Shoulder Arthroplasty & Arthritis MCQs

A 68-year-old woman sustains a severely displaced 4-part proximal humerus fracture. Radiographic evaluation demonstrates a calcar segment of 4 mm and a completely disrupted medial hinge. According to the Hertel criteria, what is the most reliable management option to ensure a predictable functional recovery given her risk of avascular necrosis?

In reverse total shoulder arthroplasty (RTSA), moving the center of rotation medially and distally relative to the native joint serves to:

A 71-year-old man presents with an inability to actively elevate his right arm above 40 degrees. Passive elevation is full. MRI reveals a massive, retracted tear of the supraspinatus and infraspinatus tendons with Goutallier stage 4 fatty infiltration. His deltoid function is intact. What is the most appropriate surgical intervention?

A 75-year-old female presents with a severely comminuted, valgus-impacted 4-part proximal humerus fracture with profound osteopenia. The tuberosities are extensively fragmented. What is the most reliable surgical option to restore active elevation in this patient?

A 74-year-old female presents with severe right shoulder pain, pseudoparalysis, and a massive, irreparable rotator cuff tear. Radiographs show superior migration of the humeral head with an acromiohumeral distance < 2 mm. Which of the following is an absolute prerequisite for a successful Reverse Total Shoulder Arthroplasty (RTSA) in this patient?

A 78-year-old female sustains a Neer three-part proximal humerus fracture after a fall. She is relatively active for her age but has significant comorbidities including diabetes and cardiac disease. Radiographs show significant displacement of the greater tuberosity and surgical neck, but the articular segment appears well-preserved. What is the MOST appropriate initial management strategy?

A 72-year-old woman with pseudoparalysis secondary to severe rotator cuff tear arthropathy is scheduled for a reverse total shoulder arthroplasty (RTSA). During preoperative templating and intraoperative execution, the surgeon intentionally places the glenosphere with an inferior tilt and an eccentric inferior overhang. This specific technique is primarily intended to minimize the risk of which of the following complications?

A 78-year-old female sustains a comminuted 4-part proximal humerus fracture and undergoes a reverse total shoulder arthroplasty (RTSA). During the procedure, the surgeon meticulously repairs the greater and lesser tuberosities around the prosthesis. Successful postoperative radiographic healing of the greater tuberosity to the proximal humeral shaft is most strongly associated with which of the following clinical outcomes?

A 74-year-old female presents 5 years after undergoing a reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy. Radiographs reveal progressive bone loss at the inferior scapular neck that extends medially past the inferior screw of the glenoid baseplate, eroding into the central peg. Based on the Sirveaux classification, what is the grade of this complication, and which surgical design alteration at the time of her index procedure would have MOST likely decreased her risk of developing it?

You are discussing the biomechanics of a reverse total shoulder arthroplasty (RTSA) with a resident.

Which of the following best describes the primary biomechanical advantage conferred by the medialized and distalized center of rotation typical of a Grammont-style reverse shoulder implant?

A 72-year-old man undergoes a reverse total shoulder arthroplasty (rTSA) for massive, irreparable rotator cuff tear arthropathy. Two years later, routine follow-up radiographs reveal grade 3 scapular notching. Which of the following surgical techniques or implant choices would have most likely decreased the incidence of this specific complication?

A 70-year-old woman undergoes reverse total shoulder arthroplasty (RTSA) for massive cuff tear arthropathy. Postoperatively, she has active forward elevation to 135 degrees but reports difficulty eating, drinking, and washing her opposite shoulder. Examination reveals a positive hornblower's sign. Which of the following muscles is most likely deficient and responsible for her functional limitations?

A 78-year-old right-hand-dominant woman sustains a closed right proximal humerus fracture after a mechanical fall. Radiographs demonstrate a 4-part fracture pattern with a head-split component, severe comminution of the tuberosities, and significant osteopenia. She lives independently but leads a sedentary lifestyle. What is the most appropriate surgical management to provide the most predictable pain relief and restoration of forward elevation?

Which of the following component design modifications or surgical techniques in reverse total shoulder arthroplasty has been shown to decrease the incidence of scapular notching?

In reverse total shoulder arthroplasty (RTSA), which of the following glenosphere configurations has been shown to most effectively minimize the risk of scapular notching?

A 72-year-old female undergoes an uncomplicated reverse total shoulder arthroplasty (rTSA) for massive rotator cuff tear arthropathy. Postoperatively, she demonstrates significantly improved forward elevation but exhibits an isolated, severe loss of active external rotation with the arm at the side. Preoperatively, she had a positive hornblower's sign. Deficiency in which of the following muscles is most directly responsible for this specific functional loss following an rTSA?

Scapular notching is a common complication following reverse total shoulder arthroplasty (RTSA). Which of the following component positioning strategies is most effective in minimizing the risk of inferior scapular notching?

A 65-year-old female underwent an anatomic total shoulder arthroplasty (TSA) 6 weeks ago utilizing a standard deltopectoral approach with subscapularis peel and repair. She now complains of increased pain and profound weakness with internal rotation. On examination, she has a positive bear-hug test and increased passive external rotation compared to the contralateral side. What is the most appropriate next step in management?

An 81-year-old, functionally independent female with severe osteoporosis sustains a 4-part proximal humerus fracture with a 'head-splitting' component following a mechanical fall. She reports excruciating pain. What surgical option provides the most predictable restoration of forward elevation and overall functional outcome in this specific patient demographic?

A 72-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for massive rotator cuff tear arthropathy. At her 2-year follow-up, she complains of mild pain, and radiographs demonstrate scapular notching. Which of the following surgical technique modifications or implant choices at the time of the index procedure would have DECREASED her risk of developing this complication?