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Shoulder & Hip Sports MCQs

Practice Set 66 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 1301

Topic: Shoulder & Hip Sports

A 55-year-old male is evaluated for chronic shoulder pain. Anteroposterior (AP) radiographs reveal an acromiohumeral interval (AHI) of 4 mm. This measurement suggests:

. A high probability of a successful primary rotator cuff repair
. An isolated subscapularis tear
. Significant superior migration of the humeral head and poor prognosis for primary cuff repair
. Multidirectional instability
. Normal glenohumeral kinematics

Correct Answer & Explanation

. A high probability of a successful primary rotator cuff repair

Explanation

A normal AHI is 7 to 14 mm. An AHI of less than 7 mm (such as 4 mm) indicates superior migration of the humeral head, often seen with massive, chronic rotator cuff tears, and correlates with high failure rates for primary repair.

Question 1302

Topic: Shoulder & Hip Sports

A 50-year-old active female is diagnosed with a Partial Articular-sided Supraspinatus Tendon Avulsion (PASTA) lesion. Arthroscopic evaluation estimates the tear involves 60% of the tendon footprint depth. What is the most widely accepted surgical management?

. Debridement alone without repair
. Subacromial decompression alone
. Completion of the tear to a full-thickness defect followed by formal repair
. Latissimus dorsi transfer
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Debridement alone without repair

Explanation

For articular-sided partial rotator cuff tears involving greater than 50% of the tendon footprint thickness, the standard of care is to complete the tear and perform a formal full-thickness repair (or an in situ repair).

Question 1303

Topic: Shoulder & Hip Sports

A 35-year-old male suffers a first-time seizure and subsequently complains of shoulder pain and severely restricted external rotation. An axillary radiograph confirms a posterior shoulder dislocation with an anteromedial humeral head defect involving 30% of the articular surface. What is the best surgical intervention?

. Closed reduction and spica casting
. Arthroscopic posterior Bankart repair
. Transfer of the lesser tuberosity or subscapularis into the defect
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Closed reduction and spica casting

Explanation

A locked posterior dislocation with a reverse Hill-Sachs defect involving 20% to 40% of the articular surface is best treated with a Modified McLaughlin procedure (transfer of the subscapularis and/or lesser tuberosity into the defect) to prevent recurrent engagement.

Question 1304

Topic: Shoulder & Hip Sports

A 45-year-old construction worker undergoes an arthroscopic double-row rotator cuff repair. Postoperatively, the patient acknowledges smoking 1 pack of cigarettes per day. How does nicotine primarily compromise rotator cuff tendon-to-bone healing?

. It causes up-regulation of osteoblasts at the footprint
. It directly lyses suture material
. It induces peripheral vasoconstriction and reduces tissue microvascularity
. It increases the proliferation of tenocytes
. It accelerates early collagen cross-linking

Correct Answer & Explanation

. It causes up-regulation of osteoblasts at the footprint

Explanation

Nicotine is a potent vasoconstrictor that significantly impairs microvascular perfusion at the repair site. This leads to local tissue hypoxia, impaired fibroblast function, and a markedly increased rate of non-healing and re-tearing.

Question 1305

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain, a sulcus sign of 2 cm, and apprehension in multiple positions. She has failed 6 months of dedicated physical therapy emphasizing periscapular strengthening. What is the surgical treatment of choice for her condition?

. Arthroscopic SLAP repair
. Latarjet procedure
. Arthroscopic or open capsular plication and inferior capsular shift
. Humeral head resurfacing
. Coracoid transfer to the posterior glenoid

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

This patient has multidirectional instability (MDI). When prolonged conservative management fails, the surgical standard of care is a capsular shift (open or arthroscopic capsular plication) to reduce the redundant capsular volume.

Question 1306

Topic: Shoulder & Hip Sports

A 25-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. He demonstrates increased external rotation and decreased internal rotation (GIRD) compared to the contralateral shoulder. MRI reveals a partial articular-sided tear of the infraspinatus and a posterosuperior labral fraying. What is the most likely diagnosis?

. Subcoracoid impingement
. Internal impingement
. Primary adhesive capsulitis
. Parsonage-Turner syndrome
. Classic external subacromial impingement

Correct Answer & Explanation

. Subcoracoid impingement

Explanation

Internal impingement occurs in overhead athletes during maximum abduction and external rotation. The greater tuberosity abuts the posterosuperior glenoid, causing undersurface 'kissing lesions' of the supraspinatus/infraspinatus and posterosuperior labrum.

Question 1307

Topic: Shoulder & Hip Sports

A massive rotator cuff tear is generally defined by which of the following criteria?

. Tear size greater than 2 cm
. Involvement of any part of the subscapularis
. A tear involving two or more entire tendons or a diameter greater than 5 cm
. Retraction strictly medial to the glenoid face
. Fatty infiltration grade 2 or higher

Correct Answer & Explanation

. Tear size greater than 2 cm

Explanation

The classic definition of a massive rotator cuff tear, originally described by Cofield, is a tear with a diameter greater than 5 cm. Alternatively, Gerber defines it as the complete detachment of two or more rotator cuff tendons.

Question 1308

Topic: Shoulder & Hip Sports

A 65-year-old man presents with an inability to actively raise his right arm above 40 degrees, despite having 150 degrees of passive forward elevation. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus with Goutallier grade 4 fatty infiltration. His subscapularis and deltoid are intact. What is the most appropriate surgical treatment?

. Arthroscopic primary repair
. Arthroscopic debridement and partial repair
. Latissimus dorsi tendon transfer
. Superior capsular reconstruction
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic primary repair

Explanation

In a patient with true pseudoparalysis and severe fatty infiltration (Goutallier grade 4) of a massive rotator cuff tear, a reverse total shoulder arthroplasty provides the most reliable return of active elevation.

Question 1309

Topic: Shoulder & Hip Sports

A 55-year-old woman undergoes arthroscopic repair of a full-thickness supraspinatus tear. Which of the following best describes the normal progression of rotator cuff tendon healing to bone?

. Immediate regeneration of the native 4-zone enthesis within 6 weeks
. Formation of a fibrovascular scar followed by a fibrocartilage transition zone and Sharpey fibers
. Primary membranous ossification replacing the tendon end
. Formation of woven bone followed by endochondral ossification
. Extensive scar tissue formation composed exclusively of Type II collagen indefinitely

Correct Answer & Explanation

. Immediate regeneration of the native 4-zone enthesis within 6 weeks

Explanation

Rotator cuff healing typically occurs via initial fibrovascular scar formation. This gradually remodels to form a fibrocartilaginous transition zone integrating with the bone via Sharpey fibers, though it rarely fully recreates the native enthesis.

Question 1310

Topic: Shoulder & Hip Sports

A 20-year-old male athlete has failed a previous arthroscopic Bankart repair and presents with recurrent anterior instability. A 3D CT scan reveals 25% anterior glenoid bone loss. What is the most appropriate definitive management?

. Revision arthroscopic Bankart repair
. Open Bankart repair and capsular shift
. Remplissage
. Latarjet procedure
. Latissimus dorsi transfer

Correct Answer & Explanation

. Revision arthroscopic Bankart repair

Explanation

In the setting of failed soft-tissue stabilization and critical anterior glenoid bone loss (>20-25%), a coracoid transfer (Latarjet procedure) is indicated to restore anterior glenoid bone stock and provide a dynamic sling effect.

Question 1311

Topic: Shoulder & Hip Sports

A 45-year-old male weightlifter presents with acute weakness in internal rotation after feeling a "pop" in his shoulder. MRI confirms an acute, isolated, full-thickness subscapularis tear retracted to the glenoid rim. What is the most appropriate management?

. Physical therapy for 6 months
. Pectoralis major transfer
. Latissimus dorsi transfer
. Arthroscopic or open primary repair
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Physical therapy for 6 months

Explanation

Acute traumatic full-thickness subscapularis tears in active patients should undergo early surgical repair. Rapid muscle atrophy and fatty infiltration occur much earlier in the subscapularis compared to the supraspinatus.

Question 1312

Topic: Shoulder & Hip Sports

A 68-year-old woman presents with chronic shoulder pain and imaging showing a massive, irreparable posterosuperior rotator cuff tear. She has an intact subscapularis and no pseudoparalysis. Which tendon transfer is most appropriate to restore external rotation?

. Pectoralis major transfer
. Lower trapezius transfer
. Pectoralis minor transfer
. Coracobrachialis transfer
. Subscapularis transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

The lower trapezius transfer is indicated for irreparable posterosuperior rotator cuff tears. It has a synergistic line of pull that excellently restores external rotation and centers the humeral head.

Question 1313

Topic: Shoulder & Hip Sports

A 32-year-old baseball pitcher presents with posterior shoulder pain. MRI reveals a large paralabral cyst in the spinoglenoid notch. Which isolated physical exam finding is most likely to be present?

. Weakness in isolated external rotation with the arm at the side
. Weakness in internal rotation
. Positive lift-off test
. Positive anterior apprehension test
. Pseudoparalysis of forward elevation

Correct Answer & Explanation

. Weakness in isolated external rotation with the arm at the side

Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve after it has innervated the supraspinatus. This leads to isolated infraspinatus denervation and isolated external rotation weakness.

Question 1314

Topic: Shoulder & Hip Sports

During arthroscopic rotator cuff repair, a double-row transosseous-equivalent (suture bridge) technique is utilized. Which of the following best describes the primary biomechanical advantage of this construct?

. It relies solely on the pullout strength of the medial anchors
. It increases the pressurized contact area between the tendon and the bone footprint
. It completely relies on Type I collagen synthesis for primary stability
. It prevents subscapularis impingement against the coracoid
. It eliminates the risk of recurrent tears by rigid fixation

Correct Answer & Explanation

. It relies solely on the pullout strength of the medial anchors

Explanation

The transosseous-equivalent (suture bridge) technique maximizes the pressurized contact area between the rotator cuff tendon and its anatomic footprint. This optimizes the biological environment for healing.

Question 1315

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a massive rotator cuff tear involving the subscapularis and supraspinatus. If the subscapularis is deemed chronically irreparable and atrophic, which tendon transfer is indicated?

. Latissimus dorsi transfer
. Pectoralis major transfer
. Lower trapezius transfer
. Rhomboid major transfer
. Levator scapulae transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

A pectoralis major transfer (typically routed subcoracoid or subclavicular) is the most utilized tendon transfer for an irreparable subscapularis tear. It restores dynamic anterior stability and internal rotation function.

Question 1316

Topic: Shoulder & Hip Sports

What is considered a critical contraindication to performing a latissimus dorsi tendon transfer for an irreparable posterosuperior rotator cuff tear?

. Patient age greater than 50
. Goutallier grade 2 fatty infiltration of the infraspinatus
. Concomitant irreparable subscapularis tear
. Mild acromioclavicular joint osteoarthritis
. Intact teres minor

Correct Answer & Explanation

. Patient age greater than 50

Explanation

A latissimus dorsi transfer relies heavily on an intact or repairable subscapularis to maintain a balanced transverse force couple. An irreparable subscapularis tear is a strict contraindication to this procedure.

Question 1317

Topic: Shoulder & Hip Sports

The "remplissage" procedure is often performed as an adjunct to an arthroscopic Bankart repair. Which of the following correctly describes the technical execution of this procedure?

. Transferring the coracoid to the anterior glenoid
. Tenodesis of the infraspinatus tendon and posterior capsule into the Hill-Sachs defect
. Tying the anterior labrum directly to the subscapularis
. Advancing the subscapularis tendon over the lesser tuberosity
. Shifting the inferior capsule to the superior glenoid

Correct Answer & Explanation

. Transferring the coracoid to the anterior glenoid

Explanation

The remplissage procedure involves suturing the infraspinatus tendon and posterior capsule into an engaging Hill-Sachs defect. This converts it to an extra-articular lesion, preventing it from engaging the anterior glenoid rim.

Question 1318

Topic: Shoulder & Hip Sports

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

. Arthroscopic Bankart repair alone
. Open Bankart repair with inferior capsular shift
. Arthroscopic Bankart repair with Remplissage
. Coracoid transfer (Latarjet procedure)
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

The Latarjet procedure is indicated for recurrent anterior shoulder instability in the presence of critical glenoid bone loss (typically >20-25%). Soft tissue stabilization alone in this setting has an unacceptably high failure rate.

Question 1319

Topic: Shoulder & Hip Sports

A 28-year-old man has recurrent anterior shoulder instability. Diagnostic arthroscopy reveals an engaging Hill-Sachs lesion and <10% glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair alone
. Open Latarjet procedure
. Arthroscopic Bankart repair with Remplissage
. Humeral head osteochondral allograft
. Capsular plication alone

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

An engaging Hill-Sachs lesion in the setting of subcritical glenoid bone loss is best treated with a Bankart repair and Remplissage (infraspinatus tenodesis into the defect) to prevent engagement and recurrent dislocation.

Question 1320

Topic: Shoulder & Hip Sports

A 30-year-old elite volleyball player presents with painless weakness in external rotation of the dominant shoulder. Physical exam reveals isolated atrophy of the infraspinatus fossa. MRI shows a paralabral cyst in the spinoglenoid notch. What is the most likely associated intra-articular pathology?

. Anterior Bankart lesion
. Posterior SLAP tear
. Subscapularis tear
. Anterior labral periosteal sleeve avulsion (ALPSA)
. Humeral avulsion of the glenohumeral ligament (HAGL)

Correct Answer & Explanation

. Anterior Bankart lesion

Explanation

Cysts at the spinoglenoid notch are highly associated with posterior or posterosuperior SLAP tears. They selectively compress the suprascapular nerve branch to the infraspinatus, causing isolated external rotation weakness and atrophy.

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