9. Shoulder and Elbow MCQs

A surgeon is planning a lateral collateral ligament (LCL) reconstruction for a patient with severe posterolateral rotatory instability (PLRI) of the elbow.

The lateral ulnar collateral ligament (LUCL), the primary restraint to PLRI, originates on the lateral epicondyle and inserts on which of the following structures?

An MRI of the shoulder demonstrates a paralabral cyst at the suprascapular notch, causing nerve compression. What is the normal anatomic relationship of the suprascapular nerve and artery to the superior transverse scapular ligament?

A sagittal oblique MRI of the shoulder demonstrates the boundaries of the rotator interval.

Which of the following structures is NOT considered a standard component within the rotator interval?

A 22-year-old motorcyclist presents after a high-speed collision. He has a mangled, pulseless left upper extremity with massive swelling over the shoulder and chest wall. Radiographs show lateral displacement of the scapula with a widened sternoclavicular joint. What is the most likely neurologic injury associated with this pattern?

A 78-year-old right-hand-dominant female with osteoporosis falls and sustains a complex 4-part proximal humerus fracture. There is a valgus impacted head, significant tuberosity displacement, and a compromised medial calcar hinge. What is the most reliable surgical option for pain relief and functional restoration in this patient?

A 25-year-old male undergoes open reduction and internal fixation for a pronation-external rotation (PER) ankle fracture. After fibular plating and medial malleolus fixation, a 'hook test' (Cotton test) is performed intraoperatively, demonstrating 4 mm of lateral translation of the fibula relative to the tibia. What is the most appropriate next step?

A 42-year-old male sustains a closed scapula fracture in a motorcycle collision. Which of the following radiographic findings represents the most widely accepted indication for operative fixation of a scapular body/neck fracture?

A 45-year-old male falls onto his outstretched hand and sustains a 'terrible triad' injury of the elbow. This injury pattern typically includes a posterior elbow dislocation, a radial head fracture, and a fracture of which of the following structures?

A 45-year-old female falls onto an outstretched hand and sustains a 'terrible triad' injury of the elbow. Which of the following describes the most widely accepted surgical sequence for reconstruction?

A 40-year-old female presents with a terrible triad injury of the elbow. During surgical reconstruction, after fixing the coronoid process and replacing the comminuted radial head with an arthroplasty, the elbow remains subluxated in extension. What is the most appropriate next step in management?

A 22-year-old motorcyclist is involved in a high-speed collision. He presents with massive swelling over his left shoulder girdle, and a chest radiograph shows profound lateral displacement of the left scapula relative to the chest wall. The overlying skin is intact. What is the most common neurologic injury associated with this diagnosis?

A 35-year-old male falls onto an outstretched hand, sustaining a severely comminuted radial head fracture, acute wrist pain, and instability of the distal radioulnar joint (DRUJ). The radial head is deemed unsalvageable. What is the most appropriate definitive management of the elbow in this patient?

A 50-year-old female falls onto her outstretched hand and presents with elbow pain. A lateral radiograph reveals a 'double arc sign'. What specific fracture pattern does this classic radiographic sign indicate?

A 12-year-old elite baseball pitcher presents with progressive medial elbow pain, exacerbated during the late cocking phase of throwing. Radiographs demonstrate widening and irregularity of the medial epicondyle apophysis. What is the most likely diagnosis?

The posterior compartment of the forearm is divided into a superficial, a mobile wad, and a deep layer. Which of the following muscles is NOT found in the deep layer of the posterior forearm?

A 22-year-old sustains a traumatic posterolateral elbow dislocation. During surgical reconstruction of the lateral ulnar collateral ligament (LUCL), accurate placement of the isometric origin and insertion points is essential. What are the true anatomical attachments of the LUCL?

A 20-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction utilizing the Docking technique.

Which bundle of the native UCL is the primary restraint to valgus stress at 90 degrees of elbow flexion and is the primary structure surgically reconstructed?

A 45-year-old construction worker complains of deep shoulder pain that worsens with overhead lifting. Physical examination reveals a positive O'Brien's test and pain with resisted forearm supination. MRI demonstrates a Type II Superior Labrum Anterior to Posterior (SLAP) tear. Given his age and occupation, what is the most appropriate surgical management if conservative therapy fails?

A 19-year-old collegiate baseball pitcher complains of medial elbow pain during the late cocking and early acceleration phases of throwing. The 'moving valgus stress test' is strongly positive. If surgical reconstruction is indicated, which bundle of the ulnar collateral ligament (UCL) must be primarily reconstructed, and at what degree of flexion is it the primary restraint to valgus stress?

A 13-year-old gymnast complains of chronic, insidious onset lateral elbow pain, stiffness, and clicking. Examination reveals a 15-degree flexion contracture. Radiographs show a radiolucent lesion on the anterolateral aspect of the capitellum. MRI confirms Osteochondritis Dissecans (OCD) with an intact articular surface. What differentiates capitellar OCD from Panner's disease?