9. Shoulder and Elbow MCQs

A 32-year-old competitive weightlifter feels a sudden "pop" in his anterior shoulder while performing a heavy bench press. Examination demonstrates an asymmetric chest wall with loss of the anterior axillary fold. If surgical repair is performed to restore function, to which anatomic footprint should the torn tendon be reattached?

A 28-year-old man sustains a blunt trauma to the posterior triangle of the neck. He presents with an inability to comfortably abduct his arm above 90 degrees and a drooping shoulder. Examination shows prominent lateral scapular winging. Injury to which of the following nerves is the most likely cause?

During the physical examination of a patient with insidious onset of shoulder pain, which of the following findings is the most reliable clinical indicator to differentiate early "freezing" stage adhesive capsulitis from rotator cuff impingement syndrome?

A 38-year-old overhead athlete presents with vague posterior shoulder pain and paresthesias over the lateral deltoid. MRI of the shoulder reveals isolated fatty atrophy of the teres minor muscle. Which vascular structure passes through the exact same anatomical space as the compromised nerve?

In the surgical technique of reverse total shoulder arthroplasty, which of the following glenoid baseplate configurations has been most strongly associated with a decreased incidence of inferior scapular notching?

A 70-year-old female presents with severe shoulder pain and pseudoparalysis. Radiographs show superior migration of the humeral head and glenohumeral osteoarthritis. She undergoes a reverse total shoulder arthroplasty (RTSA). Postoperatively, she has persistent external rotation weakness and a positive hornblower's sign. Which of the following preoperative factors most likely predicts this specific postoperative deficit?

A 75-year-old female sustains a comminuted 4-part proximal humerus fracture. Due to her age, poor bone quality, and comminution, she is treated with a reverse total shoulder arthroplasty (RTSA) rather than open reduction and internal fixation. Compared to hemiarthroplasty for this indication, RTSA is associated with:

A 68-year-old man presents with insidious onset of shoulder stiffness and mild pain two years after an anatomic total shoulder arthroplasty. Inflammatory markers (ESR, CRP) are normal. Aspiration yields no growth at 3 days. What is the most appropriate next step in diagnosing a potential Cutibacterium acnes infection?

A 40-year-old male is involved in a high-speed motorcycle accident and sustains an intra-articular glenoid fracture. Operative intervention is typically indicated for an intra-articular step-off greater than:

A 48-year-old female presents with sudden, agonizing right shoulder pain over the past 24 hours. She has no history of trauma. Radiographs reveal a large, fluffy, amorphous calcific deposit in the supraspinatus tendon. She is in the resorptive phase of calcific tendinitis. Which of the following biologic environments is responsible for the intense pain during this phase?

A 72-year-old woman undergoes a reverse total shoulder arthroplasty. At her 2-year follow-up, radiographs show grade 2 scapular notching. Which of the following implant configurations or surgical techniques is most closely associated with a decreased incidence of scapular notching?

A 21-year-old collegiate pitcher complains of vague posterior shoulder pain. Physical examination shows a 25-degree loss of internal rotation and a 15-degree gain of external rotation compared to the contralateral side. Total arc of motion is decreased by 10 degrees. What is the most appropriate initial management?

A 45-year-old woman presents with right shoulder weakness following a lymph node biopsy in the posterior triangle of the neck. On examination, the affected scapula is laterally translated and there is a droop of the shoulder. She has difficulty abducting her arm past 90 degrees. Which nerve is injured?

A 62-year-old woman with severe rheumatoid arthritis is undergoing total shoulder arthroplasty. Preoperative radiographs and CT show central glenoid wear with medialization of the joint line. The rotator cuff is intact. Which of the following components of the surgical technique is most important to optimize outcomes and component longevity?

Figure 15 shows the radiograph of a 72-year-old woman with an acute 4-part proximal humerus fracture and significant osteoporosis. She has a history of pseudoparalysis prior to the injury. Which of the following is the most appropriate definitive management?

Figure 9 shows the AP radiograph of a 74-year-old male with chronic right shoulder pain, pseudoparalysis, and limited active forward elevation to 45 degrees. The radiograph reveals superior migration of the humeral head and acetabularization of the acromion. What is the most appropriate surgical intervention?

A 35-year-old female presents with aching shoulder pain and fatigue when working overhead. Physical examination demonstrates medial winging of the scapula that is accentuated when she pushes against a wall. Which nerve and corresponding muscle are primarily affected?

A 52-year-old female presents with progressive, severe shoulder stiffness and diffuse pain over the past 4 months. Examination shows significant loss of both active and passive range of motion, particularly external rotation. Which of the following systemic conditions is most strongly associated with the development of this pathology?