Shoulder Arthroplasty & Arthritis MCQs

Which of the following intraoperative modifications is most effective at preventing scapular notching during a reverse total shoulder arthroplasty?

A 72-year-old female undergoes a reverse total shoulder arthroplasty (rTSA) for cuff tear arthropathy. The surgeon decides to use a lateralized glenosphere rather than a traditional medialized Grammont-style design. Which of the following biomechanical effects is most likely to result from this design choice?

A 72-year-old woman returns for a 3-year follow-up after a reverse total shoulder arthroplasty (RTSA). Radiographs show a radiolucent area on the scapular neck that extends past the inferior screw of the baseplate but does not reach the central peg. Which Sirveaux grade of scapular notching does this represent, and what baseplate positioning strategy could have minimized this complication?

A 68-year-old man with primary osteoarthritis is planned for an anatomic total shoulder arthroplasty. Preoperative CT reveals a Walch B2 glenoid with 25 degrees of retroversion and posterior humeral head subluxation. What is the primary concern with performing a standard anatomic total shoulder arthroplasty with asymmetric anterior glenoid reaming to correct the version?

A 76-year-old female sustains a displaced 4-part proximal humerus fracture. Radiographs demonstrate a disrupted medial calcar hinge with 3 mm of medial metaphyseal extension on the head fragment. She has pre-existing advanced rotator cuff arthropathy. What is the treatment of choice?

A 68-year-old male with massive rotator cuff tear arthropathy presents with an inability to actively elevate his arm and severe external rotation weakness. On physical examination, he has a positive Hornblower's sign and an external rotation lag sign. He is planned for a reverse total shoulder arthroplasty (RTSA). Which of the following is the most appropriate concurrent procedure to optimize his postoperative function?

A 68-year-old female with severe rotator cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (RTSA). To minimize the risk of inferior scapular notching postoperatively, how should the glenosphere ideally be positioned during the procedure?

In a reverse total shoulder arthroplasty (RTSA), medialization and distalization of the center of rotation achieves which of the following biomechanical advantages?

A 65-year-old male has active forward elevation of his right arm to only 45 degrees, though passive elevation is 160 degrees. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus. To determine if a reverse total shoulder arthroplasty (RTSA) is indicated, an injection of local anesthetic into the subacromial space is performed. What is the rationale for this test?

A 72-year-old male with severe rotator cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (RTSA). The surgeon decides to use a lateralized glenosphere construct. Which of the following is a biomechanical consequence of lateralizing the glenosphere in an RTSA?

Which of the following best describes the biomechanical rationale of a reverse total shoulder arthroplasty (RTSA) in the setting of rotator cuff tear arthropathy?

A reverse total shoulder arthroplasty (rTSA) improves active elevation in patients with rotator cuff tear arthropathy primarily through which of the following biomechanical alterations?

A 75-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for a severely displaced 4-part proximal humerus fracture. Compared to a hemiarthroplasty performed for the same indication, RTSA provides which primary functional advantage?

A 70-year-old woman undergoes a reverse total shoulder arthroplasty (rTSA) for cuff tear arthropathy. At her 2-year follow-up, radiographs show a Grade 2 scapular notching. Which of the following surgical design factors or techniques is most effective in minimizing the risk of scapular notching in rTSA?

Scapular notching is a well-recognized radiologic finding following reverse total shoulder arthroplasty (RTSA). Which of the following modifications in glenosphere positioning has been biomechanically and clinically proven to decrease the incidence of inferior scapular notching?

A 62-year-old male is 5 weeks postoperative from a deltopectoral anatomic total shoulder arthroplasty. He reports a sudden 'pop' accompanied by pain and weakness while pushing a heavy door. Physical exam reveals increased passive external rotation compared to the contralateral side and a positive bear-hug test. What is the most appropriate management?

Which design feature of a reverse total shoulder arthroplasty (RTSA) implant most effectively decreases the incidence of scapular notching?

In a reverse total shoulder arthroplasty, the center of rotation is moved medially and distally compared to native anatomy. How does this specific alteration biomechanically affect the deltoid muscle?

In reverse total shoulder arthroplasty (RTSA), inferior scapular notching is a recognized complication. Which of the following baseplate and glenosphere configurations minimizes the risk of this complication?

A 78-year-old female sustains a displaced 4-part proximal humerus fracture. Which of the following factors makes primary reverse total shoulder arthroplasty (RTSA) a more appropriate choice than open reduction internal fixation (ORIF) or anatomic hemiarthroplasty?