9. Shoulder and Elbow MCQs

A 40-year-old male with recurrent anterior shoulder dislocations undergoes an MRI arthrogram. The radiologist notes a 'J-sign' in the axillary pouch. This imaging finding is characteristic of which pathology?

A 52-year-old male presents with anterior shoulder pain characterized by a 'clunking' sensation when moving the arm into forward elevation and internal rotation. MRI reveals a narrowed distance of 4 mm between the coracoid process and the lesser tuberosity. What is the most likely diagnosis?

Which of the following structures constitutes the primary restraint to anterior translation of the humeral head with the arm in 90 degrees of abduction and 90 degrees of external rotation?

In the evaluation of glenohumeral instability, which of the following precisely describes an ALPSA lesion?

A 20-year-old man with fascioscapulohumeral dystrophy has severe scapular winging of both shoulders. He can no longer abduct above 80 degrees, and it affects his activities of daily living. A clinical photograph is shown in Figure 26. Definitive management should consist of

A 55-year-old man falls on an outstretched arm and experiences a popping sensation in his right shoulder. On exam, he has increased passive external rotation compared to the contralateral side and weakness on the belly-press test. MRI confirms an isolated, complete tear of the subscapularis tendon. What is the most appropriate initial management?

A 70-year-old woman presents with chronic, severe right shoulder pain and an inability to actively elevate her arm past 60 degrees (pseudoparalysis). Radiographs demonstrate superior migration of the humeral head with an acromiohumeral interval of 2 mm. MRI confirms massive, retracted tears of the supraspinatus and infraspinatus with fatty infiltration. What is the treatment of choice?

A 35-year-old man presents to the emergency department with shoulder pain after a generalized seizure. His arm is locked in adduction and internal rotation, with essentially no passive external rotation possible. An AP radiograph shows a 'lightbulb' sign. Which imaging view is most critical to confirm the diagnosis?

A 72-year-old male presents with long-standing shoulder pain and an inability to actively elevate his arm above 45 degrees. Radiographs demonstrate an acromiohumeral distance of 3 mm.

MRI reveals massive, retracted supraspinatus and infraspinatus tears with grade 4 fatty infiltration. What is the most appropriate surgical treatment?

A 72-year-old right-hand-dominant woman sustains a minimally displaced 2-part surgical neck fracture of the proximal humerus. She lives alone and has well-controlled diabetes. What is the most appropriate initial management?

A 24-year-old swimmer presents with anterior shoulder pain and apprehension. An MR arthrogram demonstrates a "J-sign" with extravasation of contrast inferiorly. What is the most likely diagnosis?

A 78-year-old female undergoes a reverse total shoulder arthroplasty for a severely comminuted 4-part proximal humerus fracture. What is the most critical surgical step for ensuring optimal functional external rotation and joint stability?

A 19-year-old gymnast presents with bilateral shoulder pain and multidirectional instability. On examination, she has a positive sulcus sign that does not diminish when the arm is placed in external rotation. This finding specifically indicates incompetence of which of the following structures?

A 35-year-old skier sustains an acute shoulder dislocation and presents with continued apprehension and instability. An MRI arthrogram reveals extravasation of contrast inferiorly into the axillary pouch, demonstrating a classic "J-sign". What is the most likely diagnosis?

A 72-year-old man presents with chronic shoulder pain and inability to actively elevate his arm above 45 degrees, though passive ROM is full. MRI shows massive, retracted tears of the supraspinatus and infraspinatus with Goutallier grade 4 fatty infiltration. What is the best treatment option?

When treating a 4-part proximal humerus fracture in an elderly patient with a reverse total shoulder arthroplasty, which of the following factors is most critical for achieving active external rotation postoperatively?

Which of the following best describes the fundamental biomechanical alteration achieved by a classic Grammont-style reverse total shoulder arthroplasty in a patient with advanced rotator cuff arthropathy?

A 28-year-old male sustains a shoulder dislocation and subsequent recurrent instability. An MRI arthrogram demonstrates extravasation of contrast into the axillary pouch in a U-shape, replacing the normal V-shaped axillary recess. What is the most likely diagnosis?

An 72-year-old woman presents with severe shoulder pain and inability to actively elevate her arm above 50 degrees. Radiographs demonstrate severe superior migration of the humeral head with articulation directly against the acromion, with subchondral sclerosis but no significant glenohumeral osteoarthritis. What is the most appropriate definitive surgical management?

A 75-year-old woman sustains a highly comminuted 4-part proximal humerus fracture. She lives independently and is highly active. Radiographs show significant displacement of the tuberosities and a high likelihood of humeral head ischemia. Which of the following surgical options offers the most predictable return of forward elevation?