral Avulsion of the Glenohumeral Ligament. It describes the complete detachment of the inferior glenohumeral ligament (IGHL) complex from its insertion site on the anatomical neck of the humerus. This causes a loss of the 'sling' effect of the IGHL, leading to severe anterior or anteroinferior shoulder instability. It is an important lesion to recognize, as it requires a specific surgical repair distinct from a standard Bankart repair.

Question 737

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness with elbow flexion and supination, and numbness over the lateral forearm. Which nerve is most likely injured?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure, particularly when retracting the conjoined tendon (coracobrachialis and short head of the biceps). The nerve typically enters the coracobrachialis 3-8 cm distal to the coracoid tip. Injury causes weakness in elbow flexion and supination, and sensory deficits in the lateral antebrachial cutaneous nerve distribution.

Question 738

Topic: Shoulder & Hip Sports

A 25-year-old hockey player is diagnosed with symptomatic cam-type femoroacetabular impingement (FAI). During arthroscopic osteochondroplasty, excessive resection of the femoral neck can lead to a femoral neck fracture. What is the recommended maximum depth of resection to minimize this risk?

. 5% of the femoral neck diameter
. 10% of the femoral neck diameter
. 30% of the femoral neck diameter
. 50% of the femoral neck diameter
. 70% of the femoral neck diameter

Correct Answer & Explanation

. 30% of the femoral neck diameter

Explanation

Biomechanical studies have demonstrated that resecting more than 30% of the anterolateral femoral neck diameter during osteochondroplasty for cam impingement significantly alters the load-bearing capacity of the proximal femur, exponentially increasing the risk of an iatrogenic postoperative femoral neck fracture.

Question 739

Topic: Shoulder & Hip Sports

A 24-year-old male presents with recurrent anterior shoulder instability. Imaging reveals a 15% anterior glenoid bone loss and an engaging Hill-Sachs lesion that is determined to be 'off-track'. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open Bankart repair
. Putti-Platt procedure

Correct Answer & Explanation

. Arthroscopic Bankart repair with remplissage

Explanation

Although 15% glenoid bone loss is considered subcritical, an engaging Hill-Sachs lesion makes it 'off-track'. Arthroscopic Bankart repair combined with remplissage is indicated for off-track lesions with subcritical glenoid bone loss to prevent engagement.

Question 740

Topic: Shoulder & Hip Sports

A 25-year-old hockey player is diagnosed with Femoroacetabular Impingement (FAI). Radiographs demonstrate an alpha angle of 65 degrees. Where is the cam lesion most commonly located on the femoral head-neck junction?

. Anteroinferior
. Anterosuperior
. Posterosuperior
. Posteroinferior
. Direct medial

Correct Answer & Explanation

. Anterosuperior

Explanation

Cam lesions in FAI represent an osseous bump at the femoral head-neck junction that decreases the normal concavity. They are most commonly located in the anterosuperior quadrant, leading to labral impingement during hip flexion and internal rotation.

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