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Shoulder & Hip Sports MCQs

Practice Set 41 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 801

Topic: Shoulder & Hip Sports

A 15-year-old wrestler sustains an abduction, hyperextension, and external rotation injury to his right shoulder. The MRI scan findings shown in Figures 27a and 27b are most consistent with

. an avulsion of the lesser tuberosity.
. a midsubstance tear of the capsule.
. a tear of the anterior inferior labrum.
. a tear of the subscapularis.
. a tear of the humeral insertion of the inferior glenohumeral ligament.

Correct Answer & Explanation

. a tear of the humeral insertion of the inferior glenohumeral ligament.

Explanation

An isolated avulsion of the lesser tuberosity occurs very rarely and usually is found in 12- and 13-year-old adolescents. The MRI scans reveal a tear of the humeral attachment of the inferior glenohumeral ligament, a so-called HAGL lesion. This injury to the inferior glenohumeral ligament occurs much less commonly than the classic Bankart lesion (anterior inferior labral tear). A tear of the subscapularis occurs with a similar mechanism of injury but generally occurs in older individuals. Bokor DJ, Conboy VB, Olson C: Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament: A review of 41 cases. J Bone Joint Surg Br 1999;81:93-96.

Question 802

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

. 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. Cummins CA, Messer TM, Nuber GW: Suprascapular nerve entrapment. J Bone Joint Surg Am 2000;82:415-424.

Question 803

Topic: Shoulder & Hip Sports

A coronal MRI scan through the shoulder joint is shown in Figure 26. The cyst indicated by the arrow will most likely cause compression of what nerve?

Anatomy Board Review 2002: High-Yield MCQs (Set 2) - Figure 27

. Subscapular
. Suprascapular
. Axillary
. Musculocutaneous
. Medial pectoral

Correct Answer & Explanation

. Suprascapular

Explanation

The MRI scan shows a ganglion cyst in the region of the spinoglenoid notch. These are difficult to diagnose clinically but are readily apparent on MRI. They usually cause compression of the suprascapular nerve and weakness of the infraspinatus and supraspinatus muscles. Resnick D, Kang HS (eds): Internal Derangements of Joints: Emphasis on MR Imaging. Philadelphia, PA, WB Saunders, 1997, pp 306-309.

Question 804

Topic: Shoulder & Hip Sports

A 42-year-old man sustained a fracture of the distal radius with subsequent stiffness in the ipsilateral shoulder. Despite a 6-month program of range-of-motion exercises, external rotation at the side is limited to 10 degrees. Attempts at closed manipulation are unsuccessful. Treatment should now consist of

Upper Extremity 2005 Practice Questions: Set 1 (Solved) - Figure 17

. open release of the posterior capsule.
. arthroscopic release of the rotator cuff interval.
. arthroscopic release of the anteroinferior capsule.
. open subscapularis lengthening.
. open extra-articular release.

Correct Answer & Explanation

. arthroscopic release of the rotator cuff interval.

Explanation

When external rotation at the side is limited, the most likely diagnosis is contracture of the rotator cuff interval, including the superior glenohumeral and coracohumeral ligaments. Therefore, the treatment of choice is arthroscopic release of the rotator cuff interval.

Question 805

Topic: Shoulder & Hip Sports

Initial repair of the large U-shaped rotator cuff tear shown in Figure 12 consists of closing the tear side-to-side to take advantage of margin convergence. The most significant biomechanical consequence of this repair step results in

Sports Medicine Board Review 2004: High-Yield MCQs (Set 2) - Figure 1

. increased strength of the rotator cuff repair by creating thicker repair construct.
. decreased size of the defect exposing the humeral head.
. decreased stress in the rotator cuff at the site of the side-to-side repair.
. decreased stress in the rotator cuff at the free margin and greater tuberosity interface.
. decreased stress in the rotator cuff crescent cable.

Correct Answer & Explanation

. decreased stress in the rotator cuff at the free margin and greater tuberosity interface.

Explanation

Margin convergence refers to the phenomenon that occurs with side-to-side closure of large U- or L-shaped rotator cuff tears in which the free margin of the tear converges toward the greater tuberosity as the side-to-side tear progresses. The creation of the converged cuff margin creates decreased strain in the free margin of the repaired cuff, resulting in a decreased strain in the repair sutures. While the size of the humeral head defect is made smaller with side-to-side closure, biomechanically, this is less significant. The mild increase in thickness of the repair at the side-to-side margin is less important than a reduction in stress in the repaired tissue. Stress in the crescent cable region of the cuff actually increases and becomes more physiologic in transmitting force from the cuff to the greater tuberosity. Burkhart SS: A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles. Arthroscopy 2000;16:82-90.

Question 806

Topic: Shoulder & Hip Sports

Figure 7 shows a sagittal T1-weighted MRI scan. What muscle/tendon is identified by the arrow?

Upper Extremity 2008 Practice Questions: Set 1 (Solved) - Figure 15

. Infraspinatus
. Teres minor
. Subscapularis
. Long head of triceps
. Latissimus dorsi

Correct Answer & Explanation

. Teres minor

Explanation

The sagittal T1-weighted MRI scan is useful for interpreting the quality of muscle. The arrow is pointing to the teres minor. Goutallier D, Postel JM, Gleyze P, et al: Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 2003;12:550-554.

Question 807

Topic: Shoulder & Hip Sports

A right-handed 24-year-old woman underwent an arthroscopic Bankart repair for recurrent anterior dislocations 9 months ago. Despite extensive physical therapy for 8 months, the patient has very limited range of motion (elevation to 130 degrees and external rotation to 10 degrees with the arm at the side). Shoulder radiographs are normal. The next step in management should consist of

Shoulder Board Review 2002: High-Yield MCQs (Set 2) - Figure 23

. cessation of physical therapy and acceptance of the limited range of motion.
. additional physical therapy for 3 to 4 months.
. arthroscopic capsular release.
. open release with Z-plasty lengthening of the subscapularis tendon.
. closed manipulation under anesthesia.

Correct Answer & Explanation

. arthroscopic capsular release.

Explanation

Arthroscopic capsular release is an effective means of treating stiffness that is the result of capsular contractures, such as in the case of a tight Bankart repair. Open release allows lengthening of a surgically shortened subscapularis, such as after a tight Putti-Platt repair. Additional physical therapy is unlikely to be effective because 8 months of treatment has failed to result in improvement. Accepting this degree of asymptomatic limited motion is not advisable because of the functional limitations for the patient and the increased risk of postoperative degenerative arthritis. Warner JJ, Allen AA, Marks PH, Wong P: Arthroscopic release of postoperative capsular contracture of the shoulder. J Bone Joint Surg Am 1997;79:1151-1158.

Question 808

Topic: Shoulder & Hip Sports

A 21-year-old patient has had pain and a marked decrease in active and passive shoulder motion after having had a seizure 2 months ago as the result of alcohol abuse. Current AP and axillary radiographs and a CT scan are shown in Figures 26a through 26c. Management should consist of

. closed reduction under sedation.
. total shoulder arthroplasty.
. open reduction and subscapularis and lesser tuberosity transfer.
. open reduction and disimpaction with bone grafting.
. hemiarthroplasty with the humeral component placed in less than 20 degrees of retroversion.

Correct Answer & Explanation

. open reduction and subscapularis and lesser tuberosity transfer.

Explanation

Open reduction and subscapularis and lesser tuberosity transfer into the defect is the treatment of choice in young individuals who have defects that involve between 20% to 45% of the head. Disimpaction and bone grafting is an option in injuries that are less than 3 weeks old. Closed reduction 2 to 3 months after injury usually is unsuccessful and increases the risk of fracture or neurovascular injury. Total shoulder arthroplasty is reserved for defects of greater than 50% or with associated glenoid surface damage. Hemiarthroplasty should be avoided in young individuals unless 50% or more of the head is involved. Gerber C: Chronic locked anterior and posterior dislocations, in Warner JJ, Iannotti JP, Gerber C (eds): Complex and Revision Problems in Shoulder Surgery. Philadelphia, PA, Lippincott-Raven, 1997, pp 99-113.

Question 809

Topic: Shoulder & Hip Sports

Figures 26a through 26c show the MRI scans of a 47-year-old man who underwent arthroscopic shoulder surgery 6 months ago and continues to have pain despite a prolonged course of rehabilitation. Management should now consist of

. rotator cuff repair.
. revision acromioplasty.
. fragment excision.
. open reduction and internal fixation.
. continued rehabilitation.

Correct Answer & Explanation

. open reduction and internal fixation.

Explanation

The MRI scans show an os acromiale of the mesoacromion type. This represents an unfused acromial apophysis. Pain is thought to be caused by either motion at the site or downward displacement of the anterior aspect of the acromion onto the rotator cuff, causing impingement. Most patients can be treated nonsurgically as they are usually asymptomatic. In those patients with persistent symptoms of pain and tenderness over the acromion, surgery consisting of rigid internal fixation and bone grafting has yielded satisfactory results. Excision may be a viable treatment option for the preacromion type. Herzog RJ: Magnetic resonance imaging of the shoulder. Instr Course Lect 1998;47:3-20. Warner JP, Beim GM, Higgins L: The treatment of symptomatic os acromiale. J Bone Joint Surg Am 1998;80:1320-1326.

Question 810

Topic: Shoulder & Hip Sports

Figures 36a and 36b show the MRI scans of a patient who has shoulder weakness. What is the most likely diagnosis?

. Suprascapular nerve entrapment
. Supraspinatus and infraspinatus tendon tear
. Muscular dystrophy
. Thoracic outlet syndrome
. Spinal accessory nerve disruption

Correct Answer & Explanation

. Suprascapular nerve entrapment

Explanation

The sagittal image reveals increased signal and decreased size of the supraspinatus and infraspinatus muscles, indicating muscle atrophy. The rotator cuff tendon signal is normal. The subscapularis and teres minor muscles are unaffected. Muscular dystrophy and thoracic outlet syndrome would be expected to have a more global effect. Although muscular atrophy can occur in the setting of a rotator cuff tear, the coronal image shows an intact supraspinatus. The suprascapular nerve supplies the supraspinatus and infraspinatus muscles. Therefore, suprascapular nerve entrapment would result in atrophy of these muscles with sparing of the surrounding musculature. Any lesion within the suprascapular notch, including neoplastic disease, a venous varix, or neuroma, can place pressure on the suprascapular nerve. Suprascapular nerve entrapment most commonly results from extension of a paralabral cyst or ganglion, often with associated labral pathology. Spinal accessory nerve disruption would show trapezius muscle atrophy. Resnick D, Kang HS (eds): Internal Derangement of Joints: Emphasis on MR Imaging. Philadelphia, PA, WB Saunders, 1997, pp 308-317.

Question 811

Topic: Shoulder & Hip Sports

Figure 1 shows the radiograph of a 71-year-old man who has had increasing pain and weakness in his shoulder for the past 3 years. Nonsurgical management has failed to provide relief. Examination shows 130 degrees of active forward flexion and intact external rotation strength. During surgery, a 1- x 1-cm rotator cuff tear involving the supraspinatus is encountered. Treatment should include

Shoulder 2002 Practice Questions: Set 1 (Solved) - Figure 2

. humeral head replacement with rotator cuff repair.
. humeral head replacement without rotator cuff repair.
. arthrodesis of the shoulder.
. total shoulder replacement with rotator cuff repair.
. total shoulder replacement without rotator cuff repair.

Correct Answer & Explanation

. total shoulder replacement with rotator cuff repair.

Explanation

Given the size of the rotator cuff tear, it is likely to be repaired; therefore, the treatment of choice is a total shoulder replacement with rotator cuff repair. Severe rotator cuff insufficiency can lead to early glenoid failure because of superior instability, and glenoid resurfacing should be avoided in those instances. Boyd AD Jr, Thomas WH, Scott RD, Sledge CB, Thornhill TS: Total shoulder arthroplasty versus hemiarthroplasty: Indications for glenoid resurfacing. J Arthroplasty 1990;5:329-336.

Question 812

Topic: Shoulder & Hip Sports

A patient reports pain in the hip with functional positioning. With the patient supine, pain in which of the following positions would be typical for femoral acetabular impingement?

Hip & Knee Reconstruction Board Review 2007: High-Yield MCQs (Set 2) - Figure 10

. Hip is internally rotated, passively flexed to 90 degrees, and adducted
. Hip is internally rotated, passively flexed to 90 degrees, and abducted
. Hip is externally rotated, maximally flexed to 90 degrees, and adducted
. Hip is externally rotated, passively flexed to 90 degrees, and abducted
. Hip is externally rotated, maximally flexed, and abducted

Correct Answer & Explanation

. Hip is internally rotated, passively flexed to 90 degrees, and adducted

Explanation

Patients with dysplasia often have a hypertrophic labrum. Abnormal contact between the femoral neck and the acetabular rim leads to labral injury, especially in the anterior-superior acetabular zone. Typically, young patients with the condition report pain with activity or long periods of sitting or driving. The hips often have limited motion, in particular in internal rotation and flexion. Forceful adduction with the maneuver causes pain. Vaccaro AR (ed): Orthopaedic Knowledge Update 8. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2005, pp 411-424. Beck M, Leunig M, Parvizi J, et al: Anterior femoroacetabular impingement: Part II. Midterm results of surgical treatment. Clin Orthop 2004;418:67-73.

Question 813

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball pitcher has had pain in the axillary region of his dominant shoulder for the past several weeks. While throwing a pitch during a game, he notes a sharp pulling sensation with a "pop" in his shoulder. Examination the following day reveals tenderness along the posterior axillary fold and pain and weakness with resisted extension of the shoulder. What is the most likely cause of his symptoms?

. Type 2 tear of the superior labrum anterior and posterior
. Tear of the anterior labrum
. Tear of the subscapularis tendon
. Tear of the latissimus dorsi tendon
. Tear of the supraspinatus tendon

Correct Answer & Explanation

. Tear of the latissimus dorsi tendon

Explanation

Injury to the latissimus dorsi tendon recently has been reported as a cause of pain in the thrower's shoulder. The etiology of this injury is felt to be eccentric overload during the follow-through of the throwing motion. Recommended management for this unusual injury consists of a short period of rest, followed by physical therapy to restore shoulder motion and strength. Throwing is allowed when the athlete demonstrates full, pain-free motion and good strength and balance of the rotator cuff and scapular rotator muscles. Currently there are no defined indications for surgical repair. Schickendantz MS, Ho CP, Keppler L, et al: MR imaging of the thrower's shoulder: Internal impingement, latissimus dorsi/subscapularis strains and related injuries. Magn Reson Imaging Clin N Am 1999;7:39-49.

Question 814

Topic: Shoulder & Hip Sports

A 58-year-old man has persistent pain and weakness of his right shoulder after undergoing primary rotator cuff repair 1 year ago. A clinical photograph is shown in Figure 11. Which of the following factors might make functional improvement problematic with revision rotator cuff surgery?

Upper Extremity 2005 Practice Questions: Set 1 (Solved) - Figure 29

. Patient's age
. Patient's gender
. Number of prior surgical procedures
. Detachment of the deltoid
. Duration of the rotator cuff tear

Correct Answer & Explanation

. Detachment of the deltoid

Explanation

Functional improvement after revision rotator cuff surgery is most likely to occur in patients with an intact deltoid, good-quality rotator cuff tissue, preoperative active elevation alone to 90 degrees, and only one prior rotator cuff repair. In this patient, the compromised deltoid origin might make functional improvement less likely. Djurasovic M, Marra G, Arroyo JS, et al: Revision rotator cuff repair: Factors influencing results. J Bone Joint Surg Am 2001;83:1849-1855. Bigliani LU, Cordasco FA, McIlveen SJ, et al: Operative treatment of failed repairs of the rotator cuff. J Bone Joint Surg Am 1992;74:1505-1515.

Question 815

Topic: Shoulder & Hip Sports

A 52-year-old man underwent arthroscopic repair of a 1-cm supraspinatus tendon tear 3 weeks ago. He was doing well until he fell down three stairs. One week after the fall he continues to report pain similar to his preoperative pain. An MRI scan reveals a minimally retracted 1-cm supraspinatus tendon tear in the same location as his original tear. Management should now consist of

Upper Extremity 2008 Practice Questions: Set 1 (Solved) - Figure 33

. continued physical therapy that focuses on stretching and advances to strengthening in 4 weeks.
. a cortisone injection into the subacromial space.
. revision rotator cuff repair.
. a sling with an abduction pillow for 2 weeks, followed by a stretching program.
. open rotator cuff debridement without repair.

Correct Answer & Explanation

. revision rotator cuff repair.

Explanation

The patient has retorn his rotator cuff repair. This traumatic retear is different from a chronic tear and should be treated similar to an acute rotator cuff tear. Because the patient is younger than age 65 and has a small, single tendon tear, a revision rotation cuff repair is indicated with an expected tendon healing rate of greater than 95%. A physical therapy program is not indicated, and further delay in repair compromises his functional recovery. A cortisone injection is not indicated for this repairable tendon tear. Immobilization will not allow the tendon to heal once it has retorn. A debridement procedure is not indicated on this repairable tendon tear; this procedure is indicated in painful, chronic, irreparable tendon tears. Boileau P, Brassart N, Watkinson DJ, et al: Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal? J Bone Joint Surg Am 2005;87:1229-1240. Jost B, Zumstein M, Pfirrmann CWA, et al: Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 2006;88:472-479.

Question 816

Topic: Shoulder & Hip Sports

A 39-year-old man has anterior shoulder pain after landing on his abducted left shoulder while playing softball. Examination reveals a stable glenohumeral joint, pain on passive external rotation of greater than 25 degrees, and pain and weakness on belly press (Napoleon's) test. An MRI scan is shown in Figure 32. To provide maximum pain relief and return of function, management should include

Sports Medicine Board Review 2004: High-Yield MCQs (Set 4) - Figure 1

. physical therapy to restore range of motion and rotator cuff strength.
. repair of the supraspinatus and biceps tenotomy.
. repair of the supraspinatus and biceps tenodesis.
. repair of the subscapularis and biceps tenotomy.
. repair of the subscapularis and biceps tenodesis.

Correct Answer & Explanation

. repair of the subscapularis and biceps tenodesis.

Explanation

The examination and MRI scan confirm a subscapularis rupture and dislocation of the long head of the biceps tendon. The greatest return of function will result from repair of the subscapularis and tenodesis of the biceps tendon. Physical therapy alone will result in inadequate healing of the subscapularis and will not address the biceps tendon. While biceps tenotomy is an option, it will not provide the same level of pain relief and return of function as a tenodesis in a young, active man. There is no evidence for a supraspinatus tear. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF: Traumatic tears of the subscapularis tendon: Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 1997;25:13-22.

Question 817

Topic: Shoulder & Hip Sports

A previously asymptomatic 40-year-old man injures his shoulder in a fall. Examination shows that he is unable to lift the hand away from his back while maximally internally rotated. An axial MRI scan of the shoulder is shown in Figure 14. What is the most likely diagnosis?

Anatomy 2008 Practice Questions: Set 1 (Solved) - Figure 33

. Pectoralis major tendon rupture
. Supraspinatus rupture
. Subscapularis rupture
. Bankart tear
. Humeral avulsion of the inferior glenohumeral ligament

Correct Answer & Explanation

. Subscapularis rupture

Explanation

The MRI scan shows detachment of the subscapularis from its insertion on the lesser tuberosity. The examination finding is consistent with a positive lift-off test, also indicating a tear of the subscapularis. Lyons RP, Green A: Subscapularis tendon tears. J Am Acad Orthop Surg 2005;13:353-363.

Question 818

Topic: Shoulder & Hip Sports

A 70-year-old man who underwent an uncomplicated large rotator cuff repair 6 months ago is now seeking a second opinion regarding persistent pain and weakness in his shoulder. Examination reveals that his incision is well healed and unreactive. The surgical report suggests that the tendons were secured back to bone with sutures through the greater tuberosity. Figure 28 shows a radiograph that was obtained 1 week ago. What is the most likely diagnosis?

Shoulder 2002 Practice Questions: Set 3 (Solved) - Figure 3

. Infection
. Complex regional pain syndrome with associated osteopenia
. Frozen shoulder
. Failed rotator cuff repair
. Acromioclavicular joint arthritis

Correct Answer & Explanation

. Failed rotator cuff repair

Explanation

Symptoms can persist following a rotator cuff repair for a variety of reasons. In the early postoperative period, infection is the primary concern. Stiffness and loss of motion can occur because of postoperative scarring. Complex regional pain syndrome can occur but is rare, and the diagnosis is not made with a plain radiograph. This radiograph shows a superiorly migrated humeral head that articulates with the acromion, indicating that the repair has failed. While large to massive tears may fail more commonly than once thought, the clinical outcome may be satisfactory in many patients. Mansat P, Cofield RH, Kersten TE, Rowland CM: Complications of rotator cuff repair. Orthop Clin North Am 1997;28:205-213.

Question 819

Topic: Shoulder & Hip Sports

A 50-year-old electrician who is right-hand dominant has had right shoulder pain and stiffness after sustaining an electric shock 2 months ago. An AP radiograph obtained at the time of injury was considered negative, and the patient was diagnosed with a shoulder sprain. The patient now reports continued shoulder pain and restricted motion. AP and axillary radiographs and a CT scan are shown in Figures 41a through 41c. Management should consist of

. continued observation and physical therapy.
. closed reduction in the office.
. closed reduction under anesthesia in the hospital.
. humeral arthroplasty.
. open reduction and transfer of the subscapularis and lesser tuberosity into the anteromedial humeral head defect.

Correct Answer & Explanation

. open reduction and transfer of the subscapularis and lesser tuberosity into the anteromedial humeral head defect.

Explanation

Open reduction and transfer of the subscapularis and lesser tuberosity into the humeral head defect is the treatment of choice for chronic posterior dislocations in which the articular defect consists of 20% to 40% of the articular surfaces. Closed reduction can be used if the dislocation is recognized early and the articular defect is less than 20% of the articular surface. Humeral arthroplasty is reserved for patients with an articular defect that is greater than 45% to 50% of the head. Hawkins RJ, Neer CS II, Pianta RM, Mendoza FX: Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 1987;69:9-18.

Question 820

Topic: Shoulder & Hip Sports

A 59-year-old construction worker who is right-hand dominant has had right shoulder pain for the past 9 months with no history of injury. Nonsurgical management consisting of two cortisone injections, physical therapy for 3 months, and nonsteroidal anti-inflammatory drugs has failed to provide lasting relief. Examination reveals tenderness over the acromioclavicular (AC) joint and over the subacromial bursa. He has positive Neer and Hawkins impingement signs and AC joint pain with adduction of the shoulder. Radiographs are shown in Figures 36a and 36b. An MRI scan reveals an intact rotator cuff. Management should now consist of

. open anterior acromioplasty and rotator cuff repair.
. arthroscopic acromioplasty.
. anterior acromioplasty and distal clavicle excision.
. an open Mumford procedure.
. immobilization in a sling for 4 weeks followed by additional physical therapy.

Correct Answer & Explanation

. anterior acromioplasty and distal clavicle excision.

Explanation

Because the patient has clinical and radiographic signs of AC arthritis and subacromial impingement, the treatment of choice is anterior acromioplasty and distal clavicle excision. Arthroscopic acromioplasty alone would not address the AC arthritis. The rotator cuff is intact; therefore, rotator cuff repair is not indicated. An open Mumford procedure would address the AC arthritis only and not the impingement symptoms. Immobilization might lead to stiffness of the shoulder and is not recommended for treating impingement.

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