9. Shoulder and Elbow MCQs

A 40-year-old man presents with right shoulder weakness 3 weeks after a motor vehicle collision. He complains of pain at the base of his neck and shoulder. On physical examination, forward flexion of the arm against resistance results in medial translation and prominent winging of the scapula. Injury to which of the following nerves is the most likely cause?

A 74-year-old man presents with pseudoparalysis of the right shoulder and severe glenohumeral osteoarthritis.

Which of the following biomechanical changes is achieved by the most appropriate surgical treatment for this condition?

A 28-year-old woman presents with isolated lateral scapular winging that worsens when she abducts her arm against resistance. She had a cervical lymph node biopsy 3 months ago. What is the most appropriate initial management?

During an arthroscopic rotator cuff repair, the surgeon evaluates the long head of the biceps tendon for instability. Which of the following structures forms the primary medial restraint to medial subluxation of the biceps tendon within the bicipital groove?

A 72-year-old man presents with pseudoparalysis of the shoulder and chronic massive, irreparable tears of the supraspinatus and infraspinatus. His teres minor and subscapularis are intact. Radiographs show severe glenohumeral osteoarthritis with superior migration of the humeral head. What is the treatment of choice?

A 28-year-old tennis player complains of shoulder weakness. On examination, there is lateral winging of the scapula, especially with attempted shoulder abduction. Which nerve is most likely injured?

A 75-year-old female presents with chronic right shoulder pain, inability to actively elevate her arm past 40 degrees, and normal passive range of motion. Radiographs demonstrate severe glenohumeral osteoarthritis with superior migration of the humeral head articulating with the acromion. Which of the following is the most appropriate definitive surgical management?

A 68-year-old female sustains a comminuted 4-part proximal humerus fracture after a ground-level fall. She has poor bone quality and severe comminution of the tuberosities.

Which of the following treatments provides the most predictable improvement in forward elevation?

Which of the following glenoid morphologies (Walch classification) in the setting of primary osteoarthritis is characterized by a biconcave surface and posterior subluxation of the humeral head, and carries the highest risk of early glenoid component loosening in anatomic total shoulder arthroplasty?

A 30-year-old competitive weightlifter felt a sudden "pop" in his anterior shoulder while performing a heavy bench press. He now has significant ecchymosis on his proximal arm and loss of the anterior axillary fold contour. The vast majority of these injuries occur at which anatomic location?

A 45-year-old female underwent a lymph node biopsy in the posterior triangle of her neck 3 weeks ago. She now complains of a severe ache in her shoulder and difficulty lifting her arm overhead. Physical examination reveals lateral winging of the scapula. Which nerve was most likely injured?

A 50-year-old female with poorly controlled type II diabetes presents with an insidious onset of severe diffuse shoulder pain and a profound loss of both active and passive motion, particularly external rotation. Radiographs are normal. What is the most likely diagnosis?

A 78-year-old female with osteoporosis sustains a highly comminuted 4-part proximal humerus fracture with a split humeral head.

What is the most appropriate surgical management to maximize her functional outcome?

A 75-year-old man presents with chronic right 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 tears of the supraspinatus and infraspinatus with grade 4 fatty infiltration, while the subscapularis and deltoid are intact. What is the most appropriate surgical treatment?

A 45-year-old woman undergoes arthroscopy for persistent anterior shoulder pain. The surgeon notes medial subluxation of the long head of the biceps tendon and a tear of the coracohumeral ligament. Which of the following additional structures must be torn to allow this biceps subluxation?

A 68-year-old woman with severe osteoporosis sustains a 4-part proximal humerus fracture with a head-split component. She is functionally independent and active. What is the most appropriate treatment to optimize her functional outcome and minimize complications?

A 25-year-old man presents with an acute anterior shoulder dislocation. After reduction, an MR arthrogram reveals disruption of the inferior glenohumeral ligament at its insertion onto the anatomic neck of the humerus, with contrast leaking into the axillary pouch. What is this lesion called?

During biomechanical testing of the glenohumeral joint, which capsuloligamentous structure is the primary restraint to anterior translation when the arm is positioned in 90 degrees of abduction and maximum external rotation?

A 75-year-old female sustains a comminuted 4-part proximal humerus fracture with severe osteoporosis and poor tuberosity bone quality. What is the most reliable surgical option to restore active elevation?

In a patient with a massive, chronic rotator cuff tear, which structure becomes the primary static restraint to anterosuperior translation of the humeral head?