9. Shoulder and Elbow MCQs

A 72-year-old man presents with chronic right shoulder pain and weakness. On physical examination, he has active forward elevation to 45 degrees, which improves to 160 degrees passively. He has a positive external rotation lag sign. Radiographs show a humeroacromial interval of 2 mm and severe glenohumeral osteoarthritis (Hamada grade 4). What is the most appropriate definitive management?

A 22-year-old woman falls on an outstretched hand and presents with lateral elbow pain. Radiographs reveal a displaced shear fracture of the capitellum with extension medially to include the lateral trochlear ridge. According to the Bryan and Morrey classification (with McKee modification), what type of fracture is this?

A 74-year-old woman with a history of osteoporosis and severe glenohumeral osteoarthritis sustains a highly comminuted, displaced 3-part proximal humerus fracture after a mechanical fall. Which of the following surgical interventions is associated with the most predictable pain relief and functional improvement in this specific patient profile?

A 38-year-old construction worker falls from a ladder and sustains a 'terrible triad' injury of the elbow. He is taken to the operating room for surgical stabilization. To optimize stability and functional outcomes, what is the most widely accepted sequence for repairing the injured structures?

A 45-year-old weightlifter feels a sudden 'pop' in his anterior elbow during a heavy biceps curl. Examination demonstrates a positive hook test. He undergoes a single-incision distal biceps tendon repair. Which of the following is the most commonly reported complication specifically associated with this surgical approach?

A 70-year-old man presents with an inability to actively lift his right arm above 45 degrees, though passive motion is full. Radiographs show superior migration of the humeral head, acetabularization of the acromion, and severe glenohumeral joint space narrowing. An MRI confirms massive, retracted tears of the supraspinatus and infraspinatus with Goutallier stage 4 fatty infiltration. What is the most definitive and reliable surgical option for this patient?

A 45-year-old man falls on his outstretched hand and sustains a terrible triad injury of the elbow. He undergoes operative management to restore elbow stability. Assuming a standard lateral approach is utilized, which of the following is the recommended sequence of surgical reconstruction?

A 68-year-old woman with severe glenohumeral osteoarthritis undergoes an anatomic total shoulder arthroplasty (TSA). During the procedure, the subscapularis tendon is peeled from the lesser tuberosity and subsequently repaired. Six months postoperatively, she presents with anterior shoulder pain and sudden weakness in internal rotation after lifting a heavy pot. Radiographs show a well-fixed prosthesis with normal implant position. Which of the following physical examination findings would most likely be positive in this patient?

A 72-year-old man undergoes a reverse total shoulder arthroplasty (RTSA) for massive rotator cuff tear arthropathy. According to Grammont's original biomechanical principles, how does the RTSA prosthesis alter the center of rotation and the deltoid moment arm compared to the native anatomic shoulder?

A 75-year-old female with severe shoulder pseudoparalysis and cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (RTSA). Postoperative radiographs taken 1 year later demonstrate inferior scapular notching. Which of the following surgical technique modifications during the index procedure would have most effectively minimized the risk of this complication?

A 45-year-old male falls from a height and sustains a traumatic elbow dislocation, radial head fracture, and a type II coronoid fracture. During surgical reconstruction, the radial head is replaced, the coronoid is stabilized, and the lateral collateral ligament (LCL) complex is repaired to the lateral epicondyle. Upon intraoperative testing, the elbow remains persistently unstable in extension. What is the most appropriate next step in management?

A 22-year-old female competitive swimmer presents with right arm fatigue, heaviness, and numbness in the medial forearm that worsens with overhead activities. Wright's and Roos provocative tests are positive. Symptoms have been refractory to 6 months of physical therapy, and surgical decompression is planned. Which of the following structures form the borders of the space where the compression most commonly occurs in this condition?

A 34-year-old man falls on an outstretched hand and sustains a coronal shear fracture of the capitellum that extends medially to include the majority of the trochlea (McKee modification Type IV). Which surgical approach and fixation strategy is considered most appropriate for direct visualization and anatomic reconstruction of this specific fracture pattern?

A 42-year-old man falls on an outstretched hand and sustains a posterior elbow dislocation, a radial head fracture, and a coronoid process fracture. During the surgical reconstruction of this "terrible triad" injury, what is the generally recommended sequence of repair to restore elbow stability?

A 68-year-old man presents with chronic right shoulder pain and profound weakness in forward elevation. He is unable to actively elevate his arm above 45 degrees, though passive range of motion is full. MRI demonstrates massive, retracted tears of the supraspinatus and infraspinatus with Goutallier grade 4 fatty infiltration. An anteroposterior radiograph shows severe superior migration of the humeral head with acetabularization of the acromion and an acromiohumeral interval of 2 mm. He has an intact subscapularis and teres minor, but mild glenohumeral osteoarthritis is present. Which of the following is the most appropriate definitive surgical management?

During an elbow dislocation reduction, the orthopedic surgeon must assess the integrity of the ulnar collateral ligament (UCL). Which band of the UCL is the primary restraint to valgus stress throughout the entire range of motion?

Following a radial head fracture, a surgeon must assess the blood supply to the radial head. The primary blood supply to the radial head is derived from which artery?

Which anatomical structure serves as the primary restraint to varus stress of the elbow joint?

A 45-year-old mechanic presents with a 6-month history of lateral elbow pain and gradual onset of weakness in finger and thumb extension. Wrist extension is preserved but exhibits radial deviation. There is no sensory deficit. The surgeon plans a surgical decompression of the posterior interosseous nerve (PIN). The most common site of PIN compression is the Arcade of Frohse. This structure is formed by the proximal aponeurotic edge of which muscle?

Posterolateral rotatory instability (PLRI) of the elbow typically results from an insufficiency of the lateral ulnar collateral ligament (LUCL). To effectively reconstruct this ligament, the surgeon must anatomically recreate its attachments. What are the correct anatomical origin and insertion of the LUCL?