9. Shoulder and Elbow MCQs

An 8-year-old boy falls on an outstretched hand and sustains a fracture of the radial neck. Radiographs demonstrate 50 degrees of angulation.

What is the most appropriate initial step in management?

A 76-year-old woman presents with severe right shoulder pain and an inability to actively elevate her arm above 60 degrees. Passive elevation is preserved to 150 degrees. Radiographs demonstrate a superiorly migrated humeral head with articulation against the acromion and severe glenohumeral osteoarthritis. What is the most appropriate definitive surgical management?

A 58-year-old woman sustains a severely displaced 4-part proximal humerus fracture. The humeral head is noted to be entirely devascularized on advanced imaging. When comparing hemiarthroplasty to reverse total shoulder arthroplasty (RTSA) for this patient, RTSA has been shown in the literature to provide which of the following advantages?

In evaluating a patient with suspected acromioclavicular (AC) joint arthritis versus superior labral pathology, the cross-body adduction test is performed. If the AC joint is the primary pain generator, where is the pain most predictably localized during this maneuver?

A 72-year-old man presents with chronic shoulder pain and an inability to actively elevate his arm beyond 40 degrees. Radiographs demonstrate superior migration of the humeral head articulating with the acromion and acetabularization of the coracoacromial arch. The patient is diagnosed with rotator cuff tear arthropathy. What is the most appropriate surgical treatment?

A patient is evaluated 2 years after receiving a reverse total shoulder arthroplasty (RTSA). Radiographs reveal a progressive lucency and bone loss on the inferior scapular neck. What is the primary mechanical cause of this scapular notching?

A 50-year-old woman with poorly controlled type 1 diabetes mellitus presents with a 5-month history of insidious, severe, diffuse shoulder pain and progressive loss of both active and passive range of motion. Examination shows symmetric restriction in all planes. Which clinical phase of adhesive capsulitis is she currently in?

A 70-year-old man presents with an irreparable massive rotator cuff tear. He demonstrates pseudoparalysis with active forward elevation limited to 40 degrees, but his passive range of motion is fully preserved. His deltoid function is intact. What is the most appropriate surgical treatment?

A 72-year-old woman presents with severe shoulder pain and inability to elevate her arm actively past 40 degrees. Radiographs demonstrate superior migration of the humeral head with an acromiohumeral distance of 2 mm and mild glenohumeral osteoarthritis. What is the most appropriate definitive surgical management?

A 28-year-old weightlifter presents with acute anterior shoulder pain and a visible bulge in his arm after a heavy bench press. Examination reveals weakness in adduction and internal rotation. MRI confirms a complete tear of the pectoralis major tendon at its insertion. What is the recommended treatment?

A 78-year-old woman presents with a 4-part proximal humerus fracture. She has severe osteoporosis and a sedentary lifestyle. The fracture involves significant displacement of the tuberosities and valgus impaction of the humeral head. Which of the following is the primary advantage of reverse total shoulder arthroplasty (RTSA) over hemiarthroplasty for this patient?

A 74-year-old woman with severe osteoporosis sustains a 4-part proximal humerus fracture. She has a documented history of a massive, retracted, and irreparable rotator cuff tear on the same side. The most appropriate surgical treatment is:

A 12-year-old pitcher has had a 2-month history of pain in his right dominant shoulder after throwing. He reports that the pain has gradually progressed to the point where he cannot throw without pain. He also notes that the pain now awakens him at night if he has been active. Anti-inflammatory drugs have failed to provide relief. Examination reveals no abnormalities except for some localized tenderness over the proximal humerus. Figures 32a and 32b show radiographs of both shoulders. What is the most likely diagnosis?

A 74-year-old woman presents with severe shoulder pain and an inability to actively elevate her right arm above 45 degrees. Passive forward flexion is 160 degrees. Radiographs demonstrate superior migration of the humeral head with articulation against the acromion, forming an "acetabularized" coracoacromial arch, and severe glenohumeral osteoarthritis (Hamada Grade 3). Which of the following is the most appropriate surgical treatment?

A 24-year-old minor league baseball pitcher presents with posterior shoulder pain during the late-cocking phase of throwing. Examination reveals a 25-degree loss of internal rotation compared to the contralateral side, with intact overall arc of motion. What is the most appropriate initial management?

An 80-year-old woman with a massive, irreparable rotator cuff tear presents with disabling pain and "anterosuperior escape" of the humeral head upon attempted active forward elevation. The loss of which structure is the primary anatomical prerequisite for anterosuperior escape to occur?

A 52-year-old man presents with chronic shoulder pain and pseudoparalysis of elevation. MRI shows a massive, retracted, and fatty-infiltrated supraspinatus and infraspinatus tear, but an intact subscapularis and normal articular cartilage. Which of the following is the most appropriate joint-preserving surgical option?

A 72-year-old female presents with severe right shoulder pain, active forward elevation to 40 degrees, and hornblower's sign. Radiographs show superior migration of the humeral head and bone-on-bone glenohumeral arthritis. What is the most appropriate surgical treatment?

A 25-year-old athlete suffered a traumatic shoulder dislocation. MRI reveals a 'J-sign' on the axial and coronal fluid-sensitive sequences. This finding is pathognomonic for which of the following lesions?

A 72-year-old female presents with chronic shoulder pain, an inability to actively elevate her arm past 45 degrees (pseudoparalysis), and an intact subscapularis. Radiographs show a preserved joint space without glenohumeral arthritis. What is the most reliable surgical option?