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Shoulder & Hip Sports MCQs

Practice Set 78 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 1541

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Physical exam reveals a glenohumeral internal rotation deficit (GIRD) of 25 degrees. What is the primary pathoanatomy associated with internal impingement in this athlete?

. Anterior capsule contracture causing obligate posterior translation
. Subacromial bursitis and bursal-sided cuff tearing
. Contact between the articular surface of the supraspinatus/infraspinatus and the posterosuperior glenoid
. Coracoid impingement against the subscapularis
. Dynamic subluxation of the long head of the biceps

Correct Answer & Explanation

. Anterior capsule contracture causing obligate posterior translation

Explanation

Internal impingement occurs during the late cocking phase (abduction and external rotation), leading to pathologic contact between the articular side of the posterosuperior rotator cuff and the posterosuperior glenoid labrum. GIRD is frequently an associated finding due to posterior capsular contracture.

Question 1542

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast presents with bilateral multidirectional shoulder instability. She has failed 9 months of dedicated physical therapy emphasizing periscapular stabilization. If surgical intervention is pursued, what is the most historically validated "gold standard" procedure?

. Arthroscopic Bankart repair with superior labral repair
. Latarjet procedure
. Open inferior capsular shift
. Thermal capsulorrhaphy
. Arthroscopic superior capsule reconstruction

Correct Answer & Explanation

. Arthroscopic Bankart repair with superior labral repair

Explanation

In patients with true multidirectional instability (MDI) who fail extensive conservative management, an open or arthroscopic inferior capsular shift is the procedure of choice to reduce overall capsular volume. Thermal capsulorrhaphy is obsolete due to high failure rates and chondrolysis.

Question 1543

Topic: Shoulder & Hip Sports

A 29-year-old volleyball player presents with insidious onset right shoulder weakness. MRI demonstrates an isolated paralabral cyst located in the spinoglenoid notch causing nerve compression. Which of the following clinical findings is most expected?

. Weakness in both abduction and external rotation
. Isolated weakness in external rotation with normal abduction
. Isolated weakness in abduction with normal external rotation
. Weakness in internal rotation with increased passive external rotation
. Atrophy of both the supraspinatus and infraspinatus

Correct Answer & Explanation

. Weakness in both abduction and external rotation

Explanation

The suprascapular nerve innervates the supraspinatus before traversing the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch isolatedly affects the infraspinatus, causing weakness in external rotation while preserving supraspinatus function (abduction).

Question 1544

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT scan indicates 25% glenoid bone loss and an engaging Hill-Sachs lesion. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open Latarjet procedure
. Putti-Platt procedure
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

An open Latarjet procedure (coracoid transfer) is indicated for patients with recurrent anterior shoulder instability and significant glenoid bone loss (>20-25%). Soft tissue repairs alone in the setting of critical bone loss have an unacceptably high failure rate.

Question 1545

Topic: Shoulder & Hip Sports

A 30-year-old male bodybuilder reports dull, aching posterior shoulder pain and weakness in external rotation. MRI reveals a paralabral cyst at the spinoglenoid notch. Which muscle is primarily affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Supraspinatus

Explanation

A cyst at the spinoglenoid notch typically compresses the suprascapular nerve after it has innervated the supraspinatus, leading to isolated infraspinatus weakness and atrophy. Cysts at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1546

Topic: Shoulder & Hip Sports

A 45-year-old male presents with shoulder pain and inability to externally rotate his arm after a generalized seizure. An axillary radiograph shows a posterior shoulder dislocation with a reverse Hill-Sachs lesion involving 35% of the articular surface.

The dislocation is reduced. What is the most appropriate management?

. Immobilization in a sling for 3 weeks
. Arthroscopic posterior capsulorrhaphy
. McLaughlin procedure (lesser tuberosity transfer)
. Hemiarthroplasty
. Total shoulder arthroplasty

Correct Answer & Explanation

. Immobilization in a sling for 3 weeks

Explanation

For an anteromedial humeral head defect (reverse Hill-Sachs) involving 20-40% of the articular surface, transfer of the lesser tuberosity or subscapularis into the defect (McLaughlin procedure or modification) is indicated to prevent recurrent posterior instability.

Question 1547

Topic: Shoulder & Hip Sports

A 55-year-old man falls on an outstretched hand and presents with weakness in internal rotation. He has a positive belly-press test and increased passive external rotation compared to the contralateral side. Which structure is most likely injured?

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

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The belly-press test and increased passive external rotation are classic signs of a subscapularis tendon tear. This injury often follows an acute traumatic event, such as a fall, in an older adult.

Question 1548

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A pre-operative computed tomography (CT) scan with 3D reconstruction reveals an anterior inferior glenoid bone defect measuring 26% of the native glenoid width. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic capsular plication
. Open Latarjet procedure
. Arthroscopic remplissage alone
. Open inferior capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair with suture anchors

Explanation

The Latarjet procedure is indicated for patients with recurrent anterior instability and critical glenoid bone loss (>20-25%). Arthroscopic soft tissue stabilization in the setting of critical bone loss carries an unacceptably high failure rate.

Question 1549

Topic: Shoulder & Hip Sports

A 45-year-old male presents with vague posterolateral shoulder pain and weakness. Magnetic resonance imaging (MRI) reveals a large paralabral cyst at the spinoglenoid notch compressing the traversing nerve. Which of the following physical examination findings is most likely present?

. Weakness in forward elevation only
. Isolated weakness in external rotation with the arm at the side
. Weakness in both abduction and external rotation
. Sensory deficit over the lateral deltoid
. Positive lift-off test

Correct Answer & Explanation

. Weakness in forward elevation only

Explanation

The suprascapular nerve innervates the supraspinatus and infraspinatus. Entrapment at the spinoglenoid notch affects only the branch to the infraspinatus, leading to isolated external rotation weakness without abduction deficits.

Question 1550

Topic: Shoulder & Hip Sports

A 60-year-old man feels a sudden pop in his shoulder while lifting a heavy box. On examination, he has a positive belly-press test and increased passive external rotation compared to the contralateral side. Which structure has most likely been ruptured?

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

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

A positive belly-press test and increased passive external rotation are classic physical exam findings indicating a rupture of the subscapularis tendon. The subscapularis is the primary internal rotator of the shoulder.

Question 1551

Topic: Shoulder & Hip Sports

A 25-year-old male requires surgery for recurrent anterior shoulder instability. Diagnostic arthroscopy reveals an engaging Hill-Sachs lesion and a 12% anterior glenoid bone defect. Which of the following procedures is most appropriate?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Arthroscopic subscapularis advancement
. Open capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

For subcritical glenoid bone loss (<15-20%) accompanied by an engaging (off-track) Hill-Sachs lesion, arthroscopic Bankart repair combined with remplissage effectively restores stability and prevents engagement.

Question 1552

Topic: Shoulder & Hip Sports

A 45-year-old construction worker presents with deep anterior shoulder pain. MRI arthrogram reveals an isolated Type II SLAP tear. He has failed 6 months of physical therapy and injections. What is the most appropriate surgical intervention?

. Arthroscopic SLAP repair with suture anchors
. Biceps tenodesis
. Biceps tenotomy
. Debridement of the superior labrum
. Coracoid transfer

Correct Answer & Explanation

. Arthroscopic SLAP repair with suture anchors

Explanation

In patients older than 40 years, especially laborers, biceps tenodesis is favored over SLAP repair for Type II tears. SLAP repairs in this demographic carry a higher risk of postoperative stiffness and persistent pain.

Question 1553

Topic: Shoulder & Hip Sports

A 40-year-old recreational tennis player has an MRI demonstrating a partial articular supraspinatus tendon avulsion (PASTA) involving 60% of the tendon footprint. He has failed conservative management. What is the recommended surgical management?

. Arthroscopic debridement alone
. Subacromial decompression without cuff repair
. Arthroscopic completion of the tear and repair, or transtendon repair
. Open rotator cuff repair with a patch augmentation
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic debridement alone

Explanation

For articular-sided partial rotator cuff tears involving greater than 50% of the tendon thickness, surgical repair is indicated. This can be performed either by completing the tear followed by a formal repair, or via a transtendon technique.

Question 1554

Topic: Shoulder & Hip Sports

A 65-year-old man is scheduled for repair of a massive, retracted rotator cuff tear. Which of the following preoperative MRI findings is most strongly associated with a high rate of structural failure following repair?

. Goutallier stage 1 fatty infiltration of the supraspinatus
. Tear retraction to the level of the humeral head apex
. Acromiohumeral distance of 9 mm
. Goutallier stage 3 or 4 fatty infiltration of the infraspinatus
. Presence of a subacromial spur

Correct Answer & Explanation

. Goutallier stage 1 fatty infiltration of the supraspinatus

Explanation

Advanced fatty infiltration (Goutallier stage 3 or 4, where fat is equal to or greater than muscle) is a strong predictor of poor functional outcomes and high re-tear rates following rotator cuff repair.

Question 1555

Topic: Shoulder & Hip Sports

An 18-year-old female gymnast presents with bilateral shoulder pain and a feeling of looseness. Examination reveals generalized ligamentous laxity, a prominent bilateral sulcus sign, and apprehension in multiple positions. She has not had any prior treatment. What is the most appropriate initial management?

. Arthroscopic capsular plication
. Open inferior capsular shift
. A structured 6-month physical therapy program emphasizing periscapular stabilizers
. Thermal capsulorrhaphy
. Latarjet procedure

Correct Answer & Explanation

. Arthroscopic capsular plication

Explanation

The patient has multidirectional instability (MDI). The gold standard initial management for MDI is a prolonged, dedicated physical therapy program focusing on rotator cuff and periscapular muscle strengthening.

Question 1556

Topic: Shoulder & Hip Sports

During an arthroscopic remplissage for a patient with an engaging Hill-Sachs lesion, which anatomical structures are tenodesed into the humeral head defect?

. Subscapularis tendon and anterior capsule
. Supraspinatus tendon and superior capsule
. Infraspinatus tendon and posterior capsule
. Teres minor tendon only
. Long head of the biceps tendon

Correct Answer & Explanation

. Subscapularis tendon and anterior capsule

Explanation

The remplissage procedure ('to fill' in French) involves suturing the posterior capsule and the infraspinatus tendon into the Hill-Sachs defect to render it extra-articular and prevent engagement.

Question 1557

Topic: Shoulder & Hip Sports

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

. The ALPSA lesion involves a bony fracture of the glenoid rim.
. In an ALPSA lesion, the anterior scapular periosteum remains intact and the labrum displaces medially.
. An ALPSA lesion includes an avulsion of the subscapularis tendon.
. The ALPSA lesion is synonymous with a superior labral tear.
. In an ALPSA lesion, the periosteum is completely torn away from the glenoid neck.

Correct Answer & Explanation

. The ALPSA lesion involves a bony fracture of the glenoid rim.

Explanation

Unlike a Bankart lesion where the periosteum tears, an ALPSA lesion involves an intact anterior periosteum. The labro-ligamentous complex strips and displaces medially down the scapular neck, healing in an abnormal position.

Question 1558

Topic: Shoulder & Hip Sports

A 20-year-old male presents to the emergency department following a high-speed motor vehicle collision. He has a posterior sternoclavicular dislocation and complains of progressive shortness of breath and dysphagia. A closed reduction under general anesthesia is attempted but fails. What is the most critical next step in management?

. Re-attempt closed reduction using a towel clip
. Place the patient in a figure-of-eight brace and observe
. Open reduction with a cardiothoracic surgeon available on standby
. Resection of the medial clavicle in the emergency department
. Perform a Latarjet procedure

Correct Answer & Explanation

. Re-attempt closed reduction using a towel clip

Explanation

Posterior sternoclavicular dislocations can compress the mediastinal structures (trachea, esophagus, great vessels). If closed reduction fails or is contraindicated, urgent open reduction in the operating room with cardiothoracic surgery backup is required.

Question 1559

Topic: Shoulder & Hip Sports

A 22-year-old competitive 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 Bankart repair with inferior capsular shift
. Coracoid transfer to the anterior glenoid (Latarjet)
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

In the setting of critical anterior glenoid bone loss (typically >20-25%), a bony augmentation procedure such as the Latarjet is indicated to restore glenoid tracking and prevent recurrent instability. Soft tissue procedures alone have an unacceptably high failure rate in this scenario.

Question 1560

Topic: Shoulder & Hip Sports

A 35-year-old man presents to the emergency department with severe shoulder pain after experiencing a grand mal seizure. On examination, his arm is locked in internal rotation and he is unable to actively or passively externally rotate the shoulder. An axillary lateral radiograph confirms a posterior glenohumeral dislocation with an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. Which of the following is the most appropriate surgical treatment?

. Arthroscopic posterior labral repair
. Closed reduction and spica cast immobilization in external rotation
. Open reduction and transfer of the lesser tuberosity into the defect (Modified McLaughlin)
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic posterior labral repair

Explanation

Posterior dislocations are classic after seizures or electrical shocks. For a reverse Hill-Sachs lesion involving 20-40% of the articular surface, transfer of the lesser tuberosity and subscapularis tendon into the defect (Modified McLaughlin procedure) prevents engagement and provides stability.

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