9. Shoulder and Elbow MCQs

An 81-year-old, functionally independent female with severe osteoporosis sustains a 4-part proximal humerus fracture with a 'head-splitting' component following a mechanical fall. She reports excruciating pain. What surgical option provides the most predictable restoration of forward elevation and overall functional outcome in this specific patient demographic?

A 40-year-old man falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. Which of the following correctly outlines the standard surgical sequence to optimally restore elbow stability?

A 42-year-old male weightlifter feels a pop in his anterior elbow while performing a heavy deadlift. Clinical examination reveals a positive Hook test. If surgical repair of the ruptured distal biceps tendon is performed via a single anterior incision technique, which of the following nerves is at the highest risk of iatrogenic injury?

A 72-year-old man undergoes a reverse total shoulder arthroplasty (RTSA) for massive rotator cuff tear arthropathy. Biomechanically, how does this prosthesis alter the center of rotation of the glenohumeral joint to improve active elevation?

A 72-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for massive rotator cuff tear arthropathy. At her 2-year follow-up, she complains of mild pain, and radiographs demonstrate scapular notching. Which of the following surgical technique modifications or implant choices at the time of the index procedure would have DECREASED her risk of developing this complication?

A 45-year-old man falls on an outstretched hand and sustains a 'terrible triad' injury to his elbow. Intraoperatively, the coronoid fracture is fixed with a suture lasso technique, and the radial head fracture undergoes open reduction and internal fixation. Following this, the lateral ulnar collateral ligament (LUCL) is anatomically repaired to the lateral epicondyle. During examination under anesthesia, the elbow still subluxates posteriorly at 30 degrees of flexion. What is the most appropriate next step in management?

A 45-year-old competitive weightlifter feels a sudden, painful 'pop' in his anterior elbow while performing heavy bicep curls. Examination reveals a 'Popeye' deformity and significant weakness in forearm supination. He undergoes a distal biceps tendon repair using a traditional two-incision technique. Compared to a single anterior incision approach, which of the following complications is significantly more likely with the two-incision technique?

A 35-year-old woman falls on an outstretched hand and sustains a complex elbow injury. Radiographs and CT scan demonstrate a posterior elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture. Following closed reduction, the elbow remains grossly unstable. During open surgical reconstruction, what is the most widely accepted sequence of fixation to restore elbow stability?

A 74-year-old woman presents with severe shoulder pain after a mechanical fall. Radiographs demonstrate a displaced 4-part proximal humerus fracture with severe comminution of the tuberosities. Her medical history is significant for chronic pseudoparalysis of the affected shoulder secondary to a known, massive, irreparable rotator cuff tear. What is the most appropriate surgical management?

A 35-year-old man falls from a height and sustains a traumatic elbow dislocation. After closed reduction, radiographs reveal a displaced radial head fracture, a small type 1 coronoid tip fracture, and a lateral collateral ligament (LCL) tear. He is scheduled for operative fixation. What is the standard and most appropriate sequence of surgical repair for this 'terrible triad' injury?

A 72-year-old woman with a history of osteoporosis sustains a severely comminuted 4-part proximal humerus fracture. A reverse total shoulder arthroplasty (RTSA) is planned. To optimize outcomes and restore appropriate deltoid tension, which of the following landmarks is most critical for determining the correct height of the humeral prosthesis?

A 42-year-old bodybuilder feels a 'pop' in his anterior elbow while lifting a heavy object, presenting with an abnormal contour of the biceps muscle belly and weakness in supination. He undergoes a 2-incision surgical repair of the distal biceps tendon. Which of the following complications is most specifically associated with the 2-incision technique compared to a single anterior incision technique?

A 19-year-old pitcher presents with medial elbow pain during the late cocking phase of throwing. MRI arthrogram shows a partial tear of the ulnar collateral ligament (UCL) anterior bundle. After failing nonoperative management, he undergoes surgical reconstruction. What is the precise anatomical insertion site for the graft on the ulna during a standard UCL reconstruction?

A 38-year-old woman falls on an outstretched hand and sustains a 'terrible triad' injury to her right elbow. Which of the following represents the most appropriate sequence of surgical reconstruction to effectively restore joint stability?

A 72-year-old right-hand-dominant woman sustains a 4-part proximal humerus fracture after a ground-level fall. Radiographs show a valgus impacted fracture pattern with disruption of the medial hinge and 1.5 cm of medial translation of the humeral shaft. She has pre-existing advanced glenohumeral osteoarthritis and a documented massive, irreparable rotator cuff tear. What is the most reliable surgical option for pain relief and functional restoration in this patient?

A 40-year-old patient undergoes surgical management for a 'terrible triad' injury of the elbow. A lateral approach is utilized. The coronoid fracture (Type 1) is repaired with a capsule suture lasso, the comminuted radial head is replaced, and the lateral ulnar collateral ligament (LUCL) is repaired to the lateral epicondyle. Following these steps, fluoroscopic evaluation reveals that the elbow remains persistently unstable and subluxates symmetrically at 45 degrees of flexion. What is the most appropriate next step in management?

A 72-year-old right-hand-dominant woman sustains a 4-part proximal humerus fracture. Her medical history includes severe rotator cuff arthropathy with a massive, irreparable rotator cuff tear diagnosed prior to the injury. Which of the following is the most appropriate surgical treatment?

A 6-year-old boy sustains a Bado Type I Monteggia fracture-dislocation. Radiographs show a plastic deformation of the ulna and an anterior dislocation of the radial head. During closed reduction, the radial head reduces when the forearm is supinated and the elbow is flexed, but it repeatedly subluxates upon pronation. What is the most critical step to ensure stable maintenance of the radial head reduction?

A 40-year-old weightlifter feels a 'pop' in his anterior elbow during a heavy deadlift, followed by ecchymosis and weakness in forearm supination. He undergoes surgical repair of a distal biceps tendon rupture using a single-incision anterior approach. Postoperatively, he reports isolated numbness over the lateral aspect of his forearm. Which of the following nerves was most likely injured during the surgical exposure?

A 40-year-old man sustains a terrible triad injury to his left elbow following a fall from a height. Intraoperatively, through a lateral approach, the radial head is replaced and the coronoid fracture is anatomically fixed. However, during range of motion testing, the elbow tends to subluxate posteriorly when brought into extension. Which of the following structures must be addressed next to restore stability?