Menu

Elbow & Forearm MCQs

Practice Set 46 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 901

Topic: Elbow & Forearm

The posterior compartment of the forearm is divided into a superficial, a mobile wad, and a deep layer. Which of the following muscles is NOT found in the deep layer of the posterior forearm?

. Supinator
. Abductor pollicis longus
. Extensor pollicis longus
. Extensor indicis proprius
. Extensor carpi radialis brevis

Correct Answer & Explanation

. Supinator

Explanation

The extensor carpi radialis brevis (ECRB) is part of the superficial layer (specifically the 'mobile wad of Henry' along with the brachioradialis and ECRL). The deep layer of the posterior forearm contains the Supinator, Abductor pollicis longus (APL), Extensor pollicis brevis (EPB), Extensor pollicis longus (EPL), and Extensor indicis proprius (EIP).

Question 902

Topic: Elbow & Forearm

A 22-year-old sustains a traumatic posterolateral elbow dislocation. During surgical reconstruction of the lateral ulnar collateral ligament (LUCL), accurate placement of the isometric origin and insertion points is essential. What are the true anatomical attachments of the LUCL?

. Originates at the lateral epicondyle and inserts on the annular ligament.
. Originates at the lateral epicondyle and inserts on the supinator crest of the ulna.
. Originates at the lateral supracondylar ridge and inserts on the radial tuberosity.
. Originates at the medial epicondyle and inserts on the sublime tubercle of the ulna.
. Originates at the capitellum and inserts on the coronoid process.

Correct Answer & Explanation

. Originates at the lateral epicondyle and inserts on the annular ligament.

Explanation

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

Question 903

Topic: Elbow & Forearm

A 13-year-old gymnast complains of chronic, insidious onset lateral elbow pain, stiffness, and clicking. Examination reveals a 15-degree flexion contracture. Radiographs show a radiolucent lesion on the anterolateral aspect of the capitellum. MRI confirms Osteochondritis Dissecans (OCD) with an intact articular surface. What differentiates capitellar OCD from Panner's disease?

. Panner's disease involves the radial head, whereas OCD involves the capitellum
. OCD typically occurs in younger children (<10 years old), while Panner's disease occurs in adolescents
. Panner's disease affects the entire ossific nucleus and typically occurs in children under 10, whereas OCD is a focal lesion in adolescents
. Panner's disease requires surgical drilling, while OCD is always treated conservatively
. OCD involves purely cartilage, while Panner's disease involves only subchondral bone

Correct Answer & Explanation

. Panner's disease involves the radial head, whereas OCD involves the capitellum

Explanation

Panner's disease is an osteochondrosis of the entire capitellar ossific nucleus, typically occurring in children aged 7-10 years, and is self-limiting. Capitellar OCD is a focal osteochondral defect, typically seen in older adolescent athletes (11-15 years) involved in repetitive valgus loading (gymnasts, throwers), and carries a higher risk of loose body formation and long-term sequelae.

Question 904

Topic: Elbow & Forearm

A 13-year-old male gymnast presents with a 4-month history of lateral elbow pain, locking, and catching. MRI demonstrates an osteochondritis dissecans (OCD) lesion of the capitellum with T2 fluid signal interposing between the osteochondral fragment and the underlying bone. What is the most appropriate next step in management?

. Rest, NSAIDs, and cessation of upper extremity weight-bearing for 3 months
. Arthroscopic evaluation with fragment drilling and potential fixation
. Open osteochondral allograft transplantation
. Ulnar nerve transposition to relieve secondary neuritis
. Resection of the capitellar fragment and radial head excision

Correct Answer & Explanation

. Rest, NSAIDs, and cessation of upper extremity weight-bearing for 3 months

Explanation

The patient has an unstable OCD lesion of the capitellum, as indicated by the presence of locking/catching and the MRI finding of T2 fluid signal behind the fragment (which signifies instability). While stable lesions in patients with open physes can be treated nonoperatively (rest), unstable lesions require surgical intervention. Arthroscopic evaluation to assess stability, followed by drilling (to promote healing) and internal fixation of the salvageable fragment, is the standard of care. Open osteochondral allograft is reserved for large, unsalvageable defects that have failed primary fixation.

Question 905

Topic: Elbow & Forearm

A 19-year-old collegiate baseball pitcher undergoes a modified Jobe ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. Which of the following represents the most common postoperative complication associated with this specific surgical technique?

. Medial epicondyle fracture.
. Graft rupture.
. Ulnar neuropathy.
. Heterotopic ossification of the ulnohumeral joint.
. Deep space infection.

Correct Answer & Explanation

. Medial epicondyle fracture.

Explanation

Ulnar neuropathy is the most frequent complication following UCL reconstruction, particularly with techniques like the modified Jobe that involve routine ulnar nerve transposition. Modern techniques, such as the docking procedure, minimize nerve handling and have significantly reduced this risk.

Question 906

Topic: Elbow & Forearm

A 45-year-old male presents with acute anterior elbow pain and a palpable defect after feeling a 'pop' while lifting a heavy couch. The Hook test is positive. If the surgeon elects to perform a single-incision anterior approach for anatomic repair, which of the following nerves is at highest risk of iatrogenic injury?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABC) is the most commonly injured nerve during a single-incision anterior approach for distal biceps repair. The posterior interosseous nerve is at higher risk with a two-incision approach.

Question 907

Topic: Elbow & Forearm

A patient presents with a 'terrible triad' of the elbow, which includes a posterior dislocation, radial head fracture, and coronoid fracture. When performing surgical reconstruction for this injury complex, what is the standard, biomechanically validated sequence of fixation?

. Coronoid, then radial head, then lateral collateral ligament (LCL)
. Radial head, then coronoid, then medial collateral ligament (MCL)
. LCL, then radial head, then coronoid
. MCL, then LCL, then coronoid
. Coronoid, then MCL, then radial head

Correct Answer & Explanation

. Coronoid, then radial head, then lateral collateral ligament (LCL)

Explanation

The standard surgical algorithm for the terrible triad works deep to superficial and anterior to posterior: fix the coronoid first, replace or fix the radial head second, and finally repair the LCL complex.

Question 908

Topic: Elbow & Forearm

A 42-year-old male bodybuilder feels a 'pop' in his antecubital fossa while performing heavy deadlifts. Clinical examination reveals a positive hook test. If a single-incision anterior surgical approach is chosen for repair, which structure is at the greatest risk of iatrogenic injury?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous (LABC) nerve is the most commonly injured structure during a single-incision anterior approach for distal biceps repair. In contrast, the posterior interosseous nerve (PIN) is at higher risk during a two-incision approach if retractors are improperly placed.

Question 909

Topic: Elbow & Forearm
A 55-year-old female presents with base of thumb pain. Radiographs reveal Eaton-Littler Stage III basal joint arthritis. She is scheduled for a ligament reconstruction and tendon interposition (LRTI). Which tendon is most commonly harvested for this procedure?
. Flexor carpi radialis (FCR)
. Abductor pollicis longus (APL)
. Extensor carpi radialis brevis (ECRB)
. Palmaris longus
. Extensor pollicis brevis (EPB)

Correct Answer & Explanation

. Flexor carpi radialis (FCR)

Explanation

The flexor carpi radialis (FCR) is the most frequently harvested tendon for an LRTI procedure to stabilize the thumb metacarpal base after trapeziectomy, reconstructing the beak ligament.

Question 910

Topic: Elbow & Forearm

During an anterior single-incision surgical repair of a distal biceps tendon rupture, the patient is at highest risk for injury to a specific peripheral nerve. Injury to this nerve typically results in which of the following clinical deficits?

. Weakness in thumb extension
. Numbness over the lateral aspect of the forearm
. Inability to flex the distal interphalangeal joint of the index finger
. Numbness over the dorsal web space between the thumb and index finger
. Weakness in spreading the fingers against resistance

Correct Answer & Explanation

. Weakness in thumb extension

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single-incision distal biceps repair. Injury results in numbness over the lateral (radial) aspect of the forearm.

Question 911

Topic: Elbow & Forearm

A 42-year-old female presents with neck pain radiating down her left arm. Physical examination reveals a diminished brachioradialis reflex, decreased sensation over her left thumb and index finger, and weakness in wrist extension. Which cervical nerve root is most likely affected?

. C4
. C5
. C6
. C7
. C8

Correct Answer & Explanation

. C4

Explanation

The C6 nerve root innervates the brachioradialis and wrist extensors (ECRL, ECRB). A C6 radiculopathy typically presents with a diminished brachioradialis reflex and sensory changes in the thumb and index finger.

Question 912

Topic: Elbow & Forearm

A 32-year-old gymnast falls from a height and presents with an elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture. According to established biomechanical principles for treating the 'terrible triad' of the elbow, what is the most widely recommended surgical sequence?

. Fixation of the radial head, repair of the lateral ulnar collateral ligament (LUCL), followed by coronoid fixation
. Fixation of the coronoid, fixation/replacement of the radial head, followed by repair of the LUCL
. Repair of the LUCL, fixation of the coronoid, followed by radial head replacement
. Repair of the medial collateral ligament (MCL), fixation of the radial head, followed by the coronoid
. Fixation of the radial head, repair of the MCL, followed by the LUCL

Correct Answer & Explanation

. Fixation of the radial head, repair of the lateral ulnar collateral ligament (LUCL), followed by coronoid fixation

Explanation

The standard surgical algorithm for a terrible triad injury works from 'deep to superficial' or 'inside out'. The typical sequence is: 1) Fixation of the coronoid (to restore the anterior buttress), 2) Fixation or arthroplasty of the radial head (to restore the radiocapitellar anterior restraint), 3) Repair of the lateral ulnar collateral ligament (LUCL) to the lateral epicondyle. Repair of the MCL is usually only indicated if the elbow remains unstable after the first three steps.

Question 913

Topic: Elbow & Forearm

A 35-year-old male sustained a midshaft humerus fracture resulting in a permanent radial nerve palsy. He is undergoing tendon transfer surgery to restore function. To restore functional and balanced wrist extension without inducing significant radial deviation, which of the following is the most preferred tendon transfer?

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

Correct Answer & Explanation

. Flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB)

Explanation

The most widely accepted and reliable tendon transfer to restore wrist extension in a radial nerve palsy is the Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB). The ECRB is chosen over the ECRL because its insertion is more central (base of the 3rd metacarpal), which provides pure wrist extension without the radial deviation that occurs when using the ECRL.

Question 914

Topic: Elbow & Forearm

A fracture involving the capitellum and the lateral half of the trochlea in a single piece, with associated posterior condylar comminution, is evaluated on a CT scan.

According to the Dubberley classification, this is classified as:

. Type 1A
. Type 2A
. Type 2B
. Type 3A
. Type 3B

Correct Answer & Explanation

. Type 1A

Explanation

The Dubberley classification evaluates coronal shear fractures of the distal humerus. Type 1: primarily capitellum. Type 2: capitellum and lateral half of trochlea in a single fragment. Type 3: capitellum and trochlea as separate fragments. Modifiers A and B indicate the absence (A) or presence (B) of posterior condylar comminution. Thus, Type 2B involves the capitellum and trochlea as one piece with posterior comminution.

Question 915

Topic: Elbow & Forearm

A 40-year-old female presents after falling on an outstretched hand, sustaining a "terrible triad" injury of the elbow.

Which of the following accurately describes the typical sequence of surgical repair for this injury?

. Medial collateral ligament (MCL) repair, coronoid fixation, radial head fixation, lateral collateral ligament (LCL) repair.
. Radial head fixation, LCL repair, coronoid fixation, MCL repair.
. Coronoid fixation, radial head fixation or replacement, LCL repair, followed by MCL repair if the elbow remains unstable.
. LCL repair, radial head replacement, coronoid fixation, MCL repair.
. Coronoid fixation, MCL repair, radial head fixation, LCL repair.

Correct Answer & Explanation

. Medial collateral ligament (MCL) repair, coronoid fixation, radial head fixation, lateral collateral ligament (LCL) repair.

Explanation

The standard surgical algorithm for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) typically proceeds deep to superficial, or anterior to posterior. It involves fixing the coronoid first (if accessible/indicated), followed by the radial head, and then repairing the lateral ulnar collateral ligament (LUCL/LCL complex). The MCL is generally only repaired if gross instability persists.

Question 916

Topic: Elbow & Forearm

During the surgical approach for a terrible triad injury of the elbow, what is the generally recommended sequence of reconstruction to restore elbow stability?

. Coronoid, radial head, lateral collateral ligament (LCL)
. Coronoid, LCL, radial head
. Radial head, coronoid, LCL
. LCL, radial head, coronoid
. Medial collateral ligament (MCL), coronoid, radial head

Correct Answer & Explanation

. Coronoid, radial head, lateral collateral ligament (LCL)

Explanation

The standard protocol for a terrible triad injury involves a deep-to-superficial repair sequence. This entails fixation of the coronoid first, followed by radial head repair or arthroplasty, and finally repair of the lateral collateral ligament complex.

Question 917

Topic: Elbow & Forearm

A 40-year-old male presents with a Terrible Triad injury of the elbow.

Surgical management is planned. What is the generally accepted sequence of repair to restore elbow stability?

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

Correct Answer & Explanation

. LCL repair, radial head fixation/arthroplasty, coronoid fixation

Explanation

The standard surgical algorithm for a terrible triad injury progresses from deep to superficial and medial to lateral: 1) Coronoid fixation to restore the anterior buttress, 2) Radial head fixation or replacement to restore the lateral column, and 3) Lateral ulnar collateral ligament (LUCL/LCL complex) repair. The MCL is only addressed if the elbow remains unstable after these steps.

Question 918

Topic: Elbow & Forearm

A 42-year-old tennis player undergoes surgical debridement for refractory lateral epicondylitis. Histologic examination of the excised tissue from the extensor carpi radialis brevis (ECRB) origin will most typically demonstrate which of the following?

. Acute inflammatory infiltrates with neutrophils
. Angiofibroblastic hyperplasia
. Granulomatous inflammation
. Fibrinoid necrosis
. Normal tendon architecture

Correct Answer & Explanation

. Acute inflammatory infiltrates with neutrophils

Explanation

Lateral epicondylitis (tennis elbow) is fundamentally a tendinosis, not an acute tendinitis. Histologic examination classically shows angiofibroblastic hyperplasia, characterized by disorganized collagen, fibroblasts, and poorly formed blood vessels, with an absence of acute inflammatory cells.

Question 919

Topic: Elbow & Forearm

A 45-year-old bodybuilder feels a pop in his anterior elbow during a heavy deadlift. Clinical exam shows a positive Hook test. A single-incision anterior approach is planned to repair the avulsed distal biceps tendon. During this approach, which nerve is at greatest risk of iatrogenic injury?

. Posterior interosseous nerve (PIN)
. Lateral antebrachial cutaneous nerve (LABCN)
. Medial antebrachial cutaneous nerve (MABCN)
. Ulnar nerve
. Median nerve

Correct Answer & Explanation

. Posterior interosseous nerve (PIN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) runs superficially in the lateral aspect of the antecubital fossa and is the most commonly injured nerve during the anterior single-incision approach to the distal biceps. The posterior interosseous nerve (PIN) is at higher risk during a two-incision approach or with deep, overzealous lateral retraction.

Question 920

Topic: Elbow & Forearm

A 45-year-old male feels a sudden 'pop' in his right elbow while attempting to lift a heavy box. On examination, he has a positive hook test and a visible proximal retraction of the biceps muscle belly. A single anterior incision approach is planned for distal biceps tendon repair. Which of the following nerves is at the greatest risk of iatrogenic injury during this specific surgical approach?

. Radial nerve
. Lateral antebrachial cutaneous nerve
. Posterior interosseous nerve
. Ulnar nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

The lateral antebrachial cutaneous nerve (LABC), which is the terminal sensory branch of the musculocutaneous nerve, exits lateral to the biceps tendon and is highly susceptible to neuropraxia or transection during the single-incision anterior approach to the distal biceps. The posterior interosseous nerve (PIN) is more at risk when exposing the radial tuberosity, particularly if retractors are placed too far laterally or distally, and is the classic nerve injured in a two-incision approach if the muscle splitting is incorrect, but the most frequently injured nerve overall in the single anterior incision is the LABC.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page