Menu

Shoulder & Hip Sports MCQs

Practice Set 8 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 141

Topic: Shoulder & Hip Sports
A 15-year-old white boy presents to your office with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and says his neck was twisted away at the time of fall. He was seen at the local emergency department; skull, chest, cervical and thoracic spine, and shoulder X-rays showed no damage. There was no loss of consciousness and he has no chest pain or breathing difficulties. He was observed in the hospital until stable and was referred to follow up in the hand clinic at 4 weeks and scheduled for an electromyogram. Clinical examination reveals weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature is preserved and he can grasp and release and pinch. Sensations are decreased along the distribution of the axillary nerve. There is 3 cm wasting of his arm and 2 cm of his forearm. Tinel sign is positive around the clavicle. Horner signs are absent and his arm lies against the body. The EMG report shows fibrillation potentials in the weak muscles. The parents are concerned and say they have not seen any improvement. The boy reports that he is now able to flex his elbow. When asked to demonstrate you notice that he flexes his wrist and pronates his forearm to swing his elbow into flexion. The plan of management in this boy 5 months after injury with no clinical improvement should be:
. Neurotization
. Exploration and nerve grafting
. Continued observation
. Tendon transfers

Correct Answer & Explanation

. Exploration and nerve grafting

Explanation

Neurotization is appropriate in preganglionic lesions. Around 6 months with no evidence of recovery is the ideal time for plexus exploration. Further observation will not change the picture and tendon transfers are reconstructive procedures, which are done at a later stage.

Question 142

Topic: Shoulder & Hip Sports

A 24-year-old athlete undergoes an open Latarjet procedure for recurrent anterior shoulder instability with significant glenoid bone loss. Which nerve is most at direct risk during the coracoid transfer and inferior subscapularis split?

. Musculocutaneous nerve
. Axillary nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis 5 to 8 cm distal to the coracoid process. It is at significant risk during coracoid osteotomy, mobilization, and retraction during the Latarjet procedure.

Question 143

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. Imaging reveals an anterior glenoid bone loss of 28% and an engaging Hill-Sachs lesion. Which of the following is the most appropriate definitive management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure (coracoid transfer)
. Open capsular shift
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Anterior glenoid bone loss exceeding 20-25% in the setting of recurrent anterior shoulder instability is a primary indication for a bony augmentation procedure. The Latarjet procedure restores the glenoid articular arc and provides an active sling effect via the conjoint tendon.

Question 144

Topic: Shoulder & Hip Sports

When evaluating a patient after a traumatic anterior shoulder dislocation, which of the following is the single greatest risk factor for recurrent instability?

. Male gender
. High-energy mechanism of injury
. Age of the patient at the time of the initial dislocation
. Presence of a Hill-Sachs lesion involving less than 10% of the humeral head
. Immobilization duration in internal rotation after the first dislocation

Correct Answer & Explanation

. Age of the patient at the time of the initial dislocation

Explanation

The patient's age at the time of the first dislocation is the most significant prognostic factor for recurrence. Patients under 20 years old have a recurrence rate often exceeding 80%.

Question 145

Topic: Shoulder & Hip Sports

A 70-year-old female presents with pseudoparalysis of the shoulder. Imaging reveals a massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus with superior migration of the humeral head, but an intact subscapularis and functioning deltoid. What is the most reliable surgical option to restore active forward elevation?

. Arthroscopic superior capsular reconstruction
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty
. Anatomic total shoulder arthroplasty
. Shoulder arthrodesis

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

In an elderly patient with pseudoparalysis and a massive irreparable rotator cuff tear (rotator cuff arthropathy), reverse total shoulder arthroplasty is the most reliable procedure to restore forward elevation. It biomechanically medializes the center of rotation and increases the lever arm of the deltoid.

Question 146

Topic: Shoulder & Hip Sports

A 22-year-old overhead athlete sustains an acute anterior shoulder dislocation. After reduction, an MRI arthrogram reveals an avulsion of the anterior-inferior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL). What is the specific name of this lesion?

. SLAP lesion
. Hill-Sachs lesion
. ALPSA lesion
. Bankart lesion
. HAGL lesion

Correct Answer & Explanation

. Bankart lesion

Explanation

A classic Bankart lesion is defined as an anteroinferior detachment of the labrum and the attached inferior glenohumeral ligament from the glenoid rim. It is the essential soft-tissue lesion in recurrent anterior shoulder instability.

Question 147

Topic: Shoulder & Hip Sports

A 20-year-old male suffers a traumatic anterior shoulder dislocation. Post-reduction radiographs show a posterolateral humeral head impaction fracture. What is the eponym for this specific lesion?

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

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A Hill-Sachs lesion is an impaction fracture of the posterolateral humeral head. It occurs when the humeral head dislocates anteriorly and forcefully impacts against the harder anterior glenoid rim.

Question 148

Topic: Shoulder & Hip Sports

A 25-year-old male presents with recurrent anterior shoulder instability. Advanced imaging reveals 25% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. Which surgical procedure is most appropriate to prevent recurrence?

. Arthroscopic Bankart repair alone
. Latarjet procedure
. Putti-Platt procedure
. Arthroscopic SLAP repair
. Subacromial decompression

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) combined with an engaging Hill-Sachs lesion is a strict contraindication to isolated soft-tissue (Bankart) repair. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore stability.

Question 149

Topic: Shoulder & Hip Sports

A 50-year-old male undergoes ORIF of a displaced 3-part proximal humerus fracture. During the deltopectoral approach, the subscapularis muscle is managed to gain access to the humeral head. Which of the following is the most common and recommended method for managing the subscapularis tendon to expose the humeral head in this approach, as described in the case?

. A. Complete tenotomy of the subscapularis tendon at its insertion, followed by repair.
. B. Vertical splitting of the subscapularis muscle in the direction of its fibers.
. C. Detachment of the subscapularis from the lesser tuberosity, often with a cuff-sparing lesser tuberosity osteotomy.
. D. Retraction of the subscapularis medially without any incision or detachment.
. E. Resection of a portion of the subscapularis muscle to improve visualization.

Correct Answer & Explanation

. C. Detachment of the subscapularis from the lesser tuberosity, often with a cuff-sparing lesser tuberosity osteotomy.

Explanation

Correct Answer: CThe case content, under 'Detailed Surgical Approach and Technique' and 'Subscapularis Management' for the Deltopectoral Approach, states: 'For direct access to the humeral head, the subscapularis tendon is either detached from the lesser tuberosity (often with a cuff sparing lesser tuberosity osteotomy) or split vertically in the direction of its fibers. If detached, repair is paramount.'Option A (Complete tenotomy of the subscapularis tendon at its insertion, followed by repair):While detachment is mentioned, the phrase 'often with a cuff sparing lesser tuberosity osteotomy' implies a more controlled detachment that preserves the tendon's integrity for repair, rather than a simple tenotomy which might be less favorable for healing.Option B (Vertical splitting of the subscapularis muscle in the direction of its fibers):This is listed as an alternative method, but the primary method often described for direct access to the humeral head, especially for complex fractures, is detachment from the lesser tuberosity, often with an osteotomy.Option D (Retraction of the subscapularis medially without any incision or detachment):For direct access to the humeral head and fracture fragments, simple retraction is usually insufficient, especially for complex fractures requiring extensive exposure.Option E (Resection of a portion of the subscapularis muscle to improve visualization):Resection of muscle is generally avoided to preserve function and is not a standard technique for exposing the humeral head in this approach.

Question 150

Topic: Shoulder & Hip Sports

A 50-year-old, right-hand-dominant female presents to clinic with posterior right shoulder pain and sometimes a loud noise while using her right upper extremity for overhead activities. Her pain is concentrated over the superomedial border of her scapula, but she also says her pain is underneath her shoulder blade. What is most bothersome is the fact that she is unable to brush her hair because of the discomfort she experiences. She reports that it started as only noise several years prior, but over the last several months she has developed debilitating pain with overhead activities. She works as a salon hair stylist and denies a history of trauma to her right upper extremity.

Which of the following is the most likely diagnosis?

. Impingement syndrome
. Rotator cuff tendinitis
. Suprascapular nerve entrapment
. Supraspinatus muscle tear
. Scapulothoracic bursitis

Correct Answer & Explanation

. Scapulothoracic bursitis

Explanation

Correct Answer: EThe patient's history is highly characteristic of scapulothoracic bursitis, also known as snapping scapula syndrome. Key features include the long-standing history of a 'loud noise' (crepitus) preceding the onset of pain, pain concentrated over the superomedial border of the scapula and underneath the shoulder blade, and exacerbation with overhead activities (e.g., brushing hair, working as a hair stylist). Scapulothoracic crepitus can lead to symptomatic bursitis over time. Impingement syndrome, rotator cuff tendinitis, and supraspinatus tears typically present with pain in the anterior or lateral shoulder, often without the prominent 'snapping' or 'noise' component, and are less likely to localize pain specifically to the superomedial scapular border. Suprascapular nerve entrapment would primarily cause weakness and atrophy of the supraspinatus and infraspinatus muscles, which is not described as the primary complaint in this case.

Question 151

Topic: Shoulder & Hip Sports

A 21-year-old rugby player undergoes an MR arthrogram after recurrent anterior shoulder dislocations. The MRI demonstrates an anterior labral tear that is medially displaced and healed to the glenoid neck, with an intact anterior periosteum. What is the most likely diagnosis?

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

Correct Answer & Explanation

. ALPSA lesion

Explanation

An Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion is characterized by medial displacement of the labrum with an intact anterior periosteum. Unlike a classic Bankart lesion, the periosteum is not torn, allowing the labrum to heal in an abnormal medialized position.

Question 152

Topic: Shoulder & Hip Sports

A 22-year-old collegiate football player undergoes a Latarjet procedure for recurrent anterior shoulder instability with significant glenoid bone loss. Postoperatively, he demonstrates weak elbow flexion and decreased sensation along the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at risk during the Latarjet procedure as it enters the coracobrachialis, typically 3 to 8 cm distal to the coracoid tip. Injury results in weak elbow flexion (biceps/brachialis) and lateral forearm numbness (lateral antebrachial cutaneous nerve).

Question 153

Topic: Shoulder & Hip Sports

A 45-year-old active male presents with the displaced proximal humerus fracture shown in the radiographs. The fracture involves the surgical neck and a displaced greater tuberosity. The surgeon plans for ORIF with a locking plate. Which of the following specific fracture characteristics, visible in the provided image, is a key consideration influencing the decision for surgical fixation in an active patient?

. A. The presence of a comminuted humeral head.
. B. The degree of valgus impaction of the humeral head.
. C. The significant displacement of the greater tuberosity.
. D. The presence of an isolated lesser tuberosity fracture.
. E. The absence of any articular surface involvement.

Correct Answer & Explanation

. C. The significant displacement of the greater tuberosity.

Explanation

Correct Answer: CThe radiographs clearly show significant displacement of the greater tuberosity fragment. In an active patient, a displaced greater tuberosity fracture is a strong indication for surgical fixation. The greater tuberosity is the insertion site for the supraspinatus, infraspinatus, and teres minor (rotator cuff muscles). Significant displacement can lead to rotator cuff dysfunction, impingement, and poor functional outcomes if not anatomically reduced and fixed. The case emphasizes achieving the "best functional outcome" for an active patient, which necessitates addressing such displacement.Option A (The presence of a comminuted humeral head):While comminution can influence treatment, the primary visible displacement driving the surgical decision for a three-part fracture in this context is the tuberosity. The head itself is not described as severely comminuted in the case.Option B (The degree of valgus impaction of the humeral head):Valgus impaction can be a stable pattern, sometimes managed non-operatively, especially if the head is well-aligned. The image shows displacement, not necessarily stable valgus impaction.Option D (The presence of an isolated lesser tuberosity fracture):The image shows a displaced greater tuberosity, not an isolated lesser tuberosity fracture. Isolated lesser tuberosity fractures are less common and often associated with posterior dislocations.Option E (The absence of any articular surface involvement):While the articular surface may not be severely comminuted, the displacement of the head relative to the shaft and the tuberosity implies significant disruption that, if left unaddressed, could lead to articular incongruity and pain. However, the most striking and functionally significant displacement for an active patient is the greater tuberosity.

Question 154

Topic: Shoulder & Hip Sports

A 25-year-old male sustains a first-time anterior shoulder dislocation during a rugby match. After successful closed reduction in the emergency department, he is neurovascularly intact. He is a highly active individual and desires to return to competitive sports. What is the most appropriate initial management strategy?

. Immediate surgical stabilization (arthroscopic Bankart repair)
. Sling immobilization for 3 weeks followed by a gradual rehabilitation program
. Corticosteroid injection into the glenohumeral joint to reduce inflammation
. Aggressive range of motion and strengthening exercises initiated immediately
. MRI of the shoulder to confirm labral tear and then observe

Correct Answer & Explanation

. Sling immobilization for 3 weeks followed by a gradual rehabilitation program

Explanation

Correct Answer: BFor a first-time anterior shoulder dislocation in a young, active patient, initial management typically involves a period of sling immobilization (usually 2-3 weeks) to allow for initial soft tissue healing, followed by a structured rehabilitation program. While young, active patients have a higher risk of recurrent dislocation, immediate surgical stabilization is generally not indicated for a first-time dislocation unless there are specific indications such as a large bony Bankart lesion, significant Hill-Sachs lesion, or concomitant rotator cuff tear in an older patient. The goal of initial non-operative management is to restore range of motion and strength while minimizing the risk of recurrence. Corticosteroid injections are not indicated for acute dislocations. Aggressive immediate range of motion can hinder soft tissue healing. An MRI is often performed after initial stabilization to assess for associated injuries (e.g., Bankart lesion, Hill-Sachs lesion, rotator cuff tears) which will guide long-term management and surgical decision-making, but it is not the immediate next step after reduction and neurovascular assessment.

Question 155

Topic: Shoulder & Hip Sports

A 45-year-old male presents with acute onset of right shoulder pain and weakness after attempting to lift a heavy object. On examination, he has significant weakness in external rotation and abduction. Deltoid function is intact. Radiographs are normal. Which of the following is the most likely diagnosis?

. Subscapularis tear
. Infraspinatus tear
. Supraspinatus tear
. Axillary nerve palsy
. Long head of biceps rupture

Correct Answer & Explanation

. Infraspinatus tear

Explanation

Correct Answer: BThe patient presents with acute shoulder pain and weakness, specifically in external rotation and abduction. While the supraspinatus initiates abduction, the infraspinatus is the primary external rotator. Given the intact deltoid (ruling out axillary nerve palsy) and significant weakness in external rotation, a tear of the infraspinatus is the most likely diagnosis. Subscapularis tears primarily affect internal rotation, and long head of biceps rupture typically presents with a 'Popeye' deformity and weakness in elbow flexion/supination, not primarily shoulder abduction/external rotation.

Question 156

Topic: Shoulder & Hip Sports

A 22-year-old football player sustains a recurrent anterior shoulder dislocation. Imaging demonstrates a glenoid bone loss of 25% and an engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open capsular shift
. Glenoid resurfacing with distal tibial allograft

Correct Answer & Explanation

. Latarjet procedure

Explanation

The Latarjet procedure (coracoid transfer) is indicated for anterior shoulder instability with critical glenoid bone loss (typically >20-25%). Arthroscopic Bankart repair has an unacceptably high failure rate when glenoid bone loss exceeds this threshold.

Question 157

Topic: Shoulder & Hip Sports

An 84-year-old lady presents with recurrent anterior glenohumeral instability. Which specialized radiographic view is most effective for visualizing a bony Bankart lesion or an anterior glenoid rim fracture?

. Stryker Notch view
. West Point axillary view
. Scapular Y view
. Grashey view
. Apical Oblique view

Correct Answer & Explanation

. West Point axillary view

Explanation

Correct Answer: BThe West Point axillary view is specifically designed to profile the anterior-inferior glenoid rim, making it superior for detecting bony Bankart lesions or anterior glenoid rim fractures, which are common sequelae of anterior glenohumeral dislocation. The Stryker Notch view is for Hill-Sachs lesions (posterolateral humeral head compression fracture). The Scapular Y view assesses dislocation direction. The Grashey view is a true AP. The Apical Oblique view can also show glenoid rim pathology but less specifically than West Point.

Question 158

Topic: Shoulder & Hip Sports

A 28-year-old male with recurrent anterior shoulder instability is noted to have a 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. If a Remplissage procedure were to be performed in conjunction with an arthroscopic Bankart repair for a smaller glenoid defect, which of the following best describes the Remplissage technique?

. Supraspinatus tenodesis into the Hill-Sachs defect
. Subscapularis tenodesis into the reverse Hill-Sachs defect
. Infraspinatus tenodesis and posterior capsulodesis into the Hill-Sachs defect
. Coracoid transfer to the anterior glenoid
. Iliac crest bone grafting of the humeral head

Correct Answer & Explanation

. Infraspinatus tenodesis and posterior capsulodesis into the Hill-Sachs defect

Explanation

The Remplissage procedure involves tenodesis of the infraspinatus tendon and posterior capsule into the Hill-Sachs defect. This converts an intra-articular defect into an extra-articular one, preventing it from engaging the anterior glenoid rim.

Question 159

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague shoulder pain and decreased throwing velocity. Physical examination reveals Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side. What is the primary anatomic pathology responsible for this physical finding?

. Anterior capsular laxity
. Posterior inferior capsular contracture
. Superior labral tear from anterior to posterior (SLAP)
. Pectoralis major tightness
. Coracohumeral ligament contracture

Correct Answer & Explanation

. Posterior inferior capsular contracture

Explanation

GIRD is primarily caused by contracture and thickening of the posterior inferior joint capsule. This tethering shifts the glenohumeral center of rotation posterosuperiorly, leading to internal impingement.

Question 160

Topic: Shoulder & Hip Sports

A 48-year-old construction worker presents with deep, aching shoulder pain. MR arthrogram demonstrates a Type II SLAP tear. Given his age and occupation, which of the following treatments has been shown to provide the most reliable return to work and pain relief?

. SLAP repair with suture anchors
. Debridement of the labrum only
. Biceps tenodesis
. Biceps tenotomy without tenodesis
. Coracoid transfer

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients older than 40 years, SLAP repairs have a higher rate of stiffness and failure. Biceps tenodesis is considered the preferred and more reliable treatment for Type II SLAP tears in this demographic.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page