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Shoulder & Hip Sports MCQs

Practice Set 38 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 741

Topic: Shoulder & Hip Sports

A 55-year-old active laborer with an irreparable posterosuperior rotator cuff tear is evaluated for a latissimus dorsi tendon transfer. Which of the following is a strict prerequisite for a successful functional outcome?

. An intact or repairable subscapularis
. An intact supraspinatus
. Pre-existing advanced glenohumeral arthritis
. A paralyzed axillary nerve
. Patient age greater than 75 years

Correct Answer & Explanation

. An intact or repairable subscapularis

Explanation

Latissimus dorsi transfer for an irreparable posterosuperior rotator cuff tear requires an intact or repairable subscapularis to maintain an anterior force couple. Without it, the humeral head cannot be centered in the glenoid, leading to transfer failure.

Question 742

Topic: Shoulder & Hip Sports
A 26-year-old professional volleyball player presents with persistent shoulder pain during overhead serving. MRI arthrogram reveals a detachment of the superior labrum and biceps anchor from the glenoid. Which classification type does this describe, and what is the primary surgical management for this young overhead athlete who failed conservative care?
. Type I SLAP tear; arthroscopic debridement
. Type II SLAP tear; arthroscopic SLAP repair
. Type III SLAP tear; biceps tenodesis
. Type IV SLAP tear; biceps tenotomy
. Type II SLAP tear; open Latarjet procedure

Correct Answer & Explanation

. Type II SLAP tear; arthroscopic SLAP repair

Explanation

A detachment of the superior labrum and biceps anchor from the glenoid is a Type II SLAP tear. In young overhead athletes who fail conservative management, arthroscopic repair of the labrum is generally preferred to restore native anatomy and function.

Question 743

Topic: Shoulder & Hip Sports

An 8-month-old infant presents with an unresolved Erb-Duchenne palsy (C5-C6 injury) following a difficult vertex delivery with shoulder dystocia. The affected arm rests in internal rotation and adduction at the shoulder, with the elbow extended and forearm pronated. The internal rotation contracture of the shoulder is primarily driven by the unopposed action of which of the following muscles?

. Subscapularis and Pectoralis major
. Infraspinatus and Teres minor
. Supraspinatus and Deltoid
. Latissimus dorsi and Teres major
. Biceps brachii and Coracobrachialis

Correct Answer & Explanation

. Subscapularis and Pectoralis major

Explanation

In Erb-Duchenne palsy, damage to the C5 and C6 nerve roots causes paralysis of the external rotators (infraspinatus and teres minor) and abductors (supraspinatus and deltoid) of the shoulder, as well as the elbow flexors (biceps, brachialis) and forearm supinators. The unparalyzed internal rotators—most notably the subscapularis and pectoralis major—overpower the weak external rotators, leading to a progressive internal rotation contracture of the shoulder. This positional deformity is classically referred to as the 'waiter's tip' posture.

Question 744

Topic: Shoulder & Hip Sports

A 25-year-old pitcher experiences sudden, severe right shoulder pain, followed two weeks later by profound weakness in external rotation and elevation. EMG demonstrates denervation isolated to the supraspinatus and infraspinatus. There is no history of trauma. What is the most likely diagnosis?

. Quadrilateral space syndrome
. Suprascapular notch cyst
. Parsonage-Turner syndrome
. C5 radiculopathy
. Rotator cuff tear

Correct Answer & Explanation

. Parsonage-Turner syndrome

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) typically presents with acute, severe shoulder girdle pain followed by patchy weakness and amyotrophy, most commonly affecting the upper trunk distributions like the suprascapular nerve.

Question 745

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is transferred to the anterior glenoid rim. The 'sling effect' provided by this procedure, which contributes significantly to stability when the arm is abducted and externally rotated, is created by which of the following?

. Coracoacromial ligament tensioning
. Conjoined tendon (biceps short head and coracobrachialis)
. Pectoralis minor dynamic pull
. Upper border of the subscapularis
. Transverse humeral ligament

Correct Answer & Explanation

. Conjoined tendon (biceps short head and coracobrachialis)

Explanation

The Latarjet procedure stabilizes the shoulder via a triple-blocking effect. The 'sling effect' is the dynamic stabilization provided by the conjoined tendon (short head of the biceps and coracobrachialis), which passes through the lower portion of the split subscapularis muscle. When the arm is placed in abduction and external rotation, the conjoined tendon acts as a sling to tension the inferior capsule and lower subscapularis, preventing anterior translation of the humeral head.

Question 746

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the conjoined tendon is aggressively retracted medially to facilitate exposure of the subscapularis. Over-retraction or aggressive manipulation of the conjoined tendon places which of the following nerves at greatest risk of stretch injury?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis (part of the conjoined tendon) approximately 5 to 8 cm distal to the tip of the coracoid process, though its course can be variable. Aggressive medial and distal retraction of the conjoined tendon during the Latarjet procedure or a deltopectoral approach puts the musculocutaneous nerve at significant risk for a neuropraxic stretch injury.

Question 747

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Which muscle or tendon must be split to pass the coracoid graft to the anterior glenoid neck?

. Conjoint tendon
. Pectoralis minor
. Subscapularis
. Infraspinatus
. Pectoralis major

Correct Answer & Explanation

. Subscapularis

Explanation

During the Latarjet procedure, the coracoid process with the attached conjoint tendon is passed through a horizontal split in the subscapularis muscle to reach the anterior glenoid rim. This creates a dynamic sling effect that contributes to stability.

Question 748

Topic: Shoulder & Hip Sports

In an anatomic total shoulder arthroplasty, the phenomenon of 'rocking horse' loosening of the glenoid component is most commonly caused by which of the following?

. Superior migration of the humeral head due to rotator cuff deficiency
. Failure to restore native humeral retroversion
. Use of a metal-backed glenoid component
. Unrecognized axillary nerve palsy
. Over-reaming of the anterior glenoid vault

Correct Answer & Explanation

. Superior migration of the humeral head due to rotator cuff deficiency

Explanation

Eccentric loading of the glenoid component, most commonly due to superior migration of the humeral head in the setting of rotator cuff deficiency, creates a rocking horse effect that leads to premature aseptic glenoid loosening.

Question 749

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has profound weakness in elbow flexion and decreased sensation over the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis 5-8 cm distal to the coracoid process but can have a higher entry point. It is at significant risk during coracoid osteotomy, mobilization, and retraction during the Latarjet procedure. Injury results in biceps/brachialis weakness (diminished elbow flexion) and numbness in the lateral antebrachial cutaneous nerve distribution.

Question 750

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination shows a 25-degree loss of internal rotation compared to the contralateral side. Which of the following pathologic mechanisms is primarily responsible for internal impingement in this athlete?

. Contact between the coracoid process and the subscapularis tendon
. Contact between the articular surface of the rotator cuff and the posterosuperior glenoid labrum
. Anterior capsular contracture displacing the humeral head posteriorly
. Acromioclavicular joint osteophyte abrading the supraspinatus
. Tightness of the pectoralis minor tendon causing scapular dyskinesia

Correct Answer & Explanation

. Contact between the articular surface of the rotator cuff and the posterosuperior glenoid labrum

Explanation

Internal impingement in overhead throwing athletes occurs during extreme abduction and external rotation (late cocking phase). This position causes the articular (undersurface) side of the posterosuperior rotator cuff (supraspinatus/infraspinatus) to impinge against the posterosuperior glenoid and labrum. GIRD (glenohumeral internal rotation deficit) from posterior capsular contracture frequently contributes.

Question 751

Topic: Shoulder & Hip Sports

When evaluating recurrent anterior shoulder instability, a 3D CT scan is often obtained to quantify glenoid bone loss using the 'best-fit circle' method. What is the classic critical threshold of glenoid bone loss above which isolated soft tissue stabilization (Bankart repair) has unacceptably high failure rates?

. 5-10%
. 15-18%
. 20-25%
. 35-40%
. 45-50%

Correct Answer & Explanation

. 20-25%

Explanation

The traditional 'critical' threshold for glenoid bone loss is 20-25%. Although recent literature suggests 'subcritical' bone loss (13.5-20%) can also lead to poorer outcomes, 20-25% remains the classic board answer threshold indicating the definitive need for a bony augmentation procedure (e.g., Latarjet).

Question 752

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with a massive, irreparable posterosuperior rotator cuff tear (supraspinatus and infraspinatus). He has an intact subscapularis, a severe external rotation lag, but pseudoparalysis is absent. Which tendon transfer is most appropriate to restore active external rotation and forward elevation in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Trapezius transfer to the lesser tuberosity
. Biceps rerouting and tenodesis
. Levator scapulae transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

The latissimus dorsi transfer (and increasingly the lower trapezius transfer) is indicated for young, active patients with massive, irreparable posterosuperior rotator cuff tears (involving the supraspinatus and infraspinatus). It aims to restore active external rotation and forward elevation. Key prerequisites include an intact subscapularis, intact deltoid, minimal glenohumeral arthritis, and the absence of true pseudoparalysis. Pectoralis major transfers are reserved for irreparable subscapularis tears.

Question 753

Topic: Shoulder & Hip Sports

A 70-year-old male presents with deep shoulder pain 6 years after an anatomic TSA. Radiographs demonstrate superior migration of the humeral head and a "rocking horse" loosening pattern of the polyethylene glenoid component. This specific mechanism of glenoid loosening is most commonly associated with which underlying pathology?

. Eccentric cyclic loading secondary to massive rotator cuff failure
. Indolent deep periprosthetic infection with Cutibacterium acnes
. Excessive retroversion of the humeral stem during index surgery
. Aggressive over-reaming of the anterior glenoid rim
. Unrecognized axillary nerve palsy leading to deltoid fatigue

Correct Answer & Explanation

. Eccentric cyclic loading secondary to massive rotator cuff failure

Explanation

The "rocking horse" phenomenon describes the eccentric loading of the glenoid component that leads to catastrophic early loosening. This most frequently occurs in anatomic TSA when the rotator cuff (specifically the supraspinatus) fails, causing the humeral head to migrate superiorly. The superiorly migrated head applies eccentric, unbalanced cyclic forces to the superior edge of the glenoid, levering it out of the cement mantle.

Question 754

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with insidious onset groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a pistol grip deformity of the proximal femur and an alpha angle of 75 degrees. Which of the following intra-articular pathologies is most commonly associated with this specific type of femoroacetabular impingement (FAI)?

. Avulsion of the ligamentum teres
. Circumferential crushing of the acetabular labrum
. Chondral delamination at the anterosuperior acetabulum
. Global retroversion of the acetabulum
. Ossification of the reflected head of the rectus femoris

Correct Answer & Explanation

. Chondral delamination at the anterosuperior acetabulum

Explanation

The clinical picture describes Cam-type FAI (pistol grip deformity, high alpha angle). Cam impingement generates shear forces at the chondrolabral junction of the anterosuperior acetabulum, classically causing inside-out chondral delamination while leaving the labrum relatively intact initially. In contrast, Pincer FAI (e.g., global retroversion) typically causes direct, often circumferential crushing and degeneration of the labrum.

Question 755

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a lateral center edge angle (LCEA) of 30 degrees and an alpha angle of 75 degrees. Which morphological abnormality is most likely responsible for his symptoms?

. Pincer impingement secondary to acetabular retroversion
. Cam impingement secondary to decreased anterior femoral head-neck offset
. Pincer impingement secondary to coxa profunda
. Subspine impingement secondary to an AIIS osteophyte
. Ischiofemoral impingement

Correct Answer & Explanation

. Cam impingement secondary to decreased anterior femoral head-neck offset

Explanation

An alpha angle greater than 50-55 degrees on a lateral or Dunn view radiograph is diagnostic of Cam morphology, which represents an aspherical femoral head with decreased head-neck offset (typically anterosuperiorly). This leads to cam-type femoroacetabular impingement (FAI). His LCEA of 30 degrees is normal (25-39 degrees), making pincer impingement (overcoverage) less likely.

Question 756

Topic: Shoulder & Hip Sports

A 45-year-old female presents with insidious onset groin pain. Radiographs reveal a 'cross-over sign' and an alpha angle of 45 degrees. These findings are most characteristic of which of the following?

. Cam-type femoroacetabular impingement
. Pincer-type femoroacetabular impingement
. Developmental dysplasia of the hip
. Legg-Calve-Perthes disease
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Pincer-type femoroacetabular impingement

Explanation

The 'cross-over sign' on an AP pelvis radiograph indicates acetabular retroversion or focal anterior overcoverage, which is the hallmark of Pincer-type femoroacetabular impingement (FAI). An alpha angle of 45 degrees is within normal limits (typically < 50-55 degrees), making a Cam lesion (femoral-sided abnormality) less likely.

Question 757

Topic: Shoulder & Hip Sports

In a patient with cam-type femoroacetabular impingement (FAI), where is the primary site of articular cartilage damage most commonly located?

. Anterosuperior acetabulum
. Posteroinferior acetabulum
. Medial femoral head
. Fovea capitis
. Posterior femoral neck

Correct Answer & Explanation

. Anterosuperior acetabulum

Explanation

Cam-type FAI is caused by an aspherical femoral head (often with a decreased head-neck offset or increased alpha angle). During hip flexion and internal rotation, this prominent cam lesion engages the acetabulum, causing shear forces. The resulting chondral damage typically occurs at the anterosuperior aspect of the acetabulum, frequently causing cartilage delamination at the chondrolabral junction.

Question 758

Topic: Shoulder & Hip Sports

An AP pelvis radiograph of a 30-year-old male with chronic groin pain demonstrates the anterior rim of the acetabulum crossing the posterior rim superiorly, but the medial aspect of the acetabulum does not cross the ilioischial line. What is this radiographic 'crossover sign' indicative of?

. Coxa profunda
. Protrusio acetabuli
. Focal cranial retroversion (Pincer impingement)
. Cam-type femoroacetabular impingement
. Developmental dysplasia of the hip

Correct Answer & Explanation

. Focal cranial retroversion (Pincer impingement)

Explanation

The crossover sign on a well-centered AP pelvis radiograph indicates focal cranial retroversion of the acetabulum, which is a common cause of Pincer-type femoroacetabular impingement (FAI). In a normal hip, the anterior rim line should lie medial to the posterior rim line. When they cross, it indicates that the superior-anterior acetabulum is over-covering the femoral head. Coxa profunda is characterized by the acetabular fossa medial to the ilioischial line, while protrusio occurs when the femoral head itself crosses medial to the ilioischial line.

Question 759

Topic: Shoulder & Hip Sports

A 60-year-old male presents with pseudoparalysis and intractable shoulder pain. MRI shows a massive, retracted, and irreparable tear of the supraspinatus and infraspinatus tendons. The subscapularis, teres minor, and articular cartilage are intact. Which procedure is most appropriate?

. Total shoulder arthroplasty
. Superior capsular reconstruction
. Latissimus dorsi transfer
. Reverse total shoulder arthroplasty
. Arthroscopic debridement and biceps tenotomy

Correct Answer & Explanation

. Superior capsular reconstruction

Explanation

Superior Capsular Reconstruction (SCR) is indicated for massive, irreparable posterosuperior rotator cuff tears in active patients with intact articular cartilage (no glenohumeral arthritis), a functioning deltoid, and an intact or repairable subscapularis. It helps restore the superior restraint to humeral head translation. Latissimus dorsi transfer requires an intact subscapularis but SCR more effectively prevents superior escape when the superior capsule is deficient.

Question 760

Topic: Shoulder & Hip Sports

In rotator cuff tear arthropathy with pseudoparalysis, forward elevation of the humerus away from the body is prohibited because of

. deltoid atony.
. loss of the glenoid concavity.
. loss of the humeral head depression of the biceps tendon.
. loss of compressive force on the humeral head.

Correct Answer & Explanation

. loss of compressive force on the humeral head.

Explanation

The rotator cuff serves as a humeral head compressor that stabilizes the humeral head in the glenoid concavity so that the deltoid can convert a vertical force into abduction and forward elevation. The deltoid functions normally in patients with chronic rotator cuff arthropathy, so no atony is present. Glenoid concavity can be lost over time, but this is not the primary mechanism for failure of elevation. The biceps tendon does not serve as a humeral head compressor and does not prevent proximal migration of the shoulder when it is present.

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