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Elbow & Forearm MCQs

Practice Set 25 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 481

Topic: Elbow & Forearm

A 35-year-old female presents after a fall onto an outstretched hand. She is diagnosed with a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture). According to standard protocols, what is the recommended surgical sequence for repairing these injuries?

. Radial head fixation, coronoid fixation, medial collateral ligament (MCL) repair
. Coronoid fixation, radial head fixation/replacement, lateral collateral ligament (LCL) repair
. LCL repair, radial head fixation, coronoid fixation
. MCL repair, LCL repair, coronoid fixation
. Coronoid fixation, MCL repair, radial head fixation

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, lateral collateral ligament (LCL) repair

Explanation

The standard protocol for treating a terrible triad injury follows an 'inside-out' approach. The deep anterior structures are addressed first (coronoid fixation), followed by the lateral column (radial head fixation or replacement), and finally the lateral capsuloligamentous structures (LCL repair). The MCL is generally only repaired if the elbow remains grossly unstable after the lateral side is fixed.

Question 482

Topic: Elbow & Forearm

A 28-year-old male sustains a 'terrible triad' injury of the elbow. Intraoperatively, after definitive internal fixation of the coronoid fracture and replacement of a highly comminuted radial head, the elbow exhibits persistent posterolateral rotatory instability. What is the most appropriate next step in management?

. Repair the anterior bundle of the medial collateral ligament (MCL)
. Apply a hinged external fixator
. Repair the lateral ulnar collateral ligament (LUCL)
. Immobilize the elbow in 90 degrees of flexion and full supination
. Perform an olecranon osteotomy to assess the trochlea

Correct Answer & Explanation

. Repair the lateral ulnar collateral ligament (LUCL)

Explanation

The standard algorithm for treating a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) involves restoring the anterior buttress (coronoid), restoring the lateral buttress (radial head repair or replacement), and then repairing the lateral ligamentous complex (specifically the LUCL) to the lateral epicondyle. If instability persists after LUCL repair, the MCL may be repaired or an external fixator applied.

Question 483

Topic: Elbow & Forearm

During surgical approach and debridement for refractory lateral epicondylitis, care must be taken to avoid iatrogenic injury to the lateral ulnar collateral ligament (LUCL). What is the anatomic location of the LUCL origin relative to the extensor carpi radialis brevis (ECRB) origin?

. Anterior and superficial
. Anterior and deep
. Posterior and deep
. Superior and superficial
. Distal and anterior

Correct Answer & Explanation

. Posterior and deep

Explanation

The lateral ulnar collateral ligament (LUCL) originates on the lateral epicondyle posterior and deep to the origin of the extensor carpi radialis brevis (ECRB) and the common extensor tendon. It then traverses distally to insert on the supinator crest of the ulna. Overzealous deep and posterior surgical release of the ECRB can result in iatrogenic posterolateral rotatory instability (PLRI) of the elbow.

Question 484

Topic: Elbow & Forearm

A 39-year-old woman fell onto her flexed elbow and sustained a comminuted displaced radial head and neck fracture. Radiographs confirm concentric reduction of the ulnohumeral joint. Examination reveals pain with compression of the radius and ulna at the wrist. What is the best treatment for the radial head fracture?

. Long arm cast for 2 weeks, followed by range of motion
. Early range of motion
. Metallic radial head arthroplasty
. Silastic radial head arthroplasty
. Excision of the radial head

Correct Answer & Explanation

. Metallic radial head arthroplasty

Explanation

Patients with comminuted radial neck and head fractures and associated wrist pain have a significant injury to the elbow and forearm. Nonsurgical management is an option, but initial casting will result in stiffness and early range of motion is likely to be unsuccessful secondary to pain. Surgical treatment with open reduction and internal fixation, although possible, is technically demanding and results are unpredictable with comminuted fractures. Excision alone in the face of wrist pain may lead to radial shortening. The treatment of choice is excision and metallic radial head arthroplasty. Silastic implants have been associated with synovitis and wear debris. Furry KL, Clinkscales CM: Comminuted fractures of the radial head: Arthroplasty versus internal fixation. Clin Orthop 1998;353:40-52.

Question 485

Topic: Elbow & Forearm

A 54-year-old woman sustained an elbow injury 3 months ago that was treated with open reduction and internal fixation. She now reports pain and limited elbow motion. Radiographs are shown in Figures 10a and 10b. Treatment should now consist of

. occupational therapy.
. open reduction of the radial head and annular ligament reconstruction.
. excision of the radial head.
. ulnar osteotomy and closed reduction of the radial head.
. ulnar osteotomy and open reduction of the radial head.

Correct Answer & Explanation

. ulnar osteotomy and open reduction of the radial head.

Explanation

Radiographs reveal malunion of a Monteggia fracture-dislocation. Dislocation of the posterior radial head is caused by the malunited ulnar fracture. The deformity includes shortening with an apex posterior angulation. In the acute setting, open reduction of the radial head rarely is necessary; however, in chronic dislocations, open reduction is required. Without ulnar osteotomy, recurrent radial head dislocation is likely.

Question 486

Topic: Elbow & Forearm

A 13-year-old gymnast has had recurrent right elbow pain for the past year. She denies any history of trauma. Rest and anti-inflammatory drugs have failed to provide relief. Examination reveals no localized tenderness and only slight loss of both flexion and extension (10 degrees). What is the most likely diagnosis?

. Recurrent valgus overload (medial collateral ligament sprain)
. Posterior lateral rotatory instability
. Biceps tendinitis
. Medial epicondylitis
. Osteochondritis of the capitellum

Correct Answer & Explanation

. Osteochondritis of the capitellum

Explanation

Osteochondritis of the capitellum is characterized by pain, swelling, and limited motion. Catching, clicking, and giving way also can occur. It commonly affects athletes who participate in competitive sports with high stresses, such as pitching or gymnastics. Krijnen MR, Lim L, Willems WJ: Arthoscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes. Arthroscopy 2003;19:210-214.

Question 487

Topic: Elbow & Forearm

A 24-year-old woman fell from a horse and landed on her outstretched right arm. Radiographs reveal an elbow dislocation with a type II coronoid fracture and a nonreconstructable comminuted radial head fracture. What is the most appropriate management?

Trauma 2009 Practice Questions: Set 3 (Solved) - Figure 17

. Radial head resection, open reduction and internal fixation of the coronoid, and medial collateral ligament repair
. Radial head resection and lateral collateral ligament repair
. Radial head arthroplasty alone
. Radial head arthroplasty and lateral collateral ligament repair
. Radial head arthroplasty, open reduction and internal fixation of the coronoid, and lateral collateral ligament repair

Correct Answer & Explanation

. Radial head arthroplasty, open reduction and internal fixation of the coronoid, and lateral collateral ligament repair

Explanation

The combination of an elbow dislocation and a fracture of the radial head and coronoid is known as a terrible triad injury. To restore elbow stability, each injury must be addressed. The nonreconstructable radial head fracture requires implant arthroplasty. Open reduction and internal fixation of the coronoid is also necessary as is repair of the lateral collateral ligament complex which is usually avulsed from the lateral epicondyle region. Ring D, Quintero J, Jupiter JB: Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 2002;84:1811-1815. Ring D, Jupiter JB, Zilberfarb J: Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am 2002;84:547-551.

Question 488

Topic: Elbow & Forearm

A 30-year-old firefighter sustained a longitudinal pulling injury to the arm while attempting to move a heavy object during a fire. Figure 45 shows an MRI scan of the elbow. Initial management should consist of

Shoulder Board Review 2002: High-Yield MCQs (Set 4) - Figure 9

. rest and a sling followed by a gradual return to activities.
. physical therapy and extension-block bracing.
. repair of the biceps tendon to the brachialis muscle.
. repair of the common flexor origin.
. anatomic repair of the distal biceps tendon.

Correct Answer & Explanation

. anatomic repair of the distal biceps tendon.

Explanation

Because the MRI scan shows a complete rupture of the distal biceps tendon, the preferred treatment is anatomic repair of the tendon to the radial tuberosity either with the use of suture anchors or transosseous sutures through a two-incision technique. Several studies have documented superior results with anatomic repair of the distal biceps tendon when compared with results of nonsurgical management or repair of the tendon by attachment to the brachialis muscle. Patients undergoing anatomic repair of the distal biceps tendon through a two-incision technique typically regain a functional range of motion and nearly normal strength. D'Alessandro DF, Shields CL Jr, Tibone JE, Chandler RW: Repair of distal biceps tendon ruptures in athletes. Am J Sports Med 1993;21:114-119. Boyd JB, Anderson LD: A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am 1961;43:1041-1043. Morrey BF, Askew LJ, An KN, Dobyns JH: Rupture of the distal tendon of the biceps brachii: A biomechanical study. J Bone Joint Surg Am 1985;67:418-421.

Question 489

Topic: Elbow & Forearm

A man sustained the injury shown in Figures 51a and 51b. He underwent closed reduction of the radial head dislocation and open reduction and internal fixation of the ulnar fracture. What is the most common cause of persistent radial head subluxation?

. Interosseous ligament disruption
. Annular ligament disruption
. Avulsion of the common extensor origin
. Malreduction of the ulnar fracture
. Intra-articular osteochondral debris

Correct Answer & Explanation

. Malreduction of the ulnar fracture

Explanation

The radiographs reveal a Monteggia injury, with a proximal ulnar shaft fracture and a radial head dislocation. Treatment involves open reduction and internal fixation of the ulnar fracture. With correct reduction of the ulna, the radial head is reducible and remains stable, despite an obvious soft-tissue injury around the elbow. Problems with persistent radial head subluxation are almost always attributed to malreduction of the ulnar fracture. Rare causes of persistent radial head subluxation are interposition of soft tissues in the joint and lateral ligamentous injuries. Jupiter JB, Kellam JF: Diaphyseal fractures of the forearm, in Browner B, Jupiter J, Levine A, Trafton P (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1992, pp 1421-1454.

Question 490

Topic: Elbow & Forearm

A 38-year-old woman who tripped and fell on her outstretched arm reports pain with movement. Examination reveals swelling. AP and lateral radiographs are shown in Figures 43a and 43b. Management should consist of

. excision of the fracture fragment.
. radial head replacement.
. closed reduction and cast immobilization.
. open reduction and internal fixation of the radial head.
. open reduction and internal fixation of the capitellum.

Correct Answer & Explanation

. open reduction and internal fixation of the capitellum.

Explanation

The patient has a type I (Hahn-Steinthal) capitellar fracture that is best seen on the lateral radiograph. If a fracture fragment is seen proximal to the radial head, a capitellar fracture is the most likely injury because radial head fractures do not migrate proximally. The fragment is large enough for fixation. Excision is the preferred treatment for small shear osteochondral type II (Kocher-Lorenz) capitellar fractures. Closed reduction usually is not successful because of rotation of the displaced fragment. Mehdian H, McKee M: Management of proximal and distal humerus fractures. Orthop Clin North Am 2000;31:115-127.

Question 491

Topic: Elbow & Forearm

A 55-year-old man sustained an elbow dislocation in a fall. Postreduction radiographs are shown in Figures 40a and 40b. What is the best course of management?

. Closed reduction and casting for 4 weeks
. Closed reduction and bracing with immediate range of motion
. Open reduction, lateral collateral ligament repair, and open reduction and internal fixation or metallic replacement of the radial head
. Open reduction, radial head silastic arthroplasty, and lateral collateral ligament repair
. Open reduction, lateral collateral ligament repair, and radial head excision

Correct Answer & Explanation

. Open reduction, radial head silastic arthroplasty, and lateral collateral ligament repair

Explanation

The radiographs show an elbow dislocation associated with a comminuted radial head fracture. In the setting of comminution and instability, factures of the radial head are best managed with an arthroplasty rather than open reduction and internal fixation. Resection of the radial head will worsen the instability and is not recommended. Silastic radial head replacements are contraindicated. Hildebrand KA, Patterson SD, King GJ: Acute elbow dislocations: Simple and complex. Orthop Clin North Am 1999;30:63-79.

Question 492

Topic: Elbow & Forearm

A 10-year-old girl has a right elbow deformity that is the result of trauma 5 years ago. She has no pain despite the arm deformity. The radiographs in Figures 42a and 42b show complete healing. This radiographic appearance demonstrates what complication?

. Growth arrest of the medial trochlear physis
. Varus malunion of a supracondylar humeral fracture
. Valgus malunion of a lateral condylar fracture
. Posterior and lateral dislocation of the radial head
. Osteonecrosis of the capitellum

Correct Answer & Explanation

. Varus malunion of a supracondylar humeral fracture

Explanation

Cubitus varus is a common complication of displaced supracondylar humeral fractures that are treated with closed reduction and cast immobilization. Treatment with closed reduction and percutaneous pinning decreases the incidence of this complication. Cubitus varus also can occur in minimally displaced fractures when unrecognized collapse of the medial column of the distal humerus is not corrected with manipulation. This can be detected on physical examination of the carrying angle or on radiographs measuring Baumann's angle, both in comparison to the opposite side. Cubitus varus may result in unacceptable cosmesis and may predispose the patient to fractures of the lateral condyle. The lateral radiograph demonstrates the crescent sign from overlap of the distal humerus with the olecranon seen in patients with cubitus varus. Patients with growth arrest to the medial trochlear physis would have atrophy of the trochlea on radiographs. Flynn JM, Sarwark JF, Waters PM, et al: The surgical management of pediatric fractures of the upper extremity. Instr Course Lect 2003;52:635-45. Papandrea R, Waters PM: Posttraumatic reconstruction of the elbow in the pediatric patient. Clin Orthop 2000;370:115-126.

Question 493

Topic: Elbow & Forearm

A 34-year-old woman has had painful snapping and popping in the elbow since falling while in-line skating 6 months ago. The popping also occurs when she pushes off with her hands to rise from a seated position. Initial radiographs were normal, and she was told that she had sprained her elbow. Examination reveals few findings except that she is very apprehensive when the forearm is forcefully supinated with the elbow extended or partially flexed. A radiograph taken in that position is shown in Figure 24. Treatment should consist of

Shoulder Board Review 2002: High-Yield MCQs (Set 2) - Figure 25

. arthroscopic loose body removal.
. arthroscopic debridement and loose body removal for osteochondritis dissecans of the capitellum.
. annular ligament reconstruction for posttraumatic posterior subluxation of the radial head.
. radial head resection for congenital type II dislocation of the radial head.
. lateral collateral ligament reconstruction for posterolateral rotatory instability.

Correct Answer & Explanation

. lateral collateral ligament reconstruction for posterolateral rotatory instability.

Explanation

The radiograph reveals posterolateral rotatory subluxation of the radiohumeral and ulnohumeral joints. The space between the ulna and trochlea is enlarged, particularly posteriorly at the olecranon. These findings are diagnostic of posterolateral rotatory instability, which causes recurrent subluxation and reduction as the elbow is flexed from an extended and supinated position with valgus load. The posterolateral rotatory instability apprehension test was performed on this patient and the result was positive. The lateral pivot-shift test causes a clunk as the elbow reduces but is more difficult to perform, even under general anesthesia. The patient does not have isolated subluxation of the radial head, although these findings can be mistakenly diagnosed as such. The radial head is normally shaped and does not represent a congenital dislocation. There are no findings here to suggest osteochondritis dissecans or loose bodies. O'Driscoll SW, Bell DF, Morrey BF: Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 1991;73:440-446. Burgess RC, Sprague HH: Post-traumatic posterior radial head subluxation: Two case reports. Clin Orthop 1984;186:192-194.

Question 494

Topic: Elbow & Forearm

A 45-year-old male sustains the injury pattern depicted in the provided image.

During surgical reconstruction of the lateral collateral ligament complex, identifying the correct isometric origin of the lateral ulnar collateral ligament (LUCL) on the distal humerus is critical. Where is this point located?

. At the center of the axis of rotation of the capitellum
. On the anterior border of the lateral epicondyle
. Directly on the tip of the olecranon
. At the supinator crest of the ulna
. 2 cm proximal to the lateral epicondyle

Correct Answer & Explanation

. At the center of the axis of rotation of the capitellum

Explanation

The isometric point for the LUCL origin on the humerus is the center of the axis of rotation of the capitellum. Placing a graft or suture anchor at this specific geometric location ensures that the reconstructed ligament maintains relatively constant tension throughout the elbow's entire arc of flexion and extension.

Question 495

Topic: Elbow & Forearm

In a patient with a high radial nerve palsy following a mid-shaft humerus fracture, tendon transfers are planned to restore function. Which of the following tendon transfers is the classic and most commonly utilized choice to restore wrist extension?

. Flexor carpi ulnaris (FCU) to Extensor digitorum communis (EDC)
. Flexor carpi radialis (FCR) to Extensor pollicis longus (EPL)
. Pronator teres (PT) to Extensor carpi radialis brevis (ECRB)
. Palmaris longus (PL) to Extensor carpi radialis longus (ECRL)
. Flexor digitorum superficialis (FDS) to Extensor carpi ulnaris (ECU)

Correct Answer & Explanation

. Pronator teres (PT) to Extensor carpi radialis brevis (ECRB)

Explanation

The classic transfer to restore wrist extension in a radial nerve palsy is the Pronator Teres (PT) transferred to the Extensor Carpi Radialis Brevis (ECRB). The ECRB is chosen over the ECRL because its central location on the wrist provides a more balanced extension without excessive radial deviation.

Question 496

Topic: Elbow & Forearm
A 40-year-old male sustains a severe fall onto his outstretched hand, resulting in an elbow fracture-dislocation. Radiographs and CT scans reveal a posteromedial coronoid fracture (Regan & Morrey Type III), a radial head fracture (Mason Type III), and disruption of the lateral ulnar collateral ligament (LUCL). This constellation of injuries is best described as what type of elbow instability?
. Posterolateral rotatory instability (PLRI).
. Terrible Triad injury of the elbow.
. Varus posteromedial rotatory instability (VPMRI).
. Pure elbow dislocation.
. Anterior instability of the elbow.

Correct Answer & Explanation

. Varus posteromedial rotatory instability (VPMRI).

Explanation

The described injury pattern—a posteromedial coronoid fracture, radial head fracture, and lateral ulnar collateral ligament (LUCL) disruption—is the classic 'Varus Posteromedial Rotatory Instability' (VPMRI) injury. This is a severe and often overlooked injury pattern that results from a varus force combined with axial loading and posterior external rotation. The posteromedial coronoid fracture is key, as it represents disruption of the anterior bundle of the medial collateral ligament (AMCL) attachment or an associated avulsion. The Terrible Triad injury involves a radial head fracture, coronoid fracture (usually anteromedial or tip), and LUCL disruption with posterior dislocation, and is distinct from VPMRI primarily by the coronoid fracture pattern and mechanism. PLRI involves isolated LUCL disruption. Pure elbow dislocation does not include associated fractures. Anterior instability is rare.

Question 497

Topic: Elbow & Forearm

A 6-year-old male is evaluated for a progressively worsening left upper extremity deformity and functional limitation. He was born with a congenitally short ulna and radial head dislocation. Clinical examination reveals significant forearm bowing, restricted elbow and wrist motion, and instability of the radial head. Radiographs confirm severe ulnar hypoplasia, radial bowing, and a dislocated radial head. Which of the following is the MOST appropriate surgical management strategy for this patient?

. Early radial head excision.
. Ulnar lengthening with bone grafting and radial osteotomy.
. Forearm osteotomy to correct radial bowing and stabilize radial head.
. Distal radioulnar joint (DRUJ) fusion.
. Observation with serial radiographs until skeletal maturity.

Correct Answer & Explanation

. Ulnar lengthening with bone grafting and radial osteotomy.

Explanation

The patient presents with a severe congenital forearm deformity characterized by ulnar hypoplasia, radial bowing, and radial head dislocation, often referred to as congenital radioulnar synostosis or a severe form of radial club hand spectrum with ulnar involvement. This condition causes progressive deformity and functional limitation.The management aims to improve forearm alignment and elbow/wrist function. Early radial head excision is generally contraindicated in skeletally immature patients as it can lead to further deformity (progressive ulnar deviation of the wrist) and loss of distal radial support. DRUJ fusion is not indicated here.For this complex deformity, a multi-stage approach is often required. The primary goals are to restore forearm alignment and length. Ulnar lengthening (often with an external fixator) combined with a radial osteotomy to correct the bowing can improve forearm length and alignment. This may indirectly help in reducing the radial head or improving the conditions for a stable reduction if attempted. Bone grafting may be necessary to augment lengthening.Rationale for options:A. Early radial head excision in a growing child is generally contraindicated because it can lead to progressive proximal migration of the radius and severe radial deviation of the wrist, worsening the deformity and function.B. Ulnar lengthening with bone grafting and radial osteotomy to correct bowing is the most comprehensive and appropriate surgical strategy for this severe congenital forearm deformity. It addresses the fundamental issues of ulnar deficiency and radial bowing, aiming to restore overall forearm length and alignment. This is the correct answer.C. Forearm osteotomy to correct radial bowing and stabilize radial head may be part of the treatment, but without addressing the ulnar hypoplasia (length discrepancy), the deformity will likely recur or persist. Stabilization of the radial head can be very difficult with severe ulnar hypoplasia.D. Distal radioulnar joint (DRUJ) fusion is not indicated as the primary issue is the radial head dislocation and overall forearm length/alignment, not an isolated DRUJ problem.E. Observation is inappropriate for a progressively worsening, severe deformity in a young, growing child, as it will likely lead to irreversible functional loss.

Question 498

Topic: Elbow & Forearm

In the surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), which of the following sequences is the standard recommended approach for reconstruction to restore stability?

. MCL repair, coronoid fixation, radial head fixation, LCL repair.
. Radial head fixation, coronoid fixation, LCL repair, MCL repair.
. Coronoid fixation, radial head repair or replacement, LCL repair, and MCL repair only if persistently unstable.
. LCL repair, radial head fixation, coronoid fixation.
. Coronoid fixation, MCL repair, radial head fixation.

Correct Answer & Explanation

. Coronoid fixation, radial head repair or replacement, LCL repair, and MCL repair only if persistently unstable.

Explanation

The classic, systematic approach to a terrible triad injury works from deep to superficial and typically from lateral to medial if a standard lateral approach is used. The sequence is: 1) fix the coronoid (restores the anterior buttress and capsule), 2) repair or replace the radial head (restores anterior and valgus buttress), and 3) repair the lateral collateral ligament (LCL) to the lateral epicondyle (restores posterolateral rotatory stability). The MCL is only addressed if the elbow remains persistently unstable after these primary steps.

Question 499

Topic: Elbow & Forearm

A 28-year-old male presents with persistent elbow pain after a fall, particularly with forearm rotation and direct compression of the radial head. Radiographs show a Mason Type II radial head fracture (non-displaced, involving 30% of the articular surface). There is no mechanical block to motion. What is the MOST appropriate initial management?

. Open reduction and internal fixation
. Radial head excision
. Immobilization in a long arm cast for 6 weeks
. Sling immobilization for comfort with early active range of motion
. Radial head replacement

Correct Answer & Explanation

. Sling immobilization for comfort with early active range of motion

Explanation

A Mason Type II radial head fracture that is non-displaced and involves less than 30% of the articular surface without a mechanical block is typically managed non-operatively. The mainstay of treatment is sling immobilization for comfort, followed by early active range of motion exercises to prevent stiffness. Open reduction and internal fixation is for displaced or mechanically blocking fractures. Radial head excision is generally reserved for comminuted fractures not amenable to fixation, particularly in older individuals. Long arm cast immobilization can lead to significant stiffness and is generally avoided. Radial head replacement is for severely comminuted or unreconstructable fractures, especially in unstable elbows (e.g., terrible triad).

Question 500

Topic: Elbow & Forearm

A 35-year-old male presents with persistent elbow pain and a sensation of clunking after a fall onto an outstretched hand. He has pain with forearm supination and extension of the elbow, and a positive pivot shift test. What is the MOST likely pathology?

. Medial epicondylitis
. Radial head fracture
. Posterolateral rotatory instability (PLRI)
. Ulnar collateral ligament (UCL) injury
. Olecranon bursitis

Correct Answer & Explanation

. Posterolateral rotatory instability (PLRI)

Explanation

The symptoms of elbow pain, a sensation of clunking, pain with forearm supination and extension, and a positive pivot shift test are highly characteristic of posterolateral rotatory instability (PLRI) of the elbow. This injury results from insufficiency of the lateral ulnar collateral ligament (LUCL) complex, allowing the radial head to subluxate posteriorly and externally rotate relative to the ulna. Medial epicondylitis causes medial pain. Radial head fracture would have localized tenderness. UCL injury would cause medial instability. Olecranon bursitis is superficial swelling and inflammation.

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