9. Shoulder and Elbow MCQs

When evaluating a patient with recurrent anterior shoulder instability, the primary static restraint to anterior translation must be assessed. At 90 degrees of shoulder abduction and external rotation, which structure is the primary restraint?

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?

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?

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?

During an anterior approach to the elbow for a distal biceps tendon repair, the surgeon must carefully retract the lateral antebrachial cutaneous nerve. Between which two muscles does this nerve typically emerge in the distal arm?

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?

A 20-year-old college baseball pitcher reports the insidious onset of medial elbow pain. Examination reveals medial elbow tenderness, a normal neurologic examination, and no obvious valgus laxity. Plain radiographs are normal. MRI scans are shown in Figures 39a and 39b. Management should consist of

A 32-year-old rugby player presents after an acute anterior shoulder dislocation.

A coronal T2-weighted MRI reveals a J-sign with extravasation of joint fluid inferiorly into the axillary pouch, without detachment of the labrum. What is the most likely diagnosis?

During a routine diagnostic shoulder arthroscopy for mild non-specific pain, the surgeon visualizes a cord-like middle glenohumeral ligament and an absent anterosuperior labrum. The patient has no history of instability. What is the most appropriate management of these specific intra-articular findings?

A 19-year-old collegiate wrestler sustains an acute primary anterior shoulder dislocation. After successful closed reduction, what is the most significant risk factor for recurrent instability in this patient?

A 42-year-old bodybuilder feels a pop in his anterior shoulder during a heavy bench press.

Examination shows loss of the axillary fold and weakness in internal rotation. MRI confirms a complete, retracted rupture of the pectoralis major. Which tendon head is most commonly ruptured in this scenario?

A 28-year-old male presents with acute medial sided elbow pain after throwing a javelin. Examination reveals tenderness distal to the medial epicondyle. The moving valgus stress test is positive. Which band of the ulnar collateral ligament is the primary restraint to valgus stress at 90 degrees of flexion?

A 35-year-old active manual laborer is diagnosed with a massive, retracted, and irreparable posterosuperior rotator cuff tear.

Glenohumeral cartilage is intact without arthropathy. Which of the following is a biomechanically sound, joint-preserving surgical option for restoring external rotation?

A 65-year-old man presents with severe shoulder pain, pseudoparalysis, and an irreparable massive rotator cuff tear. Radiographs show Hamada grade 3 changes (acetabularization of the acromion). Which of the following is the most appropriate definitive surgical treatment?

A 72-year-old woman with pseudoparalysis and severe rotator cuff arthropathy is scheduled for a reverse total shoulder arthroplasty (RTSA). The biomechanical advantage of RTSA relies on shifting the center of rotation in which directions compared to the native shoulder?

A 65-year-old man presents with pseudoparalysis of the right shoulder and a massive, irreparable posterosuperior rotator cuff tear. Anteroposterior radiographs demonstrate an acromiohumeral interval of 3 mm with superior subluxation of the humeral head. Which of the following is the most appropriate definitive surgical treatment?

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?

A 20-year-old collegiate swimmer presents with insidious onset of anterior shoulder pain. Examination reveals a prominent inferior medial scapular border and scapular dyskinesis at rest and during dynamic motion (SICK scapula syndrome). Initial physical therapy should focus on strengthening which of the following muscle groups?

A 20-year-old collegiate tennis player is found to have a 25-degree deficit in glenohumeral internal rotation compared to his non-dominant arm, though his total arc of motion is equivalent bilaterally. He complains of vague posterior shoulder pain. What is the most appropriate first-line treatment?

An 8-year-old boy sustains a supracondylar fracture of the humerus. Six months later, he demonstrates a prominent cubitus varus deformity. What is the primary underlying cause of this malalignment?