9. Shoulder and Elbow MCQs

During shoulder arthroscopy for a suspected massive rotator cuff tear, a distinct "comma sign" is observed. This visual landmark represents the torn edge of the subscapularis intimately attached to which of the following ligamentous structures?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain during the late cocking and early acceleration phases of throwing. Valgus stress testing reveals pain and increased laxity compared to the contralateral elbow. MRI shows a high-grade partial tear of the anterior bundle of the ulnar collateral ligament (UCL). The primary restraint to valgus stress at 90 degrees of elbow flexion is the:

A 19-year-old collegiate baseball pitcher presents with anterior shoulder pain. Examination of the throwing arm reveals 20 degrees of internal rotation (IR) and 130 degrees of external rotation (ER). The contralateral arm has 60 degrees of IR and 90 degrees of ER. What is the initial treatment of choice for this condition?

A 23-year-old collegiate baseball pitcher presents with medial elbow pain that occurs during the late cocking and early acceleration phases of throwing. Magnetic resonance imaging (MRI) reveals a high-grade partial tear of the proximal ulnar collateral ligament (UCL). He has not attempted any nonoperative treatment. What is the most appropriate initial management?

A 14-year-old gymnast complains of lateral elbow pain, clicking, and mechanical catching. Radiographs reveal a radiolucent lesion in the capitellum. MRI demonstrates fluid behind an osteochondral fragment, with an associated loose body. What is the recommended management?

A 19-year-old collegiate baseball pitcher complains of medial elbow pain during the late cocking and early acceleration phases of throwing. Valgus stress testing reproduces pain but reveals a firm endpoint. MRI demonstrates high-grade partial tearing of the ulnar collateral ligament (UCL). What is the most appropriate initial management?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain and decreased pitching velocity. MRI demonstrates a high-grade partial tear of the distal ulnar collateral ligament (UCL). During UCL reconstruction using a docking technique, where must the ulnar bone tunnel be placed to accurately recreate the native ligament footprint?

A 14-year-old male competitive gymnast presents with lateral elbow pain and mechanical catching. Radiographs show a radiolucent lesion of the capitellum. An MRI demonstrates a 12 mm osteochondral defect with a rim of high T2 signal fluid tracking completely behind the lesion. What is the recommended treatment?

A 40-year-old weightlifter requires a distal biceps tendon repair. If the surgeon opts for a traditional two-incision (Boyd-Anderson) technique rather than a single anterior extensile approach, the patient is at a relatively higher risk for which of the following complications?

A 9-year-old boy falls on an outstretched hand and sustains a radial neck fracture with 25 degrees of angulation. He has 60 degrees of pronation and supination. What is the most appropriate management?

A 72-year-old woman undergoes reverse total shoulder arthroplasty. At her 2-year follow-up, radiographs show inferior scapular notching. Which of the following surgical techniques decreases the risk of this complication?

A 32-year-old male bodybuilder feels a pop in his anterior axilla while performing a heavy bench press. Examination reveals bruising and a loss of the anterior axillary fold contour. Weakness will be most pronounced in which of the following shoulder motions?

A 40-year-old woman develops lateral scapular winging after a cervical lymph node biopsy. Which nerve was most likely injured?

A 50-year-old woman with type 1 diabetes presents with severe, progressive shoulder pain and stiffness over the last 4 months. She has an equal loss of active and passive range of motion, most notably in external rotation. What is the underlying pathophysiology of her condition?

A 78-year-old right-hand dominant woman sustains a displaced 3-part proximal humerus fracture involving the surgical neck and greater tuberosity. She has severe pre-existing glenohumeral osteoarthritis. What is the most appropriate surgical intervention?

A 35-year-old woman underwent a cervical lymph node biopsy in the posterior triangle of her neck 6 weeks ago. She now complains of a drooping right shoulder, dull aching pain, and an inability to actively elevate her arm above the horizontal plane. Physical examination reveals lateral winging of the scapula. Which of the following nerves was most likely injured?

A 22-year-old elite baseball pitcher presents with vague posterior shoulder pain. Physical examination of the throwing shoulder reveals 130 degrees of external rotation (ER) and 30 degrees of internal rotation (IR) at 90 degrees of abduction. The contralateral shoulder has 100 degrees of ER and 60 degrees of IR. The total arc of motion is 160 degrees bilaterally. What is the most appropriate initial management?

A 25-year-old male presents with pronounced medial winging of his right scapula after sustaining a direct blow to the lateral chest wall during a hockey game. He is unable to perform a wall push-up without the scapula lifting off the thorax. Which muscle and corresponding nerve are primarily affected?