Shoulder & Hip Sports MCQs

A 62-year-old laborer presents with chronic, debilitating shoulder pain and pseudoparalysis. MRI reveals a massive, retracted, irreparable tear of the supraspinatus and infraspinatus with Grade 4 fatty infiltration. The subscapularis and teres minor are intact. He undergoes an arthroscopic superior capsular reconstruction (SCR) using a thick dermal allograft.

Biomechanically, how does the SCR primarily restore shoulder kinematics in this specific clinical scenario?

A 24-year-old rugby player presents for management of recurrent anterior shoulder instability. He has had four dislocations. Computed tomography (CT) with 3D sagittal reconstruction demonstrates an anteroinferior glenoid bone loss of 22% and a large, engaging Hill-Sachs lesion. Based on current literature and evidence-based treatment algorithms, which of the following is the most appropriate surgical management?

A 65-year-old male presents with pseudoparalysis of the shoulder. An MRI reveals an irreparable, chronically retracted tear of the subscapularis tendon with significant fatty infiltration (Goutallier stage 4). The posterosuperior cuff is intact. He is scheduled to undergo a pectoralis major transfer. Which portion of the pectoralis major is typically transferred to best replicate the force vector of the native subscapularis?

A 28-year-old professional hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a pistol-grip deformity of the proximal femur.

Which of the following radiographic parameters is most diagnostic of a Cam-type femoroacetabular impingement (FAI)?

A 45-year-old recreational weightlifter presents with deep anterior shoulder pain. An MRI arthrogram demonstrates a Type II SLAP tear without rotator cuff pathology. A trial of physical therapy and injections has failed to provide relief. What is the most appropriate surgical management for this patient to minimize postoperative stiffness and maximize return to pre-injury activity?

During a classic Latarjet procedure for anterior shoulder instability with significant glenoid bone loss, the coracoid process is transferred to the anterior glenoid rim. To expose the anterior glenoid, how is the subscapularis muscle typically managed in the traditional Latarjet technique described by Walch?

A 24-year-old rugby player presents with recurrent anterior shoulder instability. A CT scan of the shoulder reveals 12% anterior glenoid bone loss and a large Hill-Sachs lesion. Applying the glenoid track concept, the Hill-Sachs lesion is calculated to be 'off-track.' Which of the following is the most appropriate surgical management to minimize the risk of recurrent instability?

A 35-year-old male weightlifter presents with chronic anterior shoulder pain that radiates down his arm. He reports pain primarily during the bench press and cross-body adduction. Physical examination reveals point tenderness over the coracoid process, and a positive O'Brien test that is relieved by external rotation. MRI of the shoulder reveals a coracohumeral distance of 4 mm and subscapularis tendinosis without a rotator cuff tear. After failing 6 months of physical therapy and corticosteroid injections, what is the most appropriate surgical management?

A 28-year-old offensive lineman complains of recurrent posterior shoulder instability that has failed extensive nonoperative management. Imaging shows a reverse Hill-Sachs lesion involving 25% of the anterior humeral articular surface and an associated posterior labral tear. To prevent engagement and provide the best clinical outcome, what is the most appropriate surgical management?

A 25-year-old hockey player is undergoing hip arthroscopy for symptomatic femoroacetabular impingement (FAI) characterized by a prominent cam lesion and an alpha angle of 70 degrees. During the osteochondroplasty, excessive bony resection of the cam lesion at the femoral head-neck junction most significantly increases the risk of which of the following complications?

A 62-year-old highly active male presents with chronic pseudoparalysis of his right shoulder. Imaging reveals a massive, retracted, and irreparable supraspinatus and infraspinatus tear. He elects to undergo an arthroscopic superior capsular reconstruction (SCR).

To optimize the biomechanical success of the SCR and effectively centralize the humeral head, the allograft must be securely attached to the superior glenoid and which other structures?

A 22-year-old hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Examination demonstrates a positive anterior impingement test. An anteroposterior pelvis radiograph is obtained.

The radiograph demonstrates a prominent "crossover sign." Measurement of the alpha angle on a Dunn lateral view is 45 degrees. Which of the following is the most likely diagnosis?

A 21-year-old male rugby player presents with recurrent anterior shoulder instability. He has had 5 dislocations in the past year. CT scan reveals 25% anterior glenoid bone loss. He undergoes an open Latarjet procedure. Which of the following describes the "sling effect" provided by the Latarjet procedure?

A 55-year-old man presents with anterior shoulder pain and weakness following a fall onto an outstretched hand. On physical examination, he demonstrates a positive bear-hug test and increased passive external rotation compared to the contralateral side. MRI confirms an isolated, full-thickness tear of the subscapularis tendon. During arthroscopic repair, which of the following structures must be carefully evaluated and is most commonly associated with this injury pattern?

A 24-year-old male hockey player presents with groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 70 degrees on the Dunn lateral view and a lateral center edge angle of 35 degrees. He is diagnosed with femoroacetabular impingement (FAI). If left untreated, the pathomechanics of his specific impingement type typically result in which of the following patterns of chondral injury?

A 22-year-old hockey player presents with chronic, deep groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an aspherical femoral head with an alpha angle of 68 degrees. If the patient undergoes hip arthroscopy, what is the most typical pattern of associated intra-articular cartilage damage expected?

A 17-year-old female swimmer presents with bilateral shoulder pain and a sensation that her shoulders frequently 'slip out of place.' Examination reveals positive sulcus signs bilaterally, positive apprehension and relocation tests, and a Beighton score of 7/9. There is no history of a distinct traumatic dislocation. She has undergone standard rotator cuff strengthening for 3 months with minimal improvement. What is the most appropriate next step in management?

A 19-year-old collegiate swimmer presents with bilateral shoulder pain and a sensation of 'slipping'. Physical examination reveals a sulcus sign of 2 cm bilaterally, positive apprehension and relocation tests, and generalized ligamentous laxity with a Beighton score of 7/9. Initial management should consist of:

A 24-year-old baseball pitcher presents with deep shoulder pain and a 'dead arm' sensation. An MRI arthrogram reveals a SLAP tear with detachment of the superior labrum and biceps anchor from the glenoid (Type II SLAP tear). Which of the following physical examination tests is designed to evaluate this pathology by utilizing active compression?

A 26-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and paresthesias over the lateral aspect of the shoulder. She also reports weakness with external rotation. An MRI demonstrates fatty infiltration and atrophy isolated to the teres minor with no rotator cuff tear. What is the most likely cause of her symptoms?