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Elbow & Forearm MCQs

Practice Set 1 of 57

This practice set contains high-yield board review questions covering key concepts in Elbow & Forearm. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: Elbow & Forearm

A 32-year-old male recreational tennis player presents with a 4-week history of progressive activity-related elbow pain in his dominant upper extremity. C linical examination demonstrates marked tenderness at the lateral epicondyle and pain at the lateral epicondyle with resisted wrist extension. No instability is detected on clinical examination. The next step in management is:

. Routine radiography
. Magnetic resonance imaging
. Activity modification, nonsteroidal anti-inflammatory agents, and physical therapy
. Open surgical excision of pathological tissue
. Arthroscopic surgical excision of pathological tissue

Correct Answer & Explanation

. Activity modification, nonsteroidal anti-inflammatory agents, and physical therapy

Explanation

This patient has lateral epicondylitis. A recent radiographic analysis of lateral epicondylitis showed that radiographs taken at initial presentation did not alter the initial management. Most patients with lateral epicondylitis respond to nonoperative treatment. Surgical treatment should only be considered after failure of a prolonged course (at least 6 months) of nonoperative treatment.

Question 2

Topic: Elbow & Forearm

Which of the following statements is true regarding the use of a two-incision technique vs a single-incision technique for distal biceps repair:

. The two-incision technique is associated with increased risk of neural injury, while the single-incision technique is associated with an increased risk of heterotopic ossification.
. The two-incision technique is associated with increased risk of heterotopic ossification, while the single-incision technique is associated with an increased risk of nerve injury.
. The two-incision technique is associated with increased risk of neural injury, while the risk of heterotopic ossification is the same for both procedures.
. The two-incision technique is associated with increased risk of heterotopic ossification, while the risk of nerve injury is the same for both procedures.
. The risk of nerve injury and heterotopic ossification is the same for both procedures.

Correct Answer & Explanation

. The two-incision technique is associated with increased risk of heterotopic ossification, while the single-incision technique is associated with an increased risk of nerve injury.

Explanation

Successful treatment of distal biceps tendon tears include dual- and single- incision techniques. The two-incision technique is associated with increased risk of heterotopic ossification, whereas the single-incision technique is associated with an increased risk of nerve injury.

Question 3

Topic: Elbow & Forearm

Approximately what percentage of supination strength is lost with an unrepaired distal biceps tendon rupture:

. 5%
. 20%
. 40%
. 60%
. 80%

Correct Answer & Explanation

. 40%

Explanation

The biceps provides approximately 40% of supination strength to the forearm.

Question 4

Topic: Elbow & Forearm

A 35-year-old woman complains of recurrent clicking and a sensation of her elbow 'giving way' when pushing up from a chair. Physical examination reveals a positive lateral pivot-shift test. Which ligamentous structure is primarily deficient in this condition?

. Annular ligament
. Anterior bundle of the ulnar collateral ligament
. Lateral ulnar collateral ligament (LUCL)
. Quadrate ligament
. Posterior bundle of the ulnar collateral ligament

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

Posterolateral rotatory instability (PLRI) is caused by a deficiency of the lateral ulnar collateral ligament (LUCL). This typically presents with locking, snapping, or a giving-way sensation when an axial load, valgus stress, and supination are applied.

Question 5

Topic: Elbow & Forearm

A 25-year-old professional baseball pitcher experiences posterior elbow pain during the deceleration phase of throwing. Imaging reveals posteromedial olecranon osteophytes. If osteophyte excision is performed, what complication is most likely if the resection is overly aggressive?

. Radial nerve injury
. Triceps rupture
. Medial epicondylitis
. Ulnar collateral ligament insufficiency
. Heterotopic ossification

Correct Answer & Explanation

. Ulnar collateral ligament insufficiency

Explanation

Valgus extension overload syndrome leads to posteromedial olecranon osteophytes. Aggressive resection of the posteromedial olecranon can remove the bony buttress effect, leading to increased strain on the UCL and subsequent valgus instability.

Question 6

Topic: Elbow & Forearm

A 45-year-old man undergoes a single-incision anterior repair for an acute distal biceps tendon rupture. Postoperatively, he notes numbness over the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

. Superficial radial nerve
. Posterior interosseous nerve
. Lateral antebrachial cutaneous nerve
. Medial antebrachial cutaneous nerve
. Median nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single-incision anterior approach to the distal biceps. It courses between the biceps and brachialis.

Question 7

Topic: Elbow & Forearm

A 40-year-old sustains a terrible triad injury of the elbow after a fall on an outstretched hand. According to standard surgical protocols, what is the recommended sequence of structural reconstruction?

. Radial head, coronoid, lateral ulnar collateral ligament (LUCL)
. Coronoid, LUCL, radial head
. Coronoid, radial head, lateral ulnar collateral ligament (LUCL)
. LUCL, radial head, coronoid
. Radial head, LUCL, coronoid

Correct Answer & Explanation

. Coronoid, LUCL, radial head

Explanation

The standard surgical protocol for a terrible triad injury is to repair from deep to superficial, generally starting with the coronoid, followed by the radial head (repair or replacement), and finally the LUCL.

Question 8

Topic: Elbow & Forearm

A 30-year-old sustains an isolated anteromedial facet fracture of the coronoid. This specific fracture pattern is most closely associated with which mechanism and concomitant ligamentous injury?

. Valgus stress and UCL tear
. Varus posteromedial rotatory instability and LCL tear
. Posterolateral rotatory instability and LUCL tear
. Axial load and interosseous membrane tear
. Direct posterior blow and triceps avulsion

Correct Answer & Explanation

. Varus posteromedial rotatory instability and LCL tear

Explanation

Anteromedial facet fractures of the coronoid are pathognomonic for varus posteromedial rotatory instability. This injury pattern typically involves a concomitant tear of the lateral collateral ligament (LCL) complex.

Question 9

Topic: Elbow & Forearm

In a patient undergoing surgical debridement for recalcitrant medial epicondylitis, which muscular origins are most commonly involved in the pathologic tendinosis?

. Flexor carpi ulnaris and palmaris longus
. Pronator teres and flexor carpi radialis
. Flexor digitorum superficialis and flexor digitorum profundus
. Brachioradialis and extensor carpi radialis longus
. Extensor carpi radialis brevis and supinator

Correct Answer & Explanation

. Pronator teres and flexor carpi radialis

Explanation

Medial epicondylitis primarily involves the origin of the pronator teres and the flexor carpi radialis. Surgical management involves excision of the angiofibroblastic tissue at this origin.

Question 10

Topic: Elbow & Forearm

A 9-year-old boy presents with lateral elbow pain and stiffness. Radiographs show sclerosis, fragmentation, and flattening of the entire capitellum without loose bodies. What is the most likely diagnosis?

. Osteochondritis dissecans of the capitellum
. Panner disease
. Radial head fracture
. Lateral epicondylitis
. Synovial chondromatosis

Correct Answer & Explanation

. Panner disease

Explanation

Panner disease is an osteochondrosis of the capitellum that affects younger children (usually under 10 years old), involves the entire capitellum, and is typically self-limiting. OCD affects older children and typically involves localized lesions.

Question 11

Topic: Elbow & Forearm

The capitellum is prone to osteochondritis dissecans due to a tenuous vascular supply. The dominant intraosseous vascular supply to the capitellum enters from which direction?

. Anterior
. Posterior
. Medial
. Lateral
. Distal

Correct Answer & Explanation

. Posterior

Explanation

The primary blood supply to the capitellum comes from posteriorly via end-arteries. This makes the anterior and lateral portions susceptible to avascular necrosis and OCD under repetitive stress.

Question 12

Topic: Elbow & Forearm

In a patient diagnosed with refractory medial epicondylitis, which of the following tendinous structures is most commonly targeted during surgical debridement?

. Flexor carpi ulnaris and flexor digitorum superficialis
. Pronator quadratus and brachioradialis
. Flexor carpi radialis and pronator teres
. Flexor digitorum profundus and palmaris longus
. Extensor carpi radialis brevis and extensor digitorum communis

Correct Answer & Explanation

. Flexor carpi radialis and pronator teres

Explanation

Medial epicondylitis primarily involves microtearing and tendinosis at the origin of the flexor carpi radialis (FCR) and the pronator teres. Surgical intervention specifically targets these tendinous origins for debridement.

Question 13

Topic: Elbow & Forearm

A 45-year-old falls onto an outstretched hand and sustains a "terrible triad" injury of the elbow. Which of the following describes the standard recommended sequence of surgical repair for this injury?

. MCL repair followed by LCL repair
. Radial head fixation, coronoid fixation, then LCL repair
. Coronoid fixation, radial head fixation or replacement, then LCL repair
. LCL repair, coronoid fixation, then radial head fixation
. Radial head excision without replacement followed by MCL repair

Correct Answer & Explanation

. Coronoid fixation, radial head fixation or replacement, then LCL repair

Explanation

The standard surgical sequence for a terrible triad injury involves repairing structures from deep to superficial. This typically means addressing the coronoid fracture first, followed by the radial head, and finally the lateral collateral ligament (LCL).

Question 14

Topic: Elbow & Forearm

A 35-year-old woman complains of recurrent elbow clicking and a feeling that the elbow will "give way" when pushing up from a chair. On examination, a pivot-shift test is positive. This condition is most likely caused by insufficiency of which of the following ligaments?

. Annular ligament
. Lateral ulnar collateral ligament (LUCL)
. Anterior bundle of the MCL
. Quadrate ligament
. Oblique cord

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

Posterolateral rotatory instability (PLRI) classically presents with apprehension or giving way when an axial load, valgus force, and supination are applied. It is primarily caused by an insufficiency of the lateral ulnar collateral ligament (LUCL).

Question 15

Topic: Elbow & Forearm

During a single-incision anterior approach for a distal biceps tendon repair, the patient develops postoperative numbness over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

. Superficial radial nerve
. Posterior interosseous nerve
. Lateral antebrachial cutaneous nerve
. Medial antebrachial cutaneous nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) exits the deep fascia laterally between the biceps and brachialis muscles. It is the most commonly injured nerve during a single-incision anterior approach for distal biceps repair.

Question 16

Topic: Elbow & Forearm

A 7-year-old boy presents with a 3-month history of dull, aching lateral elbow pain without a specific injury. Radiographs reveal fragmentation and sclerosis of the entire capitellum. What is the most likely diagnosis?

. Osteochondritis dissecans of the capitellum
. Little League elbow
. Panner's disease
. Lateral epicondylitis
. Radial head osteonecrosis

Correct Answer & Explanation

. Panner's disease

Explanation

Panner's disease is an osteochondrosis of the capitellum that typically affects children younger than 10 years old and involves the entire ossific nucleus. It is a self-limiting condition treated with symptomatic rest, unlike OCD which occurs in older adolescents.

Question 17

Topic: Elbow & Forearm

A patient sustains an anteromedial facet fracture of the coronoid process. If left untreated, this specific fracture pattern is highly associated with which type of elbow instability?

. Valgus instability
. Posterolateral rotatory instability (PLRI)
. Varus posteromedial rotatory instability
. Longitudinal radioulnar dissociation
. Isolated anterior instability

Correct Answer & Explanation

. Varus posteromedial rotatory instability

Explanation

Anteromedial facet fractures of the coronoid result from a varus load combined with axial compression. This injury pattern disrupts the essential bony buttress of the coronoid, leading to varus posteromedial rotatory instability if not anatomically fixed.

Question 18

Topic: Elbow & Forearm

A 40-year-old female presents with recurrent elbow clicking and a sensation of giving way when pushing up from a chair. Physical examination reveals apprehension with axial load, supination, and valgus stress applied to the elbow. Which of the following structures is most likely deficient?

. Anterior bundle of the ulnar collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Radial collateral ligament
. Common extensor origin

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

Posterolateral rotatory instability (PLRI) is caused by insufficiency of the lateral ulnar collateral ligament (LUCL). The classic mechanism of provocation is axial load, supination, and valgus stress, mimicking pushing off a chair.

Question 19

Topic: Elbow & Forearm

A 35-year-old male falls from a ladder and sustains a terrible triad injury of the elbow. He undergoes open reduction and internal fixation. What is the recommended sequence of surgical repair for this injury pattern?

. Coronoid, radial head, lateral collateral ligament
. Lateral collateral ligament, radial head, coronoid
. Radial head, lateral collateral ligament, coronoid
. Coronoid, lateral collateral ligament, radial head
. Lateral collateral ligament, coronoid, radial head

Correct Answer & Explanation

. Coronoid, lateral collateral ligament, radial head

Explanation

The classic algorithm for treating a terrible triad injury of the elbow (elbow dislocation, radial head fracture, coronoid fracture) starts deep/medial and works superficial/lateral. The recommended sequence is repairing the coronoid, followed by the radial head, and finally the lateral ulnar collateral ligament (LUCL).

Question 20

Topic: Elbow & Forearm

A 9-year-old gymnast presents with lateral elbow pain and stiffness. Radiographs demonstrate sclerosis and fragmentation of the entire capitellum without a localized loose body or distinct crater. Given her age and radiographic findings, what is the most likely diagnosis?

. Osteochondritis dissecans
. Panner's disease
. Lateral epicondylitis
. Radial head fracture
. Synovial chondromatosis

Correct Answer & Explanation

. Panner's disease

Explanation

Panner's disease is an osteochondrosis of the capitellum typically affecting children under 10 years old, involving the entire ossific nucleus. Unlike OCD, it does not typically produce loose bodies and usually resolves completely with conservative management.

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