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Shoulder & Hip Sports MCQs

Practice Set 65 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 1281

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D CT scan of the shoulder reveals 26% anterior glenoid bone loss. What is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair
. Latarjet procedure
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

The Latarjet procedure is indicated for patients with critical anterior glenoid bone loss (typically >20-25%), especially in collision athletes. Arthroscopic soft-tissue repair alone has unacceptably high failure rates in this setting.

Question 1282

Topic: Shoulder & Hip Sports

A 55-year-old man presents with anterior shoulder pain and weakness after a fall. On examination, he demonstrates a positive bear-hug test and a positive belly-press test, but normal external rotation strength. Which tendon is most likely injured?

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

Correct Answer & Explanation

. Supraspinatus

Explanation

The bear-hug and belly-press tests specifically evaluate the subscapularis tendon. The belly-press test assesses the lower subscapularis, while the bear-hug test evaluates the upper subscapularis.

Question 1283

Topic: Shoulder & Hip Sports



Based on the glenoid track concept, which of the following defines an 'off-track' Hill-Sachs lesion?

. The lesion is located entirely lateral to the glenoid track margin.
. The medial margin of the lesion extends further medial than the glenoid track.
. The lesion covers less than 15% of the articular surface of the humeral head.
. The lesion is associated with a reverse Bankart tear.
. The lesion does not engage the anterior glenoid rim during abduction.

Correct Answer & Explanation

. The lesion is located entirely lateral to the glenoid track margin.

Explanation

An 'off-track' Hill-Sachs lesion has a medial margin that extends beyond the calculated glenoid track. This allows the lesion to engage the anterior glenoid rim during extreme abduction and external rotation, causing recurrent instability.

Question 1284

Topic: Shoulder & Hip Sports

A 35-year-old man is evaluated in the emergency department following an unprovoked generalized tonic-clonic seizure. His arm is locked in internal rotation and he cannot actively externally rotate. Radiographs reveal a posterior shoulder dislocation. Which bony defect is most likely present?

. Hill-Sachs lesion
. Reverse Hill-Sachs lesion
. Bony Bankart lesion
. ALPSA lesion
. GLAD lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

Posterior shoulder dislocations are classic following seizures or electrical shock and lock the arm in internal rotation. The anteromedial humeral head impacts the posterior glenoid, creating an impaction fracture known as a reverse Hill-Sachs lesion.

Question 1285

Topic: Shoulder & Hip Sports

A 48-year-old manual laborer presents with persistent anterior shoulder pain. MRI arthrogram reveals an isolated Type II SLAP tear. Nonoperative management has failed. What is the most appropriate surgical treatment?

. Arthroscopic debridement of the labrum
. Arthroscopic SLAP repair with suture anchors
. Biceps tenodesis
. Coracoacromial ligament release
. Weaver-Dunn procedure

Correct Answer & Explanation

. Arthroscopic debridement of the labrum

Explanation

In patients over 40 or those who perform heavy labor, biceps tenodesis is preferred over SLAP repair. SLAP repair in older patients has higher complication rates, including postoperative stiffness and persistent pain.

Question 1286

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball pitcher presents with posterior shoulder pain during the late-cocking phase of throwing. MRI shows articular-sided partial tearing of the supraspinatus and posterosuperior labral fraying. Which structure is the rotator cuff abutting to cause this pathology?

. Coracoacromial arch
. Acromioclavicular joint
. Posterosuperior glenoid rim
. Anterior inferior glenoid
. Coracoid process

Correct Answer & Explanation

. Coracoacromial arch

Explanation

Internal impingement occurs during extreme abduction and external rotation (late-cocking phase), where the posterosuperior rotator cuff is pinched between the greater tuberosity and the posterosuperior glenoid rim.

Question 1287

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, how does an ALPSA (anterior labroligamentous periosteal sleeve avulsion) lesion mechanically differ from a classic Bankart lesion?

. It involves avulsion of the ligament from the humeral side rather than the glenoid.
. The labroligamentous complex is displaced medially and inferiorly, healing to the glenoid neck.
. It represents a bony avulsion fracture of the anterior inferior glenoid rim.
. It involves isolated injury to the articular cartilage without labral detachment.
. It involves the long head of the biceps anchor superiorly.

Correct Answer & Explanation

. It involves avulsion of the ligament from the humeral side rather than the glenoid.

Explanation

An ALPSA lesion is characterized by an intact periosteal sleeve that allows the detached anteroinferior labrum to shift medially and inferiorly, healing in a non-anatomic position on the glenoid neck. A classic Bankart involves a frank capsuloperiosteal disruption.

Question 1288

Topic: Shoulder & Hip Sports

During a massive rotator cuff repair, you identify a retracted subscapularis tendon. To safely mobilize it, you must be aware of its primary innervation. The subscapularis is innervated by branches from which cord of the brachial plexus?

. Lateral cord
. Medial cord
. Posterior cord
. Anterior divisions of the superior trunk
. Direct branches from C8 and T1

Correct Answer & Explanation

. Lateral cord

Explanation

The subscapularis is innervated by the upper and lower subscapular nerves, which both branch directly from the posterior cord of the brachial plexus.

Question 1289

Topic: Shoulder & Hip Sports

An 18-year-old competitive swimmer presents with multidirectional instability of the shoulder. She has completed 6 months of an aggressive periscapular stabilization and strengthening program without improvement. What is the most appropriate surgical intervention?

. Latarjet procedure
. Arthroscopic Remplissage
. Arthroscopic anterior Bankart repair
. Capsular shift procedure
. Biceps tenodesis

Correct Answer & Explanation

. Latarjet procedure

Explanation

When a minimum of 6 months of physical therapy fails in a patient with true multidirectional instability (MDI), a capsular shift (typically addressing the redundant inferior capsular pouch) is the surgical treatment of choice.

Question 1290

Topic: Shoulder & Hip Sports

When performing an arthroscopic stabilization for recurrent anterior shoulder instability, which of the following is the primary indication for adding a 'Remplissage' procedure to a Bankart repair?

. Anterior glenoid bone loss greater than 25%
. Presence of a massive, retracted rotator cuff tear
. Subcritical glenoid bone loss with an engaging, off-track Hill-Sachs lesion
. A reverse Hill-Sachs lesion
. A concomitant Type II SLAP tear

Correct Answer & Explanation

. Anterior glenoid bone loss greater than 25%

Explanation

Remplissage involves tenodesis of the infraspinatus and posterior capsule into a Hill-Sachs defect. It is indicated for off-track, engaging Hill-Sachs lesions in the setting of subcritical (<15-20%) anterior glenoid bone loss.

Question 1291

Topic: Shoulder & Hip Sports

Which of the following anatomic structures are the primary components found within the rotator interval?

. Superior glenohumeral ligament, coracohumeral ligament, long head of the biceps tendon
. Middle glenohumeral ligament, inferior glenohumeral ligament, long head of the biceps tendon
. Coracoacromial ligament, supraspinatus tendon, subscapularis tendon
. Supraspinatus tendon, infraspinatus tendon, teres minor tendon
. Short head of the biceps, coracobrachialis, pectoralis minor

Correct Answer & Explanation

. Superior glenohumeral ligament, coracohumeral ligament, long head of the biceps tendon

Explanation

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

Question 1292

Topic: Shoulder & Hip Sports

A lower trapezius tendon transfer is performed for a patient with an irreparable posterosuperior rotator cuff tear. The line of pull of the transferred lower trapezius tendon most closely mimics which native rotator cuff muscle to restore what specific motion?

. Supraspinatus; active abduction
. Subscapularis; active internal rotation
. Teres major; active adduction
. Infraspinatus; active external rotation
. Teres minor; active extension

Correct Answer & Explanation

. Supraspinatus; active abduction

Explanation

The lower trapezius transfer vector closely mimics the infraspinatus muscle. It is highly effective at restoring active external rotation in patients with irreparable posterosuperior cuff tears.

Question 1293

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D computed tomography (CT) scan reveals 26% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic anterior labral repair with anchor fixation
. Arthroscopic capsular plication
. Open coracoid transfer to the anterior glenoid (Latarjet)
. Arthroscopic remplissage alone
. Open inferior capsular shift

Correct Answer & Explanation

. Arthroscopic anterior labral repair with anchor fixation

Explanation

Anterior glenoid bone loss greater than 20-25% in a contact athlete is an indication for a bony augmentation procedure, most commonly the Latarjet procedure. Soft tissue Bankart repairs have an unacceptably high failure rate in this setting.

Question 1294

Topic: Shoulder & Hip Sports

A 68-year-old male with a massive, retracted rotator cuff tear is being evaluated for surgical repair. Preoperative MRI shows Goutallier stage 4 fatty infiltration of the supraspinatus and infraspinatus. What does this finding indicate regarding the prognosis of a primary repair?

. It is a normal age-related finding and does not affect healing
. It indicates muscular hypertrophy compensating for the tear
. It predicts a higher likelihood of structural failure after repair
. It signifies that a single-row repair is biomechanically superior to double-row
. It confirms an intact suprascapular nerve

Correct Answer & Explanation

. It is a normal age-related finding and does not affect healing

Explanation

Goutallier stage 3 or 4 fatty infiltration (more fat than muscle) is an irreversible change that strongly correlates with poor functional outcomes and high re-tear rates following primary rotator cuff repair.

Question 1295

Topic: Shoulder & Hip Sports

A 35-year-old male weightlifter complains of vague posterior shoulder pain and weakness with external rotation. MRI reveals a paralabral cyst located strictly at the spinoglenoid notch. Which physical exam finding is most likely present?

. Weakness in both abduction and external rotation
. Isolated weakness in external rotation with the arm at the side
. Positive lift-off test
. Positive belly-press test
. Weakness in internal rotation

Correct Answer & Explanation

. Weakness in both abduction and external rotation

Explanation

A cyst at the spinoglenoid notch compresses the distal suprascapular nerve, resulting in isolated denervation and weakness of the infraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1296

Topic: Shoulder & Hip Sports

During the Latarjet procedure, the coracoid process is transferred to the anterior glenoid. The primary stabilizing mechanism of this procedure in abduction and external rotation is attributed to:

. The bone block increasing the anteroposterior diameter of the glenoid
. The sling effect of the conjoint tendon on the lower subscapularis and capsule
. The repair of the coracoacromial ligament to the capsule
. The shortening of the musculocutaneous nerve
. The tightening of the middle glenohumeral ligament

Correct Answer & Explanation

. The bone block increasing the anteroposterior diameter of the glenoid

Explanation

While the Latarjet provides a triple blocking effect, the most significant biomechanical contribution in abduction and external rotation is the dynamic sling effect of the conjoint tendon over the inferior subscapularis.

Question 1297

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete is diagnosed with recurrent shoulder instability. Advanced imaging demonstrates an 'off-track' Hill-Sachs lesion and 12% anterior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Humeral head osteochondral allografting
. Open anterior capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

An 'off-track' Hill-Sachs lesion will engage the anterior glenoid rim during external rotation. When combined with subcritical glenoid bone loss (less than 20%), an arthroscopic Bankart repair combined with Remplissage is indicated to prevent engagement.

Question 1298

Topic: Shoulder & Hip Sports

A patient with a massive rotator cuff tear is examined in the clinic. The examiner supports the patient's arm in 90 degrees of abduction in the scapular plane with the elbow flexed to 90 degrees, and asks the patient to externally rotate against resistance. The patient is unable to do so, and the hand drops forward. Which muscle is predominantly deficient?

. Supraspinatus
. Subscapularis
. Teres major
. Teres minor
. Pectoralis major

Correct Answer & Explanation

. Supraspinatus

Explanation

This describes Hornblower's sign, which is highly sensitive and specific for an irreparable tear or severe fatty degeneration of the teres minor.

Question 1299

Topic: Shoulder & Hip Sports

Which of the following findings accurately differentiates an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion from a classic Bankart lesion on MRI?

. The labrum is detached completely with an associated bony fragment
. The anterior labrum is displaced medially and remains attached to the intact scapular periosteum
. The superior labrum is stripped from anterior to posterior
. There is extravasation of contrast into the axillary pouch
. The inferior glenohumeral ligament is avulsed from the humeral neck

Correct Answer & Explanation

. The labrum is detached completely with an associated bony fragment

Explanation

An ALPSA lesion involves an avulsion of the anterior labroligamentous complex where the periosteum remains intact, allowing the labrum to roll medially and scar down on the glenoid neck. It has a higher recurrence rate if not properly mobilized during repair.

Question 1300

Topic: Shoulder & Hip Sports

A 60-year-old man sustains an acute traumatic fall. He presents with profound weakness in internal rotation and a positive lift-off test. If this specific rotator cuff tendon is completely torn and left untreated, which secondary pathology is most likely to develop?

. Acromioclavicular joint osteoarthritis
. Medial subluxation or dislocation of the long head of the biceps tendon
. Atrophy of the deltoid muscle
. Adhesive capsulitis
. Teres minor fatty infiltration

Correct Answer & Explanation

. Acromioclavicular joint osteoarthritis

Explanation

The subscapularis tendon and the coracohumeral ligament are critical stabilizers of the long head of the biceps tendon. An untreated complete subscapularis tear frequently leads to medial subluxation or dislocation of the biceps tendon.

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