9. Shoulder and Elbow MCQs

A 45-year-old golfer fails 6 months of conservative treatment for medial epicondylitis. During open surgical debridement, the surgeon must identify and excise the primary degenerative tissue. Which structure is the primary source of the pathology?

Scapular notching is a recognized complication of reverse total shoulder arthroplasty (RTSA), most commonly occurring at the inferior scapular neck. Which surgical technical modification reduces the incidence of inferior scapular notching?

A 72-year-old female is 3 years post-operative from a reverse total shoulder arthroplasty (RTSA) utilizing a Grammont-style prosthesis. Radiographs reveal bone loss on the scapular neck extending beyond the inferior screw of the baseplate. According to the Sirveaux classification, what grade is this scapular notching?

A 45-year-old male sustains an elbow injury. Radiographs show an anteromedial facet fracture of the coronoid. Which specific ligament is most likely injured in this pattern, leading to varus posteromedial rotatory instability?

A 26-year-old female presents with shoulder weakness 4 months after a cervical lymph node biopsy. On exam, her scapula is laterally translated and wings when she attempts to abduct the arm against resistance. The medial border is depressed. Which nerve was most likely injured?

A 38-year-old female complains of a "clunking" sensation in her elbow when pushing up from a chair. A lateral pivot-shift test is performed to evaluate for posterolateral rotatory instability (PLRI). What is the specific mechanical subluxation that occurs during the provocation phase of this test?

In planning a Reverse Total Shoulder Arthroplasty (RTSA) for severe rotator cuff tear arthropathy, how does the prosthesis biomechanically alter the shoulder joint to improve active elevation?

A 45-year-old female undergoes a cervical lymph node biopsy in the posterior triangle of her neck. Postoperatively, she reports a dull ache in her shoulder and difficulty with overhead activities. Examination reveals a laterally displaced and rotated scapula. Which nerve and corresponding muscle were most likely injured?

Which ligamentous complex is the primary restraint to posterolateral rotatory instability (PLRI) of the elbow, frequently injured following a fall on an outstretched hand resulting in axial loading, valgus, and supination forces?

A 38-year-old male falls from a ladder and sustains a complex elbow injury. Clinical and radiographic evaluation demonstrates varus posteromedial rotatory instability. Which specific osseous structure is typically fractured in this exact injury pattern?

A 40-year-old male sustains a severely comminuted radial head fracture and a concomitant distal radioulnar joint (DRUJ) disruption (Essex-Lopresti injury). If the radial head is completely excised without prosthetic replacement, what is the most likely late mechanical complication?

A newborn is diagnosed with radial longitudinal deficiency (radial clubhand). The right thumb is completely absent. You are counseling the parents on the management plan. Prior to any reconstructive orthopedic surgical intervention such as centralization of the carpus on the ulna, which of the following is an absolute prerequisite regarding the affected upper extremity?

A 6-year-old boy presents with a displaced lateral condyle fracture of the humerus. Which of the following is the most common long-term complication if this fracture goes on to nonunion?

A 6-year-old boy sustained a supracondylar humerus fracture treated with closed reduction and percutaneous pinning. Several years later, he presents with a noticeable cosmetic deformity of his elbow, though his range of motion is full and painless. What is the most likely deformity, and how does it affect elbow function?

A newborn infant presents with a right upper extremity held rigidly in adduction and internal rotation, with the elbow extended, forearm pronated, and wrist flexed. The infant's grasp reflex remains fully intact. This classic presentation is due to an injury to which of the following neural structures?

Which of the following best describes the fundamental biomechanical advantage of a reverse total shoulder arthroplasty in a patient suffering from rotator cuff tear arthropathy?

A newborn infant presents in the delivery room with the right upper extremity internally rotated, adducted at the shoulder, extended at the elbow, and pronated at the forearm. The grasp reflex is fully intact. Which specific nerve roots of the brachial plexus are most likely injured?

A 20-year-old collegiate pitcher undergoes a Ulnar Collateral Ligament (UCL) reconstruction utilizing a palmaris longus autograft (Tommy John surgery). Which bundle of the UCL is the primary restraint to valgus stress at the elbow during the late cocking and early acceleration phases of throwing, and must be reconstructed?

A 21-year-old collegiate pitcher undergoes ulnar collateral ligament (UCL) reconstruction using the docking technique with a palmaris longus autograft.

What is the most common postoperative complication associated with this procedure?

A 30-year-old competitive weightlifter feels a sudden tearing sensation in his anterior shoulder/chest while performing the eccentric (downward) phase of a heavy bench press. On examination, he has weakness in internal rotation and an asymmetric axillary fold.

Which portion of the pectoralis major tendon is most susceptible to injury in this scenario?