9. Shoulder and Elbow MCQs

Histological evaluation of surgical specimens from patients undergoing operative management for chronic lateral epicondylitis (tennis elbow) most characteristically demonstrates which of the following?

A 19-year-old male sustains a complete distal biceps tendon rupture during a wrestling match. He undergoes an anatomic surgical repair. Which of the following complications is most frequently associated with a single-incision anterior approach using a cortical button?

A 17-year-old male baseball pitcher complains of chronic medial elbow pain and decreased throwing velocity. Valgus stress testing reproduces pain at the medial epicondyle. MRI shows a high-grade partial tear of the ulnar collateral ligament (UCL). He is scheduled for UCL reconstruction. What is the optimal placement of the graft to best recreate the primary restraint to valgus stress?

During the late cocking phase of throwing, the 'peel-back' mechanism places maximal stress on which of the following glenohumeral structures, leading to a specific pattern of labral injury?

A 24-year-old professional baseball pitcher presents with vague posterior shoulder pain and decreased pitching velocity. Physical exam of the throwing shoulder reveals 20 degrees of internal rotation and 130 degrees of external rotation at 90 degrees of abduction. What is the most appropriate initial treatment?

A 14-year-old female gymnast complains of lateral elbow pain and occasional catching. Radiographs reveal a radiolucency at the capitellum. An MRI demonstrates a 12 mm osteochondral defect with a high T2 signal line behind the fragment. What is the most appropriate management?

The anterior bundle of the ulnar collateral ligament (UCL) of the elbow originates on the anteroinferior medial epicondyle and inserts on the:

A 14-year-old female gymnast presents with lateral elbow pain and catching. Radiographs show an unstable osteochondritis dissecans (OCD) lesion of the capitellum. Which of the following is the most likely etiology of this condition?

A 20-year-old collegiate baseball pitcher presents with medial elbow pain and decreased throwing velocity. Valgus stress testing reveals pain and laxity at 30 degrees of elbow flexion. MRI arthrogram shows a high-grade partial tear of the anterior bundle of the ulnar collateral ligament (UCL). Which specific portion is the primary restraint to valgus stress at 30, 60, and 90 degrees of flexion?

A 35-year-old male construction worker has deep shoulder pain. MRI shows a Type II Superior Labrum Anterior Posterior (SLAP) tear. He elects for biceps tenodesis. Where is the preferred location for subpectoral biceps tenodesis to minimize the risk of a "Popeye" deformity and residual bicipital groove pain?

A 68-year-old female with chronic pseudoparalysis of the right shoulder and a massive irrepairable rotator cuff tear undergoes a reverse total shoulder arthroplasty (RTSA). The biomechanical advantage of RTSA that restores active elevation is primarily achieved by:

A 20-year-old collegiate baseball pitcher presents with medial elbow pain and decreased pitching velocity. Valgus stress testing reveals gapping at 30 degrees of flexion. Which bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress during the late cocking and early acceleration phases of throwing?

A 30-year-old rugby player presents with recurrent anterior shoulder instability after a traumatic dislocation. An MRI arthrogram reveals contrast extravasation into the dependent portion of the axillary recess, creating a classic "J" sign. Which of the following lesions is most likely present?

A 14-year-old gymnast presents with elbow pain and a locked joint after a fall.

Radiographs demonstrate an elbow dislocation with a missing medial epicondyle on the AP view. What is an absolute indication for open reduction and internal fixation of the medial epicondyle?

A 7-year-old boy is evaluated for a progressive deformity of his right elbow. He sustained a supracondylar humerus fracture 4 years ago that was treated with closed reduction and percutaneous pinning. Physical examination reveals a cubitus varus deformity of 15 degrees. If left untreated, what long-term complication is most uniquely associated with this specific deformity?

A 29-year-old male sustains a terrible triad injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture). Operative management is planned. According to standard treatment algorithms, what is the typical sequence of surgical repair?

A 45-year-old man feels a 'pop' in his anterior elbow while lifting a heavy object. The Hook test is positive. If surgical repair of the distal biceps is performed utilizing a single-incision anterior approach, which nerve is at greatest risk of iatrogenic injury?

A 55-year-old female sustains a complex elbow injury consisting of a radial head fracture, a coronoid process fracture, and elbow dislocation. What is the standard algorithmic sequence of surgical reconstruction for this terrible triad injury?