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Shoulder & Hip Sports MCQs

Practice Set 94 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 1861

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, tendon-to-bone healing progresses through inflammatory, proliferative, and remodeling phases. During the remodeling phase, which type of collagen is primarily synthesized to replace the provisional matrix?
. Type I
. Type II
. Type III
. Type IV
. Type VI

Correct Answer & Explanation

. Type I

Explanation

During the initial proliferative healing phase of a rotator cuff repair, primarily Type III collagen is deposited as scar tissue. In the remodeling phase, this is gradually replaced by stronger, highly organized Type I collagen.

Question 1862

Topic: Shoulder & Hip Sports

A 25-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 22% anterior glenoid bone loss and an "off-track" Hill-Sachs lesion. Which of the following best describes the primary biomechanical advantage of this specific surgical technique?

. Deepening of the glenoid concavity by the bone block
. The "sling effect" of the conjoint tendon on the inferior capsule
. Tensioning of the superior glenohumeral ligament (SGHL)
. Restoration of the native anterior labral bumper
. Shortening and overtensioning of the subscapularis tendon

Correct Answer & Explanation

. The "sling effect" of the conjoint tendon on the inferior capsule

Explanation

The Latarjet procedure primarily provides stability through the "sling effect" of the conjoint tendon on the anteroinferior capsule during arm abduction and external rotation. This dynamic stabilization accounts for the majority of the procedure's success, supplemented by the bone block increasing the glenoid arc.

Question 1863

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher complains of posterior shoulder pain exclusively during the late cocking phase of throwing. Physical examination reveals a 25-degree deficit in internal rotation compared to the contralateral side. A superior labrum anterior to posterior (SLAP) tear is identified on MR arthrography. Which mechanism best explains the development of this specific labral pathology?

. Anterior subluxation due to isolated subscapularis insufficiency
. Traction injury from the long head of the biceps during the deceleration phase
. The "peel-back" mechanism driven by a tight posteroinferior capsule
. Superior migration of the humeral head secondary to supraspinatus weakness
. Impingement of the greater tuberosity against the anterior acromion

Correct Answer & Explanation

. The "peel-back" mechanism driven by a tight posteroinferior capsule

Explanation

In overhead throwers, Glenohumeral Internal Rotation Deficit (GIRD) caused by a contracted posteroinferior capsule shifts the glenohumeral contact point posterosuperiorly. During the late cocking phase (abduction and maximal external rotation), this shift causes the biceps root to twist and transmit torsional forces, known as the peel-back mechanism, tearing the superior labrum.

Question 1864

Topic: Shoulder & Hip Sports

During hip arthroscopy for a patient with symptomatic femoroacetabular impingement (FAI), the surgeon addresses a large Cam lesion. Which intra-articular pathologic pattern is most classically associated with this specific femoral morphology?

. Anterosuperior acetabular cartilage delamination and adjacent labral tearing
. Posteroinferior labral tearing and isolated ligamentum teres rupture
. Diffuse global cartilage thinning and secondary psoas impingement
. Acetabular overcoverage leading to a contre-coup posterior cartilage lesion
. Hypertrophy of the pulvinar causing central capsular laxity

Correct Answer & Explanation

. Anterosuperior acetabular cartilage delamination and adjacent labral tearing

Explanation

Cam morphology, defined by a loss of spherical head-neck offset, engages the anterosuperior acetabular rim during hip flexion and internal rotation. This repetitive shear stress leads to an "inside-out" pattern of acetabular articular cartilage delamination from the subchondral bone, often accompanied by an adjacent labral detachment.

Question 1865

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. CT scan demonstrates an engaging Hill-Sachs lesion and 27% anterior glenoid bone loss. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open capsular shift
. Biceps tenodesis

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) in a collision athlete with recurrent anterior instability is an absolute indication for a bony augmentation procedure, such as the Latarjet procedure. Arthroscopic soft tissue stabilization has unacceptably high failure rates in this setting.

Question 1866

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague, deep posterior shoulder pain during the late cocking phase of throwing. Physical examination demonstrates a 25-degree deficit in internal rotation at 90 degrees of abduction compared to the contralateral side. What is the most appropriate initial management for this patient?

. Anterior capsulorrhaphy
. Arthroscopic SLAP repair
. Posterior capsule stretching and rotator cuff strengthening
. Latarjet procedure
. Biceps tenodesis

Correct Answer & Explanation

. Posterior capsule stretching and rotator cuff strengthening

Explanation

Glenohumeral internal rotation deficit (GIRD) is a primary driver of internal impingement and secondary SLAP tears in overhead athletes due to a posterior peel-back mechanism. The cornerstone of initial management is a targeted stretching program (e.g., sleeper stretches) for the posterior capsule.

Question 1867

Topic: Shoulder & Hip Sports

A 21-year-old hockey player presents with chronic groin pain exacerbated by hip flexion. A frog-leg lateral radiograph reveals an alpha angle of 65 degrees. Physical exam yields a positive FADIR test. The bony deformity associated with this condition is most likely caused by an abnormality located at which of the following sites?

. Acetabular rim
. Anterolateral femoral head-neck junction
. Greater trochanter
. Ischial tuberosity
. Lesser trochanter

Correct Answer & Explanation

. Anterolateral femoral head-neck junction

Explanation

This patient has Cam-type femoroacetabular impingement (FAI), characterized by a reduced femoral head-neck offset. The aspherical bone formation is most commonly located at the anterolateral femoral head-neck junction.

Question 1868

Topic: Shoulder & Hip Sports

A 20-year-old collegiate football lineman presents with recurrent anterior shoulder dislocations. A 3D CT scan reveals 27% anterior glenoid bone loss and an "off-track" Hill-Sachs lesion. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Open inferior capsular shift
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical anterior glenoid bone loss (typically >20-25%) combined with an off-track Hill-Sachs lesion carries an unacceptably high failure rate with soft tissue stabilization alone. A bony augmentation procedure, such as the Latarjet procedure, is indicated.

Question 1869

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player with a history of multiple anterior shoulder dislocations presents for surgical evaluation. A 3D CT scan reveals 26% anterior glenoid bone loss. Which of the following surgical procedures is most appropriate to minimize his recurrence risk?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Open Latarjet procedure
. Open anterior capsular shift
. Arthroscopic superior capsular reconstruction

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

Critical anterior glenoid bone loss (>20-25%) in a collision athlete results in a high failure rate with soft tissue stabilization alone. The Latarjet procedure (coracoid transfer) is the gold standard to restore the bony arc and provide a dynamic sling.

Question 1870

Topic: Shoulder & Hip Sports

A 24-year-old professional hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 75 degrees. Which of the following is true regarding this patient's pathomorphology?

. It represents global overcoverage of the acetabulum
. It is associated with primary retroversion of the acetabulum
. It typically damages the posteroinferior acetabular labrum
. It indicates a decreased anterior femoral head-neck offset
. It requires a periacetabular osteotomy for correction

Correct Answer & Explanation

. It indicates a decreased anterior femoral head-neck offset

Explanation

An elevated alpha angle (>50-55 degrees) is diagnostic of Cam-type femoroacetabular impingement (FAI). This pathomorphology indicates a loss of normal anterior femoral head-neck offset, leading to anterosuperior labral and chondral damage.

Question 1871

Topic: Shoulder & Hip Sports

A 65-year-old patient presents with a massive, chronically retracted tear of the supraspinatus and infraspinatus tendons. Electromyography demonstrates denervation potentials in the infraspinatus muscle. What is the predominant anatomic mechanism for this associated neuropathy?

. Direct compression by an associated paralabral cyst
. Traction injury of the suprascapular nerve at the suprascapular notch
. Traction injury of the axillary nerve in the quadrilateral space
. Compression of the suprascapular nerve at the spinoglenoid notch
. Avulsion of the upper trunk of the brachial plexus

Correct Answer & Explanation

. Traction injury of the suprascapular nerve at the suprascapular notch

Explanation

Massive, medially retracted posterosuperior rotator cuff tears alter the resting tension on the suprascapular nerve. The tethering effect primarily causes a traction neuropathy at the suprascapular notch due to 'bowstringing'.

Question 1872

Topic: Shoulder & Hip Sports

A 20-year-old male collegiate hockey player presents with recurrent anterior shoulder instability. A 3D CT scan reconstruction demonstrates 25% anterior glenoid bone loss and a small off-track Hill-Sachs lesion. What is the most appropriate surgical management?

. Arthroscopic anterior Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Open Latarjet procedure
. Open inferior capsular shift
. Arthroscopic superior capsular reconstruction

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

In a collision athlete with critical anterior glenoid bone loss (>20-25%), isolated soft tissue repair has an unacceptably high failure rate. A bone-block augmentation procedure, such as the Latarjet procedure, is indicated to restore glenoid tracking and anterior stability.

Question 1873

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. A 3D CT scan demonstrates a 25% anterior glenoid bone loss and a non-engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical intervention for this athlete?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair
. Latarjet procedure
. Arthroscopic superior labrum anterior and posterior (SLAP) repair

Correct Answer & Explanation

. Latarjet procedure

Explanation

In high-demand collision athletes with critical anterior glenoid bone loss (typically >20-25%), isolated soft tissue repairs have an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the gold standard to restore stability.

Question 1874

Topic: Shoulder & Hip Sports

A 60-year-old male presents with a massive, irreparable posterosuperior rotator cuff tear and pseudoparalysis. He has minimal glenohumeral arthritis. Superior capsular reconstruction (SCR) is planned. The graft used in SCR primarily acts to prevent which of the following kinematic abnormalities?

. Anterior subluxation of the humeral head
. Inferior subluxation of the humeral head
. Superior migration of the humeral head
. Internal rotation of the humerus
. Retraction of the subscapularis tendon

Correct Answer & Explanation

. Superior migration of the humeral head

Explanation

Superior capsular reconstruction (SCR) utilizes a graft attached from the superior glenoid to the greater tuberosity. Its primary biomechanical role is to prevent superior migration of the humeral head, thereby restoring a stable fulcrum for the deltoid.

Question 1875

Topic: Shoulder & Hip Sports

A 25-year-old professional baseball pitcher presents with pain in the late cocking phase of throwing. MRI reveals a peel-back SLAP lesion. What biomechanical alteration in the thrower's shoulder is most closely associated with the pathogenesis of this specific lesion?

. Glenohumeral internal rotation deficit (GIRD)
. Excessive anterior capsular laxity
. Acromioclavicular joint arthrosis
. Subscapularis tendon tearing
. Short head of the biceps rupture

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD)

Explanation

GIRD involves posteroinferior capsular contracture, shifting the glenohumeral contact point posterosuperiorly during maximum external rotation. This shift dramatically increases the peel-back forces on the superior labrum and biceps anchor, causing SLAP tears.

Question 1876

Topic: Shoulder & Hip Sports

A 19-year-old collegiate football linebacker presents with recurrent anterior shoulder instability. A 3D computed tomography scan reveals 25% anterior glenoid bone loss and a Hill-Sachs lesion that engages the anterior glenoid rim in abduction and external rotation ("off-track"). Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Coracoid process transfer
. Osteochondral allograft of the humeral head
. Open inferior capsular shift

Correct Answer & Explanation

. Coracoid process transfer

Explanation

In collision athletes with recurrent anterior shoulder instability and critical anterior glenoid bone loss (>20-25%), an isolated Bankart repair has an unacceptably high failure rate. A coracoid process transfer (Latarjet procedure) is the preferred treatment to restore stability through its unique triple-blocking effect. A Bankart repair with remplissage is typically reserved for "off-track" lesions with subcritical (<15-20%) glenoid bone loss.

Question 1877

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with persistent groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an alpha angle of 72 degrees.

During operative intervention for this condition, damage to which aspect of the labrum and cartilage is most characteristically found?

. Anterosuperior labrum and adjacent acetabular cartilage delamination
. Posteroinferior labral tear with intact cartilage
. Isolated ligamentum teres avulsion
. Global chondromalacia of the femoral head
. Posterior labral calcification

Correct Answer & Explanation

. Anterosuperior labrum and adjacent acetabular cartilage delamination

Explanation

Cam impingement typically causes shear forces at the chondrolabral junction during flexion and internal rotation. This leads to anterosuperior labral tears and outside-in delamination of the adjacent acetabular cartilage.

Question 1878

Topic: Shoulder & Hip Sports

A 28-year-old professional hockey player complains of insidious onset, activity-related anterior groin pain. An AP pelvis radiograph

shows the anterior rim of the acetabulum crossing the posterior rim in the superior aspect of the joint. What does this radiographic finding indicate?

. Cam impingement
. Acetabular retroversion
. Acetabular anteversion
. Coxa profunda
. Protrusio acetabuli

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The 'crossover sign' occurs when the anterior wall line crosses the posterior wall line on a perfectly positioned AP pelvis radiograph. This indicates acetabular retroversion, a common cause of pincer-type femoroacetabular impingement (FAI).

Question 1879

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with gradual onset of anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 75 degrees on the modified Dunn lateral view and normal acetabular version.

What is the underlying pathomorphology?

. Acetabular retroversion leading to pincer impingement
. Decreased femoral head-neck offset leading to cam impingement
. Excessive femoral anteversion
. Coxa profunda
. Ischiofemoral impingement

Correct Answer & Explanation

. Decreased femoral head-neck offset leading to cam impingement

Explanation

An alpha angle greater than 50-55 degrees on a lateral radiograph indicates a loss of femoral head-neck offset, characteristic of cam-type femoroacetabular impingement (FAI). This extra bone abuts the acetabular rim during flexion and internal rotation.

Question 1880

Topic: Shoulder & Hip Sports

A 24-year-old female presents with chronic groin pain exacerbated by prolonged sitting and deep hip flexion. An anteroposterior (AP) pelvis radiograph demonstrates a 'crossover sign' and a lateral center-edge angle (LCEA) of 45 degrees.

Which of the following describes the most likely underlying pathoanatomy and the appropriate surgical treatment?

. Loss of femoral head-neck offset requiring femoral osteochondroplasty
. Focal or global acetabular overcoverage requiring acetabular rim trimming and labral repair
. Developmental dysplasia of the hip requiring a periacetabular osteotomy
. Slipped capital femoral epiphysis deformity requiring in situ pinning
. Iliopsoas tendon snapping requiring arthroscopic release

Correct Answer & Explanation

. Focal or global acetabular overcoverage requiring acetabular rim trimming and labral repair

Explanation

The patient's clinical presentation and radiographic findings (crossover sign and LCEA > 40 degrees) are diagnostic of pincer-type femoroacetabular impingement (FAI). The crossover sign indicates cranial acetabular retroversion (anterior overcoverage), while an LCEA > 40 degrees indicates global overcoverage (coxa profunda). The surgical management for symptomatic pincer impingement that has failed conservative care is arthroscopic or open acetabular rim trimming with subsequent labral refixation. Cam impingement (Option A) is characterized by an abnormal alpha angle and loss of femoral head-neck offset, not a crossover sign. Dysplasia (Option C) is characterized by undercoverage (LCEA < 20 degrees).

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