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Shoulder & Hip Sports MCQs

Practice Set 76 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 1501

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, the surgeon identifies the 'comma sign' tissue dropping deep into the joint. Tracing this structure superiorly and laterally leads directly to the torn edge of which anatomical structure?

. Supraspinatus tendon
. Long head of the biceps tendon
. Superior glenohumeral ligament
. Superolateral corner of the subscapularis tendon
. Coracoacromial ligament

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The 'comma sign' is formed by the avulsion and medial retraction of the superior glenohumeral ligament and coracohumeral ligament complex. Following the comma sign superiorly and laterally leads directly to the superolateral corner of a retracted subscapularis tear.

Question 1502

Topic: Shoulder & Hip Sports

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

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Open Latarjet procedure
. Arthroscopic capsular plication
. Open inferior capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

The open Latarjet procedure (coracoid transfer) is indicated for recurrent anterior shoulder instability in patients with critical glenoid bone loss, typically defined as greater than 20-25%. Arthroscopic soft tissue repair alone has a highly unacceptable failure rate in this scenario.

Question 1503

Topic: Shoulder & Hip Sports

A 28-year-old professional baseball pitcher presents with posterior shoulder pain. MRI arthrogram shows undersurface fraying of the posterior supraspinatus and posterosuperior labrum. This pathology is primarily exacerbated by which of the following shoulder positions?

. Abduction and external rotation
. Abduction and internal rotation
. Adduction and internal rotation
. Forward flexion and internal rotation
. Extension and internal rotation

Correct Answer & Explanation

. Abduction and external rotation

Explanation

This describes internal impingement, common in overhead throwing athletes. It occurs during late cocking and early acceleration, where the shoulder is in extreme abduction and external rotation, pinching the posterosuperior labrum and articular-sided rotator cuff.

Question 1504

Topic: Shoulder & Hip Sports

During the physical examination of a 55-year-old man with a suspected rotator cuff tear, the examiner asks the patient to place the palm of his hand on his contralateral shoulder and attempts to externally rotate the patient's hand while the patient resists. Which specific structure is best isolated by this test?

. Supraspinatus tendon
. Infraspinatus tendon
. Teres minor tendon
. Lower subscapularis tendon
. Upper subscapularis tendon

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

This describes the 'bear-hug' test, which is highly sensitive and specific for evaluating tears of the upper portion of the subscapularis tendon. The lift-off test is generally more specific to the lower subscapularis.

Question 1505

Topic: Shoulder & Hip Sports

A 35-year-old man presents after a seizure with a locked posterior shoulder dislocation. CT scan demonstrates an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. The dislocation is irreducible closed. What is the most appropriate surgical intervention?

. Arthroscopic posterior labral repair
. Open reduction with transfer of the greater tuberosity into the defect
. Open reduction with transfer of the lesser tuberosity into the defect
. Anatomic total shoulder arthroplasty
. Shoulder arthrodesis

Correct Answer & Explanation

. Arthroscopic posterior labral repair

Explanation

For reverse Hill-Sachs lesions involving 20% to 40% of the articular surface, transfer of the lesser tuberosity (with or without the subscapularis tendon) into the defect is the standard treatment (modified McLaughlin procedure). Defects >40-50% generally require arthroplasty.

Question 1506

Topic: Shoulder & Hip Sports

In evaluating a standard anteroposterior radiograph of the shoulder in a patient with chronic rotator cuff disease, what is the earliest radiographic sign indicative of rotator cuff tear arthropathy?

. Superior migration of the humeral head with an acromiohumeral distance less than 7 mm
. Acetabularization of the acromion
. Femoralization of the humeral head
. Inferior osteophyte formation on the glenoid
. Subchondral cysts in the greater tuberosity

Correct Answer & Explanation

. Superior migration of the humeral head with an acromiohumeral distance less than 7 mm

Explanation

The earliest radiographic manifestation of massive rotator cuff tearing and impending arthropathy is superior migration of the humeral head, defined by an acromiohumeral distance (AHD) of less than 7 mm. Acetabularization and femoralization occur in later stages (Hamada classification).

Question 1507

Topic: Shoulder & Hip Sports

A 40-year-old construction worker presents with persistent shoulder pain despite 6 months of nonoperative management. MRI reveals an articular-sided partial tear of the supraspinatus tendon involving 60% of the tendon footprint depth (PASTA lesion). What is the recommended surgical management?

. Arthroscopic debridement of the tear without repair
. Arthroscopic repair of the tendon
. Open acromioplasty and bursectomy only
. Biceps tenodesis alone
. Superior capsular reconstruction

Correct Answer & Explanation

. Arthroscopic debridement of the tear without repair

Explanation

For partial rotator cuff tears involving greater than 50% of the tendon footprint depth, surgical repair (either by completion of the tear and repair or a transtendon repair) is indicated. Debridement alone is inadequate for tears >50%.

Question 1508

Topic: Shoulder & Hip Sports

The concept of the 'glenoid track' is used to evaluate anterior shoulder instability. Which of the following statements correctly defines an 'off-track' Hill-Sachs lesion?

. The lateral margin of the lesion is lateral to the glenoid track.
. The lesion involves more than 20% of the humeral head articular surface.
. The medial margin of the lesion is medial to the glenoid track.
. The lesion is oriented vertically relative to the humeral shaft.
. The lesion remains completely contained within the glenoid track during abduction.

Correct Answer & Explanation

. The lateral margin of the lesion is lateral to the glenoid track.

Explanation

An off-track Hill-Sachs lesion occurs when its medial margin lies medial to the medial border of the glenoid track. This indicates that the lesion will engage the anterior glenoid rim during abduction and external rotation, typically necessitating a remplissage or bone block.

Question 1509

Topic: Shoulder & Hip Sports

A 58-year-old man with a massive, irreparable posterosuperior rotator cuff tear is scheduled for a latissimus dorsi tendon transfer. For this procedure to be successful in restoring active forward elevation, which of the following muscles MUST be functionally intact to provide a balanced force couple?

. Teres major
. Subscapularis
. Rhomboid major
. Levator scapulae
. Pectoralis minor

Correct Answer & Explanation

. Teres major

Explanation

A successful latissimus dorsi transfer for a massive posterosuperior cuff tear requires an intact and functioning subscapularis to maintain the anterior-posterior force couple of the shoulder, keeping the humeral head centered on the glenoid.

Question 1510

Topic: Shoulder & Hip Sports

A 22-year-old elite collegiate baseball pitcher is diagnosed with an isolated Type II SLAP tear via MRI arthrogram. He has significant glenohumeral internal rotation deficit (GIRD) on exam. What is the most appropriate initial management?

. Physical therapy focusing on internal rotation stretching and scapular stabilizers
. Arthroscopic SLAP repair with suture anchors
. Open biceps tenodesis
. Arthroscopic biceps tenotomy
. Corticosteroid injection into the subacromial space

Correct Answer & Explanation

. Physical therapy focusing on internal rotation stretching and scapular stabilizers

Explanation

First-line treatment for an isolated Type II SLAP tear in an overhead throwing athlete, especially with concomitant GIRD, is conservative management. Physical therapy emphasizing posterior capsular stretching (sleeper stretches) and scapular stabilization is highly effective and avoids the stiffness often seen post-SLAP repair.

Question 1511

Topic: Shoulder & Hip Sports

A 28-year-old male volleyball player presents with isolated, painless weakness in external rotation of his dominant shoulder. MRI reveals a paralabral ganglion cyst. At which of the following anatomic locations is the cyst most likely causing nerve compression?

. Suprascapular notch
. Quadrilateral space
. Triangular interval
. Rotator interval
. Spinoglenoid notch

Correct Answer & Explanation

. Suprascapular notch

Explanation

A cyst at the spinoglenoid notch compresses the distal suprascapular nerve, causing isolated denervation and atrophy of the infraspinatus (external rotation weakness). Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1512

Topic: Shoulder & Hip Sports

A 52-year-old woman sustains an acute anterior shoulder dislocation. After a successful closed reduction in the emergency department, she complains of persistent pain and is completely unable to actively abduct her arm. Axillary nerve sensation is intact. What is the most likely associated injury?

. Bankart lesion
. Hill-Sachs lesion
. Rotator cuff tear
. Greater tuberosity fracture
. Coracoid fracture

Correct Answer & Explanation

. Bankart lesion

Explanation

In patients older than 40 years, there is a high incidence (ranging from 30% to 80% in older cohorts) of concomitant rotator cuff tears following acute anterior shoulder dislocations. Persistent inability to abduct after reduction should prompt immediate advanced imaging (MRI or US).

Question 1513

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder dislocations. CT scan reveals 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with capsular shift
. Open Bankart repair
. Coracoid transfer (Latarjet procedure)
. Iliac crest bone grafting
. Arthroscopic remplissage alone

Correct Answer & Explanation

. Arthroscopic Bankart repair with capsular shift

Explanation

In collision athletes with critical anterior glenoid bone loss (>20-25%), an arthroscopic or open Bankart repair has unacceptably high failure rates. A Latarjet procedure (coracoid transfer) is indicated to restore anterior stability via its triple-blocking effect.

Question 1514

Topic: Shoulder & Hip Sports

A 65-year-old man presents with chronic shoulder weakness and a massive, retracted rotator cuff tear. Which of the following preoperative MRI findings is the strongest contraindication to a primary tendon repair?

. Acromiohumeral distance of 8 mm
. Goutallier stage 3 or 4 fatty infiltration of the infraspinatus
. A tear involving the supraspinatus and upper subscapularis
. Coracohumeral interval of 6 mm
. Concomitant Type II SLAP tear

Correct Answer & Explanation

. Acromiohumeral distance of 8 mm

Explanation

High-grade (Goutallier 3 or 4) fatty infiltration and muscle atrophy indicate irreversible muscle degeneration. Attempting primary repair in these settings is associated with extremely high structural failure rates.

Question 1515

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability and bipolar bone loss, a Hill-Sachs lesion is considered 'off-track' (engaging) under which of the following conditions?

. When the intact anterior glenoid rim is less than 20% of its native width
. When the medial margin of the Hill-Sachs lesion is medial to the glenoid track
. When the lesion involves the inferior pole of the humeral head
. When it is associated with a concomitant HAGL lesion
. When the depth of the lesion exceeds 1 cm

Correct Answer & Explanation

. When the intact anterior glenoid rim is less than 20% of its native width

Explanation

The glenoid track concept determines engagement. A Hill-Sachs lesion is 'off-track' if its medial margin extends further medial than the intact glenoid track, meaning it will engage the anterior glenoid rim during abduction and external rotation.

Question 1516

Topic: Shoulder & Hip Sports

A 45-year-old laborer with an intact subscapularis presents with persistent pain and pseudoparalysis of external rotation due to a massive, irreparable posterosuperior rotator cuff tear. Which tendon transfer is most appropriate?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Rhomboid major transfer
. Serratus anterior transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

Latissimus dorsi or lower trapezius transfers are indicated to restore active external rotation and forward elevation in younger patients with massive, irreparable posterosuperior tears, provided the subscapularis and deltoid are intact.

Question 1517

Topic: Shoulder & Hip Sports

A 30-year-old weightlifter presents with posterior shoulder pain during bench presses. Examination reveals a positive jerk test. MRI confirms a posterior labral tear. What is the most appropriate initial management?

. Arthroscopic posterior stabilization
. Open posterior capsular shift
. Physical therapy focusing on periscapular and posterior deltoid strengthening
. Latarjet procedure
. Pectoralis major tendon transfer

Correct Answer & Explanation

. Arthroscopic posterior stabilization

Explanation

Initial management for posterior shoulder instability is nonoperative, focusing on comprehensive physical therapy to strengthen the dynamic posterior stabilizers (posterior cuff, periscapular muscles, and posterior deltoid).

Question 1518

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness of external rotation but normal active forward elevation. Examination reveals isolated atrophy in the infraspinatus fossa. A paralabral cyst is most likely compressing the suprascapular nerve at which anatomical location?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branches to the infraspinatus (external rotation). Compression further proximal at the suprascapular notch would also denervate the supraspinatus.

Question 1519

Topic: Shoulder & Hip Sports

A 28-year-old male with recurrent anterior instability undergoes an MRI arthrogram that shows no Bankart lesion, but reveals an avulsion of the inferior glenohumeral ligament from the humeral neck. What is this lesion termed?

. ALPSA lesion
. Perthes lesion
. HAGL lesion
. GLAD lesion
. PASTA lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

Humeral Avulsion of the Glenohumeral Ligament (HAGL) causes recurrent anterior instability. It lacks the typical labral detachment (Bankart) and requires surgical repair to the humeral neck.

Question 1520

Topic: Shoulder & Hip Sports

How does an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion classically differ from a standard Bankart lesion?

. The anterior scapular periosteum remains intact, allowing medial displacement of the labrum
. It involves an avulsion of the IGHL from the humeral side
. It involves an osteochondral defect of the glenoid face
. It predominantly affects the posterior labrum
. It requires isolated subscapularis repair without labral fixation

Correct Answer & Explanation

. The anterior scapular periosteum remains intact, allowing medial displacement of the labrum

Explanation

In an ALPSA lesion, the labroligamentous complex avulses from the glenoid rim but the scapular periosteum remains intact. This allows the torn complex to displace and heal medially on the glenoid neck.

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