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Shoulder & Hip Sports MCQs

Practice Set 69 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 1361

Topic: Shoulder & Hip Sports

A 28-year-old woman presents with bilateral shoulder pain and feelings of instability. She has a positive sulcus sign, generalized ligamentous hyperlaxity, and apprehension with extreme ranges of motion but no history of acute dislocation. What is the mainstay of initial treatment?

. Supervised physical therapy focusing on periscapular and rotator cuff strengthening
. Arthroscopic capsular plication
. Open inferior capsular shift
. Botulinum toxin injection to the pectoralis major
. Immediate immobilization in an external rotation sling

Correct Answer & Explanation

. Supervised physical therapy focusing on periscapular and rotator cuff strengthening

Explanation

This patient has multidirectional instability (MDI). The cornerstone of treatment for MDI is an extended course of physical therapy focusing on strengthening the periscapular stabilizers and the rotator cuff to provide dynamic joint stability.

Question 1362

Topic: Shoulder & Hip Sports

A 21-year-old collegiate athlete is evaluated for recurrent anterior shoulder instability. MRI reveals a Hill-Sachs lesion that is determined to be "off-track". What is the primary clinical significance of an "off-track" lesion in surgical planning?

. It requires isolated arthroscopic soft tissue repair.
. It indicates posterior capsular contracture.
. It is an absolute contraindication to surgery.
. It has a high risk of engagement and requires bony or soft-tissue augmentation (remplissage).
. It guarantees the patient will develop early osteoarthritis.

Correct Answer & Explanation

. It requires isolated arthroscopic soft tissue repair.

Explanation

An "off-track" Hill-Sachs lesion means the defect will engage the anterior glenoid rim when the arm is abducted and externally rotated. This requires addressing the defect directly, either via remplissage or a bony augmentation procedure, to prevent recurrent instability.

Question 1363

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with his fourth anterior shoulder dislocation. Advanced imaging demonstrates a 26% anterior glenoid bone loss. Which of the following is the most appropriate surgical management to minimize the risk of recurrence?

. Arthroscopic Bankart repair
. Open Latarjet procedure
. Arthroscopic Bankart repair with Remplissage
. Arthroscopic inferior capsular shift
. Osteochondral allograft reconstruction

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

In the setting of recurrent anterior instability with critical glenoid bone loss (>20-25%), a bone-block procedure such as the Latarjet is indicated. Soft-tissue repairs alone (e.g., Bankart) have an unacceptably high failure rate in this scenario.

Question 1364

Topic: Shoulder & Hip Sports

A 55-year-old man presents with anterior shoulder pain after a fall. Physical examination reveals a positive belly-press test and negative lift-off test. Passive range of motion testing is most likely to reveal which of the following compared to the contralateral normal shoulder?

. Increased passive external rotation
. Decreased passive external rotation
. Increased active internal rotation
. Decreased passive forward elevation
. Positive apprehension sign in abduction

Correct Answer & Explanation

. Increased passive external rotation

Explanation

A positive belly-press test with a negative lift-off test suggests an isolated tear of the upper subscapularis. A physical examination hallmark of a subscapularis tear is increased passive external rotation due to the loss of the anterior restraints.

Question 1365

Topic: Shoulder & Hip Sports

A 28-year-old weightlifter presents with chronic, vague posterior shoulder pain. Examination demonstrates normal forward elevation, normal strength in internal rotation, and symmetric active external rotation in adduction. However, he has marked weakness in external rotation when the arm is abducted to 90 degrees. MRI demonstrates a paralabral cyst. At what anatomic location is this cyst most likely compressing the nerve?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Isolated weakness of the infraspinatus (tested via external rotation in 90 degrees of abduction) indicates compression of the suprascapular nerve at the spinoglenoid notch. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1366

Topic: Shoulder & Hip Sports

A 24-year-old female presents with recurrent anterior shoulder instability. Arthroscopy reveals an engaging Hill-Sachs lesion. Which of the following best describes the biomechanics of an engaging Hill-Sachs lesion?

. The defect tracks parallel to the anterior glenoid rim during internal rotation
. The defect levers the humeral head out of the joint during forward flexion
. The defect drops over the anterior glenoid rim during abduction and external rotation
. The defect is located on the anteromedial humeral head and engages posteriorly
. The defect prevents congruent reduction in the resting anatomical position

Correct Answer & Explanation

. The defect tracks parallel to the anterior glenoid rim during internal rotation

Explanation

An engaging Hill-Sachs lesion is a posterolateral humeral head defect that aligns parallel to the anterior glenoid rim and "drops in" or engages during abduction and external rotation, leading to instability. This typically requires a remplissage or bone grafting procedure.

Question 1367

Topic: Shoulder & Hip Sports

During an arthroscopic stabilization for anterior shoulder instability, the surgeon notes an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion. How does this differ anatomically from a classic Bankart lesion?

. The labrum is detached with a complete tear of the anterior periosteum
. The anterior scapular periosteum remains intact, and the labrum displaces medially
. The labrum is intact but there is a bony avulsion of the glenoid rim
. The superior labrum is detached anterior to the biceps anchor
. The inferior glenohumeral ligament is avulsed from its humeral insertion

Correct Answer & Explanation

. The labrum is detached with a complete tear of the anterior periosteum

Explanation

In an ALPSA lesion, the anterior labrum is detached from the glenoid rim, but the anterior scapular periosteum remains intact, allowing the labroligamentous complex to displace and heal medially on the glenoid neck. A classic Bankart lesion involves a complete tear of the periosteum.

Question 1368

Topic: Shoulder & Hip Sports

A 68-year-old man presents with a massive, retracted rotator cuff tear. On physical examination, he is unable to maintain his arm in external rotation against gravity when the arm is supported in 90 degrees of abduction, causing his hand to drop to his mouth when attempting to blow a horn. This "Hornblower's sign" is most indicative of severe fatty infiltration in which of the following muscles?

. Supraspinatus
. Subscapularis
. Latissimus dorsi
. Infraspinatus
. Teres minor

Correct Answer & Explanation

. Supraspinatus

Explanation

A positive Hornblower's sign (inability to actively maintain external rotation in 90 degrees of abduction) is highly specific for a tear and advanced fatty infiltration of the teres minor. The infraspinatus is primarily responsible for external rotation with the arm at the side.

Question 1369

Topic: Shoulder & Hip Sports

During the open Latarjet procedure, the coracoid process is transferred to the anterior glenoid neck. Which of the following correctly describes the handling of the subscapularis muscle to allow exposure and transfer of the bone block?

. Complete tenotomy of the subscapularis at its insertion
. Elevation of the subscapularis from the lesser tuberosity with a bony wafer
. A horizontal split made in line with the fibers of the subscapularis
. Z-lengthening of the subscapularis tendon
. Release of the superior half of the subscapularis tendon only

Correct Answer & Explanation

. Complete tenotomy of the subscapularis at its insertion

Explanation

The classic Latarjet procedure approaches the anterior glenoid by performing a horizontal split through the mid-substance of the subscapularis muscle, separating the upper two-thirds from the lower one-third. This preserves the musculotendinous unit and dynamic stability.

Question 1370

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast presents with bilateral shoulder pain and a sensation of slipping with overhead activities. Examination reveals positive sulcus signs bilaterally, positive apprehension and relocation tests, and generalized ligamentous laxity.

What is the initial treatment of choice for this condition?

. Arthroscopic capsular plication
. Physical therapy focusing on periscapular stabilizers and rotator cuff strengthening
. Open inferior capsular shift
. Thermal capsulorrhaphy
. Latarjet procedure

Correct Answer & Explanation

. Arthroscopic capsular plication

Explanation

This patient has multidirectional instability (MDI). The cornerstone and initial treatment of choice for MDI is a prolonged, structured physical therapy program focusing on strengthening the periscapular stabilizers and rotator cuff musculature.

Question 1371

Topic: Shoulder & Hip Sports

Biomechanically, active shoulder elevation can be maintained in the setting of a massive supraspinatus tear if the "transverse force couple" remains intact. Which two muscles primarily comprise this critical transverse force couple?

. Deltoid and Supraspinatus
. Subscapularis and Pectoralis Major
. Subscapularis and Infraspinatus
. Teres minor and Teres major
. Coracobrachialis and Biceps

Correct Answer & Explanation

. Deltoid and Supraspinatus

Explanation

The transverse force couple balances anterior and posterior forces to keep the humeral head centered on the glenoid during active elevation. It is primarily composed of the subscapularis anteriorly and the infraspinatus (and teres minor) posteriorly.

Question 1372

Topic: Shoulder & Hip Sports

A 32-year-old male is evaluated for a locked posterior shoulder dislocation following a generalized seizure. CT imaging reveals an anteromedial humeral head impression defect (reverse Hill-Sachs lesion) involving 25% of the articular surface. Which of the following is the most appropriate surgical intervention?

. Arthroscopic posterior Bankart repair alone
. Open transfer of the lesser tuberosity into the defect (Modified McLaughlin)
. Anatomic total shoulder arthroplasty
. Reverse total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Arthroscopic posterior Bankart repair alone

Explanation

For a reverse Hill-Sachs lesion between 20% and 40% of the articular surface, filling the defect with the subscapularis tendon alone (McLaughlin) or the lesser tuberosity (modified McLaughlin) is the standard treatment to restore stability and prevent the defect from engaging the posterior glenoid.

Question 1373

Topic: Shoulder & Hip Sports

Following rotator cuff repair, tendon-to-bone healing progresses through distinct biological phases. During the early proliferative phase (1 to 3 weeks post-repair), which type of collagen is predominantly synthesized to form the initial scar tissue matrix?

. Type I
. Type III
. Type II
. Type X
. Type V

Correct Answer & Explanation

. Type I

Explanation

During the early proliferative phase of tendon healing, fibroblasts predominantly synthesize Type III collagen, which provides early, disorganized scaffolding. This is gradually remodeled into the stronger, more organized Type I collagen over subsequent months.

Question 1374

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals a 25% anterior glenoid bone loss. What is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Arthroscopic remplissage
. Latarjet procedure
. Open Bankart repair
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

Glenoid bone loss greater than 20-25% in the setting of recurrent anterior shoulder instability is an indication for a bony augmentation procedure like the Latarjet. Soft tissue repairs have unacceptably high failure rates in this setting.

Question 1375

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with a chronic, massive, irreparable posterosuperior rotator cuff tear. He has severe weakness in external rotation and active elevation, but subscapularis function remains intact. He has minimal glenohumeral osteoarthritis. Which of the following is the most appropriate tendon transfer?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Pectoralis minor transfer
. Pronator teres transfer
. Biceps brachii rerouting

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

Latissimus dorsi or lower trapezius tendon transfers are indicated for massive, irreparable posterosuperior rotator cuff tears in younger, active patients. An intact or repairable subscapularis is highly recommended for a successful latissimus dorsi transfer.

Question 1376

Topic: Shoulder & Hip Sports

A 45-year-old man presents with anterior shoulder pain and weakness after falling onto an outstretched arm. Physical examination reveals a positive bear-hug test and increased passive external rotation of the shoulder. Which structure is most likely injured?

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

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The bear-hug test, belly-press test, and lift-off test evaluate subscapularis function. A tear of the subscapularis often presents with increased passive external rotation due to the loss of its anterior restraint.

Question 1377

Topic: Shoulder & Hip Sports

A 28-year-old man undergoes magnetic resonance arthrography (MRA) for recurrent anterior shoulder instability. The radiologist notes a 'J-sign' on the coronal fluid-sensitive sequences, representing a capsuloligamentous injury. What specific lesion does this finding describe?

. ALPSA lesion
. GLAD lesion
. HAGL lesion
. Bankart lesion
. SLAP tear

Correct Answer & Explanation

. ALPSA lesion

Explanation

Humeral Avulsion of the Glenohumeral Ligament (HAGL) produces a 'J-sign' on MRI arthrography. The normal U-shaped axillary pouch drops down into a J-shape due to the detachment of the inferior glenohumeral ligament from the humeral neck.

Question 1378

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast complains of bilateral shoulder pain and a feeling of looseness. Examination reveals a positive sulcus sign that does not reduce with external rotation. What is the most appropriate initial management?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Thermal capsulorrhaphy
. Physical therapy focusing on periscapular and rotator cuff strengthening
. Latarjet procedure

Correct Answer & Explanation

. Arthroscopic capsular plication

Explanation

The initial management for multidirectional instability (MDI) is a prolonged trial (at least 6 months) of physical therapy focusing on strengthening the dynamic stabilizers. Surgical stabilization is reserved for cases strictly refractory to conservative care.

Question 1379

Topic: Shoulder & Hip Sports

A 38-year-old elite volleyball player has isolated atrophy of the infraspinatus muscle and weakness in external rotation. An MRI reveals a paralabral cyst. At which anatomic location is the nerve most likely compressed?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Suprascapular notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch (often by a paralabral cyst associated with a posterior SLAP tear) results in isolated infraspinatus weakness. Compression more proximally at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 1380

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan of the shoulder reveals 28% bone loss of the anterior-inferior glenoid width. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic capsular plication
. Coracoid transfer (Latarjet procedure)
. Humeral head osteochondral allografting
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

Anterior glenoid bone loss exceeding 20-25% in the setting of recurrent instability is an indication for a bony augmentation procedure. The Latarjet procedure (coracoid transfer) addresses the bone defect and provides a sling effect via the conjoint tendon.

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