9. Shoulder and Elbow MCQs

A 55-year-old woman with poorly controlled type 1 diabetes mellitus presents with severe, progressive shoulder pain and stiffness over the past 4 months. Examination reveals global loss of active and passive range of motion, with external rotation limited to 10 degrees. Radiographs are normal. The pathophysiology of this condition is primarily characterized by fibroblastic proliferation and thickening of which capsular structures?

A 35-year-old woman presents with persistent shoulder pain and weakness 6 months after a posterior triangle cervical lymph node biopsy. Examination reveals lateral winging of the scapula and an inability to actively abduct the arm past 90 degrees. If nonoperative management fails, which tendon transfer procedure is most appropriate?

A 72-year-old male with a known chronic, massive rotator cuff tear presents with worsening shoulder pain. Plain radiographs show an acromiohumeral interval of 3 mm, acetabularization of the coracoacromial arch, and severe narrowing of the glenohumeral joint space with inferior osteophytes. According to the Hamada classification, what grade is this patient's rotator cuff tear arthropathy?

A 28-year-old male bodybuilder felt a sudden 'pop' in his anterior axilla while performing heavy bench presses. Physical examination demonstrates the loss of the anterior axillary fold and weakness in internal rotation and adduction of the shoulder. MRI confirms a complete tear of the sternal head of the pectoralis major. Where does the majority of these ruptures anatomically occur?

A 70-year-old woman is scheduled to undergo a reverse total shoulder arthroplasty for cuff tear arthropathy. The Grammont-style reverse prosthesis changes the biomechanics of the shoulder joint to restore active elevation. Which of the following best describes this biomechanical alteration?

A 65-year-old man presents with progressive pain and stiffness 8 months after an anatomic total shoulder arthroplasty. Serum ESR and CRP are within normal limits. Joint aspiration is performed, and cultures are held for 14 days, eventually growing Cutibacterium acnes. Which of the following characterizes this organism?

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a 25-degree loss of glenohumeral internal rotation (GIRD) compared to the contralateral side. Pathologic contracture of which structure is primarily responsible for this physical exam finding?

A 26-year-old man presents with right shoulder pain and weakness 3 weeks after a viral illness. On examination, forward elevation is limited to 90 degrees, and there is prominent medial winging of the scapula when he pushes against a wall.

Which nerve is most likely affected, and what muscle does it innervate?

A 60-year-old man undergoes a lower trapezius tendon transfer augmented with an Achilles tendon allograft for a massive, irreparable posterosuperior rotator cuff tear.

What nerve supplies the transferred muscle, and what primary motion is restored?

A 75-year-old man presents with chronic right shoulder pain and an inability to actively elevate his arm above 60 degrees, though passive elevation is 150 degrees. Radiographs demonstrate severe glenohumeral osteoarthritis with superior migration of the humeral head articulating with the acromion. Which of the following is the most appropriate surgical management?

A 55-year-old woman presents with 4 months of progressive, insidious onset right shoulder pain and stiffness. Physical examination shows significantly restricted active and passive external rotation with the arm at the side. Radiographs are normal. Which of the following systemic conditions is most strongly associated with this diagnosis and portends a more refractory clinical course?

A 32-year-old man presents with right shoulder weakness 3 months after a severe viral illness. Examination demonstrates pronounced medial winging of the scapula when he pushes against a wall. EMG confirms a localized nerve injury. If nonoperative management fails after 12 to 18 months, which surgical procedure is most appropriate?

A 72-year-old female undergoes reverse total shoulder arthroplasty (RTSA) for severe rotator cuff tear arthropathy. By what primary biomechanical mechanism does this prosthesis restore active shoulder elevation?

A 65-year-old man with primary glenohumeral osteoarthritis is planned for an anatomic total shoulder arthroplasty. CT imaging demonstrates a biconcave glenoid with severe posterior cartilage wear and posterior subluxation of the humeral head. This represents which Walch classification?

A 76-year-old female presents with acute lateral shoulder pain 4 months after undergoing a reverse total shoulder arthroplasty. Radiographs reveal an acromial base stress fracture (Levy Type II). Which surgical factor most significantly increases the risk of this complication?

A 24-year-old carpenter presents with a dull ache in his right shoulder and inability to fully elevate his arm. Examination reveals medial winging of the scapula that worsens when he pushes against a wall. Injury to which nerve is the most likely cause?

Which design parameter of a reverse total shoulder arthroplasty most effectively decreases the risk of scapular notching?

A 65-year-old man presents with insidious onset of shoulder pain 18 months following an anatomic total shoulder arthroplasty. Inflammatory markers are normal. Aspirate cultures grow Cutibacterium acnes at 10 days. Which of the following best describes this organism?

When converting a patient from an anatomic total shoulder arthroplasty to a reverse total shoulder arthroplasty, what happens to the center of rotation of the glenohumeral joint?