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Elbow & Forearm MCQs

Practice Set 2 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 21

Topic: Elbow & Forearm

A 45-year-old woman complains of elbow clicking and a sense of instability when pushing off from a chair. The underlying pathology primarily involves deficiency of which of the following structures?

. Medial ulnar collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Radial collateral ligament
. Quadrate ligament

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

Posterolateral rotatory instability (PLRI) is caused by incompetence of the lateral ulnar collateral ligament (LUCL). Patients typically report apprehension or mechanical symptoms when the arm is supinated, valgus-stressed, and loaded in extension.

Question 22

Topic: Elbow & Forearm

A 22-year-old collegiate baseball pitcher presents with posterior elbow pain during the deceleration phase of throwing. Imaging reveals loose bodies and osteophytes in the posteromedial olecranon fossa. What is the most likely underlying pathophysiology?

. Lateral epicondylitis
. Radiocapitellar overload
. Medial ulnar collateral ligament attenuation
. Posterolateral rotatory instability
. Biceps tendinosis

Correct Answer & Explanation

. Medial ulnar collateral ligament attenuation

Explanation

Valgus extension overload is typically secondary to chronic attenuation of the anterior bundle of the medial UCL. This leads to excessive valgus laxity, causing impingement of the posteromedial olecranon against the medial wall of the olecranon fossa.

Question 23

Topic: Elbow & Forearm

A 14-year-old male gymnast presents with lateral elbow pain and mechanical catching. MRI demonstrates fluid behind a loose osteochondral fragment in the capitellum. What is the most appropriate initial management?

. Rest, NSAIDs, and cessation of gymnastics for 6 weeks
. Arthroscopic fragment removal and microfracture
. Open reduction and internal fixation of the capitellum
. Ulnar collateral ligament reconstruction
. Radial head resection

Correct Answer & Explanation

. Arthroscopic fragment removal and microfracture

Explanation

In osteochondritis dissecans (OCD) of the capitellum, an unstable lesion indicated by mechanical symptoms and fluid behind the fragment on MRI warrants surgical intervention. Arthroscopic fragment excision and marrow stimulation (microfracture) is standard for smaller defects.

Question 24

Topic: Elbow & Forearm

In the surgical management of a 'terrible triad' injury of the elbow, which of the following represents the standard sequence of repair to restore stability?

. LUCL repair, radial head repair/replacement, coronoid repair
. Coronoid repair, radial head repair/replacement, LUCL repair
. Coronoid repair, LUCL repair, MUCL repair
. Radial head repair/replacement, coronoid repair, LUCL repair
. LUCL repair, coronoid repair, radial head repair/replacement

Correct Answer & Explanation

. Coronoid repair, radial head repair/replacement, LUCL repair

Explanation

The standard surgical protocol for a terrible triad injury proceeds from deep to superficial: coronoid fixation first, followed by radial head repair or arthroplasty, and finally restoration of the lateral ulnar collateral ligament (LUCL).

Question 25

Topic: Elbow & Forearm

A 7-year-old boy presents with dull, aching lateral elbow pain without a history of significant trauma. Radiographs show sclerosis and fragmentation of the capitellum without loose bodies. What is the most likely diagnosis?

. Osteochondritis dissecans of the capitellum
. Panner disease
. Lateral epicondylitis
. Radial head subluxation
. Little League elbow

Correct Answer & Explanation

. Panner disease

Explanation

Panner disease is an osteochondrosis of the capitellum typically affecting boys aged 7 to 10 years. Unlike osteochondritis dissecans seen in adolescents, Panner disease generally heals completely with conservative treatment and rest.

Question 26

Topic: Elbow & Forearm

Which of the following is the most common radiographic finding in patients with lateral epicondylitis:

. Soft tissue calcification at the lateral aspect of the elbow
. Coronoid osteophyte
. Olecranon osteophyte
. Intraosseous cyst
. Osteochondritis dessicans

Correct Answer & Explanation

. Soft tissue calcification at the lateral aspect of the elbow

Explanation

In a radiographic analysis of 294 patients with lateral epicondylitis, 20 patients had lateral soft tissue calcification, 14 patients had coronoid osteophytes, nine patients had olecranon osteophytes, two patients had intraosseous cysts, and two patients had osteochondritis dessicans. The author concluded that routine radiography is not warranted in the initial management of lateral epicondylitis.

Question 27

Topic: Elbow & Forearm

A 21-year-old baseball pitcher is scheduled for an ulnar collateral ligament (UCL) reconstruction (Tommy John surgery). What is the most commonly utilized and historically preferred autograft for this procedure?

. Bone-patellar tendon-bone
. Semitendinosus
. Palmaris longus
. Plantaris
. Extensor carpi radialis brevis

Correct Answer & Explanation

. Palmaris longus

Explanation

The palmaris longus tendon is the most frequently used and historically standard autograft for UCL reconstruction due to its expendability and appropriate dimensions. If absent, alternative grafts like the gracilis or plantaris are used.

Question 28

Topic: Elbow & Forearm

A 14-year-old elite baseball pitcher presents with chronic lateral elbow pain and catching. Imaging reveals an advanced osteochondral defect (OCD) of the capitellum. The vulnerability of the capitellum to avascular necrosis is primarily due to its blood supply, which consists of:

. An extensive collateral network from the radial recurrent artery
. Vessels derived strictly from the anterior joint capsule
. A highly vascularized central physis
. End arteries entering posteriorly with poor collateral circulation
. A single end artery entering the anterior articular surface

Correct Answer & Explanation

. End arteries entering posteriorly with poor collateral circulation

Explanation

The capitellum is supplied by limited intraosseous vessels derived from end arteries entering posteriorly. This lack of collateral circulation makes the capitellum extremely susceptible to ischemic injury and osteochondritis dissecans from repetitive valgus-extension overload.

Question 29

Topic: Elbow & Forearm

A 14-year-old male baseball pitcher complains of lateral elbow pain. Radiographs reveal a radiolucency of the capitellum with a sclerotic margin. What is the most likely diagnosis?

. Panner disease
. Medial epicondyle apophysitis
. Osteochondritis dissecans of the capitellum
. Little League elbow
. Radial head fracture

Correct Answer & Explanation

. Osteochondritis dissecans of the capitellum

Explanation

Osteochondritis dissecans (OCD) of the capitellum typically occurs in adolescent throwers or gymnasts (ages 12-15) presenting with lateral elbow pain and radiolucent defects. Panner disease affects younger children (ages 7-10) and typically involves the entire capitellum without focal loose body formation.

Question 30

Topic: Elbow & Forearm

A 13-year-old gymnast complains of lateral elbow pain and catching. Radiographs demonstrate a radiolucent defect in the capitellum with a sclerotic margin.

What fundamentally differentiates osteochondritis dissecans (OCD) of the capitellum from Panner's disease?

. Panner's disease primarily affects older adolescents
. OCD involves the entire capitellar ossific nucleus
. Panner's disease is a self-limiting osteochondrosis that does not typically produce loose bodies
. OCD always resolves with conservative rest and never requires surgery

Correct Answer & Explanation

. Panner's disease is a self-limiting osteochondrosis that does not typically produce loose bodies

Explanation

Panner's disease is an osteochondrosis of the capitellum typically seen in children under 10 years old and resolves nonoperatively without loose body formation. OCD affects older adolescents, involves a localized subchondral defect, and frequently produces loose bodies.

Question 31

Topic: Elbow & Forearm

In a patient with posterolateral rotatory instability (PLRI) of the elbow, what is the key deficient structure causing this pathology?

. Medial ulnar collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Radial collateral ligament
. Interosseous membrane

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

PLRI of the elbow is primarily caused by insufficiency of the lateral ulnar collateral ligament (LUCL). This leads to abnormal rotatory subluxation of the ulna relative to the trochlea.

Question 32

Topic: Elbow & Forearm

A 40-year-old male feels a sudden pop in his anterior elbow while lifting a heavy box. On examination, what is the most sensitive and specific clinical test for diagnosing a complete distal biceps tendon rupture?

. Positive Speed's test
. Positive Yergason's test
. Absent hook test
. Positive Ludington's test
. Weakness in elbow extension

Correct Answer & Explanation

. Absent hook test

Explanation

The hook test is highly sensitive and specific for detecting distal biceps tendon ruptures. An intact tendon allows the examiner to hook their index finger under its lateral edge, which is absent in complete ruptures.

Question 33

Topic: Elbow & Forearm

A fourteen-year-old little league pitcher has lateral elbow pain that is worsened by throwing. Plain radiographs demonstrate fragmentation of the capitellum with no evidence of a loose body. A presumptive diagnosis of osteochondritis dissecans of the capitellum has been made. He has undergone rest, followed by physical therapy over the past three months. Now range of motion is from 30 to 120, and pain is present when attempting to throw. The next appropriate step is:

. Extension Dyna-Splint at night time
. Aggressive range of motion with physical therapy and iontophoresis
. Rest until skeletal maturity is reached, and further re-evaluation
. Arthroscopy of the elbow with debridement of defect
. Open reduction and internal fixation of capitellar fracture

Correct Answer & Explanation

. Arthroscopy of the elbow with debridement of defect

Explanation

This patient has osteochondritits dissecans of the capitellum from pitching. OC D of the capitellum differs from Panner's disease, which is a osteochondrosis of the capitellum which occurs at a younger age (7-12) and is less symptomatic. Initial treatment of osteochondritis dissecans of the capitellum is rest and occasional splinting. Arthroscopy is indicated for both detached lesions and those who have failed conservative therapy. The entire joint should be a assessed, loose fragments removed and the subchondral bone of the defect is debrieded to a healthy vascular bed.

Question 34

Topic: Elbow & Forearm

If a distal biceps tendon avulsion is not repaired or reconstructed, what is the likely result:

. Loss of 90% of flexion an 20 % of supination strength
. No loss of flexion strength and 40% loss of supination strength
. 20% loss of flexion strength and no loss of supination strength
. No significant clinical deficit will occur
. 20% loss of flexion and 40% loss of supination strength

Correct Answer & Explanation

. 20% loss of flexion and 40% loss of supination strength

Explanation

Untreated distal biceps rupture results in a loss of about 20% flexion and 40% supination strength.

Question 35

Topic: Elbow & Forearm

A 45-year-old bodybuilder undergoes a two-incision surgical repair of a distal biceps tendon rupture. Compared to the single-incision anterior approach, the two-incision approach is historically associated with a higher risk of which of the following complications?

. Lateral antebrachial cutaneous nerve palsy
. Posterior interosseous nerve palsy
. Heterotopic ossification and radioulnar synostosis
. Median nerve entrapment
. Recurrent tendon rupture

Correct Answer & Explanation

. Heterotopic ossification and radioulnar synostosis

Explanation

The two-incision technique avoids anterior structures, lowering LACN and PIN injury rates, but carries a higher risk of heterotopic ossification and radioulnar synostosis due to subperiosteal dissection of the ulna.

Question 36

Topic: Elbow & Forearm

Posterolateral rotatory instability (PLRI) of the elbow typically follows a traumatic dislocation or iatrogenic injury. This condition is primarily characterized by insufficiency of which of the following ligamentous structures?

. Radial collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Accessory collateral ligament
. Quadrate ligament

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

PLRI is the most common pattern of chronic elbow instability and is caused by an injury or deficiency of the lateral ulnar collateral ligament (LUCL). The LUCL serves as the primary restraint to posterolateral rotatory subluxation of the radius relative to the humerus.

Question 37

Topic: Elbow & Forearm

A 35-year-old male presents with posterolateral rotatory instability (PLRI) of the elbow after a traumatic dislocation. The primary ligamentous restraint deficient in this condition is the lateral ulnar collateral ligament (LUCL). What is the normal insertion site of the LUCL?

. Radial tuberosity
. Coronoid process
. Olecranon tip
. Supinator crest of the ulna
. Annular ligament

Correct Answer & Explanation

. Radial tuberosity

Explanation

The lateral ulnar collateral ligament (LUCL) originates on the lateral epicondyle and blends with the annular ligament before inserting onto the supinator crest of the proximal ulna. It acts as the primary restraint against PLRI.

Question 38

Topic: Elbow & Forearm

A 35-year-old man complains of his elbow "clicking" and giving way when pushing himself up from a chair. Examination reveals a positive lateral pivot-shift test of the elbow. Which ligament is primarily incompetent in this condition?

. Anterior bundle of the medial collateral ligament
. Posterior bundle of the medial collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Radial collateral ligament

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

Posterolateral rotatory instability (PLRI) is caused by an insufficiency of the lateral ulnar collateral ligament (LUCL). The diagnosis is clinically confirmed by a positive lateral pivot-shift test showing subluxation with axial load, supination, and valgus stress.

Question 39

Topic: Elbow & Forearm

A 40-year-old man falls on an outstretched hand, sustaining a 'terrible triad' injury of the elbow. Which of the following describes the recommended sequence of surgical reconstruction to restore stability?

. LCL repair, radial head fixation/replacement, coronoid fixation
. Coronoid fixation, radial head fixation/replacement, LCL repair
. MCL repair, radial head fixation, coronoid fixation
. Radial head fixation, LCL repair, MCL repair
. Coronoid fixation, MCL repair, radial head replacement

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair

Explanation

The standard surgical sequence for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) works deep to superficial: coronoid fixation, then radial head repair or replacement, followed by lateral collateral ligament (LCL) complex repair.

Question 40

Topic: Elbow & Forearm

A 21-year-old collegiate baseball pitcher complains of posteromedial elbow pain occurring primarily during the deceleration phase of throwing. Examination reveals a 15-degree flexion contracture and sharp pain with forced terminal extension. What is the most likely diagnosis?

. Medial epicondylitis
. Ulnar collateral ligament acute rupture
. Valgus extension overload syndrome
. Osteochondritis dissecans of the capitellum
. Cubital tunnel syndrome

Correct Answer & Explanation

. Valgus extension overload syndrome

Explanation

Valgus extension overload in throwers is caused by repetitive impingement of the posteromedial olecranon into the olecranon fossa, often leading to posteromedial osteophytes and pain with forced extension.

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