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Shoulder & Hip Sports MCQs

Practice Set 4 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 61

Topic: Shoulder & Hip Sports

Which of the following is the primary stabilizing mechanism of the Latarjet procedure in treating anterior shoulder instability?

. Deepening of the glenoid concavity via the bone block
. The "sling effect" of the conjoined tendon on the inferior subscapularis and capsule
. Restoring the anatomic origin of the long head of the biceps
. Shortening of the anterior capsule to limit external rotation
. Dynamic stabilization from the transferred pectoralis minor

Correct Answer & Explanation

. The "sling effect" of the conjoined tendon on the inferior subscapularis and capsule

Explanation

The Latarjet procedure provides stability primarily via the "sling effect" of the conjoined tendon across the inferior subscapularis when the arm is abducted and externally rotated. This accounts for 50-70% of the stabilizing effect.

Question 62

Topic: Shoulder & Hip Sports

A 24-year-old hockey player presents with groin pain exacerbated by flexion and internal rotation. Radiographs demonstrate an elevated alpha angle on the frog-leg lateral view. What is the primary pathomechanical consequence of this structural abnormality?

. Pincer impingement causing posterior labral tears
. Cam impingement leading to chondral delamination at the anterosuperior acetabulum
. Dysplastic instability leading to ligamentum teres hypertrophy
. Ischiofemoral impingement causing quadratus femoris edema
. Subspine impingement causing rectus femoris tendinosis

Correct Answer & Explanation

. Cam impingement leading to chondral delamination at the anterosuperior acetabulum

Explanation

An elevated alpha angle indicates a Cam-type deformity, which is an aspherical femoral head-neck junction. This creates shear forces during flexion and internal rotation, typically causing anterosuperior acetabular chondral delamination.

Question 63

Topic: Shoulder & Hip Sports

In the evaluation of femoroacetabular impingement (FAI), an alpha angle greater than 55 degrees measured on a modified Dunn lateral radiograph is most indicative of:

. Pincer impingement
. Cam impingement
. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli

Correct Answer & Explanation

. Cam impingement

Explanation

The alpha angle is used to quantify the loss of anterior head-neck offset in the proximal femur. An angle greater than 50-55 degrees indicates the presence of a cam deformity, which can lead to chondrolabral damage during hip flexion.

Question 64

Topic: Shoulder & Hip Sports

According to the "Glenoid Track" concept in anterior shoulder instability, a Hill-Sachs lesion is considered "off-track" if it:

. Is wider than the anterior-to-posterior distance of the glenoid.
. Extends medial to the medial margin of the glenoid track.
. Engages the anterior glenoid rim only when the arm is internally rotated.
. Involves more than 40% of the humeral head articular surface.
. Is accompanied by a bony Bankart lesion of any size.

Correct Answer & Explanation

. Extends medial to the medial margin of the glenoid track.

Explanation

An off-track Hill-Sachs lesion extends medial to the calculated medial margin of the glenoid track. This means the lesion can engage the anterior rim of the glenoid during abduction and external rotation, necessitating procedures like a remplissage or Latarjet.

Question 65

Topic: Shoulder & Hip Sports

An anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion differs from a classic Bankart lesion in that the ALPSA lesion involves:

. A bony fracture of the anterior inferior glenoid rim
. An avulsion of the inferior glenohumeral ligament from the humeral head
. An intact periosteum with the labrum displaced medially and inferiorly along the glenoid neck
. A complete rupture of the anterior labrum with disruption of the scapular periosteum
. A superior labral tear extending into the biceps anchor

Correct Answer & Explanation

. An intact periosteum with the labrum displaced medially and inferiorly along the glenoid neck

Explanation

In an ALPSA lesion, the anterior labrum is avulsed but the anterior scapular periosteum remains intact, acting as a sleeve. This allows the labroligamentous complex to heal in a medially displaced and externally rotated position, potentially leading to higher recurrence rates if not properly mobilized during repair.

Question 66

Topic: Shoulder & Hip Sports

A volleyball player presents with posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst in the spinoglenoid notch. Which muscle is predominantly affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Deltoid
. Subscapularis

Correct Answer & Explanation

. Infraspinatus

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. Entrapment at the suprascapular notch affects both, whereas entrapment distal to this at the spinoglenoid notch leads to isolated infraspinatus weakness (external rotation).

Question 67

Topic: Shoulder & Hip Sports

In athletes with femoroacetabular impingement (FAI), a Cam lesion typically produces chondral damage by which of the following mechanisms?

. Linear impaction of the acetabular rim during terminal extension
. Shear forces generated by an aspherical femoral head entering the acetabulum during flexion and internal rotation
. Global overcoverage of the femoral head leading to pincer-type compression
. Direct avulsion of the ligamentum teres during deep flexion
. Ischemic necrosis of the anterosuperior labrum due to capsular stretching

Correct Answer & Explanation

. Shear forces generated by an aspherical femoral head entering the acetabulum during flexion and internal rotation

Explanation

A Cam lesion is an aspherical extension of the femoral head-neck junction. During hip flexion and internal rotation, this non-spherical portion enters the acetabulum, generating significant shear forces that peel the cartilage away from the labrum at the anterosuperior rim.

Question 68

Topic: Shoulder & Hip Sports

The Latarjet procedure is often used for recurrent anterior shoulder instability with significant glenoid bone loss. What is the most commonly injured nerve during this procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is the most commonly injured nerve during a Latarjet procedure due to its proximity to the coracoid process and conjoint tendon, which is mobilized and transferred during the operation.

Question 69

Topic: Shoulder & Hip Sports

Internal snapping hip syndrome is often a source of groin pain in dancers and martial artists. The snapping sensation is typically caused by the snapping of which structure over the iliopectineal eminence?

. Iliotibial band
. Rectus femoris tendon
. Iliopsoas tendon
. Gluteus maximus tendon
. Sartorius tendon

Correct Answer & Explanation

. Iliopsoas tendon

Explanation

Internal snapping hip (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the anterior femoral head, often producing an audible click and groin pain.

Question 70

Topic: Shoulder & Hip Sports

Cam-type femoroacetabular impingement (FAI) is frequently diagnosed in young male athletes with groin pain. The underlying pathomorphology is best described by which of the following?

. Focal over-coverage of the femoral head by the acetabulum
. An aspherical femoral head with decreased anterior head-neck offset
. Acetabular retroversion leading to anterior over-coverage
. A deep acetabular socket (coxa profunda)
. An excessively large alpha angle in a normally spherical femoral head

Correct Answer & Explanation

. An aspherical femoral head with decreased anterior head-neck offset

Explanation

Cam-type FAI is caused by an aspherical femoral head (often a 'bump' at the anterolateral head-neck junction), which leads to a decreased head-neck offset. This asphericity causes a shear injury to the acetabular cartilage and labrum during flexion.

Question 71

Topic: Shoulder & Hip Sports

Internal impingement of the shoulder between the posterosuperior glenoid rim and the rotator cuff typically occurs with the arm in this position:

. Abduction and internal rotation
. Adduction and external rotation
. Adduction and internal rotation
. Abduction, external rotation, and extension
. Abduction, external rotation, and flexion

Correct Answer & Explanation

. Abduction, external rotation, and extension

Explanation

Internal impingement of the shoulder occurs with the arm in the abducted, externally rotated, and extended position. This entity may be responsible for shoulder pain commonly occurring in overhead and throwing athletes. Initial treatment is focused on therapy that strengthens the anterior structures and scapular retractors and stretches the posterior structures. If nonoperative treatment fails, arthroscopic debridement, thermal capsular shrinkage, and humeral derotational osteotomy have all been used with varying degrees of success.

Question 72

Topic: Shoulder & Hip Sports

This slide is a computed tomogram of the shoulder of a 22-year-old rugby player. The most likely diagnosis is:

. Anterior shoulder instability
. Posterior shoulder instability
. Glenohumeral arthritis
. Supraspinatus tear
. Subscapularis tear

Correct Answer & Explanation

. Posterior shoulder instability

Explanation

The computed tomogram shows a posterior avulsion of the glenoid rim and an impaction fracture of the anterior aspect of the humeral head consisted with a prior posterior dislocation.

Question 73

Topic: Shoulder & Hip Sports

A professional volleyball player presents with insidious onset of shoulder weakness. Examination reveals marked atrophy of the infraspinatus with isolated weakness in external rotation, but normal supraspinatus bulk and strength. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Cervical neural foramen (C5 radiculopathy)

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch results in isolated infraspinatus denervation, as the motor branch to the supraspinatus has already branched off. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 74

Topic: Shoulder & Hip Sports

In the assessment of anterior glenohumeral instability, the concept of the "glenoid track" is utilized to evaluate bone loss. An "engaging" Hill-Sachs lesion is best defined clinically and radiographically as a defect that:

. Remains strictly within the boundaries of the normal glenoid track
. Involves the articular surface of the lesser tuberosity
. Engages the anterior glenoid rim when the shoulder is abducted and externally rotated
. Occupies greater than 10% of the humeral head circumference
. Is oriented completely parallel to the anterior glenoid rim during internal rotation

Correct Answer & Explanation

. Engages the anterior glenoid rim when the shoulder is abducted and externally rotated

Explanation

An engaging Hill-Sachs lesion is an "off-track" defect. During the extremes of abduction and external rotation, the defect drops over the anterior glenoid rim, causing the joint to lever out and dislocate.

Question 75

Topic: Shoulder & Hip Sports

Which of the following structures is NOT considered part of the boundaries or contents of the rotator cuff interval?

. Superior glenohumeral ligament
. Coracohumeral ligament
. Supraspinatus tendon
. Teres minor tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Teres minor tendon

Explanation

The rotator cuff interval is bounded by the supraspinatus superiorly, subscapularis inferiorly, and the coracoid base medially. It contains the long head of the biceps tendon, the superior glenohumeral ligament, and the coracohumeral ligament; the teres minor is posterior.

Question 76

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player has weakness in external rotation but normal abduction strength. An MRI shows isolated atrophy of the infraspinatus. Entrapment of the suprascapular nerve is most likely occurring at which location?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve passes through the spinoglenoid notch to innervate the infraspinatus after having already supplied the supraspinatus. Compression at this notch (often by a paralabral cyst) results in isolated infraspinatus weakness.

Question 77

Topic: Shoulder & Hip Sports

Which of the following combinations of structures accurately defines the contents of the rotator interval of the shoulder?

. Supraspinatus tendon, infraspinatus tendon, and coracohumeral ligament
. Subscapularis tendon, superior glenohumeral ligament, and axillary nerve
. Coracohumeral ligament, superior glenohumeral ligament, and long head of the biceps tendon
. Long head of the triceps, coracoacromial ligament, and middle glenohumeral ligament
. Short head of the biceps, coracobrachialis, and coracohumeral ligament

Correct Answer & Explanation

. Supraspinatus tendon, infraspinatus tendon, and coracohumeral ligament

Explanation

The rotator interval is the triangular anatomical space between the supraspinatus and subscapularis tendons. It contains the long head of the biceps tendon, the superior glenohumeral ligament (SGHL), and the coracohumeral ligament (CHL).

Question 78

Topic: Shoulder & Hip Sports

In the setting of a massive rotator cuff tear involving the supraspinatus and infraspinatus, which intact anatomical structure limits superior translation (escape) of the humeral head?

. Coracohumeral ligament
. Superior glenohumeral ligament
. Coracoacromial ligament
. Transverse humeral ligament
. Conoid ligament

Correct Answer & Explanation

. Coracoacromial ligament

Explanation

The coracoacromial ligament forms the critical "roof" of the coracoacromial arch over the humeral head. In massive rotator cuff tears, it provides a crucial static restraint against superior humeral head escape and should generally be preserved during surgery.

Question 79

Topic: Shoulder & Hip Sports

Following two previous shoulder stabilization procedures for recurrent dislocations, a 45-year-old man complains of pain and limited motion. Examination reveals increased passive external rotation and an inability to lift the back of the hand away from his back. Which of the following muscles is injured:

. Subscapularis
. Supraspinatus
. Infraspinatus
. Deltoid
. Teres minor

Correct Answer & Explanation

. Subscapularis

Explanation

The patient has an incompetent subscapularis muscle. An inability to lift the back of the hand away from the back (a positive Liftoff test) has been described by Gerber and colleagues and is a reliable method of evaluating subscapularis integrity. Patients with subscapularis tears often demonstrate an increase in passive external rotation and weakness in internal rotation.

Question 80

Topic: Shoulder & Hip Sports
Which of the following structures is involved in the "essential lesion" of a stiff shoulder?
. Biceps tendon
. Coracohumeral ligament
. Posterior capsule
. Labrum
. Axillary pouch

Correct Answer & Explanation

. Coracohumeral ligament

Explanation

The long head of the biceps tendon defines the region of the rotator interval, which is the area between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. This region usually is contracted in individuals who lack external rotation of the adducted shoulder. Coracohumeral ligament contracture is an important component of adhesive capsulitis.

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