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9. Shoulder and Elbow MCQs

Practice Set 168 of 197

This practice set contains high-yield board review questions covering key concepts in 9. Shoulder and Elbow. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 3341

Topic: Elbow & Forearm

A 40-year-old laborer undergoes operative repair of a distal biceps tendon rupture utilizing a classic two-incision technique. Which complication is historically more associated with the two-incision technique compared to the single anterior incision technique?

. Lateral antebrachial cutaneous nerve palsy
. Posterior interosseous nerve (PIN) palsy
. Radioulnar synostosis
. Radial artery injury
. Median nerve neurapraxia

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve palsy

Explanation

Radioulnar synostosis (or heterotopic ossification) is historically more common with the two-incision technique due to muscle-splitting near the interosseous membrane. The single-incision technique carries a higher risk of lateral antebrachial cutaneous and PIN injuries.

Question 3342

Topic: Shoulder Arthroplasty & Arthritis

In planning an anatomic total shoulder arthroplasty for primary osteoarthritis, a CT scan reveals a Walch B2 glenoid morphology. What specifically characterizes this type of glenoid wear?

. Symmetric concentric wear
. Biconcave glenoid with posterior wear and posterior subluxation
. Retroversion of >25 degrees with a dysplastic appearance
. Medialized wear without retroversion
. Anterior wear with anterior subluxation

Correct Answer & Explanation

. Symmetric concentric wear

Explanation

A Walch B2 glenoid is defined by biconcavity due to asymmetric posterior wear, often accompanied by posterior subluxation of the humeral head. This presents a high risk of glenoid component loosening if not addressed with eccentric reaming or augmented components.

Question 3343

Topic: 9. Shoulder and Elbow

A 45-year-old male presents to the emergency department with an acute anterior dislocation of the glenohumeral joint. What is the most common neurological injury associated with this dislocation pattern in an adult patient, and what muscle function is consequently impaired?

. Musculocutaneous nerve; biceps brachii
. Radial nerve; triceps brachii
. Axillary nerve; deltoid
. Suprascapular nerve; supraspinatus
. Long thoracic nerve; serratus anterior

Correct Answer & Explanation

. Musculocutaneous nerve; biceps brachii

Explanation

The axillary nerve is most frequently injured in anterior shoulder dislocations due to its anatomical course near the inferior capsule. It innervates the deltoid and teres minor, leading to weakness in shoulder abduction and external rotation.

Question 3344

Topic: Elbow & Forearm
A 32-year-old female sustains a fracture involving the capitellum with extension medially into the lateral trochlear ridge. According to the Bryan and Morrey classification, which type best describes this fracture?
. Kocher-Lorenz (Type II)
. Hahn-Steinthal (Type I)
. Broberg-Morrey (Type III)
. McKee modification (Type IV)
. Grantham (Type V)

Correct Answer & Explanation

. McKee modification (Type IV)

Explanation

A coronal shear fracture of the capitellum that extends medially to involve the lateral trochlear ridge is classified as a Type IV fracture according to the McKee modification. Recognizing this medial extension is crucial for surgical planning and ensuring adequate fixation.

Question 3345

Topic: 9. Shoulder and Elbow

A 21-year-old collegiate baseball pitcher presents with medial elbow pain. The moving valgus stress test is performed, producing pain optimally at an arc between 120 and 70 degrees of flexion. Which specific bundle of the Ulnar Collateral Ligament (UCL) is primarily being evaluated by this test?

. Transverse bundle
. Anterior band of the anterior bundle
. Posterior band of the anterior bundle
. Posterior bundle
. Lateral ulnar collateral ligament

Correct Answer & Explanation

. Transverse bundle

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress. It is divided into an anterior band (taut in extension) and a posterior band (taut in flexion). The moving valgus stress test evaluates the UCL, and pain precisely between 120 and 70 degrees points to insufficiency of the anterior bundle, particularly the posterior band which tightens during flexion.

Question 3346

Topic: Elbow & Forearm

A 42-year-old bodybuilder feels a pop in his anterior elbow during a heavy deadlift. The examiner performs the Hook test. What is the anatomic structure being evaluated, and what constitutes a positive test?

. Distal triceps; inability to hook finger under tendon
. Distal biceps; inability to hook finger under the lateral edge of the tendon
. Ulnar collateral ligament; pain with hooking the medial epicondyle
. Median nerve; paresthesias when hooking the lacertus fibrosus
. Brachialis; pain upon resisted flexion with the forearm pronated

Correct Answer & Explanation

. Distal triceps; inability to hook finger under tendon

Explanation

The Hook test specifically evaluates the integrity of the distal biceps tendon. A positive test occurs when the examiner's index finger cannot hook under the intact biceps tendon from the lateral side, indicating a complete rupture.

Question 3347

Topic: 9. Shoulder and Elbow

A collegiate baseball pitcher complains of medial elbow pain and decreased velocity. The moving valgus stress test is performed. The test is considered positive if pain is reproduced at the medial elbow during which specific arc of elbow motion?

. 120 to 70 degrees of flexion
. 30 to 0 degrees of extension
. 70 to 120 degrees of flexion
. 0 to 30 degrees of flexion
. 90 to 130 degrees of flexion

Correct Answer & Explanation

. 120 to 70 degrees of flexion

Explanation

The moving valgus stress test evaluates the integrity of the Ulnar Collateral Ligament (UCL). A positive test reproduces maximal medial elbow pain in the "shear zone" between 120 and 70 degrees of elbow flexion as the examiner rapidly extends the elbow with valgus torque applied.

Question 3348

Topic: 9. Shoulder and Elbow

A 20-year-old collegiate javelin thrower presents with medial elbow pain. The examiner grasps the patient's thumb on the affected side and applies a valgus stress to the elbow while it is flexed beyond 90 degrees. A positive test indicates insufficiency of which structure?

. Radial collateral ligament
. Lateral ulnar collateral ligament
. Anterior bundle of the ulnar collateral ligament
. Posterior bundle of the ulnar collateral ligament
. Common flexor origin

Correct Answer & Explanation

. Radial collateral ligament

Explanation

The milking maneuver evaluates the ulnar collateral ligament (UCL) of the elbow. Flexing the elbow past 90 degrees places maximal stress specifically on the posterior band of the anterior bundle and the posterior bundle of the UCL.

Question 3349

Topic: Shoulder Arthroplasty & Arthritis

A 72-year-old woman is 3 years status post a reverse total shoulder arthroplasty. Radiographs show inferior scapular notching extending past the inferior glenoid screw. Which surgical factor most effectively minimizes the risk of this complication?

. Superior placement of the glenosphere
. Neutral version of the humeral stem
. Inferior translation and inferior tilt of the glenosphere
. Decreasing the glenosphere size
. Medialization of the center of rotation

Correct Answer & Explanation

. Superior placement of the glenosphere

Explanation

Scapular notching is a frequent complication of reverse TSA caused by mechanical impingement of the humeral cup against the scapular neck. Inferior translation and inferior tilt of the glenosphere baseplate significantly reduce this risk.

Question 3350

Topic: Elbow & Forearm

A 45-year-old falls onto an outstretched hand resulting in a terrible triad injury of the elbow. During surgical reconstruction, what is the generally recommended sequence of repair?

. Radial head, coronoid, lateral collateral ligament (LCL)
. LCL, radial head, coronoid
. Coronoid, LCL, radial head
. Coronoid, radial head, LCL
. LCL, coronoid, radial head

Correct Answer & Explanation

. Radial head, coronoid, lateral collateral ligament (LCL)

Explanation

The standard surgical sequence for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) is repairing deep to superficial. This involves addressing the coronoid first, then the radial head (fixation or replacement), and finally the LCL complex.

Question 3351

Topic: Elbow & Forearm

Following a two-incision surgical repair of a distal biceps tendon rupture, the patient reports inability to extend the fingers and thumb, with radial deviation during wrist extension. Which nerve was most likely injured?

. Lateral antebrachial cutaneous nerve
. Posterior interosseous nerve
. Anterior interosseous nerve
. Superficial radial nerve
. Ulnar nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The posterior interosseous nerve (PIN) is at risk during the two-incision technique for distal biceps repair if the forearm is not kept in pronation during posterolateral exposure. PIN palsy presents with weakness in finger and thumb extension, and radial deviation on wrist extension due to extensor carpi ulnaris weakness.

Question 3352

Topic: Shoulder Pathology

A 26-year-old mechanic sustains a traction injury to his neck and shoulder. He demonstrates medial scapular winging that worsens when pushing against a wall. Which nerve is injured and which muscle is affected?

. Spinal accessory nerve; Trapezius
. Long thoracic nerve; Serratus anterior
. Dorsal scapular nerve; Rhomboids
. Thoracodorsal nerve; Latissimus dorsi
. Axillary nerve; Deltoid

Correct Answer & Explanation

. Spinal accessory nerve; Trapezius

Explanation

Medial scapular winging is caused by paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. Lateral winging is typically due to spinal accessory nerve injury affecting the trapezius.

Question 3353

Topic: 9. Shoulder and Elbow

A 62-year-old male with primary glenohumeral osteoarthritis presents for shoulder arthroplasty. CT imaging demonstrates a Walch B2 glenoid with 20 degrees of retroversion. What is the primary concern if an uncorrected anatomic total shoulder arthroplasty is performed?

. Anterior instability
. Early loosening of the glenoid component
. Coracoid impingement
. Rotator cuff failure
. Axillary nerve palsy

Correct Answer & Explanation

. Anterior instability

Explanation

A Walch B2 glenoid features biconcavity and posterior wear with excessive retroversion. If an anatomic TSA is placed without correcting the retroversion, there is a high risk of posterior subluxation and eccentric loading, leading to early glenoid component loosening.

Question 3354

Topic: 9. Shoulder and Elbow

A 21-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft (Tommy John surgery). The sublime tubercle is the anatomical insertion point for which band of the UCL?

. Posterior band
. Transverse band
. Anterior band
. Oblique band
. Accessory band

Correct Answer & Explanation

. Posterior band

Explanation

The anterior band of the medial ulnar collateral ligament is the primary restraint to valgus stress at the elbow. It originates on the anteroinferior medial epicondyle and inserts distally on the sublime tubercle of the proximal ulna.

Question 3355

Topic: 9. Shoulder and Elbow

Which of the following baseplate and glenosphere configurations in reverse total shoulder arthroplasty is most effective at minimizing the risk of scapular notching?

. Superior tilt and superior overhang
. Neutral tilt and flush placement
. Inferior tilt and inferior overhang
. Superior tilt and inferior overhang
. Inferior tilt and superior overhang

Correct Answer & Explanation

. Superior tilt and superior overhang

Explanation

Scapular notching is a frequent complication caused by impingement of the humeral component on the scapular neck. Placing the baseplate with inferior tilt and allowing the glenosphere to overhang inferiorly helps clear the scapular neck during arm adduction.

Question 3356

Topic: Elbow & Forearm

In the surgical management of a terrible triad injury of the elbow, which of the following is the generally recommended sequence of repair to restore stability?

. LCL repair, coronoid fixation, radial head fixation
. Coronoid fixation, radial head fixation or replacement, LCL repair
. Radial head fixation or replacement, LCL repair, coronoid fixation
. LCL repair, MCL repair, coronoid fixation
. Coronoid fixation, MCL repair, radial head replacement

Correct Answer & Explanation

. LCL repair, coronoid fixation, radial head fixation

Explanation

The standard protocol for a terrible triad injury is to repair deep to superficial, starting anteriorly. The sequence is coronoid fixation, followed by radial head fixation or replacement, and finally lateral collateral ligament (LCL) repair to restore the lateral tension band.

Question 3357

Topic: Shoulder Pathology

A 40-year-old woman develops lateral winging of the scapula and a drooping shoulder three weeks after a posterior triangle neck lymph node biopsy. Which nerve was most likely injured, and what is the preferred definitive tendon transfer if nonoperative management fails?

. Long thoracic nerve; Pectoralis major transfer
. Spinal accessory nerve; Eden-Lange procedure
. Dorsal scapular nerve; Split pectoralis major transfer
. Long thoracic nerve; Eden-Lange procedure
. Spinal accessory nerve; Latissimus dorsi transfer

Correct Answer & Explanation

. Long thoracic nerve; Pectoralis major transfer

Explanation

Injury to the spinal accessory nerve results in trapezius palsy, causing lateral scapular winging. If conservative management fails after 1 year, the Eden-Lange procedure (transfer of levator scapulae and rhomboids) is indicated to stabilize the scapula.

Question 3358

Topic: Elbow & Forearm

A 45-year-old male undergoes a single-incision anterior repair of a distal biceps tendon rupture. Postoperatively, he complains of numbness and paresthesia along the lateral aspect of his forearm. Which nerve was most likely injured?

. Posterior interosseous nerve (PIN)
. Superficial radial nerve
. Lateral antebrachial cutaneous nerve (LABCN)
. Medial antebrachial cutaneous nerve (MABCN)
. Anterior interosseous nerve (AIN)

Correct Answer & Explanation

. Posterior interosseous nerve (PIN)

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single-incision anterior distal biceps repair due to its proximity to the surgical field. The PIN is more at risk during a two-incision approach.

Question 3359

Topic: Elbow & Forearm

A 32-year-old sustains a highly comminuted, unsalvageable radial head fracture along with severe wrist pain and distal radioulnar joint (DRUJ) instability. What is the most appropriate management strategy?

. Radial head excision alone
. Radial head excision and DRUJ pinning in pronation
. Radial head arthroplasty and DRUJ pinning in supination
. Open reduction internal fixation of the radial head and DRUJ pinning in neutral
. Radial head excision and ulnar shortening osteotomy

Correct Answer & Explanation

. Radial head excision alone

Explanation

This patient has an Essex-Lopresti lesion consisting of a radial head fracture, interosseous membrane tear, and DRUJ disruption. Management requires radial head arthroplasty to restore longitudinal stability and pinning of the DRUJ in supination to allow the IOM to heal.

Question 3360

Topic: 9. Shoulder and Elbow

Which glenosphere modification minimizes the risk of scapular notching in reverse total shoulder arthroplasty?

. Superior translation and superior tilt
. Inferior translation and inferior tilt
. Lateral offset and superior tilt
. Medial offset and superior tilt
. Superior translation and neutral tilt

Correct Answer & Explanation

. Superior translation and superior tilt

Explanation

Inferior translation and inferior tilt of the glenosphere move the center of rotation distally. This prevents mechanical impingement of the humeral component against the inferior scapular neck during adduction.

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