9. Shoulder and Elbow MCQs

A 30-year-old woman presents with medial scapular winging that is accentuated when she pushes against a wall. Which nerve and corresponding muscle are most likely affected?

Which of the following systemic conditions has the strongest and most well-documented association with the development of adhesive capsulitis of the shoulder?

A 68-year-old man with primary osteoarthritis of the shoulder has a B2 glenoid identified on preoperative CT scan. According to the Walch classification, a B2 glenoid is characterized by:

A 72-year-old woman undergoes a reverse total shoulder arthroplasty (rTSA) for cuff tear arthropathy. Postoperatively, she achieves 150 degrees of active forward elevation but complains of profound weakness and inability to actively externally rotate her arm when at her side. Which of the following concurrent procedures would have best addressed this specific postoperative deficit?

An 82-year-old female presents with a severely comminuted 4-part proximal humerus fracture after a fall. Imaging reveals a disrupted medial hinge, less than 2 mm of metaphyseal extension attached to the articular segment, and severe osteoporosis. A reverse total shoulder arthroplasty (rTSA) is chosen over open reduction internal fixation (ORIF). What biomechanical principle explains the functional success of rTSA in this setting?

A 45-year-old woman undergoes a posterior triangle lymph node biopsy. Three weeks later, she complains of a dull ache in her shoulder and an inability to elevate her arm above 90 degrees. Examination shows lateral displacement and downward rotation of the scapula. Which nerve was most likely injured, and what is the primary affected muscle?

A 55-year-old woman with type 1 diabetes presents with insidious onset of progressive shoulder stiffness and pain, currently in the "freezing" stage of idiopathic adhesive capsulitis. Histologic evaluation of her shoulder capsule would most likely show an abundance of which cell type, and contracture of which primary structure in the rotator interval?

A 75-year-old man is 4 years status post a Grammont-style reverse total shoulder arthroplasty. Radiographs show Grade 3 scapular notching. Which intraoperative technical error most significantly increases the risk of this specific complication?

An orthopaedic surgeon is planning an anatomic total shoulder arthroplasty for a 68-year-old man with primary osteoarthritis. Preoperative axillary CT imaging demonstrates a biconcave glenoid with severe posterior cartilaginous wear and 22 degrees of retroversion. According to the Walch classification, what type of glenoid morphology is this?

A 36-year-old man presents to the emergency department after suffering a generalized tonic-clonic seizure. He complains of severe anterior shoulder pain. On examination, his arm is fixed in internal rotation, and he has zero degrees of active or passive external rotation. The AP shoulder radiograph shows a "lightbulb sign." What is the most appropriate initial management?

A 72-year-old woman undergoes a reverse total shoulder arthroplasty for severe rotator cuff tear arthropathy. To minimize the risk of scapular notching postoperatively, which of the following baseplate and glenosphere configurations is most appropriate?

A 68-year-old man presents with chronic right shoulder pain and an inability to actively elevate his arm past 45 degrees. Radiographs reveal superior migration of the humeral head and severe glenohumeral arthritis. Which of the following is the most appropriate definitive surgical management?

Which of the following comorbidities is most strongly associated with both the development of adhesive capsulitis and a more refractory course to conservative treatment?

A 65-year-old woman with severe glenohumeral osteoarthritis undergoes an anatomic total shoulder arthroplasty. Ten years later, she presents with progressive pain and a loss of active elevation. What is the most common cause of late failure in anatomic total shoulder arthroplasty?

A 28-year-old man sustains a severe elbow injury. Imaging confirms a terrible triad injury pattern.

What is the recommended sequence of surgical reconstruction to restore elbow stability?

A 40-year-old manual laborer complains of right shoulder ache and a prominent medial scapular border, especially when doing a wall push-up. An injury to which nerve is responsible for this physical finding?

A 72-year-old woman undergoes reverse total shoulder arthroplasty (rTSA) for massive, irreparable rotator cuff tear arthropathy. Postoperatively, what surgical technique modification regarding glenoid baseplate and glenosphere positioning has been biomechanically and clinically proven to minimize the risk of inferior scapular notching?

A 65-year-old woman with cuff tear arthropathy undergoes a reverse total shoulder arthroplasty. During templating and component positioning, which of the following modifications minimizes the risk of scapular notching?

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain and a significant decrease in throwing velocity. Physical examination reveals a 25-degree deficit in glenohumeral internal rotation compared to the contralateral side. What is the most likely primary pathophysiology for this range of motion deficit?

A 72-year-old man presents with chronic shoulder pain and inability to actively elevate his arm above 40 degrees. Passive elevation is 150 degrees. Radiographs show superior migration of the humeral head with an acromiohumeral interval of 3 mm. The deltoid is functioning normally. What is the most appropriate surgical treatment?