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Elbow & Forearm MCQs

Practice Set 26 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 501

Topic: Elbow & Forearm

A 45-year-old male falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. He undergoes operative management. Which of the following is the most widely accepted sequence of structural repair to systematically restore elbow stability?

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

Correct Answer & Explanation

. Coronoid, radial head, lateral ulnar collateral ligament

Explanation

The standard inside-out surgical sequence for a terrible triad elbow injury is fixation of the coronoid first, followed by radial head repair or replacement, and finally lateral ulnar collateral ligament (LUCL) repair. This progressive stabilization restores the anterior buttress before addressing the lateral column.

Question 502

Topic: Elbow & Forearm

A 38-year-old bodybuilder undergoes surgical repair of a distal biceps tendon rupture using a traditional two-incision technique. Compared to a single-incision anterior approach, this patient is at a statistically higher risk for which of the following postoperative complications?

. Lateral antebrachial cutaneous nerve neurapraxia
. Posterior interosseous nerve palsy
. Radioulnar synostosis
. Radial nerve complete transection
. Early tendon re-rupture

Correct Answer & Explanation

. Radioulnar synostosis

Explanation

The two-incision technique for distal biceps repair carries a higher risk of heterotopic ossification and radioulnar synostosis compared to the single-incision approach. Conversely, single-incision approaches carry a higher risk of lateral antebrachial cutaneous (LABC) nerve injury.

Question 503

Topic: Elbow & Forearm

A 45-year-old female falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. Radiographs and CT show a posterior elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture. During surgical reconstruction, what is the most widely accepted sequence of repair to restore elbow stability?

. Fixation of the coronoid, followed by radial head replacement or fixation, and finally lateral collateral ligament (LCL) repair.
. Repair of the lateral collateral ligament (LCL), followed by radial head fixation, and finally coronoid fixation.
. Radial head replacement, followed by medial collateral ligament (MCL) repair, and finally lateral collateral ligament (LCL) repair.
. Fixation of the coronoid, followed by medial collateral ligament (MCL) repair, and finally lateral collateral ligament (LCL) repair.
. Medial collateral ligament (MCL) repair, followed by coronoid fixation, and finally radial head replacement.

Correct Answer & Explanation

. Fixation of the coronoid, followed by radial head replacement or fixation, and finally lateral collateral ligament (LCL) repair.

Explanation

The standard protocol for terrible triad injuries involves an inside-out or deep-to-superficial repair sequence. The coronoid is addressed first, followed by the radial head, and finally the lateral collateral ligament complex to restore joint kinematics.

Question 504

Topic: Elbow & Forearm

A 38-year-old male undergoes a single-incision anterior approach for a distal biceps tendon rupture repair. Postoperatively, he notes numbness along the radial-volar aspect of his forearm. Which nerve was most likely injured during the exposure?

. Posterior interosseous nerve (PIN)
. Lateral antebrachial cutaneous nerve (LABC)
. Ulnar nerve
. Anterior interosseous nerve (AIN)
. Superficial radial nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABC)

Explanation

The lateral antebrachial cutaneous nerve (LABC) is the most commonly injured nerve during a single-incision anterior approach to the distal biceps. The two-incision technique decreases this nerve risk but carries a higher risk of radioulnar synostosis.

Question 505

Topic: Elbow & Forearm

Which of the following structures is most commonly affected in 'tennis elbow' (lateral epicondylitis)?

. Flexor Carpi Radialis
. Extensor Carpi Radialis Brevis
. Extensor Carpi Ulnaris
. Brachioradialis
. Biceps Brachii

Correct Answer & Explanation

. Extensor Carpi Radialis Brevis

Explanation

Lateral epicondylitis, or 'tennis elbow,' is a degenerative tendinopathy (not purely inflammatory) primarily affecting the origin of the extensor carpi radialis brevis (ECRB) tendon at the lateral epicondyle. While other extensors can be involved, ECRB is consistently the most affected. The other muscles listed are either flexors, other extensors, or not primarily involved.

Question 506

Topic: Elbow & Forearm

A 40-year-old male presents with acute pain and swelling at the base of his thumb, worse with movement. Examination reveals tenderness localized to the extensor pollicis longus (EPL) tendon where it crosses the extensor carpi radialis longus (ECRL) and brevis (ECRB) tendons. What is the most likely diagnosis?

. De Quervain's Tenosynovitis
. Intersection Syndrome
. Flexor Carpi Radialis Tenosynovitis
. Thumb CMC Osteoarthritis
. Wartenberg's Syndrome

Correct Answer & Explanation

. Intersection Syndrome

Explanation

Intersection Syndrome (also known as 'squeaker's wrist' or 'oarsman's wrist') is an inflammatory condition affecting the crossing point of the first dorsal compartment tendons (APL, EPB) and the second dorsal compartment tendons (ECRL, ECRB). The pain described in the question, however, is at the crossing point of the third dorsal compartment tendon (EPL) over the second dorsal compartment tendons (ECRL, ECRB), which is known asproximalintersection syndrome (or sometimes referred to as intersection syndrome if referring to the more common distal intersection of APL/EPB over ECRL/ECRB is not the case). The question specified EPL over ECRL/ECRB. De Quervain's affects the first dorsal compartment (APL, EPB). The scenario describes a variant of intersection syndrome. Given the options, Intersection Syndrome is the best fit, despite the nuance of the specific tendons mentioned (often 'distal' intersection syndrome is what is implied, involving APL/EPB crossing ECRL/ECRB more proximally). Proximal Intersection syndrome involves EPL crossing ECRL/ECRB tendons.

Question 507

Topic: Elbow & Forearm

A patient with a high radial nerve palsy requires tendon transfers to restore wrist, finger, and thumb extension. The standard Boyes transfer is planned. Which muscle is typically transferred to the Extensor Carpi Radialis Brevis (ECRB) to restore wrist extension?

. Flexor Carpi Radialis (FCR)
. Flexor Carpi Ulnaris (FCU)
. Palmaris Longus (PL)
. Pronator Teres (PT)
. Flexor Digitorum Superficialis (FDS)

Correct Answer & Explanation

. Pronator Teres (PT)

Explanation

In classic tendon transfers for radial nerve palsy, the Pronator Teres (PT) is transferred to the ECRB to restore strong wrist extension. The FCR or FCU is typically used for finger extension (to EDC), and PL is used for thumb extension (to EPL).

Question 508

Topic: Elbow & Forearm

A 28-year-old male sustains an open Monteggia fracture-dislocation (ulnar shaft fracture with radial head dislocation). Which of the following is the most important principle of surgical management?

. Closed reduction and long arm cast immobilization.
. Fixation of the ulnar shaft fracture and assessment of radial head reduction.
. Immediate radial head excision.
. External fixation of both the ulna and radius.
. Primary elbow arthrodesis.

Correct Answer & Explanation

. Fixation of the ulnar shaft fracture and assessment of radial head reduction.

Explanation

A Monteggia fracture-dislocation (ulnar shaft fracture with associated radial head dislocation) is an unstable injury. The key principle of surgical management in adults is to anatomically reduce and stably fix the ulnar shaft fracture (typically with a plate and screws). Once the ulnar length and alignment are restored, the radial head dislocation usually reduces spontaneously. The radial head reduction must then be confirmed both clinically and radiographically. If the radial head remains dislocated after ulnar fixation, soft tissue interposition or annular ligament injury may require further exploration. Closed reduction and casting are rarely successful in adults. Radial head excision is generally avoided in younger patients. External fixation is reserved for severe open injuries. Primary elbow arthrodesis is a salvage procedure.

Question 509

Topic: Elbow & Forearm

In the surgical management of the 'terrible triad' of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), standard treatment algorithms suggest addressing structures from deep to superficial. Which structure is typically repaired last, and only if residual instability persists?

. Coronoid process
. Radial head
. Lateral ulnar collateral ligament (LUCL)
. Medial collateral ligament (MCL)
. Common extensor origin

Correct Answer & Explanation

. Coronoid process

Explanation

The standard sequence is fixing the coronoid, then addressing the radial head, followed by the LUCL. The MCL is typically only repaired if the elbow remains grossly unstable in extension after the anterior and lateral structures are stabilized.

Question 510

Topic: Elbow & Forearm

A 45-year-old carpenter presents with a chronic, unretractable rupture of the extensor pollicis longus (EPL) tendon, which occurred 3 months following a non-operative distal radius fracture. The surgeon plans a tendon transfer to restore thumb extension. Which of the following is the most appropriate and commonly used donor tendon for this procedure?

. Extensor carpi radialis longus (ECRL)
. Extensor carpi radialis brevis (ECRB)
. Extensor digitorum communis (EDC) to the index finger
. Extensor indicis proprius (EIP)
. Palmaris longus (PL)

Correct Answer & Explanation

. Extensor indicis proprius (EIP)

Explanation

The Extensor Indicis Proprius (EIP) is the gold standard donor tendon for restoring EPL function. It has an appropriate line of pull, sufficient excursion, and its harvest leaves the index finger with independent extension via the intact EDC tendon.

Question 511

Topic: Elbow & Forearm

You are discussing the 'terrible triad' of the elbow in a Trauma viva. Which of the following best represents the standard surgical sequence for reconstructing this injury pattern?

. MCL repair, LCL repair, radial head fixation, coronoid fixation
. Radial head fixation, coronoid fixation, MCL repair, LCL repair
. Coronoid fixation, radial head fixation/replacement, LCL repair, MCL repair (if needed)
. LCL repair, radial head fixation, coronoid fixation, MCL repair
. Coronoid fixation, MCL repair, radial head fixation, LCL repair

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair, MCL repair (if needed)

Explanation

The standard surgical algorithm for a terrible triad (coronoid fracture, radial head fracture, elbow dislocation) restores stability from deep to superficial: fix the coronoid, fix/replace the radial head, then repair the LCL. The MCL is only repaired if the elbow remains unstable.

Question 512

Topic: Elbow & Forearm

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

. Lateral collateral ligament repair, coronoid fixation, radial head fixation/replacement
. Radial head fixation, coronoid fixation, lateral collateral ligament repair
. Coronoid fixation, radial head fixation/replacement, lateral collateral ligament repair
. Lateral collateral ligament repair, radial head fixation, coronoid fixation
. Coronoid fixation, lateral collateral ligament repair, radial head fixation/replacement

Correct Answer & Explanation

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

Explanation

The standard surgical sequence for a terrible triad injury of the elbow begins with deep to superficial repair: 1. Fixation of the coronoid fracture (or anterior capsule), 2. Fixation or replacement of the radial head, and 3. Repair of the lateral collateral ligament (LCL) complex.

Question 513

Topic: Elbow & Forearm

During the surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), repair of the lateral ulnar collateral ligament (LUCL) is a critical step to restore stability. What are the correct anatomical origin and insertion of the LUCL?

. Lateral epicondyle to the radial neck
. Lateral epicondyle to the supinator crest of the ulna
. Capitellum to the annular ligament
. Lateral epicondyle to the coronoid process
. Radial head to the supinator crest of the ulna

Correct Answer & Explanation

. Lateral epicondyle to the supinator crest of the ulna

Explanation

The lateral ulnar collateral ligament (LUCL) is the primary restraint to posterolateral rotatory instability. It originates on the lateral epicondyle of the humerus and inserts distally onto the supinator crest of the proximal ulna.

Question 514

Topic: Elbow & Forearm

During surgical management of a 'terrible triad' injury of the elbow (coronoid fracture, radial head fracture, elbow dislocation), what is the most widely accepted sequence of repair according to the standard surgical algorithm?

. LCL -> Radial Head -> Coronoid -> MCL
. Coronoid -> Radial Head -> LCL -> MCL (if needed)
. Radial Head -> LCL -> Coronoid -> MCL
. MCL -> Coronoid -> Radial Head -> LCL
. Coronoid -> MCL -> Radial Head -> LCL

Correct Answer & Explanation

. Coronoid -> Radial Head -> LCL -> MCL (if needed)

Explanation

The standard surgical algorithm for a terrible triad injury emphasizes a deep-to-superficial repair from the lateral side. The sequence is typically: 1) Repair or fix the coronoid (to restore anterior stability), 2) Repair or replace the radial head, 3) Repair the lateral collateral ligament (LCL) complex. The medial collateral ligament (MCL) is only repaired if the elbow remains unstable after the lateral-sided and osseous repairs are complete.

Question 515

Topic: Elbow & Forearm

In a standard Boyes tendon transfer for a high radial nerve palsy, which muscle is transferred to the extensor carpi radialis brevis to restore wrist extension?

. Pronator teres
. Flexor carpi ulnaris
. Flexor carpi radialis
. Flexor digitorum superficialis
. Palmaris longus

Correct Answer & Explanation

. Pronator teres

Explanation

In standard tendon transfer algorithms for radial nerve palsy (such as the Boyes or Jones transfers), wrist extension is restored by transferring the Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB). The PT is an ideal donor because of its synergistic action and adequate excursion.

Question 516

Topic: Elbow & Forearm

In a patient with a permanent high radial nerve palsy, a standard Boyes tendon transfer is planned. To restore thumb extension (extensor pollicis longus), which of the following muscles is most classically transferred?

. Flexor carpi ulnaris (FCU)
. Flexor digitorum superficialis (FDS) of the ring finger
. Palmaris longus (PL)
. Pronator teres (PT)
. Brachioradialis (BR)

Correct Answer & Explanation

. Pronator teres (PT)

Explanation

In standard tendon transfers for radial nerve palsy (e.g., Jones or Boyes), the Pronator Teres (PT) is transferred to the Extensor Carpi Radialis Brevis (ECRB) for wrist extension. For thumb extension, the Palmaris Longus (PL) is most commonly transferred to the Extensor Pollicis Longus (EPL). Finger extension is usually restored by transferring FCU or FDS to the EDC.

Question 517

Topic: Elbow & Forearm
A 6-year-old boy falls on an outstretched hand and presents with elbow swelling and pain. Radiographs reveal a plastic deformation of the ulna with an anterior dislocation of the radial head. According to the Bado classification, what type of Monteggia lesion is this?
. Bado Type I
. Bado Type II
. Bado Type III
. Bado Type IV
. This is an isolated radial head dislocation, not a Monteggia lesion

Correct Answer & Explanation

. Bado Type I

Explanation

A Monteggia fracture-dislocation is an ulnar shaft fracture (or plastic deformation in children) with a radial head dislocation. Bado Type I features anterior dislocation of the radial head. Type II is posterior, Type III is lateral, and Type IV involves fractures of both the radius and ulna with an anterior radial head dislocation.

Question 518

Topic: Elbow & Forearm

A 42-year-old female falls from a height and sustains a comminuted, irreparable radial head fracture along with severe wrist pain. Examination reveals instability of the distal radioulnar joint (DRUJ) and marked proximal migration of the radius on stress fluoroscopy. Which of the following is the most appropriate surgical management?

. Radial head excision alone
. Radial head excision and DRUJ pinning
. Radial head replacement and DRUJ pinning
. Radial head excision and ulnar shortening osteotomy
. Open reduction and internal fixation of the radial head with DRUJ pinning

Correct Answer & Explanation

. Radial head replacement and DRUJ pinning

Explanation

This is an Essex-Lopresti injury (radial head fracture, interosseous membrane tear, and DRUJ disruption). Excision of the radial head without replacement will lead to unopposed proximal radial migration, ulnocarpal impaction, and chronic wrist pain. Management requires restoration of the radiocapitellar joint (using a radial head arthroplasty if the fracture is irreparable) to restore longitudinal column stability, followed by reduction and stabilization (pinning) of the DRUJ.

Question 519

Topic: Elbow & Forearm

A patient with a chronic, irreversible high radial nerve palsy requires tendon transfer surgery to restore wrist and digit extension. What is the most widely utilized and standard tendon transfer to restore wrist extension?

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

Correct Answer & Explanation

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

Explanation

The Pronator Teres (PT) to Extensor Carpi Radialis Brevis (ECRB) transfer is the workhorse procedure for restoring wrist extension in radial nerve palsy. The ECRB is preferred over the ECRL because of its more central insertion, which provides balanced dorsiflexion of the wrist without excessive radial deviation.

Question 520

Topic: Elbow & Forearm

In the surgical management of the 'terrible triad' of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), restoring posterolateral rotatory stability is critical. Which ligamentous structure must be meticulously repaired to address this specific instability?

. Anterior bundle of the Medial Collateral Ligament (AMCL)
. Posterior bundle of the Medial Collateral Ligament (PMCL)
. Radial Collateral Ligament (RCL)
. Lateral Ulnar Collateral Ligament (LUCL)
. Quadrate ligament

Correct Answer & Explanation

. Lateral Ulnar Collateral Ligament (LUCL)

Explanation

The Lateral Ulnar Collateral Ligament (LUCL) is the primary restraint to posterolateral rotatory instability (PLRI) of the elbow. In a terrible triad injury, the standard surgical algorithm involves fixing or replacing the radial head, addressing the coronoid/anterior capsule, and rigorously repairing the LUCL to restore lateral stability and prevent subluxation.

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