Menu

Elbow & Forearm MCQs

Practice Set 49 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 961

Topic: Elbow & Forearm
A 30-year-old female falls onto an outstretched hand. A radiograph reveals a coronal shear fracture. According to the current classification systems, a coronal shear fracture of the capitellum that extends medially to include a large contiguous portion of the trochlea is classified as:
. Hahn-Steinthal fracture (Type I)
. Kocher-Lorenz fracture (Type II)
. Broberg-Morrey fracture (Type III)
. McKee modification (Type IV)
. Bryan and Morrey Type I

Correct Answer & Explanation

. McKee modification (Type IV)

Explanation

The McKee modification describes a Type IV capitellar fracture, which is a coronal shear fracture that involves not only the capitellum but extends medially to include the lateral ridge and a significant portion of the trochlea. Type I (Hahn-Steinthal) involves a large fragment of the capitellum with subchondral bone. Type II (Kocher-Lorenz) is an articular cartilage fragment with minimal bone. Type III is a comminuted fracture.

Question 962

Topic: Elbow & Forearm

A 25-year-old female presents with lateral elbow pain and a sensation of the elbow 'clunking' out of place when pushing herself up from a chair with her forearms supinated. Physical examination demonstrates apprehension and subluxation during a lateral pivot shift test. This condition is primarily caused by insufficiency of which ligamentous structure?

. Annular ligament
. Radial collateral ligament
. Lateral ulnar collateral ligament (LUCL)
. Anterior band of the medial collateral ligament
. Posterior band of the medial collateral ligament

Correct Answer & Explanation

. Annular ligament

Explanation

The patient's history and positive lateral pivot shift test are classic for posterolateral rotatory instability (PLRI) of the elbow. PLRI is caused by insufficiency or rupture of the lateral ulnar collateral ligament (LUCL). The LUCL originates on the lateral epicondyle and inserts on the supinator crest of the ulna, acting as the primary restraint to varus and external rotation stress of the elbow.

Question 963

Topic: Elbow & Forearm

A 45-year-old male undergoes a single-incision anterior approach repair for an acute distal biceps tendon rupture. Postoperatively, he has an excellent return of flexion and supination strength but complains of numbness and tingling radiating down the radial aspect of his volar forearm. Which nerve is most likely injured?

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

Correct Answer & Explanation

. Posterior interosseous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN), which is the terminal sensory branch of the musculocutaneous nerve, is the most commonly injured nerve during a single-incision anterior approach for distal biceps tendon repair. It exits laterally from beneath the biceps muscle belly and courses distally in the subcutaneous tissue, making it highly susceptible to injury or retraction neuropraxia. In contrast, the posterior interosseous nerve (PIN) is more at risk during a two-incision approach or if dissection proceeds too far radially or if retractors are placed aggressively against the radius.

Question 964

Topic: Elbow & Forearm
A 40-year-old female sustains a coronal shear fracture of the distal humerus following a fall. CT imaging demonstrates a fracture line that separates the entire capitellum and the lateral aspect of the trochlea in a single piece from the posterior humeral column. According to the Bryan and Morrey classification as modified by McKee, what type of fracture is this?
. Type I (Hahn-Steinthal)
. Type II (Kocher-Lorenz)
. Type III (Broberg-Morrey)
. Type IV (McKee)
. Type V

Correct Answer & Explanation

. Type IV (McKee)

Explanation

Coronal shear fractures of the distal humerus are classified by Bryan and Morrey. Type I (Hahn-Steinthal) is a large osseous fragment containing the capitellum. Type II (Kocher-Lorenz) is a purely articular cartilage sleeve avulsion with very little bone. Type III (Broberg-Morrey) is a severely comminuted capitellum. McKee modified the classification by adding Type IV, which describes a coronal shear fracture that involves the capitellum AND the lateral aspect of the trochlea (often termed a 'capitellotrochlear' fracture). Recognition is critical because Type IV fractures require fixation of the trochlear component to prevent late instability or arthrosis.

Question 965

Topic: Elbow & Forearm

A 28-year-old male sustains a high-energy fall, resulting in a highly comminuted, unsalvageable radial head fracture, acute wrist pain with dorsal prominence of the distal ulna, and tearing of the interosseous membrane. Which of the following treatments for the radial head is strictly contraindicated in this specific injury pattern?

. Open reduction and internal fixation of the radial head
. Metallic radial head arthroplasty
. Radial head excision alone
. Silicone radial head arthroplasty
. Both C and D

Correct Answer & Explanation

. Open reduction and internal fixation of the radial head

Explanation

The patient has an Essex-Lopresti lesion (radial head fracture, disruption of the distal radioulnar joint [DRUJ], and tearing of the longitudinal interosseous membrane). In this longitudinal instability pattern, the radial head acts as the critical secondary stabilizer preventing proximal migration of the radius. Therefore, simple radial head excision (or the use of non-structural silicone implants that cannot resist axial loads) is absolutely contraindicated, as it will lead to proximal radial migration, ulnocarpal impaction, and severe wrist and elbow dysfunction. A rigid metallic radial head replacement is required.

Question 966

Topic: Elbow & Forearm

A 40-year-old bodybuilder undergoes a single-incision anterior approach for the repair of a distal biceps tendon rupture. Postoperatively, he complains of numbness and tingling along the radial border of his forearm. Which of the following nerves is most likely injured?

. Superficial branch of the radial nerve
. Posterior interosseous nerve
. Lateral antebrachial cutaneous nerve
. Medial antebrachial cutaneous nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Superficial branch of the radial nerve

Explanation

The lateral antebrachial cutaneous nerve (LABC) is the most commonly injured nerve during a single-incision anterior approach for distal biceps repair. It exits between the biceps and brachialis and supplies sensation to the lateral forearm.

Question 967

Topic: Elbow & Forearm

A 55-year-old male undergoes a radial head excision for an unrepairable radial head fracture. Three months later, he develops severe wrist pain and proximal migration of the radius. Injury to which of the following structures is the primary cause of this complication?

. Triangular fibrocartilage complex
. Lateral ulnar collateral ligament
. Annular ligament
. Interosseous membrane
. Proximal radioulnar joint capsule

Correct Answer & Explanation

. Triangular fibrocartilage complex

Explanation

This is an Essex-Lopresti lesion, characterized by longitudinal radioulnar dissociation due to disruption of the interosseous membrane. Radial head excision is contraindicated in these injuries, as the radial head is a vital secondary stabilizer to proximal migration.

Question 968

Topic: Elbow & Forearm

Following a traumatic posterolateral elbow dislocation, a 40-year-old patient complains of a clicking sensation and instability when pushing off from a chair. The primary anatomical structure responsible for preventing this specific instability is the:

. Medial ulnar collateral ligament
. Annular ligament
. Lateral ulnar collateral ligament
. Radial collateral ligament
. Coronoid process

Correct Answer & Explanation

. Medial ulnar collateral ligament

Explanation

The patient is describing posterolateral rotatory instability (PLRI) of the elbow. The lateral ulnar collateral ligament (LUCL) is the primary static restraint to PLRI.

Question 969

Topic: Elbow & Forearm

A 21-year-old collegiate baseball pitcher presents with posterior elbow pain during the deceleration phase of throwing. He reports a loss of terminal extension. Radiographs are most likely to show osteophyte formation in which location?

. Anteromedial coronoid
. Posteromedial olecranon
. Capitellum
. Radial head
. Lateral epicondyle

Correct Answer & Explanation

. Anteromedial coronoid

Explanation

Valgus extension overload in throwers causes impingement of the olecranon in the olecranon fossa. This repetitive microtrauma characteristically leads to osteophyte formation at the posteromedial tip of the olecranon.

Question 970

Topic: Elbow & Forearm

During surgical release for recalcitrant lateral epicondylitis, the pathologic tissue is identified deep to the extensor aponeurosis. Histologic evaluation of this tissue typically reveals angiofibroblastic hyperplasia. Which specific tendinous structure is primarily involved?

. Extensor carpi radialis longus
. Extensor digitorum communis
. Extensor carpi radialis brevis
. Extensor carpi ulnaris
. Brachioradialis

Correct Answer & Explanation

. Extensor carpi radialis longus

Explanation

Lateral epicondylitis primarily involves microtearing and degenerative changes (angiofibroblastic hyperplasia) of the origin of the extensor carpi radialis brevis (ECRB) tendon.

Question 971

Topic: Elbow & Forearm

A 35-year-old male presents with elbow instability following a sprain. On examination, he has a positive lateral pivot-shift test. Which structure is primarily responsible for preventing posterolateral rotatory instability (PLRI) of the elbow?

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

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

The lateral ulnar collateral ligament (LUCL) is the primary restraint to varus and external rotation stress, preventing PLRI. Disruption typically occurs from a fall on an outstretched hand with the arm in supination.

Question 972

Topic: Elbow & Forearm

A 40-year-old laborer undergoes operative repair of a distal biceps tendon rupture utilizing a classic two-incision technique. Which complication is historically more associated with the two-incision technique compared to the single anterior incision technique?

. Lateral antebrachial cutaneous nerve palsy
. Posterior interosseous nerve (PIN) palsy
. Radioulnar synostosis
. Radial artery injury
. Median nerve neurapraxia

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve palsy

Explanation

Radioulnar synostosis (or heterotopic ossification) is historically more common with the two-incision technique due to muscle-splitting near the interosseous membrane. The single-incision technique carries a higher risk of lateral antebrachial cutaneous and PIN injuries.

Question 973

Topic: Elbow & Forearm
A 32-year-old female sustains a fracture involving the capitellum with extension medially into the lateral trochlear ridge. According to the Bryan and Morrey classification, which type best describes this fracture?
. Kocher-Lorenz (Type II)
. Hahn-Steinthal (Type I)
. Broberg-Morrey (Type III)
. McKee modification (Type IV)
. Grantham (Type V)

Correct Answer & Explanation

. McKee modification (Type IV)

Explanation

A coronal shear fracture of the capitellum that extends medially to involve the lateral trochlear ridge is classified as a Type IV fracture according to the McKee modification. Recognizing this medial extension is crucial for surgical planning and ensuring adequate fixation.

Question 974

Topic: Elbow & Forearm

A 42-year-old bodybuilder feels a pop in his anterior elbow during a heavy deadlift. The examiner performs the Hook test. What is the anatomic structure being evaluated, and what constitutes a positive test?

. Distal triceps; inability to hook finger under tendon
. Distal biceps; inability to hook finger under the lateral edge of the tendon
. Ulnar collateral ligament; pain with hooking the medial epicondyle
. Median nerve; paresthesias when hooking the lacertus fibrosus
. Brachialis; pain upon resisted flexion with the forearm pronated

Correct Answer & Explanation

. Distal triceps; inability to hook finger under tendon

Explanation

The Hook test specifically evaluates the integrity of the distal biceps tendon. A positive test occurs when the examiner's index finger cannot hook under the intact biceps tendon from the lateral side, indicating a complete rupture.

Question 975

Topic: Elbow & Forearm

A 45-year-old falls onto an outstretched hand resulting in a terrible triad injury of the elbow. During surgical reconstruction, what is the generally recommended sequence of repair?

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

Correct Answer & Explanation

. Radial head, coronoid, lateral collateral ligament (LCL)

Explanation

The standard surgical sequence for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) is repairing deep to superficial. This involves addressing the coronoid first, then the radial head (fixation or replacement), and finally the LCL complex.

Question 976

Topic: Elbow & Forearm

Following a two-incision surgical repair of a distal biceps tendon rupture, the patient reports inability to extend the fingers and thumb, with radial deviation during wrist extension. Which nerve was most likely injured?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The posterior interosseous nerve (PIN) is at risk during the two-incision technique for distal biceps repair if the forearm is not kept in pronation during posterolateral exposure. PIN palsy presents with weakness in finger and thumb extension, and radial deviation on wrist extension due to extensor carpi ulnaris weakness.

Question 977

Topic: Elbow & Forearm

In the surgical management of a terrible triad injury of the elbow, which of the following is the generally recommended sequence of repair to restore stability?

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

Correct Answer & Explanation

. LCL repair, coronoid fixation, radial head fixation

Explanation

The standard protocol for a terrible triad injury is to repair deep to superficial, starting anteriorly. The sequence is coronoid fixation, followed by radial head fixation or replacement, and finally lateral collateral ligament (LCL) repair to restore the lateral tension band.

Question 978

Topic: Elbow & Forearm

A 45-year-old male undergoes a single-incision anterior repair of a distal biceps tendon rupture. Postoperatively, he complains of numbness and paresthesia along the lateral aspect of his forearm. Which nerve was most likely injured?

. Posterior interosseous nerve (PIN)
. Superficial radial nerve
. Lateral antebrachial cutaneous nerve (LABCN)
. Medial antebrachial cutaneous nerve (MABCN)
. Anterior interosseous nerve (AIN)

Correct Answer & Explanation

. Posterior interosseous nerve (PIN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single-incision anterior distal biceps repair due to its proximity to the surgical field. The PIN is more at risk during a two-incision approach.

Question 979

Topic: Elbow & Forearm

A 32-year-old sustains a highly comminuted, unsalvageable radial head fracture along with severe wrist pain and distal radioulnar joint (DRUJ) instability. What is the most appropriate management strategy?

. Radial head excision alone
. Radial head excision and DRUJ pinning in pronation
. Radial head arthroplasty and DRUJ pinning in supination
. Open reduction internal fixation of the radial head and DRUJ pinning in neutral
. Radial head excision and ulnar shortening osteotomy

Correct Answer & Explanation

. Radial head excision alone

Explanation

This patient has an Essex-Lopresti lesion consisting of a radial head fracture, interosseous membrane tear, and DRUJ disruption. Management requires radial head arthroplasty to restore longitudinal stability and pinning of the DRUJ in supination to allow the IOM to heal.

Question 980

Topic: Elbow & Forearm

In the surgical management of a terrible triad injury of the elbow, what is the most widely accepted sequential order of repair?

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

Correct Answer & Explanation

. LCL repair, coronoid fixation, radial head replacement

Explanation

Standard protocol addresses deep to superficial structures from inside-out. The anterior column (coronoid) is fixed first, followed by the lateral column (radial head), and finally the lateral collateral ligament complex.

Test Yourself

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

On this Page