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Shoulder Pathology MCQs

Practice Set 5 of 12

This practice set contains high-yield board review questions covering key concepts in Shoulder Pathology. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 81

Topic: Shoulder Pathology

A patient presents with medial winging of the scapula after a traumatic injury. The injured nerve originates from which of the following roots of the brachial plexus?

. C5-C6-C7
. C8-T1
. C5-C6
. C7-C8-T1
. C4-C5

Correct Answer & Explanation

. C5-C6-C7

Explanation

Medial winging of the scapula is caused by paralysis of the serratus anterior muscle due to injury of the long thoracic nerve. The long thoracic nerve originates from the anterior rami of the C5, C6, and C7 nerve roots.

Question 82

Topic: Shoulder Pathology

A patient presents with winged scapula following a breast lumpectomy and axillary node dissection. The affected nerve innervates which of the following muscles?

. Rhomboid major
. Trapezius
. Serratus anterior
. Latissimus dorsi
. Levator scapulae

Correct Answer & Explanation

. Serratus anterior

Explanation

The long thoracic nerve innervates the serratus anterior muscle. Injury to this nerve leads to medial scapular winging.

Question 83

Topic: Shoulder Pathology

In the evaluation of a patient with scapular winging, physical examination reveals medial prominence of the scapula when pushing against a wall. Injury to which nerve is the most likely cause?

. Spinal accessory nerve
. Long thoracic nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Thoracodorsal nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

Medial scapular winging is caused by serratus anterior weakness, which is innervated by the long thoracic nerve. Lateral winging is typically due to trapezius dysfunction, which is innervated by the spinal accessory nerve.

Question 84

Topic: Shoulder Pathology
A 25-year-old hockey player sustains a grade III acromioclavicular (AC) joint separation. If nonoperative management is chosen, what is the most likely long-term clinical outcome compared to early operative fixation?
. Higher rate of symptomatic AC joint arthritis
. No significant difference in objective strength and functional scores
. Significantly decreased overhead range of motion
. Higher risk of neurovascular compromise
. Increased risk of adhesive capsulitis

Correct Answer & Explanation

. No significant difference in objective strength and functional scores

Explanation

Studies comparing operative versus nonoperative treatment for Grade III AC joint separations show no significant long-term differences in functional outcomes, strength, or return to play. However, operative management carries higher risks of complications such as hardware failure and infection.

Question 85

Topic: Shoulder Pathology

A 28-year-old bodybuilder complains of vague shoulder weakness. Physical examination demonstrates prominent medial winging of the scapula when the patient performs a wall push-up. Which nerve is most likely injured?

. Long thoracic nerve
. Spinal accessory nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Axillary nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

Medial winging of the scapula is caused by paralysis or weakness of the serratus anterior muscle. The serratus anterior is innervated by the long thoracic nerve, and this deficit is classically highlighted during a wall push-up.

Question 86

Topic: Shoulder Pathology

A 34-year-old female hairdresser presents with paresthesias in her medial forearm and hand, worsening when she works with her arms elevated. She is diagnosed with neurogenic thoracic outlet syndrome. Compression of the brachial plexus most commonly occurs at which of the following anatomical locations?

. Between the anterior and middle scalene muscles
. Between the middle and posterior scalene muscles
. Deep to the pectoralis major muscle
. At the spiral groove of the humerus
. Within the cubital tunnel

Correct Answer & Explanation

. Between the anterior and middle scalene muscles

Explanation

Neurogenic thoracic outlet syndrome most frequently results from compression of the brachial plexus roots or trunks within the interscalene triangle. This space is bordered by the anterior scalene, middle scalene, and the first rib.

Question 87

Topic: Shoulder Pathology

A 28-year-old weightlifter presents with a dull ache in his right shoulder and noticeable weakness. On examination, performing a wall push-up causes his right scapula to exhibit significant medial winging. Injury to which of the following nerves is the primary cause of this finding?

. Spinal accessory nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Long thoracic nerve
. Axillary nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

Medial winging of the scapula is caused by serratus anterior muscle weakness, which is innervated by the long thoracic nerve. Lateral winging, in contrast, is typically associated with trapezius weakness due to a spinal accessory nerve injury.

Question 88

Topic: Shoulder Pathology

Thoracic outlet syndrome commonly involves compression within the interscalene triangle. Which of the following structures pass through the interscalene triangle?

. Subclavian vein and brachial plexus
. Subclavian artery and brachial plexus
. Subclavian artery, subclavian vein, and brachial plexus
. Subclavian vein and phrenic nerve
. Subclavian artery and vagus nerve

Correct Answer & Explanation

. Subclavian vein and brachial plexus

Explanation

The interscalene triangle is bordered by the anterior scalene, middle scalene, and the first rib. It contains the subclavian artery and the roots/trunks of the brachial plexus. The subclavian vein runs anterior to the anterior scalene muscle.

Question 89

Topic: Shoulder Pathology

A patient presents with shoulder weakness after a superficial lymph node biopsy in the posterior triangle of the neck. Examination shows a prominent medial border of the scapula with lateral translation and an inability to abduct the arm past 90 degrees. Which nerve was most likely injured?

. Long thoracic nerve
. Spinal accessory nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Axillary nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

The spinal accessory nerve (CN XI) runs superficially in the posterior triangle of the neck and is vulnerable during minor procedures. Injury paralyzes the trapezius, causing lateral winging of the scapula and difficulty elevating the arm past 90 degrees.

Question 90

Topic: Shoulder Pathology

A 45-year-old patient presents with lateral winging of the scapula and inability to shrug the shoulder following a lymph node biopsy in the posterior triangle of the neck. Which of the following muscles has most likely been denervated?

. Serratus anterior
. Rhomboid major
. Trapezius
. Levator scapulae
. Latissimus dorsi

Correct Answer & Explanation

. Serratus anterior

Explanation

The spinal accessory nerve (CN XI) courses through the posterior triangle of the neck to innervate the trapezius muscle. Injury to this nerve causes lateral scapular winging and weakness in shoulder elevation.

Question 91

Topic: Shoulder Pathology

In a patient with neurogenic thoracic outlet syndrome caused by a cervical rib, the lower trunk of the brachial plexus is commonly compressed. This lower trunk is formed by the union of which nerve roots?

. C8 and T1
. C5 and C6
. C7 only
. C6, C7, and C8
. C5, C6, and C7

Correct Answer & Explanation

. C8 and T1

Explanation

The lower trunk of the brachial plexus is formed by the union of the C8 and T1 ventral rami. Compression of the lower trunk typically yields ulnar-sided hand symptoms and intrinsic muscle wasting.

Question 92

Topic: Shoulder Pathology

A 45-year-old woman presents with shoulder pain and an inability to elevate her arm above 90 degrees following a lymph node biopsy in the posterior cervical triangle. Examination reveals lateral winging of the scapula. Which of the following muscles is primarily denervated?

. Serratus anterior
. Trapezius
. Rhomboid major
. Levator scapulae
. Latissimus dorsi

Correct Answer & Explanation

. Serratus anterior

Explanation

The spinal accessory nerve (CN XI) innervates the trapezius and is at risk during procedures in the posterior cervical triangle. Injury leads to lateral winging of the scapula and profound difficulty with overhead elevation.

Question 93

Topic: Shoulder Pathology

A 25-year-old athlete presents with medial winging of the scapula after a traction injury to the shoulder. Which nerve is most likely injured, and what are its contributing nerve roots?

. Spinal accessory nerve; CN XI
. Long thoracic nerve; C5, C6, C7
. Dorsal scapular nerve; C5
. Suprascapular nerve; C5, C6
. Thoracodorsal nerve; C6, C7, C8

Correct Answer & Explanation

. Spinal accessory nerve; CN XI

Explanation

Medial winging of the scapula is caused by paralysis of the serratus anterior muscle. This muscle is innervated by the long thoracic nerve, which arises from the C5, C6, and C7 nerve roots.

Question 94

Topic: Shoulder Pathology

Following a radical mastectomy, a patient presents with a noticeable "winging" of the scapula with arm elevation. The injured nerve originates from which of the following brachial plexus segments?

. C5, C6, C7 roots
. Upper and middle trunks
. Posterior cord
. Lateral cord
. C8, T1 roots

Correct Answer & Explanation

. C5, C6, C7 roots

Explanation

A winged scapula in this context is typically caused by injury to the long thoracic nerve, which innervates the serratus anterior. This nerve originates directly from the ventral rami of the C5, C6, and C7 nerve roots.

Question 95

Topic: Shoulder Pathology

A patient presents with medial winging of the scapula after an axillary node dissection, indicating injury to the long thoracic nerve. From which cervical nerve roots does this nerve originate?

. C5, C6
. C5, C6, C7
. C6, C7, C8
. C7, C8, T1
. C8, T1

Correct Answer & Explanation

. C5, C6

Explanation

The long thoracic nerve innervates the serratus anterior muscle and is formed by the ventral rami of the C5, C6, and C7 cervical nerve roots.

Question 96

Topic: Shoulder Pathology

A 35-year-old patient undergoes a lymph node biopsy in the posterior triangle of the neck. Postoperatively, the patient is unable to abduct the arm past 90 degrees and demonstrates scapular winging. Injury to which of the following nerves is the most likely cause?

. Long thoracic nerve
. Spinal accessory nerve
. Suprascapular nerve
. Axillary nerve
. Dorsal scapular nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

The spinal accessory nerve (CN XI) innervates the trapezius and is highly vulnerable during procedures in the posterior cervical triangle. Trapezius palsy leads to lateral scapular winging and inability to actively abduct the shoulder past 90 degrees.

Question 97

Topic: Shoulder Pathology

A 21-year-old gymnast presents with medial scapular winging. The inferior medial border of the scapula becomes extremely prominent when she pushes against a wall. Which muscle and nerve combination are primarily affected?

. Trapezius; Spinal accessory nerve
. Serratus anterior; Long thoracic nerve
. Rhomboids; Dorsal scapular nerve
. Latissimus dorsi; Thoracodorsal nerve

Correct Answer & Explanation

. Trapezius; Spinal accessory nerve

Explanation

Classic medial winging of the scapula, especially pronounced with forward elevation or wall push-ups, is caused by weakness or paralysis of the serratus anterior muscle. This muscle is innervated by the long thoracic nerve.

Question 98

Topic: Shoulder Pathology

A 22-year-old football player sustains a blunt injury to the posterolateral neck and subsequently develops classic medial winging of the scapula. The injured nerve originates directly from which of the following neural structures?

. Ventral rami of C5, C6, C7
. Upper trunk of the brachial plexus
. Lateral cord of the brachial plexus
. Posterior cord of the brachial plexus
. Ventral rami of C8, T1

Correct Answer & Explanation

. Ventral rami of C5, C6, C7

Explanation

Medial winging of the scapula results from paralysis of the serratus anterior muscle. This muscle is innervated by the long thoracic nerve, which originates directly from the ventral rami of C5, C6, and C7 before the formation of the trunks.

Question 99

Topic: Shoulder Pathology

A 52-year-old woman presents with isolated medial scapular winging that is significantly accentuated when she pushes against a wall with her arms forward. She has a history of an axillary lymph node dissection. Injury to which of the following nerves is the primary cause of her deficit?

. Spinal accessory nerve
. Long thoracic nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Thoracodorsal nerve

Correct Answer & Explanation

. Spinal accessory nerve

Explanation

Medial scapular winging is classically caused by serratus anterior muscle paralysis due to long thoracic nerve injury. Lateral winging is typically caused by trapezius paralysis secondary to spinal accessory nerve injury.

Question 100

Topic: Shoulder Pathology

A patient presents with winging of the scapula characterized by medial translation of the inferior pole during active wall push-ups. Which nerve is most likely injured, and what is its segmental origin?

. Long thoracic nerve (C5, C6, C7)
. Spinal accessory nerve (CN XI)
. Dorsal scapular nerve (C5)
. Suprascapular nerve (C5, C6)
. Thoracodorsal nerve (C6, C7, C8)

Correct Answer & Explanation

. Long thoracic nerve (C5, C6, C7)

Explanation

Medial winging of the scapula is caused by paralysis of the serratus anterior, which is innervated by the long thoracic nerve (roots C5, C6, C7). Lateral winging is typically associated with spinal accessory nerve (trapezius) injury.

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