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9. Shoulder and Elbow MCQs

Practice Set 12 of 197

This practice set contains high-yield board review questions covering key concepts in 9. Shoulder and Elbow. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 221

Topic: 9. Shoulder and Elbow
Who are the most common athletes to get medial epicondylitis of the elbow?
. Tennis players
. Golfers
. Swimmers
. Gymnasts
. Basketball players

Correct Answer & Explanation

. Tennis players

Explanation

Although medial epicondylitis is called golfer's elbow, tennis players are more likely to have this condition. Medial epicondylitis can occur in any sport such as baseball pitching, javelin throwing, swimming, and gymnastics in which athletes place a significant valgus flexion force on their elbow.

Question 222

Topic: Elbow & Forearm

A patient with refractory lateral epicondylitis undergoes open surgical debridement. The primary pathological tissue targeted during this procedure is the origin of which of the following structures?

. Extensor carpi radialis longus (ECRL)
. Extensor carpi radialis brevis (ECRB)
. Extensor digitorum communis (EDC)
. Extensor carpi ulnaris (ECU)
. Supinator

Correct Answer & Explanation

. Extensor carpi radialis brevis (ECRB)

Explanation

Lateral epicondylitis primarily involves angiofibroblastic hyperplasia of the origin of the Extensor Carpi Radialis Brevis (ECRB). Surgical management focuses on excising this degenerative tissue while sparing the overlying ECRL.

Question 223

Topic: 9. Shoulder and Elbow

The 'terrible triad' of the elbow is notoriously difficult to manage due to profound instability. This injury pattern typically involves a posterior elbow dislocation, a radial head fracture, and a fracture of which of the following structures?

. Olecranon
. Capitellum
. Coronoid process
. Medial epicondyle
. Lateral epicondyle

Correct Answer & Explanation

. Coronoid process

Explanation

The terrible triad of the elbow consists of an elbow dislocation, a radial head fracture, and a coronoid fracture. Restoration of the coronoid and radial head is critical for re-establishing anterior osseous buttressing and elbow stability.

Question 224

Topic: 9. Shoulder and Elbow

During shoulder arthroscopy for instability, the surgeon identifies a Buford complex. This normal anatomical variant is defined by a thickened, cord-like middle glenohumeral ligament and the absence of which structure?

. Anterosuperior labrum
. Anteroinferior labrum
. Posterosuperior labrum
. Superior labrum anterior to posterior (SLAP) attachment
. Inferior glenohumeral ligament

Correct Answer & Explanation

. Anterosuperior labrum

Explanation

A Buford complex is present in about 1.5% of shoulders and consists of a cord-like middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It must not be mistakenly repaired to the glenoid, as doing so will severely restrict external rotation.

Question 225

Topic: Elbow & Forearm

A 45-year-old male presents with recurrent posterolateral rotatory instability (PLRI) of the elbow. During surgical reconstruction of the lateral ulnar collateral ligament (LUCL), the isometric point on the lateral epicondyle must be identified for graft placement. Where is this point anatomically located?

. At the center of the capitellum axis of rotation
. Posterior and distal to the lateral epicondyle
. Anterior and proximal to the lateral epicondyle
. Directly on the supracondylar ridge
. At the radial notch of the ulna

Correct Answer & Explanation

. At the center of the capitellum axis of rotation

Explanation

The isometric point for LUCL reconstruction is located on the lateral epicondyle at the center of the capitellum's axis of rotation. Improper graft placement here leads to laxity or stiffness during different arcs of elbow motion.

Question 226

Topic: Elbow & Forearm

A 32-year-old female fell on an outstretched hand and sustained the injury shown in the radiograph.

Assuming this is a "terrible triad" injury of the elbow, which of the following is the standard evidence-based surgical sequence for management?

. MCL repair, radial head fixation, coronoid fixation, LCL repair
. Coronoid fixation, radial head fixation or replacement, LCL repair, MCL repair if needed
. Radial head fixation, LCL repair, coronoid fixation, MCL repair
. LCL repair, coronoid fixation, radial head fixation, MCL repair
. Coronoid fixation, LCL repair, radial head replacement, ulnar nerve transposition

Correct Answer & Explanation

. Coronoid fixation, radial head fixation or replacement, LCL repair, MCL repair if needed

Explanation

The terrible triad of the elbow consists of an elbow dislocation, radial head fracture, and coronoid fracture. The standard surgical approach works deep to superficial: coronoid fixation, radial head repair/replacement, followed by LCL complex repair.

Question 227

Topic: Shoulder Pathology

A 28-year-old pitcher complains of right upper extremity heaviness, fatigue, and numbness in the ulnar digits after throwing. Examination reveals a positive Adson's test and reproduction of symptoms with hyperabduction. If neurogenic thoracic outlet syndrome is confirmed, the neurovascular bundle is most commonly compressed between which structures?

. Anterior and middle scalene muscles
. Middle and posterior scalene muscles
. Clavicle and first rib
. Pectoralis minor and the coracoid process
. Cervical rib and the C7 transverse process

Correct Answer & Explanation

. Anterior and middle scalene muscles

Explanation

Neurogenic thoracic outlet syndrome most frequently involves compression at the interscalene triangle. This anatomical space is bordered by the anterior scalene muscle, the middle scalene muscle, and the first rib.

Question 228

Topic: 9. Shoulder and Elbow

Lateral epicondylitis is associated with a tear in the fibers of which muscle:

. Extensor carpi radialis brevis (EC RB)
. Extensor carpi radialis longus (EC RL)
. Brachioradialis
. Supinator
. Anconeus

Correct Answer & Explanation

. Extensor carpi radialis brevis (EC RB)

Explanation

Current consensus is that tennis elbow is associated with a strain or microtear of the EC RB origin, which lies beneath the EC RL.

Question 229

Topic: 9. Shoulder and Elbow

The gold standard for diagnosis of lateral epicondylitis is considered:

. History and physical examination
. Plain radiographs
. Electromyography
. Magnetic resonance imaging
. Radionuclear bone scan

Correct Answer & Explanation

. History and physical examination

Explanation

The clinical diagnosis of lateral epicondylitis is supported by specific provocative tests. The gold standard for diagnosis is the history and physical examination. Tenderness on examination is localized to the lateral epicondyle, which can radiate into the forearm; the area of maximum tenderness is approximately 2 mm to 5 mm distal and anterior to the midpoint of the lateral epicondyle. There is usually a history of overuse or of a repetitive activity. The pain is aggravated, with the elbow extended, by resisted wrist and finger extension or with passive finger and wrist flexion.

Question 230

Topic: 9. Shoulder and Elbow

The amount of time that nonoperative management should be followed for lateral epicondylitis is closest to:

. 1 day
. 1 week
. 1 month
. 3 months
. 6 months or longer

Correct Answer & Explanation

. 6 months or longer

Explanation

Ninety to 95% of all patients with tennis elbow respond to nonoperative treatment, and it remains the mainstay for treatment of lateral epicondylitis. Operative treatment may be indicated for debilitating pain in patients without other pathologic causes of pain for whom nonoperative treatment has failed after a reasonable length of time. This time period is usually a minimum of 6 to 12 months.

Question 231

Topic: Elbow & Forearm

Extracorporeal shock wave therapy ____ in the treatment of lateral epicondylitis in high-quality trials.

. Is ineffective
. Is beneficial
. Has not been tested
. Improves short-term pain
. Improves function

Correct Answer & Explanation

. Is ineffective

Explanation

Current studies have found no benefit of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

Question 232

Topic: 9. Shoulder and Elbow

Which of the following are characteristic signs of PIN palsy:

. Weakness in finger extension
. Pain in dorsum of hand
. Elbow tenderness
. Weakness in finger extension, and elbow tenderness
. Weakness in finger extension, elbow tenderness, and pain in dorsum of hand

Correct Answer & Explanation

. Weakness in finger extension, and elbow tenderness

Explanation

Painless finger drop is characteristic of posterior interosseous nerve palsy. This syndrome may also involve elbow tenderness in the absence of other clinical findings. Pain in the dorsum of the hand is not associated with this condition because the posterior interosseous nerve contains no sensory component.

Question 233

Topic: Elbow & Forearm

Iontophoresis has been effectively used in all of the following EXC EPT:

. C arpal tunnel syndrome
. Wrist arthritis
. Shoulder/rotator cuff tendinitis
. Lateral epicondylitis
. Medial epicondylitis

Correct Answer & Explanation

. Lateral epicondylitis

Explanation

Iontophoresis is effective in soft tissue conditions such as rotator cuff bursitis and lateral epicondylitis.

Question 234

Topic: 9. Shoulder and Elbow

The anatomic location of the pathologic lesion of lateral epicondylitis is the:

. Extensor carpi radialis longus (EC RL)
. Extensor carpi radialis brevis (EC RB)
. Extensor digitorum longus (EDL)
. Extensor digitorum communis (EDC )
. Annular ligament

Correct Answer & Explanation

. Extensor carpi radialis brevis (EC RB)

Explanation

While the EC RL and EDL can sometimes be involved, the primary location of most cases of tennis elbow show characteristic changes at the origin of the EC RB.

Question 235

Topic: 9. Shoulder and Elbow

Which of the following injectable substances have shown benefit in the treatment of lateral epicondylitis:

. C orticosteroids
. Autologous blood
. Botulinum toxin
. None of the above
. All of the above

Correct Answer & Explanation

. All of the above

Explanation

All of these substances have been shown to have efficacy in the treatment of tennis elbow. However, placebo saline injections have also been proven to add some benefit compared to no treatment.

Question 236

Topic: Elbow & Forearm

Common concomitant intra-articular pathology that can be found and addressed at arthroscopy for lateral epicondylitis include all of the following, except:

. Synovial plica
. Loose body
. Synovitis
. Medial epicondylitis
. Chondral lesion

Correct Answer & Explanation

. Medial epicondylitis

Explanation

While all of the other answers are intra-articular lesions that have been reported in elbow arthroscopies, medial epicondylitis is an extra-articular condition and must be addressed in an open fashion given the proximity of the ulnar nerve.

Question 237

Topic: Elbow & Forearm

A 45-year-old male presents with a terrible triad injury of the elbow after a fall on an outstretched hand.

According to standard surgical protocols, what is the most appropriate sequence of repair to restore elbow stability?

. Fix or replace the radial head, repair the LCL, then address the coronoid
. Fix the coronoid, fix or replace the radial head, then repair the LCL
. Repair the MCL, fix the coronoid, then fix the radial head
. Repair the LCL, fix the coronoid, then fix the radial head
. Fix the coronoid, repair the MCL, then fix the radial head

Correct Answer & Explanation

. Fix the coronoid, fix or replace the radial head, then repair the LCL

Explanation

The standard inside-out surgical sequence for a terrible triad injury is to fix the coronoid first to restore the anterior buttress. This is followed by radial head fixation or replacement, and finally repair of the lateral collateral ligament (LCL) complex.

Question 238

Topic: 9. Shoulder and Elbow

Medial epicondylitis is primarily associated with tendinosis and microtearing of the origin of which of the following muscle groups?

. Flexor carpi ulnaris and flexor digitorum profundus
. Pronator teres and flexor carpi radialis
. Palmaris longus and flexor digitorum superficialis
. Brachioradialis and pronator quadratus
. Supinator and extensor carpi radialis brevis

Correct Answer & Explanation

. Pronator teres and flexor carpi radialis

Explanation

Medial epicondylitis (Golfer's elbow) involves the common flexor origin. The most commonly affected muscles are the pronator teres and the flexor carpi radialis (FCR).

Question 239

Topic: Elbow & Forearm
According to the Bado classification, a Type III Monteggia fracture-dislocation is characterized by a proximal ulna fracture with which associated radial head displacement?
. Anterior dislocation of the radial head
. Posterior dislocation of the radial head
. Lateral or anterolateral dislocation of the radial head
. Anterior dislocation with a radial head fracture
. Medial dislocation of the radial head

Correct Answer & Explanation

. Lateral or anterolateral dislocation of the radial head

Explanation

In the Bado classification of Monteggia injuries, Type I is anterior, Type II is posterior, Type III is lateral or anterolateral, and Type IV involves fractures of both the radius and ulna with an anterior radial head dislocation.

Question 240

Topic: 9. Shoulder and Elbow

The ulnar collateral ligament (MCL) complex of the elbow provides critical valgus stability. Which specific anatomical bundle of this complex is the primary restraint to valgus stress at 90 degrees of elbow flexion?

. Anterior bundle
. Posterior bundle
. Transverse bundle
. Lateral ulnar collateral ligament
. Annular ligament

Correct Answer & Explanation

. Anterior bundle

Explanation

The anterior bundle of the ulnar collateral ligament (MCL) is the primary restraint to valgus stress of the elbow throughout the arc of motion, particularly at 90 degrees of flexion. The posterior bundle acts as a secondary restraint, and the transverse bundle contributes minimally to stability.

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