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Elbow & Forearm MCQs

Practice Set 50 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 981

Topic: Elbow & Forearm

Which of the following complications is significantly more common following a two-incision technique for distal biceps tendon repair compared to a single anterior incision?

. Lateral antebrachial cutaneous nerve palsy
. Radial nerve palsy
. Heterotopic ossification and radioulnar synostosis
. Re-rupture of the tendon
. Posterior interosseous nerve palsy

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve palsy

Explanation

While the two-incision technique decreases the risk of lateral antebrachial cutaneous nerve injury, it traverses the interosseous membrane. This carries a higher risk of heterotopic ossification and potentially debilitating proximal radioulnar synostosis.

Question 982

Topic: Elbow & Forearm
A 45-year-old female sustains an elbow dislocation, a Regan-Morrey Type II coronoid fracture, and a Mason Type III radial head fracture. During the surgical reconstruction of this "terrible triad" injury, which structure is typically repaired last to restore stability?
. Coronoid process
. Radial head
. Lateral ulnar collateral ligament (LUCL)
. Medial collateral ligament (MCL)
. Common extensor origin

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

The standard surgical algorithm for an elbow terrible triad is fixing the coronoid first, followed by radial head repair or replacement, and finally repairing the LUCL. The MCL is generally only repaired if the elbow remains grossly unstable in extension after the lateral and anterior structures are stabilized.

Question 983

Topic: Elbow & Forearm

During an anterior single-incision repair of a distal biceps tendon rupture using cortical button fixation, the patient develops postoperative weakness in thumb and finger extension, but normal, radially deviated wrist extension. Which nerve was likely injured?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The posterior interosseous nerve (PIN) is at risk during single-incision distal biceps repairs if the drill plunges too far through the posterior radial cortex. PIN injury causes weakness in thumb and digit extension with preserved radial wrist extension, as the ECRL is innervated proximal to the PIN.

Question 984

Topic: Elbow & Forearm

Following a single-incision anterior repair of a distal biceps tendon rupture using a cortical button, the patient complains of numbness over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

. Superficial radial nerve
. Posterior interosseous nerve (PIN)
. Lateral antebrachial cutaneous nerve (LABCN)
. Median nerve
. Medial antebrachial cutaneous nerve

Correct Answer & Explanation

. Superficial radial nerve

Explanation

The LABCN is the most commonly injured nerve during a single-incision distal biceps repair. This is due to its anatomic proximity to the surgical field and the cephalic vein within the subcutaneous tissues.

Question 985

Topic: Elbow & Forearm

A 30-year-old professional baseball pitcher undergoes ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. What is the most frequently reported complication following this procedure?

. Graft rupture
. Medial epicondyle fracture
. Ulnar neuropathy
. Heterotopic ossification
. Radial head osteochondritis dissecans

Correct Answer & Explanation

. Graft rupture

Explanation

Ulnar neuropathy is the most common complication following UCL reconstruction (Tommy John surgery), occurring in up to 10-15% of cases. Careful handling and potential transposition of the nerve can mitigate this risk.

Question 986

Topic: Elbow & Forearm

A 50-year-old man presents with persistent elbow pain and lateral-sided snapping. He previously underwent surgery for lateral epicondylitis involving an aggressive release of the common extensor origin. Examination shows varus instability when the elbow is tested in supination. What structure has been iatrogenically compromised?

. Medial collateral ligament
. Radial collateral ligament
. Lateral ulnar collateral ligament (LUCL)
. Annular ligament
. Biceps tendon

Correct Answer & Explanation

. Medial collateral ligament

Explanation

The lateral ulnar collateral ligament (LUCL) is the primary stabilizer against posterolateral rotatory instability (PLRI). Overly aggressive surgical debridement of the common extensor origin for tennis elbow can iatrogenically injure the underlying LUCL.

Question 987

Topic: Elbow & Forearm
A 45-year-old mechanic sustains a highly comminuted Mason Type III radial head fracture and an Essex-Lopresti injury. The radial head is deemed unsalvageable. What is the most appropriate management of the radial head?
. Radial head excision alone
. Radial head excision and silastic implant arthroplasty
. Radial head excision and temporary radioulnar pinning
. Radial head arthroplasty with a metallic implant
. Closed reduction and casting

Correct Answer & Explanation

. Radial head arthroplasty with a metallic implant

Explanation

In an Essex-Lopresti injury, there is longitudinal radioulnar instability due to interosseous membrane disruption. Radial head excision alone leads to proximal radial migration; therefore, a rigid metallic radial head arthroplasty is required to maintain longitudinal stability.

Question 988

Topic: Elbow & Forearm

In a patient with a high radial nerve palsy, which of the following is the most standard tendon transfer utilized to restore wrist extension?

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

Correct Answer & Explanation

. Flexor carpi ulnaris (FCU) to Extensor digitorum communis (EDC)

Explanation

The classic and most reliable tendon transfer to restore wrist extension in a radial nerve palsy is transferring the Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB). The ECRB is chosen over the ECRL because of its more central insertion, which limits radial deviation during wrist extension.

Question 989

Topic: Elbow & Forearm

In the surgical management of a 'terrible triad' injury of the elbow, what is the standard algorithmic sequence of anatomic reconstruction?

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

Correct Answer & Explanation

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

Explanation

The standard surgical algorithm for a terrible triad (elbow dislocation with radial head and coronoid fractures) is to proceed from deep to superficial: coronoid fixation or anterior capsular repair, followed by radial head repair or replacement, and finally lateral collateral ligament (LCL) repair. The MCL is typically only repaired if the elbow remains grossly unstable after these steps.

Question 990

Topic: Elbow & Forearm
A distal humerus fracture consists of a coronal shear fracture involving the entire capitellum and the lateral portion of the trochlea, but leaves the lateral epicondyle intact. According to the McKee modification of the Bryan and Morrey classification, 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

The McKee modification added Type IV to the Bryan and Morrey classification. Type I is a large osseous capitellar piece. Type II is a thin articular cartilage sleeve. Type III is comminuted. Type IV (McKee) is a coronal shear fracture that involves both the capitellum and the lateral half of the trochlea.

Question 991

Topic: Elbow & Forearm

A patient presents with a "terrible triad" injury of the elbow following a fall onto an outstretched hand. During operative management, what is the standard recommended sequence of surgical reconstruction to restore stability?

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

Correct Answer & Explanation

. MCL repair, LCL repair, radial head fixation, coronoid fixation

Explanation

The standard surgical algorithm for a terrible triad injury begins deep and moves superficial: fixation of the coronoid first, followed by the radial head, then repair of the lateral collateral ligament (LCL) complex. MCL repair is only performed if the elbow remains unstable after these steps.

Question 992

Topic: Elbow & Forearm
A 34-year-old female falls onto an outstretched hand and sustains a capitellum fracture. Radiographs and CT show a coronal shear fracture that involves the capitellum and extends medially to include the majority of the trochlea. According to the Bryan-Morrey classification (incorporating the McKee modification), what type of fracture is this?
. Type I (Hahn-Steinthal)
. Type II (Kocher-Lorenz)
. Type III (Broberg-Morrey)
. Type IV (McKee modification)
. Type V

Correct Answer & Explanation

. Type IV (McKee modification)

Explanation

The McKee modification of the Bryan-Morrey classification adds Type IV, which describes a coronal shear fracture involving the capitellum that extends medially to include most or all of the trochlea, often referred to as a capitellotrochlear fracture.

Question 993

Topic: Elbow & Forearm

During surgical management of a 'terrible triad' injury of the elbow, what is the recommended sequence of reconstruction to restore concentric stability?

. MCL repair, radial head fixation, coronoid fixation, LCL repair
. Coronoid fixation, radial head fixation or arthroplasty, LCL repair, and lastly MCL repair if still unstable
. Radial head fixation, LCL repair, coronoid fixation, MCL repair
. LCL repair, coronoid fixation, radial head fixation, MCL repair
. MCL repair, coronoid fixation, radial head arthroplasty, LCL repair

Correct Answer & Explanation

. MCL repair, radial head fixation, coronoid fixation, LCL repair

Explanation

The standard surgical sequence for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) typically works from deep to superficial: 1) Coronoid fixation (restores anterior buttress), 2) Radial head fixation or replacement (restores lateral column), 3) LCL complex repair (restores posterolateral rotatory stability). MCL repair is generally only performed if the elbow remains grossly unstable in extension after the first three steps are completed.

Question 994

Topic: Elbow & Forearm

During a single-incision anterior approach for distal biceps tendon repair, the forearm is held in full supination while passing sutures and reattaching the tendon to the radial tuberosity. Which nerve is at greatest risk of injury if retractors are placed too deeply on the lateral aspect of the proximal radius?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The posterior interosseous nerve (PIN) wraps around the radial neck within the supinator muscle. Retractors placed blindly or deeply on the lateral side of the radius can compress or stretch the PIN. Keeping the forearm in supination moves the PIN further laterally and posteriorly, protecting it during the anterior approach, but deep radial retractor placement still poses the greatest risk to this structure.

Question 995

Topic: Elbow & Forearm

In the surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), what is the most accepted sequence of reconstruction to restore stability?

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

Correct Answer & Explanation

. MCL repair, coronoid fixation, radial head repair, LCL repair

Explanation

The standard protocol for a terrible triad injury works deep to superficial and medial to lateral: coronoid fixation first, followed by radial head repair or arthroplasty, and then LCL repair. The MCL is only addressed if the elbow remains grossly unstable after lateral sided repair.

Question 996

Topic: Elbow & Forearm

A 45-year-old male falls from a height and sustains a terrible triad injury of the elbow. During surgical reconstruction, which of the following represents the most appropriate sequence of repair?

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

Correct Answer & Explanation

. LCL repair, then radial head fixation, then coronoid fixation

Explanation

The standard surgical protocol for a terrible triad injury follows a deep-to-superficial, inside-out approach. The coronoid is fixed first to restore anterior stability, followed by the radial head, and finally the lateral collateral ligament (LCL).

Question 997

Topic: Elbow & Forearm

A 35-year-old male undergoes surgical repair of an acute distal biceps tendon rupture. The surgeon utilizes a traditional two-incision technique. Which of the following complications is significantly more common with this approach compared to a single anterior incision technique?

. Lateral antebrachial cutaneous nerve neuropraxia
. Posterior interosseous nerve palsy
. Radioulnar synostosis
. Brachial artery pseudoaneurysm
. Superficial radial nerve entrapment

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve neuropraxia

Explanation

The two-incision technique carries a higher risk of heterotopic ossification and radioulnar synostosis due to violation of the interosseous membrane. A single anterior incision has a higher risk of lateral antebrachial cutaneous nerve (LACN) injury.

Question 998

Topic: Elbow & Forearm

During a two-incision distal biceps tendon repair, the tendon is advanced to its native footprint on the radial tuberosity. To maximally restore supination strength, the anatomical footprint of the distal biceps tendon should be targeted on which aspect of the radial tuberosity?

. Anterior aspect
. Posterior-ulnar aspect
. Directly lateral aspect
. Distal-most aspect
. Proximal-radial aspect

Correct Answer & Explanation

. Anterior aspect

Explanation

The native footprint of the distal biceps tendon is located on the posterior and ulnar aspect of the radial tuberosity. Reattaching the tendon to this native, posterior-ulnar position acts as a mechanical cam, wrapping around the radius to maximize the moment arm for powerful supination. Anterior placement significantly reduces supination torque.

Question 999

Topic: Elbow & Forearm

After completing its motor innervation to the anterior compartment of the arm, the musculocutaneous nerve continues distally to provide sensory innervation to the lateral forearm. It emerges piercing the deep fascia to become the lateral antebrachial cutaneous nerve at which specific anatomical landmark?

. Medial to the distal biceps tendon
. Lateral to the distal biceps tendon
. Between the two heads of the pronator teres
. Posterior to the brachioradialis muscle belly
. Through the central substance of the lacertus fibrosus

Correct Answer & Explanation

. Medial to the distal biceps tendon

Explanation

The musculocutaneous nerve travels distally between the biceps and brachialis muscles and emerges lateral to the distal biceps tendon just above the elbow crease, where it pierces the deep fascia to become the lateral antebrachial cutaneous nerve.

Question 1000

Topic: Elbow & Forearm

The 'mobile wad of Henry' in the proximal lateral forearm comprises which three muscles?

. Pronator teres, Flexor carpi radialis, Palmaris longus
. Brachioradialis, Extensor carpi radialis longus, Extensor carpi radialis brevis
. Extensor digitorum communis, Extensor digiti minimi, Extensor carpi ulnaris
. Supinator, Abductor pollicis longus, Extensor pollicis brevis
. Brachialis, Biceps brachii, Coracobrachialis

Correct Answer & Explanation

. Pronator teres, Flexor carpi radialis, Palmaris longus

Explanation

The mobile wad of Henry refers to the three muscles located in the lateral compartment of the proximal forearm: the brachioradialis, extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB). These are often retracted together during the anterior (Henry) approach to the radius.

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