9. Shoulder and Elbow MCQs

During the baseball pitching motion, at which phase does the ulnar collateral ligament (UCL) of the elbow experience the highest valgus stress, placing it at the greatest risk for injury?

A 22-year-old collegiate baseball pitcher presents with medial elbow pain that is worse during the late cocking and early acceleration phases of throwing. The moving valgus stress test is positive. An MRI confirms a full-thickness tear of the anterior bundle of the ulnar collateral ligament (UCL). He elects to undergo UCL reconstruction utilizing the docking technique. During the surgical approach to expose the sublime tubercle, which of the following muscle-fascia intervals or techniques is typically utilized?

A 19-year-old competitive swimmer presents with bilateral, vague shoulder pain and a sensation of her shoulders 'sliding out of joint.' She has no history of distinct trauma. Physical examination demonstrates a positive sulcus sign, a positive load and shift test both anteriorly and posteriorly, and generalized ligamentous laxity (Beighton score of 7/9). She is diagnosed with multidirectional instability (MDI). If nonoperative management is chosen, which of the following should be the primary focus of her rehabilitation program?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain and a significant decrease in throwing velocity. A moving valgus stress test is positive. MRI arthrography demonstrates a high-grade partial tear of the ulnar collateral ligament (UCL). During the late cocking and early acceleration phases of throwing, which structure serves as the primary restraint to valgus stress at the elbow?

A 14-year-old female gymnast complains of lateral elbow pain, mechanical clicking, and a 15-degree extension deficit. Radiographs and an MRI demonstrate an osteochondritis dissecans (OCD) lesion of the capitellum with an unstable 10 mm osteochondral fragment and fluid tracking behind the lesion. What is the most appropriate next step in management?

A 62-year-old heavy laborer presents with right shoulder pain and profound weakness in external rotation with the arm at the side. MRI reveals a massive, retracted, and fatty-infiltrated tear of the supraspinatus and infraspinatus tendons (Goutallier stage 4), with an intact subscapularis and teres minor. Radiographs show a normal acromiohumeral distance and no osteoarthritis (Hamada grade 1). After failing 6 months of conservative management, which of the following surgical interventions is most appropriate?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain that occurs during the late cocking and early acceleration phases of throwing. On examination, the moving valgus stress test is performed, producing pain that is maximal between 70 and 120 degrees of elbow flexion. Which anatomical structure is most likely compromised?

A 30-year-old competitive weightlifter feels a sudden tear in his anterior shoulder while performing a heavy bench press. He presents with extensive ecchymosis over the medial arm and loss of the normal anterior axillary fold contour. Surgery is planned. In a complete rupture of the sternocostal head of the pectoralis major, what is the most appropriate anatomical location for surgical footprint repair?

A 62-year-old male laborer presents with chronic right shoulder pain and profound pseudoparalysis. Radiographs reveal superior migration of the humeral head with an acromiohumeral interval of 3 mm and severe glenohumeral osteoarthritis (Hamada Grade 4). MRI confirms a massive, retracted, irreparable tear of the supraspinatus and infraspinatus with grade 4 fatty infiltration. What is the most appropriate surgical management?

A 20-year-old collegiate baseball pitcher presents with medial elbow pain and decreased velocity. MRI reveals a high-grade partial tear of the ulnar collateral ligament (UCL). Biomechanical testing of the elbow indicates that the primary restraint to valgus stress at 90 degrees of elbow flexion is the:

A 19-year-old collegiate baseball pitcher presents with medial elbow pain that is worst during the late cocking and early acceleration phases of throwing. He reports feeling a 'pop' followed by inability to continue pitching. The moving valgus stress test is positive. MRI confirms a full-thickness tear of the ulnar collateral ligament (UCL). Which band of the UCL is the primary restraint to valgus stress during these critical throwing phases?

A 65-year-old male presents with chronic right shoulder pain and weakness. Physical examination reveals an inability to actively elevate the arm past 60 degrees (pseudoparalysis), a positive drop arm test, and significant external rotation weakness. MRI demonstrates a massive, retracted, irreparable tear of the supraspinatus and infraspinatus with Grade 4 fatty infiltration (Goutallier). The subscapularis and teres minor are intact. He does not have advanced glenohumeral osteoarthritis. What is the most appropriate surgical treatment?

A 2-year-old girl is brought to the emergency department after her father swung her by her hands. She refuses to use her left arm, holding it in slight flexion and pronation. Radiographs of the elbow are normal. What anatomic structure is primarily involved in this pathology?

A 75-year-old right-hand-dominant woman with a history of osteoporosis falls onto her shoulder. Radiographs demonstrate a displaced 4-part proximal humerus fracture with head-splitting components, severe comminution of the tuberosities, and a disrupted medial calcar hinge. Her pre-injury baseline was active and independent. Which of the following surgical options is associated with the most predictable restoration of forward elevation and pain relief in this patient?

A 22-year-old male motorcyclist is struck by a car and presents with massive swelling of the right shoulder girdle and an entirely flail, pulseless right upper extremity. Chest radiograph shows severe lateral displacement of the scapula. Which of the following neurologic injuries is most commonly associated with this specific pattern of high-energy trauma?

During surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), you perform fixation of the coronoid fragment, replace the non-reconstructible radial head with a metallic arthroplasty, and repair the lateral ulnar collateral ligament (LUCL) to its anatomic origin on the lateral epicondyle. Upon fluoroscopic examination through a full arc of motion, the elbow subluxates posteriorly when extended past 30 degrees. What is the most appropriate next step to restore stability?

A 35-year-old male is involved in a high-speed motor vehicle collision and sustains a 'terrible triad' injury of the elbow. Which of the following describes the most appropriate sequence of surgical reconstruction to restore stability?

A 35-year-old woman falls onto an outstretched hand and presents with a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid process fracture). Which of the following describes the most universally accepted surgical sequence for reconstructing this injury?

During surgical management of a 'terrible triad' elbow injury (elbow dislocation, radial head fracture, and coronoid fracture), the surgeon sequentially fixes the coronoid process fracture, replaces the highly comminuted radial head with an arthroplasty, and meticulously repairs the lateral ulnar collateral ligament (LUCL) to the lateral epicondyle. Upon examination under fluoroscopy, the elbow remains persistently unstable and subluxates posteriorly in extension. What is the most appropriate next step in the standard surgical algorithm?

A 44-year-old woman falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. Operative intervention is planned. To restore concentric stability of the elbow joint, which of the following represents the most appropriate and widely accepted sequence of surgical reconstruction?