9. Shoulder and Elbow MCQs

A 60-year-old male presents with increasing pain 18 months after an anatomic total shoulder arthroplasty. Inflammatory markers are mildly elevated. Aspiration yields cloudy fluid, but routine aerobic and anaerobic cultures at 3 days are negative. What is the most likely causative organism?

A 55-year-old female with poorly controlled type II diabetes presents with a 4-month history of insidious onset global shoulder pain and progressively decreasing range of motion. Examination reveals a significant loss of both active and passive external rotation. Radiographs are normal. What is the most appropriate initial treatment?

A 26-year-old female presents with weakness and prominence of her right shoulder blade after a viral illness. Physical examination demonstrates medial winging of the scapula, which is accentuated when she pushes against a wall. Which nerve is most likely affected?

A 40-year-old male is brought to the emergency department after suffering a generalized seizure. He complains of severe shoulder pain and cannot externally rotate the arm. An AP radiograph shows a "lightbulb" sign. What is the most likely diagnosis?

A 65-year-old male heavy laborer complains of sudden onset of pain and a bulge in his lower arm after lifting a heavy object. He has an obvious "Popeye" deformity but reports minimal pain currently. What is the most appropriate management?

A 65-year-old male presents with severe shoulder pain and decreased range of motion. Radiographs show joint space narrowing, large inferior osteophytes, and subchondral sclerosis. MRI shows an intact rotator cuff. What is the most appropriate definitive surgical treatment?

A 65-year-old woman presents with severe osteoarthritis of the right shoulder. CT scan reveals a retroverted glenoid of 20 degrees and posterior humeral head subluxation with asymmetric posterior wear. According to the Walch classification, which glenoid type is this?

In reverse total shoulder arthroplasty, the center of rotation is moved in which directions compared to the native shoulder anatomy?

Which of the following modifications in reverse total shoulder arthroplasty component positioning has been shown to decrease the incidence of scapular notching?

A 52-year-old woman presents with insidious onset of profound shoulder stiffness and pain over the last 4 months. Passive and active ROM are equally restricted. Which systemic condition is most strongly associated with an increased incidence and severity of this disorder?

A 72-year-old woman is 6 months status-post an uncomplicated reverse total shoulder arthroplasty. She reports a sudden onset of lateral shoulder pain after lifting a heavy grocery bag, with a subsequent drop in active elevation. Radiographs show a displaced fracture of the acromion base. What factor is most associated with this complication?

A 19-year-old male presents to the trauma bay following a high-speed motor vehicle collision. He complains of chest pain, shortness of breath, and dysphagia. His left shoulder is protracted, and there is a palpable depression at the left sternoclavicular joint. Which imaging study is the gold standard to evaluate this injury?

A 24-year-old professional baseball pitcher presents with decreasing throwing velocity and shoulder pain in the late cocking phase. Examination reveals a loss of internal rotation of 25 degrees compared to the contralateral side, with a corresponding increase in external rotation. What is the primary anatomic structure responsible for this finding?

A 72-year-old female presents with pseudoparalysis of her right shoulder and severe pain. Imaging confirms a massive, retracted, irreparable rotator cuff tear involving the supraspinatus and infraspinatus, with advanced glenohumeral osteoarthritis. Her deltoid function is intact. Which of the following is the most appropriate surgical treatment?

According to the Walch classification of glenoid morphology in primary osteoarthritis, a B2 glenoid is best described by which of the following?

A 48-year-old female with poorly controlled type 1 diabetes presents with insidious onset of progressive shoulder stiffness and pain. Examination reveals a significant loss of both active and passive range of motion, particularly in external rotation. What is the most appropriate initial management?

In a reverse total shoulder arthroplasty, lateralization of the glenosphere provides which of the following biomechanical advantages compared to a traditional medialized design?

A 28-year-old male presents with shoulder pain and weakness after a posterior triangle neck biopsy. On physical examination, the scapula translates laterally and superiorly with attempted shoulder abduction. Injury to which of the following nerves is the most likely cause?

A 65-year-old male with primary osteoarthritis of the shoulder is planning to undergo an anatomic total shoulder arthroplasty. Preoperative CT scan demonstrates a biconcave glenoid with retroversion of 20 degrees and posterior subluxation of the humeral head. This glenoid morphology is best classified as:

A 42-year-old female presents with sudden onset of severe, unprovoked left shoulder pain that lasted for two weeks, followed by progressive weakness in shoulder elevation as the pain subsided. An MRI of the shoulder and cervical spine is unremarkable. What is the most likely diagnosis?