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9. Shoulder and Elbow MCQs

Practice Set 131 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 2601

Topic: Shoulder Pathology

A 28-year-old man presents with persistent shoulder pain and weakness 4 months after a blunt trauma to his right neck and shoulder region. On examination, forward elevation of the arm against resistance exacerbates the prominence of the medial border of the scapula. Which of the following nerves is most likely injured?

. Spinal accessory nerve
. Long thoracic nerve
. Dorsal scapular nerve
. Suprascapular nerve
. Axillary nerve

Correct Answer & Explanation

. Long thoracic nerve

Explanation

Prominence of the medial border of the scapula with forward elevation indicates medial winging, which is caused by serratus anterior weakness. The serratus anterior is innervated by the long thoracic nerve.

Question 2602

Topic: 9. Shoulder and Elbow

A 35-year-old woman presents with acute, severe, unremitting right shoulder pain of 2 weeks' duration, which started spontaneously. The intense pain has recently subsided, but she has now developed profound weakness in shoulder abduction and external rotation. MRI of the shoulder demonstrates no structural tendon pathology. What is the most likely diagnosis?

. Acute calcific tendinitis
. Parsonage-Turner syndrome
. Cervical radiculopathy
. Massive rotator cuff tear
. Adhesive capsulitis

Correct Answer & Explanation

. Parsonage-Turner syndrome

Explanation

Parsonage-Turner syndrome (neuralgic amyotrophy) classically presents with acute severe shoulder pain lasting days to weeks, followed by patchy muscle weakness and atrophy as the pain subsides. It is a self-limiting brachial neuritis often requiring only supportive care.

Question 2603

Topic: 9. Shoulder and Elbow

A 50-year-old woman with type 1 diabetes mellitus presents with insidious onset of progressive shoulder stiffness and pain. Passive range of motion is globally restricted, particularly in external rotation with the arm at the side. Thickening and contracture of which of the following structures is most characteristic of this condition?

. Inferior glenohumeral ligament
. Superior glenohumeral ligament
. Coracohumeral ligament
. Coracoacromial ligament
. Transverse humeral ligament

Correct Answer & Explanation

. Coracohumeral ligament

Explanation

Adhesive capsulitis typically involves robust fibroblastic proliferation and contracture of the rotator interval and the coracohumeral ligament. Contracture of the coracohumeral ligament is the primary reason for the hallmark loss of passive external rotation with the arm adducted.

Question 2604

Topic: Elbow & Forearm

A 42-year-old mechanic sustains an acute distal biceps tendon rupture and undergoes repair using a two-incision technique. Compared to a single anterior incision approach, the two-incision technique carries a historically higher risk of which of the following postoperative complications?

. Lateral antebrachial cutaneous nerve palsy
. Posterior interosseous nerve injury
. Heterotopic ossification and radioulnar synostosis
. Re-rupture of the tendon
. Brachial artery injury

Correct Answer & Explanation

. Heterotopic ossification and radioulnar synostosis

Explanation

The two-incision technique for distal biceps repair avoids the anterior structures, reducing the risk of lateral antebrachial cutaneous nerve (LABCN) and radial nerve injuries. However, it carries a higher risk of heterotopic ossification and radioulnar synostosis.

Question 2605

Topic: 9. Shoulder and Elbow

A 29-year-old man requires a glenohumeral arthrodesis due to an irreparable total brachial plexus injury. To optimize postoperative function, allowing his hand to reach his mouth and perineum, what is the generally recommended position for fusing the glenohumeral joint?

. 30 degrees abduction, 30 degrees flexion, 30 degrees internal rotation
. 60 degrees abduction, 30 degrees flexion, 0 degrees internal rotation
. 10 degrees abduction, 0 degrees flexion, 60 degrees internal rotation
. 45 degrees abduction, 45 degrees flexion, 30 degrees external rotation
. 20 degrees abduction, 20 degrees extension, 45 degrees internal rotation

Correct Answer & Explanation

. 30 degrees abduction, 30 degrees flexion, 30 degrees internal rotation

Explanation

The ideal position for shoulder arthrodesis is approximately 20-30 degrees of abduction, 20-30 degrees of flexion, and 30-40 degrees of internal rotation. This position allows periscapular motion to optimally position the hand for essential daily activities.

Question 2606

Topic: 9. Shoulder and Elbow

Placing the glenosphere inferiorly in reverse total shoulder arthroplasty accomplishes which of the following biomechanical effects?

. Decreases deltoid wrapping
. Increases the risk of scapular notching
. Tensions the remaining rotator cuff
. Lowers the center of rotation and increases deltoid mechanical advantage
. Increases the moment arm of the subscapularis

Correct Answer & Explanation

. Lowers the center of rotation and increases deltoid mechanical advantage

Explanation

Placing the glenosphere inferiorly in a reverse total shoulder arthroplasty lowers the center of rotation, which tensions the deltoid and increases its mechanical advantage. It also helps minimize the risk of inferior scapular notching.

Question 2607

Topic: Shoulder Pathology

A 24-year-old male sustains a traction injury to his shoulder and presents with lateral scapular winging. Which of the following nerve-muscle combinations is most likely injured?

. Long thoracic nerve, serratus anterior
. Spinal accessory nerve, trapezius
. Dorsal scapular nerve, rhomboids
. Suprascapular nerve, infraspinatus
. Axillary nerve, deltoid

Correct Answer & Explanation

. Spinal accessory nerve, trapezius

Explanation

Lateral scapular winging is typically caused by injury to the spinal accessory nerve, resulting in trapezius palsy. Medial winging is caused by long thoracic nerve injury, leading to serratus anterior palsy.

Question 2608

Topic: Shoulder Arthroplasty & Arthritis

After an anatomic total shoulder arthroplasty performed via a deltopectoral approach, a patient presents at 6 weeks with sudden onset of weakness in internal rotation and increased passive external rotation. What is the most likely complication?

. Axillary nerve neurapraxia
. Subscapularis failure
. Anterior component instability
. Coracoid fracture
. Deltoid detachment

Correct Answer & Explanation

. Subscapularis failure

Explanation

Sudden loss of internal rotation strength with increased passive external rotation shortly after an anatomic TSA (via a deltopectoral approach) is highly suspicious for failure of the subscapularis repair. Early surgical intervention is typically warranted.

Question 2609

Topic: 9. Shoulder and Elbow

A 72-year-old female presents with severe, intractable right shoulder pain. Active forward elevation is limited to 40 degrees (pseudoparalysis). Radiographs reveal an acromiohumeral distance of 2 mm and superior migration of the humeral head, but an intact anterior deltoid is noted on exam. What is the most appropriate surgical treatment?

. Hemiarthroplasty
. Superior capsular reconstruction
. Reverse total shoulder arthroplasty
. Anatomic total shoulder arthroplasty
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

Pseudoparalysis with superior humeral head migration and acetabularization of the acromion indicates severe rotator cuff tear arthropathy. Reverse total shoulder arthroplasty is the treatment of choice as it medializes and distalizes the center of rotation, allowing the intact deltoid to elevate the arm.

Question 2610

Topic: Shoulder Pathology

A 28-year-old male presents with a dull ache around his shoulder and noticeable medial scapular winging when performing a wall push-up. Which muscle is denervated, and what is the root origin of the affected nerve?

. Serratus anterior; C5, C6, C7
. Trapezius; Cranial Nerve XI
. Rhomboids; C5
. Latissimus dorsi; C6, C7, C8
. Serratus anterior; C8, T1

Correct Answer & Explanation

. Serratus anterior; C5, C6, C7

Explanation

Medial scapular winging is caused by paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. The long thoracic nerve originates from the roots of C5, C6, and C7.

Question 2611

Topic: 9. Shoulder and Elbow

A 65-year-old female presents with pseudoparalysis of the right shoulder, a massive irreducible rotator cuff tear, and mild glenohumeral osteoarthritis. What is the most appropriate surgical treatment?

. Hemiarthroplasty
. Anatomic total shoulder arthroplasty
. Reverse total shoulder arthroplasty
. Latissimus dorsi tendon transfer
. Superior capsule reconstruction

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

Reverse total shoulder arthroplasty (RTSA) is the treatment of choice for elderly patients with massive, irreparable rotator cuff tears and pseudoparalysis. Hemiarthroplasty and anatomic TSA rely on a functional rotator cuff, while tendon transfers or SCR are less reliable in the setting of true pseudoparalysis.

Question 2612

Topic: 9. Shoulder and Elbow

A 40-year-old female presents with acute, severe right shoulder pain without trauma. Radiographs show a dense, homogenous calcific deposit in the supraspinatus tendon. During which phase of calcific tendinitis does the patient typically experience the most acute pain?

. Formative phase
. Resting phase
. Resorptive phase
. Post-calcific phase
. Pre-calcific phase

Correct Answer & Explanation

. Resorptive phase

Explanation

Calcific tendinitis causes the most severe, acute pain during the resorptive phase. In this phase, the calcium deposit takes on a toothpaste-like consistency and vascular invasion occurs, leading to profound inflammation.

Question 2613

Topic: 9. Shoulder and Elbow

A 55-year-old manual laborer has a massive, irreparable posterosuperior rotator cuff tear with an intact subscapularis, no glenohumeral arthritis, and no pseudoparalysis. What is the most appropriate joint-preserving surgical option?

. Anatomic total shoulder arthroplasty
. Reverse total shoulder arthroplasty
. Superior capsular reconstruction (SCR)
. Arthroscopic extensive debridement alone
. Pectoralis major tendon transfer

Correct Answer & Explanation

. Superior capsular reconstruction (SCR)

Explanation

Superior capsular reconstruction (SCR) is indicated for younger, active patients with massive, irreparable posterosuperior rotator cuff tears, intact subscapularis, and no glenohumeral arthritis to restore superior joint stability.

Question 2614

Topic: Shoulder Arthroplasty & Arthritis

How does a reverse total shoulder arthroplasty (RTSA) fundamentally improve shoulder function in a patient with advanced rotator cuff tear arthropathy?

. Medializes and distalizes the center of rotation
. Lateralizes and proximalizes the center of rotation
. Medializes and proximalizes the center of rotation
. Lateralizes and distalizes the center of rotation
. Restores the precise anatomic center of rotation

Correct Answer & Explanation

. Medializes and distalizes the center of rotation

Explanation

RTSA improves function by medializing and distalizing the joint's center of rotation. This increases the lever arm and resting tension of the deltoid, allowing it to initiate abduction without a functional rotator cuff.

Question 2615

Topic: 9. Shoulder and Elbow
A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate 150% superior displacement of the distal clavicle relative to the acromion, with a significantly increased coracoclavicular distance. What is the classification and typical management of this injury?
. Type II, nonoperative
. Type III, strictly nonoperative
. Type IV, nonoperative
. Type V, operative
. Type VI, nonoperative

Correct Answer & Explanation

. Type V, operative

Explanation

A Rockwood Type V AC joint injury is characterized by 100-300% superior displacement of the clavicle due to disruption of the AC/CC ligaments and the deltotrapezial fascia. It is typically managed operatively in young, active patients.

Question 2616

Topic: Shoulder Arthroplasty & Arthritis

A 72-year-old woman undergoes a reverse total shoulder arthroplasty. At her 1-year follow-up, she complains of mild pain. Radiographs reveal inferior scapular notching (Sirveaux grade 2). Which of the following surgical modifications during the index procedure would have most likely decreased the risk of this complication?

. Superior placement of the glenosphere
. Using a smaller diameter glenosphere
. Inferior translation and inferior tilt of the glenosphere
. Decreasing the lateralization of the glenosphere
. Increasing the humeral neck-shaft angle to 155 degrees

Correct Answer & Explanation

. Inferior translation and inferior tilt of the glenosphere

Explanation

Inferior scapular notching is a common complication of reverse TSA. Inferior translation, inferior tilt, lateralization of the glenosphere, and using a lower humeral neck-shaft angle decrease the risk of notching.

Question 2617

Topic: 9. Shoulder and Elbow

A 42-year-old man presents with sudden, severe shoulder pain that started 3 weeks ago without trauma. The pain has now resolved, but he notices profound weakness in raising his arm and a "winging" scapula. EMG reveals denervation of the serratus anterior and supraspinatus. What is the most likely diagnosis?

. Cervical radiculopathy
. Parsonage-Turner syndrome
. Massive rotator cuff tear
. Fascioscapulohumeral muscular dystrophy
. Adhesive capsulitis

Correct Answer & Explanation

. Parsonage-Turner syndrome

Explanation

Parsonage-Turner syndrome typically presents with a sudden onset of severe shoulder pain followed by patchy weakness and muscle atrophy as the pain subsides. Management is generally supportive.

Question 2618

Topic: 9. Shoulder and Elbow

A 68-year-old man with primary glenohumeral osteoarthritis is being considered for an anatomic total shoulder arthroplasty (TSA). Preoperative CT scan reveals a biconcave glenoid with 25 degrees of retroversion and significant posterior humeral head subluxation. What is the most appropriate surgical strategy?

. Anatomic TSA with standard glenoid component
. Anatomic TSA with posterior eccentric reaming of the glenoid
. Anatomic TSA with structural bone grafting of the glenoid
. Reverse total shoulder arthroplasty
. Hemiarthroplasty

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

A Walch B2 glenoid with excessive retroversion (>15-20 degrees) and posterior subluxation is prone to early glenoid component loosening in anatomic TSA. Reverse TSA is generally preferred to provide stability and avoid early failure.

Question 2619

Topic: Shoulder Pathology

A 26-year-old woman complains of painful crepitus and snapping at the superomedial border of her scapula with arm movement. Nonoperative measures have failed after 6 months. She is scheduled for surgery. Excision of which of the following bursae is typically performed along with resection of the superomedial angle?

. Subacromial and subdeltoid
. Infraserratus and supraserratus
. Subscapular and subcoracoid
. Trapezoid and conoid
. Olecranon and bicipitoradial

Correct Answer & Explanation

. Infraserratus and supraserratus

Explanation

Snapping scapula syndrome often involves inflammation of the infraserratus and supraserratus bursae. Surgical management includes bursectomy of these spaces and resection of the superomedial angle of the scapula.

Question 2620

Topic: 9. Shoulder and Elbow

An 81-year-old woman presents with an inability to actively elevate her right arm above 40 degrees. She has full passive range of motion. Radiographs show superior migration of the humeral head with an acromiohumeral interval of 3 mm. MRI confirms a massive, retracted rotator cuff tear. Her condition is best classified as:

. Adhesive capsulitis
. Pseudoparalysis
. Parsonage-Turner syndrome
. Sprengel deformity
. Shoulder pseudoarthrosis

Correct Answer & Explanation

. Pseudoparalysis

Explanation

Pseudoparalysis of the shoulder is defined as an inability to actively elevate the arm past 90 degrees in the presence of full passive range of motion. It is typically due to a massive rotator cuff tear.

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