9. Shoulder and Elbow MCQs

A 65-year-old male presents with a chronic massive rotator cuff tear and pseudoparalysis (active elevation less than 90 degrees). Physical examination reveals an intact deltoid, and radiographs demonstrate no evidence of glenohumeral osteoarthritis. What is the most appropriate surgical management?

A 24-year-old competitive tennis player presents with right shoulder pain and weakness, particularly when serving. On examination, there is prominent medial winging of the scapula that worsens when he pushes against a wall. Which of the following nerves is most likely injured, and what is the corresponding muscle?

A 76-year-old woman sustains a displaced 4-part proximal humerus fracture. She has a history of severe osteoporosis. A decision is made to proceed with reverse total shoulder arthroplasty (rTSA). Healing of the tuberosities to the humeral shaft in rTSA is primarily associated with:

A 60-year-old man with primary glenohumeral osteoarthritis presents for total shoulder arthroplasty. A preoperative CT scan reveals a Walch B2 glenoid with 20 degrees of retroversion and posterior subluxation of the humeral head. Which of the following strategies is most appropriate for managing the glenoid deformity during anatomic TSA?

When placing the glenoid baseplate during a reverse total shoulder arthroplasty, the optimal position to minimize scapular notching and maximize range of motion is:

A 52-year-old woman with type 1 diabetes presents with severe left shoulder stiffness. She has equal loss of active and passive range of motion. Radiographs are normal. Which of the following is true regarding adhesive capsulitis in diabetic patients compared to idiopathic cases?

A 65-year-old man with primary glenohumeral osteoarthritis presents with a Walch B2 glenoid demonstrating 22 degrees of retroversion. He is scheduled for an anatomic total shoulder arthroplasty. If eccentric reaming is chosen to correct the version, what is the maximum recommended correction before significantly risking glenoid vault violation and peg perforation?

Which of the following best describes the biomechanical alteration achieved by a Grammont-style reverse total shoulder arthroplasty?

A 45-year-old mechanic presents with shoulder pain and difficulty lifting heavy objects above his head. On examination, having the patient perform a wall push-up exacerbates medial prominence of the scapula. This clinical finding is most characteristic of an injury to which of the following nerves?

A 21-year-old collegiate baseball pitcher reports insidious onset of posterior shoulder pain. Examination reveals a 25-degree deficit in glenohumeral internal rotation on the dominant arm compared to the contralateral side, with normal total arc of motion. What is the most appropriate initial management?

A 72-year-old female presents with chronic shoulder pain and inability to actively elevate her arm above 45 degrees. Radiographs demonstrate superior migration of the humeral head articulating with the acromion, consistent with Hamada grade 3 cuff tear arthropathy. Her axillary nerve is intact. What is the most appropriate surgical treatment?

A 40-year-old diabetic female presents to the emergency department with acute, excruciating shoulder pain without preceding trauma. Radiographs show a large, fluffy, ill-defined calcific deposit in the supraspinatus tendon. During which phase of calcific tendinitis does the patient typically experience the most severe pain?

A 50-year-old manual laborer presents with a massive, retracted, irreparable posterosuperior rotator cuff tear. He has significant weakness in external rotation and a positive Hornblower's sign. The glenohumeral joint shows no arthritic changes. Which of the following tendon transfers is best indicated to restore active external rotation?

A 35-year-old male is evaluated in the emergency department following an unprovoked generalized tonic-clonic seizure. He complains of severe shoulder pain and his arm is locked in an internally rotated position. An AP radiograph demonstrates a symmetric "light bulb" appearance of the humeral head without an obvious fracture. What is the most likely diagnosis?

In the design and biomechanics of a reverse total shoulder arthroplasty (RSA), how does the prosthesis primarily compensate for a deficient rotator cuff to allow active forward elevation?

A 38-year-old male complains of a drooping shoulder and lateral scapular winging 6 months after undergoing a radical neck dissection for squamous cell carcinoma. He has difficulty sustaining abduction above 90 degrees. Which nerve was most likely injured during his prior surgery?

A 72-year-old woman is 6 months postoperative from a reverse total shoulder arthroplasty for cuff tear arthropathy. She reports a sudden onset of lateral shoulder pain after lifting a light box. Radiographs reveal a non-displaced fracture of the acromion base. What is the most appropriate initial management?

A 45-year-old woman presents with right shoulder aching and fatigue. She underwent a cervical lymph node biopsy 4 months ago. Examination reveals lateral winging of the scapula and inability to actively abduct the arm past 90 degrees. Which nerve is most likely injured?

A 72-year-old female presents with sudden onset of superior shoulder pain 6 months after a reverse total shoulder arthroplasty for rotator cuff tear arthropathy. Radiographs show a displaced fracture of the acromion base (Levy type II). What is the most appropriate initial management?

A 68-year-old male with a massive, irreparable posterosuperior rotator cuff tear and no glenohumeral arthritis presents with pseudoparalysis of the shoulder. He has an intact subscapularis and functioning deltoid. Which of the following is the most appropriate surgical treatment?