Shoulder Arthroplasty & Arthritis MCQs

Scapular notching is a common radiographic finding after reverse total shoulder arthroplasty (RTSA). According to the Sirveaux classification, a notch that extends past the inferior screw of the glenoid baseplate is classified as:

A 70-year-old female presents with new-onset lateral shoulder pain 4 months after undergoing an uncomplicated reverse total shoulder arthroplasty (RTSA). Radiographs demonstrate a Levy Type II acromial stress fracture at the base of the acromion. What is the most appropriate initial management?

A 72-year-old male who underwent a reverse total shoulder arthroplasty (RTSA) returns for his 3-year follow-up. Radiographs demonstrate a Sirveaux grade 3 scapular notch. Which surgical technique during the initial index procedure would have most effectively decreased the risk of this complication?

A 68-year-old female undergoes a reverse total shoulder arthroplasty (RTSA). Six weeks postoperatively, she presents to the emergency department with an anterior dislocation of the prosthesis. Which of the following is considered the most significant mechanical risk factor for instability following a RTSA?

A 74-year-old male presents with pseudoparalysis of the shoulder and a massive, irreparable rotator cuff tear involving the supraspinatus, infraspinatus, and teres minor. Clinical exam reveals a positive Hornblower's sign. Which of the following is the most appropriate surgical intervention to optimize his functional outcome?

To minimize the risk of inferior scapular notching during a reverse total shoulder arthroplasty (RTSA), how should the glenosphere ideally be positioned?

A 65-year-old male undergoes anatomic total shoulder arthroplasty. Six weeks postoperatively, he complains of anterior shoulder pain and weakness in internal rotation. Exam shows a positive belly-press test and increased anterior translation. What is the most reliable definitive management for a confirmed complete avulsion of the subscapularis in this setting?

A 72-year-old male with massive, irreparable posterosuperior rotator cuff tear pseudoparalysis exhibits a positive hornblower's sign and severe drop sign. He is planned for a reverse total shoulder arthroplasty (RTSA). Which adjunctive procedure should be considered to optimize his functional outcome?

A 68-year-old male presents with severe, chronic shoulder pain and pseudoparalysis of active elevation. MRI reveals a massive, retracted tear of the supraspinatus and infraspinatus tendons with severe fatty infiltration (Goutallier stage 4) and superior migration of the humeral head. He has an intact, functioning deltoid muscle. Which surgical intervention provides the most reliable restoration of active elevation and pain relief?

When performing a reverse total shoulder arthroplasty for rotator cuff tear arthropathy, moving the center of rotation medially and inferiorly relative to the native anatomy accomplishes which of the following mechanical advantages?

A 72-year-old female with cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (rTSA) using a Grammont-style prosthesis.

How does this classic implant design primarily alter the biomechanics of the shoulder to improve active elevation?

A 72-year-old female undergoes a reverse total shoulder arthroplasty (rTSA) for massive, irreparable cuff tear arthropathy.

By medializing and distalizing the center of rotation (COR), which of the following primary biomechanical advantages is achieved?

A 48-year-old electrician presents with worsening bilateral shoulder pain and weakness, particularly with overhead activities. He reports chronic symptoms that have been progressive over several years. Physical examination reveals bilateral atrophy of the infraspinatus and supraspinatus muscles, marked weakness in external rotation and abduction, and positive 'horn blower's sign' on the right. MRI of the right shoulder confirms a massive, irreparable rotator cuff tear with significant fatty infiltration and retraction of the supraspinatus and infraspinatus tendons, and superior migration of the humeral head. What is the MOST appropriate surgical management option for this patient?

A 75-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for rotator cuff tear arthropathy. Six months postoperatively, she presents with persistent shoulder pain, weakness, and a positive 'drop arm' sign. X-rays show no signs of loosening or infection. Physical examination reveals impaired active external rotation. What is the MOST likely cause of her persistent symptoms and functional deficit?

A 65-year-old female presents with chronic shoulder pain, night pain, and weakness in elevation and external rotation. She reports difficulty lifting her arm above 90 degrees. MRI shows a massive, irreparable rotator cuff tear involving the supraspinatus, infraspinatus, and subscapularis, with significant humeral head superior migration (rotator cuff tear arthropathy). Which of the following procedures is MOST appropriate to restore function and relieve pain?

A 72-year-old female undergoes a reverse total shoulder arthroplasty for rotator cuff tear arthropathy. Postoperatively, what glenosphere positioning modification most effectively decreases the risk of scapular notching?

A 72-year-old right-hand-dominant female presents with a severely displaced Neer 4-part proximal humerus fracture. Which of the following is the strongest indication to perform a Reverse Total Shoulder Arthroplasty (RTSA) rather than a Hemiarthroplasty?

A 60-year-old man has a massive, irreparable posterosuperior rotator cuff tear. He has intact subscapularis and teres minor function. He complains primarily of an inability to actively elevate his arm above 40 degrees but has minimal pain (pseudoparalysis). Which of the following is the most appropriate surgical treatment?

A 78-year-old woman with severe osteoporosis presents with a 4-part proximal humerus fracture after a fall. She has a history of severe rotator cuff arthropathy with pseudo-paralysis of the shoulder prior to the injury. What is the most appropriate surgical intervention?