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Shoulder & Hip Sports MCQs

Practice Set 43 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 841

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, the 'glenoid track' concept is utilized to assess the risk of recurrent dislocation.

A Hill-Sachs lesion is considered 'off-track' and at high risk of engagement if it meets which of the following criteria?

. It extends medially beyond the medial margin of the glenoid track
. It is entirely contained within the glenoid track boundaries
. It is associated with greater than 10% anterior glenoid bone loss
. It engages only in isolated external rotation without abduction
. It spares the central articular cartilage of the humeral head

Correct Answer & Explanation

. It extends medially beyond the medial margin of the glenoid track

Explanation

The glenoid track is defined as the zone of contact between the humeral head and the glenoid during arm abduction and external rotation. It is calculated based on the intact glenoid width minus anterior bone loss. If the medial margin of a Hill-Sachs defect extends further medially than the medial boundary of the glenoid track, the lesion is 'off-track.' This means it will drop over the anterior glenoid rim during functional positioning, 'engaging' and levering the humerus out of joint.

Question 842

Topic: Shoulder & Hip Sports

A 21-year-old male suffers a traumatic anterior shoulder dislocation. An MRI reveals a Bankart lesion. What is the defining anatomical characteristic of a classic Bankart lesion?

. Avulsion of the anterior-inferior labrum with the anterior band of the inferior glenohumeral ligament
. Compression fracture of the posterolateral humeral head
. Superior labrum anterior to posterior tear extending to the biceps anchor
. Avulsion of the posterior-inferior labrum
. Capsular stretch without frank labral detachment

Correct Answer & Explanation

. Avulsion of the anterior-inferior labrum with the anterior band of the inferior glenohumeral ligament

Explanation

A Bankart lesion is defined as an avulsion of the anterior-inferior capsulolabral complex from the glenoid rim. This specifically involves the anterior band of the inferior glenohumeral ligament (IGHL).

Question 843

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain. She reports a sensation that her shoulders are constantly 'slipping out' of place, especially during the pull phase of her stroke. Physical examination demonstrates generalized ligamentous laxity, a positive sulcus sign bilaterally, and positive apprehension tests anteriorly and posteriorly. Scapular dyskinesia is prominent. What is the most appropriate initial management?

. Arthroscopic labral repair (SLAP repair)
. Physical therapy focusing on periscapular stabilization and rotator cuff strengthening
. Open inferior capsular shift
. Arthroscopic plication of the anterior capsule
. Latarjet procedure

Correct Answer & Explanation

. Physical therapy focusing on periscapular stabilization and rotator cuff strengthening

Explanation

This patient has classic symptoms of Multidirectional Instability (MDI) of the shoulder, often associated with generalized ligamentous laxity (Ehlers-Danlos, Marfan, or simply physiological hyperlaxity) and confirmed by a positive sulcus sign. The cornerstone of initial treatment for MDI is a prolonged, dedicated physical therapy program (minimum 3-6 months) focusing on strengthening the dynamic stabilizers of the shoulder (periscapular muscles and rotator cuff). Surgical stabilization (e.g., open or arthroscopic inferior capsular shift) is strictly reserved for patients who fail extensive conservative management.

Question 844

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, the 'margin convergence' technique is most biomechanically appropriate and effective for which specific tear pattern?

. Crescent-shaped tear
. U-shaped tear
. L-shaped tear
. Reverse L-shaped tear
. Partial-thickness articular-sided tear

Correct Answer & Explanation

. U-shaped tear

Explanation

Margin convergence is an arthroscopic technique popularized by Burkhart, used primarily for large U-shaped rotator cuff tears. By suturing the anterior and posterior leaves of the tear together side-to-side, the free margin of the cuff is brought closer to the greater tuberosity, significantly decreasing the strain required to fix the remaining tendon to the bone bed.

Question 845

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague, deep shoulder pain and a 'dead arm' sensation. During physical examination, the O'Brien test (Active Compression Test) is performed. Which of the following findings during the O'Brien test is considered a classic positive result for a Superior Labrum Anterior Posterior (SLAP) tear?

. Pain with the arm fully internally rotated that is not relieved by external rotation
. Pain deep in the shoulder with the arm internally rotated that is relieved by external rotation
. Pain strictly localized to the acromioclavicular joint with the arm internally rotated
. Apprehension without pain when the arm is brought into external rotation and abduction
. Inability to actively elevate the arm above 90 degrees due to weakness

Correct Answer & Explanation

. Pain deep in the shoulder with the arm internally rotated that is relieved by external rotation

Explanation

The O'Brien (Active Compression) test is performed with the shoulder in 90 degrees of forward flexion and 10-15 degrees of adduction. The patient resists a downward force with the arm fully internally rotated (thumb pointing down), and then the test is repeated with the arm fully externally rotated (palm up). A positive test for a SLAP tear is pain located deep within the shoulder during internal rotation that is diminished or eliminated during external rotation. Pain localized superficially to the AC joint during the internal rotation phase suggests AC joint pathology, not a SLAP tear.

Question 846

Topic: Shoulder & Hip Sports

A 22-year-old collegiate football player presents with recurrent anterior shoulder instability. Advanced imaging reveals a 15% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. He undergoes an arthroscopic Bankart repair combined with a remplissage procedure. What structure is transferred or tenodesed into the Hill-Sachs defect during a remplissage?

. Subscapularis tendon
. Infraspinatus tendon and posterior joint capsule
. Supraspinatus tendon
. Long head of the biceps tendon
. Teres major tendon

Correct Answer & Explanation

. Infraspinatus tendon and posterior joint capsule

Explanation

The remplissage procedure (French for 'to fill') addresses a large, engaging Hill-Sachs lesion that may otherwise lever the humeral head out of the glenoid even after a Bankart repair. It involves capsulotenodesis of the posterior capsule and the infraspinatus tendon into the humeral head defect. This effectively makes the Hill-Sachs lesion extra-articular and prevents it from engaging the anterior glenoid rim during abduction and external rotation.

Question 847

Topic: Shoulder & Hip Sports

A 55-year-old carpenter presents with right shoulder pain and weakness after attempting to lift a heavy tool box. On physical examination, he demonstrates a positive drop-arm test and profound weakness with active abduction in the scapular plane. An MRI confirms a massive, retracted tear of the supraspinatus and infraspinatus tendons. Fatty infiltration of these muscles is graded. Which classification system is most commonly used to grade fatty infiltration of the rotator cuff muscles on imaging?

. Patte classification
. Goutallier classification
. Snyder classification
. Hamada classification
. Seebauer classification

Correct Answer & Explanation

. Goutallier classification

Explanation

The Goutallier classification is used to quantify the amount of fatty infiltration of the rotator cuff muscles, originally described on CT but now widely adapted for MRI. High grades of fatty infiltration (Goutallier 3 and 4) are associated with poor functional outcomes and higher re-tear rates following surgical repair.

Question 848

Topic: Shoulder & Hip Sports
A 24-year-old professional baseball pitcher presents with vague anterior shoulder pain and a 'dead arm' sensation. MR arthrogram reveals a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon, resulting in an unstable biceps anchor. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

The Snyder classification of SLAP (Superior Labrum Anterior to Posterior) tears: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is a detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the superior labrum that extends into the biceps tendon, resulting in instability of the biceps anchor.

Question 849

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes MRI of the shoulder for chronic weakness and pain. The radiologist notes a positive 'tangent sign' on the sagittal oblique T1-weighted images.

What does this radiographic finding specifically indicate regarding the supraspinatus muscle?

. Intramuscular fatty infiltration of Goutallier Stage 1
. Retraction of the tendon medial to the glenoid rim
. Complete tearing of the anterior cable of the rotator cuff
. Severe muscle atrophy signifying a likely irreparable tear
. Concomitant injury to the suprascapular nerve

Correct Answer & Explanation

. Severe muscle atrophy signifying a likely irreparable tear

Explanation

The 'tangent sign' is assessed on a sagittal oblique MRI slice (Y-view). A line is drawn connecting the superior border of the coracoid process to the superior border of the scapular spine. If the supraspinatus muscle belly falls below this line, the tangent sign is positive. This indicates severe muscle atrophy and is strongly predictive of an irreparable rotator cuff tear and poor functional outcomes following attempted repair.

Question 850

Topic: Shoulder & Hip Sports

A newborn delivered via forceps-assisted vaginal delivery presents with the right upper extremity held in adduction, internal rotation, and extension at the elbow, with the wrist flexed ('waiter's tip' posture). Which nerve roots are predominantly injured in this condition?

. C8 and T1
. C7, C8, and T1
. C5 and C6
. C5, C6, and C7
. Isolated C7

Correct Answer & Explanation

. C5 and C6

Explanation

The 'waiter's tip' posture is characteristic of Erb's palsy, which is an upper trunk brachial plexus injury involving the C5 and C6 nerve roots. This causes paralysis of the deltoid and supraspinatus (loss of abduction), infraspinatus and teres minor (loss of external rotation), and biceps and brachialis (loss of elbow flexion). Injury to C8 and T1 results in Klumpke's palsy, affecting the intrinsic muscles of the hand (claw hand).

Question 851

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has a history of recurrent anterior shoulder instability. A 3D reconstructed pre-operative CT scan is shown.

The imaging demonstrates an inverted pear-shaped glenoid with a calculated anterior-inferior bone loss of 27%. What is the most appropriate surgical management to minimize his recurrence risk?

. Arthroscopic Bankart repair with capsular plication
. Arthroscopic remplissage alone
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In patients with anterior shoulder instability and significant glenoid bone loss (>20-25%, often creating an 'inverted pear' appearance), soft tissue procedures alone (like an arthroscopic Bankart repair) have unacceptably high recurrence rates. A bony augmentation procedure, most commonly the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid neck), is the gold standard treatment.

Question 852

Topic: Shoulder & Hip Sports

A 20-year-old collegiate swimmer presents with bilateral shoulder pain. On physical examination, she demonstrates a positive sulcus sign and apprehension in abduction/external rotation, but she is able to voluntarily dislocate and reduce her shoulders without pain. She has no history of an acute traumatic dislocation. Which of the following is the most appropriate initial management?

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Physical therapy emphasizing periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Physical therapy emphasizing periscapular and rotator cuff strengthening

Explanation

This patient exhibits classic signs of atraumatic, multidirectional instability (MDI), often characterized by the AMBRI acronym (Atraumatic, Multidirectional, Bilateral, Rehabilitation, Inferior capsular shift). The hallmark of treatment for MDI is a prolonged, dedicated physical therapy program focusing on strengthening the dynamic stabilizers of the shoulder (rotator cuff and periscapular muscles). Surgery (inferior capsular shift) is reserved for patients who fail extensive conservative management.

Question 853

Topic: Shoulder & Hip Sports

A 24-year-old rugby player has recurrent anterior shoulder instability with 25% anterior glenoid bone loss on a 3D CT scan.

A Latarjet procedure is performed. What is the primary biomechanical stabilizing mechanism of this procedure when the shoulder is in the apprehension position (abduction/external rotation)?

. Bony augmentation of the glenoid arc by the coracoid graft
. Sling effect of the conjoined tendon against the inferior subscapularis and capsule
. Anatomic repair of the torn coracoacromial ligament
. Tensioning of the middle glenohumeral ligament (MGHL)
. Rerouting the long head of the biceps brachii

Correct Answer & Explanation

. Sling effect of the conjoined tendon against the inferior subscapularis and capsule

Explanation

The Latarjet procedure involves transferring the coracoid process with the attached conjoined tendon to the anterior glenoid. While the bony block restores the glenoid arc (the 'bony effect'), biomechanical studies have demonstrated that the primary stabilizing mechanism in abduction and external rotation is the dynamic 'sling effect.' The conjoined tendon acts as a hammock against the inferior capsule and lower subscapularis, preventing anterior translation of the humeral head.

Question 854

Topic: Shoulder & Hip Sports
During arthroscopic evaluation of a 22-year-old baseball pitcher's shoulder, a superior labral anterior to posterior (SLAP) tear is identified. The labrum is visibly frayed, but the biceps anchor is completely intact and firmly attached to the superior glenoid tubercle without any detachment. What type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

Type I SLAP tears are characterized by fraying and degeneration of the superior labrum with an intact biceps anchor. Type II involves detachment of the superior labrum and biceps anchor from the glenoid. 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 biceps tendon.

Question 855

Topic: Shoulder & Hip Sports
A 22-year-old collegiate baseball pitcher presents with deep shoulder pain, decreased velocity, and a positive O'Brien's test. MRI arthrogram reveals a Type II SLAP lesion. What anatomic feature specifically distinguishes a Type II SLAP tear from a Type I tear?
. 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 labrum with an intact biceps anchor
. A bucket-handle tear of the labrum extending into the biceps tendon
. A labral tear extending into the middle glenohumeral ligament

Correct Answer & Explanation

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

Explanation

Snyder classification of SLAP tears: Type I is fraying of the labrum with an intact anchor. Type II is detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear with an intact anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

Question 856

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain and a sensation of instability in multiple directions. Physical examination reveals a positive sulcus sign and generalized ligamentous laxity. If surgical intervention is ultimately indicated after exhaustive physical therapy, the procedure must address the primary patholaxity, which is characterized by:

. An avulsion of the anterior labrum from the glenoid rim
. An increased volume and redundancy of the inferior capsular pouch
. A complete tear of the superior glenohumeral ligament
. An engaging Hill-Sachs lesion
. A congenital hypoplasia of the glenoid

Correct Answer & Explanation

. An increased volume and redundancy of the inferior capsular pouch

Explanation

The patient has multidirectional instability (MDI) of the shoulder, characterized by symptomatic instability in more than one direction (anterior, posterior, inferior). The hallmark pathoanatomy of MDI is a patulous (redundant/increased volume) inferior capsule. If a prolonged course of physical therapy (focusing on rotator cuff and periscapular stabilization) fails, the surgical treatment of choice is an inferior capsular shift to reduce capsular volume.

Question 857

Topic: Shoulder & Hip Sports



A 50-year-old male undergoes arthroscopic rotator cuff repair for a massive, retracted tear. To improve lateral excursion of the supraspinatus tendon, the surgeon releases the coracohumeral ligament (CHL). Which of the following is true regarding the physiological function of the intact CHL?

. It primarily originates on the acromion and inserts on the greater tuberosity.
. It acts as a primary restraint to external rotation when the arm is adducted.
. It seamlessly blends with the inferior glenohumeral ligament complex.
. It acts as a dynamic active stabilizer of the long head of the biceps tendon.
. It limits internal rotation when the arm is abducted to 90 degrees.

Correct Answer & Explanation

. It acts as a primary restraint to external rotation when the arm is adducted.

Explanation

The coracohumeral ligament (CHL) originates on the base of the coracoid process and blends into the rotator interval, inserting onto the greater and lesser tuberosities. It is a primary static restraint to inferior translation and external rotation of the humerus when the shoulder is in an adducted position.

Question 858

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes arthroscopic rotator cuff repair and is noted to have a highly degenerate long head of the biceps tendon. A biceps tenotomy is performed. Compared to biceps tenodesis, simple tenotomy is associated with a statistically higher rate of:

. Postoperative stiffness
. Cosmetic deformity (Popeye sign)
. Deep infection
. Chronic regional pain syndrome
. Need for revision surgery

Correct Answer & Explanation

. Cosmetic deformity (Popeye sign)

Explanation

While both biceps tenotomy and tenodesis yield similarly good outcomes regarding pain relief and function, simple tenotomy has a significantly higher rate of cosmetic deformity (the 'Popeye' muscle bulge) and occasional cramping, compared to tenodesis.

Question 859

Topic: Shoulder & Hip Sports

In the surgical management of recurrent anterior shoulder instability, a 'remplissage' procedure is occasionally performed as an adjunct to arthroscopic Bankart repair. The remplissage procedure addresses a large Hill-Sachs lesion by tenodesing which of the following structures into the defect?

. Subscapularis
. Long head of the biceps brachii
. Infraspinatus
. Teres minor
. Supraspinatus

Correct Answer & Explanation

. Infraspinatus

Explanation

The term 'remplissage' translates to 'filling' in French. It is an arthroscopic procedure used to treat engaging or off-track Hill-Sachs lesions (posterosuperior humeral head impaction fractures). It involves the capsulotenodesis of the posterior capsule and the infraspinatus tendon into the humeral head defect, thereby converting an intra-articular defect into an extra-articular one and preventing it from engaging the anterior glenoid rim during abduction and external rotation.

Question 860

Topic: Shoulder & Hip Sports

A 22-year-old rugby player with recurrent anterior shoulder instability and 25% glenoid bone loss undergoes a Latarjet procedure. This procedure restores stability through a described 'triple-blocking' effect. Which of the following mechanisms is considered the most significant dynamic contributor to anterior stability in the Latarjet procedure?

. The static bony block extending the glenoid articular arc
. The sling effect of the conjoined tendon reinforcing the inferior capsule and subscapularis when the arm is abducted and externally rotated
. The repair of the native capsule to the coracoacromial ligament stump
. The dynamic tensioning of the long head of the biceps brachii
. The tenodesis of the subscapularis directly to the anterior labrum

Correct Answer & Explanation

. The sling effect of the conjoined tendon reinforcing the inferior capsule and subscapularis when the arm is abducted and externally rotated

Explanation

The Latarjet procedure provides a 'triple-blocking' effect for anterior shoulder instability. The three components are: 1) The dynamic 'sling' effect of the conjoined tendon across the inferior subscapularis and anterior capsule when the arm is abducted and externally rotated; 2) The static bony effect of the coracoid bone block increasing the glenoid arc; and 3) The capsular repair (capsule sutured to the CA ligament stump). Biomechanical studies have demonstrated that the dynamic sling effect of the conjoined tendon contributes most significantly to the stability provided by the construct, accounting for up to 75% of the stabilizing force.

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