9. Shoulder and Elbow MCQs

A macrosomic newborn presents with decreased spontaneous motion of the left upper extremity after a difficult breech delivery. Radiographs show a normal glenohumeral relationship but medial displacement of the proximal humeral shaft relative to the glenoid. What is the most appropriate next step in diagnosis or management?

A 4.5 kg neonate is delivered via normal vaginal delivery complicated by shoulder dystocia. Postnatally, the infant exhibits absent active movement of the right hand and fingers, a claw-like hand deformity, and ptosis and miosis of the right eye. The shoulder and elbow movements are relatively preserved. Which nerve roots are most likely injured?

A 36-year-old recreational athlete feels a pop in his antecubital fossa while lifting weights. He has pain, swelling, and deformity. Representative sagittal and coronal MRI slices are shown in Figures 1 and 2, respectively. What is the most common major complications associated with surgical repair of this structure?

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A 58-year-old man has right shoulder pain. An examination reveals full range of motion in all planes but 4/5 forward elevation strength (Figures 90a and 90b).

A 78-year-old woman undergoes a reverse total shoulder arthroplasty for cuff tear arthropathy. Her preoperative, 3-month postoperative, and

A 45-year-old female falls from a ladder and sustains an injury to her right elbow. Radiographs similar to the typical appearance of this injury pattern

demonstrate a posterior elbow dislocation, a radial head fracture, and a coronoid fracture. According to the standard lateral-to-medial surgical protocol (e.g., Pugh et al.), what is the correct sequence of structural fixation?

A 74-year-old male complains of right shoulder pain and an inability to elevate his arm actively beyond 30 degrees (pseudoparalysis). Radiographs demonstrate superior migration of the humeral head with severe acromiohumeral narrowing (Hamada grade 4). MRI confirms a massive, retracted, unrepairable tear of the supraspinatus and infraspinatus with fatty infiltration. The deltoid muscle is fully intact, and axillary nerve function is normal. What is the most appropriate surgical treatment?

A 45-year-old male undergoes a single-incision anterior approach for repair of a complete distal biceps tendon rupture. During the post-operative follow-up, he complains of numbness and tingling over the lateral aspect of his proximal forearm. Which nerve was most likely injured or stretched by retraction during this procedure?

A 35-year-old laborer with an irreparable brachial plexus injury (affecting the C5-C6 roots) and a flail shoulder but functional hand and elbow undergoes a glenohumeral arthrodesis. To maximize postoperative functional outcome, allowing the patient to reach his mouth and perineum, the arthrodesis should be secured in which of the following positions?

A 35-year-old male falls from a ladder and sustains an elbow dislocation. Radiographs demonstrate a posterior elbow dislocation associated with a radial head fracture and a coronoid process fracture. What is the standard algorithmic sequence of surgical reconstruction for this injury pattern to restore elbow stability?

A 72-year-old male is 2 years post-operative from a reverse total shoulder arthroplasty (RTSA). Routine radiographs reveal prominent inferior scapular notching.

Which of the following surgical techniques or implant choices during the index procedure would have best minimized the risk of developing this complication?

A 25-year-old female presents with lateral elbow pain and a sensation of the elbow 'clunking' out of place when pushing herself up from a chair with her forearms supinated. Physical examination demonstrates apprehension and subluxation during a lateral pivot shift test. This condition is primarily caused by insufficiency of which ligamentous structure?

A 22-year-old rugby player sustains a traumatic anterior shoulder dislocation. After reduction, he experiences recurrent instability.

An MR arthrogram demonstrates a 'J-sign' on the coronal oblique view with extravasation of contrast inferiorly. Which of the following is the most likely diagnosis?

A 45-year-old male undergoes a single-incision anterior approach repair for an acute distal biceps tendon rupture. Postoperatively, he has an excellent return of flexion and supination strength but complains of numbness and tingling radiating down the radial aspect of his volar forearm. Which nerve is most likely injured?

A 32-year-old male sustains a fall onto his extended arm and presents with an elbow injury. CT imaging reveals a fracture of the anteromedial facet of the coronoid process. This specific fracture pattern is highly associated with which of the following injury mechanisms and instability patterns?

A 12-year-old right-hand-dominant baseball pitcher presents with chronic medial elbow pain that worsens during the late cocking and early acceleration phases of throwing.

Radiographs demonstrate widening and irregularity of the medial epicondyle apophysis. What is the primary pathophysiologic biomechanical mechanism responsible for this condition (Little Leaguer's elbow)?

A 75-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for a highly comminuted, osteoporotic 4-part proximal humerus fracture. Despite surgical efforts, the tuberosities fail to heal to the shaft postoperatively. Compared to patients with healed tuberosities, what functional deficit is most prominent in this patient?

A 30-year-old male powerlifter feels a 'tearing' sensation in his anterior axilla while performing a one-rep max bench press. He presents with extensive ecchymosis, loss of the anterior axillary fold contour, and weakness in internal rotation and adduction. In a complete rupture of the pectoralis major during this specific athletic activity, which anatomic segment typically fails first?