9. Shoulder and Elbow MCQs

A 35-year-old patient falls on an outstretched hand and presents with severe elbow pain and instability. Radiographs confirm a posterior elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture.

If operative intervention is indicated, what is the most widely accepted surgical sequence for addressing this 'terrible triad' injury?

A 40-year-old male weightlifter feels a sudden 'pop' in his anterior elbow during a heavy deadlift. Clinical examination reveals a proximal retraction of the biceps muscle belly and significant weakness in forearm supination. If the surgeon chooses a traditional two-incision surgical approach for the repair, what complication is classically most associated with this specific technique?

A 5-year-old child presents to the emergency department after an elbow injury. The orthopedic resident reviews the elbow radiographs to assess for any avulsion fractures. According to the normal sequential ossification of the pediatric elbow (CRITOE), at what age does the medial epicondyle ossification center typically appear?

A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. Clinical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinel's sign is positive around the clavicle. Horner's signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion. Diagnosis of the condition is:

A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. Clinical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3-cm wasting of his arm and 2 cm of the forearm. Tinel's sign is positive around the clavicle. Horner's signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion. The level of lesion is:

A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle 8 weeks ago. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. Clinical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3 cm wasting of his arm and 2 cm of the forearm. Tinel's sign is positive around the clavicle. Horner's signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion. The plan of management in this patient 5 months postinjury with no clinical improvement should be:

A 15-year-old boy presented with inability to elevate his right shoulder and flex his elbow. He sustained a fall from an all-terrain vehicle eight weeks prior. He landed on the right shoulder and twisted his neck. Radiographs of the skull, chest, cervical and thoracic spine, and shoulder were normal. There was no loss of consciousness, chest pain, or breathing difficulties. The patient was observed in the hospital until stable and referred for follow-up in the hand clinic at 4 weeks. An electromyelogram (EMG) was scheduled. Clinical examination revealed weakness of deltoid, supraspinatus, infraspinatus, teres minor, biceps, brachialis, brachioradialis, and extensor carpi radialis longus. The remainder of his forearm musculature was preserved and he could grasp, release, and pinch. Sensations were decreased along the distribution of the axillary nerve. There was 3-cm wasting of his arm and 2 cm of the forearm. Tinel's sign is positive around the clavicle. Horner's signs are absent and his arm lies against the body. The EMG report showed fibrillation potentials in the weak muscles. The patient can now flex his elbow. When asked to demonstrate, he flexes his wrist and pronates his forearm to swing his elbow into flexion. The most important function that needs to be restored in this patient is:

Indications for operative treatment in an acute elbow dislocation include:

When performing open reduction and internal fixation of radial neck fractures, the plate should be placed:

Heterotopic ossification after elbow dislocations is not associated with which of the following:

Favorable indications for attempted replantation include:

Which of the following areas is not involved in ulnar club hand:

All of the following are true statements regarding elbow involvement in ulnar club hand except:

A 45-year-old man presents with marked lateral elbow pain. He says that the pain has been present for 3 weeks. He has no history of recent trauma. He is an avid tennis player, and he feels increased pain after playing tennis and when doing wrist extension exercises in the gym. His pain is maximally reproduced with resisted middle finger extension and with forearm supination with the elbow extended. Electromyography would confirm the diagnosis as:

A 45-year-old man presents with marked lateral elbow pain. He says that the pain has been present for 3 weeks. He has no history of recent trauma. He is an avid tennis player, and he feels increased pain after playing tennis and when doing wrist extension exercises in the gym. His pain is maximally reproduced with resisted middle finger extension and with forearm supination with the elbow extended. Which of the following is the appropriate initial treatment:

A 24-year-old motorcyclist sustains a traction injury to his right brachial plexus. Exam shows absent shoulder abduction, elbow flexion, and wrist extension. Sensation is absent in the C5, C6, and C7 dermatomes. Sensory nerve action potentials (SNAPs) for the median and radial nerves are normal in the right upper extremity. What does this indicate?

During the surgical repair of a "terrible triad" injury of the elbow, which of the following sequences is the standard algorithm for reconstruction?

A 28-year-old female overhead athlete complains of vague pain, numbness, and tingling in her medial forearm and fourth and fifth digits. Symptoms are exacerbated by overhead activities. Provocative maneuvers such as the Roos stress test and Adson's test are positive. Which anatomical structure is most frequently responsible for this specific pattern of neural compression?

A 22-year-old male is evaluated 6 months after sustaining a massive upper extremity crush injury. He has intact shoulder abduction and elbow flexion but cannot actively extend his wrist or fingers.

EMG demonstrates absent motor units in the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) with no signs of reinnervation. Tendon transfers are planned. Which of the following is the most standard and reliable tendon transfer to restore active wrist extension?

The most common forearm deformity in patients with hereditary multiple osteochondromatosis is: