9. Shoulder and Elbow MCQs

An 18-year-old male rugby player is brought to the emergency department after falling on his shoulder during a tackle. He complains of severe pain at the base of his neck, difficulty swallowing, and a feeling of shortness of breath. On examination, the medial end of his right clavicle is not palpable, and there is a visible depression at the sternoclavicular joint. He is hemodynamically stable. What is the most appropriate next step in management?

A 45-year-old female presents after falling on an outstretched hand. Radiographs reveal a posterolateral elbow dislocation, a displaced radial head fracture, and a Type II coronoid fracture. Operative intervention is planned. To optimize biomechanical stability, what is the generally accepted surgical sequence for repairing the 'terrible triad' of the elbow?

A 40-year-old female presents after falling from a height. She sustains a comminuted, unsalvageable radial head fracture, a longitudinal tear of the interosseous membrane, and dislocation of the distal radioulnar joint (DRUJ). Which of the following is the most appropriate management of the proximal radius in this specific clinical entity?

A 45-year-old male sustains a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture). The coronoid fracture is a Type II according to Regan and Morrey, and the radial head is comminuted. When proceeding with operative management, what is the classic and most biomechanically sound sequence of reconstruction?

A 6-year-old boy presents with a Bado Type I Monteggia fracture-dislocation (anterior dislocation of the radial head with fracture of the ulnar diaphysis). In the operating room, an anatomic closed reduction of the ulnar shaft is achieved and confirmed under fluoroscopy; however, the radial head remains persistently dislocated. What is the most likely cause of this persistent radial head dislocation?

Surgical management of a 'Terrible Triad' injury of the elbow (elbow dislocation, radial head fracture, coronoid fracture) typically follows a systematic approach to restore joint stability. What is the standard, most widely accepted sequence of structural repair/fixation during the operation?

A 45-year-old female falls on an outstretched hand and sustains a capitellum fracture. CT imaging demonstrates a coronal shear fracture that involves the capitellum and the lateral ridge of the trochlea, with extensive posterior articular comminution. Based on the Dubberley classification, this is a Type 3B fracture. What does the 'B' designation specifically indicate in this classification?

A newborn suffers a brachial plexus injury during a difficult macrosomic delivery, affecting the C5 and C6 nerve roots. Which of the following best describes the classic upper extremity posture associated with this injury?

A 45-year-old male presents with right arm pain and numbness. Examination reveals a diminished brachioradialis reflex, weakness in wrist extension, and decreased sensation over the dorsal aspect of the thumb and index finger. Which cervical nerve root is most likely compressed?

A 35-year-old male sustains a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, coronoid fracture). Standard surgical management requires a specific sequence of repair. Which of the following is the most widely accepted first step in the internal fixation sequence for this injury?

A 28-year-old male sustained a midshaft humerus fracture 6 months ago resulting in a complete radial nerve palsy with no signs of recovery on recent EMG. For surgical reconstruction, a tendon transfer is planned. The pronator teres (PT) is most commonly transferred to which structure to restore wrist extension?

A newborn infant presents with the right upper extremity held rigidly in internal rotation, adduction, elbow extension, and wrist flexion (the classic 'waiter's tip' posture). The hand grasp reflex is remarkably preserved. Which brachial plexus nerve roots are primarily injured?

In a patient with an irreversible high radial nerve palsy, multiple tendon transfers are planned. What is the standard transfer utilized to restore active wrist extension?

During a cervical lymph node biopsy in the posterior triangle of the neck, a patient sustains an iatrogenic nerve injury leading to a laterally winged scapula. Which muscle is predominantly affected by this injury?

A 35-year-old female presents with pain, weakness, and paresthesias affecting the medial aspect of her forearm and the ring and small fingers of her hand. True neurogenic thoracic outlet syndrome is suspected. Compression of which part of the brachial plexus is most characteristic of this presentation?

A patient presents with shoulder weakness and pain two months after a radical neck dissection for squamous cell carcinoma. Examination reveals winging of the scapula with lateral translation of the inferior pole. Which muscle is denervated, and what is its primary motor nerve?

In patients with neurogenic thoracic outlet syndrome, compression most commonly occurs within the interscalene triangle. What are the anatomical borders of this triangle?

A 42-year-old female sustains a "terrible triad" injury of the elbow. She is taken to the operating room for definitive fixation. To optimize stability and clinical outcomes, what is the generally recommended sequence of surgical reconstruction?