9. Shoulder and Elbow MCQs

A 72-year-old man presents with chronic, severe right shoulder pain and an inability to actively elevate his arm past 40 degrees. Radiographs demonstrate superior migration of the humeral head with acromiohumeral articulation and severe glenohumeral osteoarthritis. MRI shows a massive, retracted supraspinatus and infraspinatus tear. What is the optimal surgical treatment?

A 72-year-old woman presents with severe shoulder pain, active forward elevation to 50 degrees, and a positive drop arm test. Radiographs show a superiorly migrated humeral head with severe glenohumeral osteoarthritis. MRI confirms a massive, retracted rotator cuff tear with grade 4 fatty infiltration. What is the most appropriate treatment?

Reverse total shoulder arthroplasty (RTSA) is highly effective for patients with rotator cuff arthropathy. Which of the following best describes the primary biomechanical advantage of RTSA compared to anatomic total shoulder arthroplasty?

A 74-year-old man presents with chronic, severe shoulder pain and pseudoparalysis of the right arm. Examination demonstrates active forward elevation to 40 degrees and intact axillary nerve function.

Radiographs show severe superior migration of the humeral head with acetabularization of the acromion. What is the most appropriate surgical treatment?

A 42-year-old woman presents to the clinic with acute, extremely severe, burning shoulder pain that started spontaneously 2 weeks ago. The pain has now decreased, but she has developed profound weakness in shoulder abduction and external rotation. EMG demonstrates acute denervation. What is the most likely diagnosis?

A 50-year-old woman with severe adhesive capsulitis undergoes arthroscopic capsular release. The surgeon carefully releases the thickened structures within the rotator interval. Which of the following is NOT a normal anatomic component of the rotator interval?

A 30-year-old recreational skier presents with persistent anterior shoulder instability. An MRI arthrogram reveals extravasation of contrast into the axilla and a "J-sign" replacing the normal U-shaped inferior glenohumeral recess. What is the diagnosis?

A 74-year-old female presents with severe right shoulder pain, pseudoparalysis, and a massive, irreparable rotator cuff tear. Radiographs show superior migration of the humeral head with an acromiohumeral distance < 2 mm. Which of the following is an absolute prerequisite for a successful Reverse Total Shoulder Arthroplasty (RTSA) in this patient?

A 35-year-old laborer presents with persistent superior shoulder pain and impingement symptoms. An axillary radiograph reveals an unfused acromial apophysis (meso-acromiale) that is mobile on physical examination. After failing 6 months of conservative management, what is the recommended surgical intervention?

During the late cocking phase of throwing, the shoulder is maximally abducted and externally rotated. Which structural component is the primary restraint to anterior glenohumeral translation in this specific position?

Reconstruction of the medial ulnar collateral ligament (MUCL) of the elbow typically targets the anterior bundle. The anterior bundle is the primary restraint to valgus stress at which of the following elbow flexion angles?

A 22-year-old baseball pitcher presents with anterior shoulder pain and apprehension. Biomechanical evaluation of the glenohumeral joint during the late cocking phase of throwing (90 degrees of abduction and maximal external rotation) demonstrates that anterior translation is primarily restrained by which structure?

A 24-year-old overhead athlete presents with recurrent anterior shoulder instability. Biomechanical testing demonstrates maximum instability when the arm is positioned in 90 degrees of abduction and maximum external rotation. Which specific structure is the primary restraint to anterior translation in this position?

When designing a hinged external fixator for a complex elbow fracture-dislocation, precise alignment of the fixator axis is critical. The instant center of rotation of the normal ulnohumeral joint is best described as:

A 24-year-old overhead throwing athlete presents with anterior shoulder instability. The physical examination reveals apprehension when the shoulder is placed in 90 degrees of abduction and maximum external rotation. Which ligamentous structure is the primary restraint to anterior translation in this specific position?

A 24-year-old baseball pitcher presents with right upper extremity numbness and fatigue. Examination reveals a diminished radial pulse with shoulder hyperabduction. The compression is clinically suspected to occur within the interscalene triangle. Which of the following structures is most likely NOT compressed in this specific space?

During surgical decompression for recalcitrant intersection syndrome, the surgeon identifies intense tenosynovitis at the crossing point of two muscle bellies over two underlying tendons. The muscle bellies involved in this pathology belong to the:

A patient is evaluated for posterolateral rotatory instability (PLRI) of the elbow following a dislocation. This condition is primarily associated with incompetence of the lateral ulnar collateral ligament (LUCL). What is the exact distal insertion site of the LUCL?

A patient presents with pronounced medial winging of the scapula after a direct blow to the lateral chest wall. The injured nerve originates from which of the following brachial plexus structures?

During a posterior cervical foraminotomy at C5-C6, the surgeon aggressively retracts the lateral aspect of the facet joint. Which of the following anatomical structures is most at risk of iatrogenic injury in the extraforaminal space?