Menu

9. Shoulder and Elbow MCQs

Practice Set 169 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 3361

Topic: Elbow & Forearm

In the surgical management of a terrible triad injury of the elbow, what is the most widely accepted sequential order of repair?

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

Correct Answer & Explanation

. LCL repair, coronoid fixation, radial head replacement

Explanation

Standard protocol addresses deep to superficial structures from inside-out. The anterior column (coronoid) is fixed first, followed by the lateral column (radial head), and finally the lateral collateral ligament complex.

Question 3362

Topic: Elbow & Forearm

Which of the following complications is significantly more common following a two-incision technique for distal biceps tendon repair compared to a single anterior incision?

. Lateral antebrachial cutaneous nerve palsy
. Radial nerve palsy
. Heterotopic ossification and radioulnar synostosis
. Re-rupture of the tendon
. Posterior interosseous nerve palsy

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve palsy

Explanation

While the two-incision technique decreases the risk of lateral antebrachial cutaneous nerve injury, it traverses the interosseous membrane. This carries a higher risk of heterotopic ossification and potentially debilitating proximal radioulnar synostosis.

Question 3363

Topic: 9. Shoulder and Elbow

A 45-year-old female undergoes radial head replacement for a comminuted fracture. Postoperatively, she exhibits restricted elbow flexion and lateral elbow pain. If overstuffing of the radiocapitellar joint is present, what associated radiographic finding is most likely?

. Medial joint space widening on AP radiograph
. Proximal migration of the radius
. Increased ulnar variance
. Ulnohumeral joint subluxation
. Lateral joint space narrowing

Correct Answer & Explanation

. Medial joint space widening on AP radiograph

Explanation

Overstuffing the radial head acts as a cam, over-tensioning the lateral structures and shifting the ulna. This leads to capitellar wear, restricted flexion, and asymmetric medial joint space gapping on AP radiographs.

Question 3364

Topic: Shoulder Pathology

A 32-year-old female presents with shoulder weakness and lateral scapular winging 4 weeks after an excisional lymph node biopsy in the posterior cervical triangle. Which nerve is most likely injured, and which muscle is denervated?

. Long thoracic nerve; serratus anterior
. Spinal accessory nerve; trapezius
. Dorsal scapular nerve; rhomboids
. Suprascapular nerve; infraspinatus
. Axillary nerve; deltoid

Correct Answer & Explanation

. Long thoracic nerve; serratus anterior

Explanation

Iatrogenic injury to the spinal accessory nerve in the posterior triangle denervates the trapezius. This results in lateral winging of the scapula, characterized by lateral translation and downward rotation of the acromion.

Question 3365

Topic: Shoulder Arthroplasty & Arthritis

A 72-year-old male who underwent a reverse total shoulder arthroplasty (RTSA) 6 months ago presents with new-onset lateral shoulder pain. Radiographs reveal a Levy Type II fracture at the base of the acromion. What is the most appropriate initial management?

. Open reduction and internal fixation with a tension band construct
. Sling immobilization and symptomatic treatment
. Revision to an anatomic total shoulder arthroplasty
. Arthroscopic subacromial decompression
. Immediate revision of the glenosphere to a smaller size

Correct Answer & Explanation

. Open reduction and internal fixation with a tension band construct

Explanation

Acromial stress fractures are a known complication of RTSA due to increased deltoid tension. Levy Type II fractures (located posterior to the acromioclavicular joint) are typically managed non-operatively with sling immobilization, although surgery may be considered for severe displacement or symptomatic nonunion.

Question 3366

Topic: Elbow & Forearm
A 45-year-old female sustains an elbow dislocation, a Regan-Morrey Type II coronoid fracture, and a Mason Type III radial head fracture. During the surgical reconstruction of this "terrible triad" injury, which structure is typically repaired last to restore stability?
. Coronoid process
. Radial head
. Lateral ulnar collateral ligament (LUCL)
. Medial collateral ligament (MCL)
. Common extensor origin

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

The standard surgical algorithm for an elbow terrible triad is fixing the coronoid first, followed by radial head repair or replacement, and finally repairing the LUCL. The MCL is generally only repaired if the elbow remains grossly unstable in extension after the lateral and anterior structures are stabilized.

Question 3367

Topic: Elbow & Forearm

During an anterior single-incision repair of a distal biceps tendon rupture using cortical button fixation, the patient develops postoperative weakness in thumb and finger extension, but normal, radially deviated wrist extension. Which nerve was likely injured?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The posterior interosseous nerve (PIN) is at risk during single-incision distal biceps repairs if the drill plunges too far through the posterior radial cortex. PIN injury causes weakness in thumb and digit extension with preserved radial wrist extension, as the ECRL is innervated proximal to the PIN.

Question 3368

Topic: 9. Shoulder and Elbow

A 45-year-old female with type 1 diabetes presents with insidious onset of shoulder pain and stiffness. Which of the following best describes the typical natural history of her condition?

. Rapid progression to glenohumeral osteoarthritis within 2 years
. Self-limiting course with complete resolution of symptoms in 3-6 months
. Progressive worsening requiring early surgical capsular release
. Freezing, frozen, and thawing phases typically lasting 1 to 3 years
. Permanent severe loss of motion without surgical intervention

Correct Answer & Explanation

. Rapid progression to glenohumeral osteoarthritis within 2 years

Explanation

Adhesive capsulitis typically follows a protracted, self-limiting course progressing through freezing, frozen, and thawing phases. The entire process generally lasts 1 to 3 years, although diabetic patients may experience a more prolonged course with a higher risk of residual stiffness.

Question 3369

Topic: 9. Shoulder and Elbow

A 65-year-old female with primary glenohumeral osteoarthritis has a Walch B2 glenoid with 25 degrees of retroversion and posterior humeral head subluxation. What is the most reliable surgical option to correct the deformity and minimize early glenoid component loosening?

. Hemiarthroplasty
. Anatomic total shoulder arthroplasty with asymmetric anterior reaming
. Anatomic total shoulder arthroplasty with standard pegged glenoid
. Reverse total shoulder arthroplasty
. Resection arthroplasty

Correct Answer & Explanation

. Hemiarthroplasty

Explanation

In older patients with a Walch B2 glenoid and severe retroversion (>20-25 degrees) or significant posterior subluxation, reverse total shoulder arthroplasty (RTSA) is preferred. Attempting to correct severe retroversion with asymmetric reaming removes critical subchondral bone, leading to early glenoid component failure.

Question 3370

Topic: 9. Shoulder and Elbow

A 22-year-old collegiate baseball pitcher complains of posteromedial elbow pain and a loss of throwing velocity. Exam reveals a flexion contracture of 10 degrees and pain with forced passive elbow extension. A moving valgus stress test is negative. What is the most likely diagnosis?

. Medial epicondylitis
. Ulnar collateral ligament complete tear
. Valgus extension overload syndrome
. Flexor pronator mass strain
. Cubital tunnel syndrome

Correct Answer & Explanation

. Medial epicondylitis

Explanation

Valgus extension overload (VEO) syndrome results from repetitive impingement of the olecranon in the olecranon fossa during the deceleration phase of throwing. It is characterized by posteromedial pain, flexion contractures, and osteophyte formation, often with an intact ulnar collateral ligament.

Question 3371

Topic: 9. Shoulder and Elbow

Following severe elbow trauma, a patient develops severe stiffness. Radiographs confirm extensive anterior heterotopic ossification (HO). When planning surgical excision of the HO, what is the most appropriate timing for the intervention?

. 4 weeks post-injury
. 8 weeks post-injury
. Once alkaline phosphatase levels normalize
. Wait 18-24 months for complete maturation
. When radiographic margins are well-defined and range of motion has plateaued

Correct Answer & Explanation

. 4 weeks post-injury

Explanation

Current evidence suggests that excision of heterotopic ossification around the elbow can be safely performed when radiographic margins are well-corticated and the patient's range of motion has plateaued (typically 4-6 months). Waiting 18 months or for normal alkaline phosphatase is no longer considered strictly necessary.

Question 3372

Topic: 9. Shoulder and Elbow

A 72-year-old female presents with progressive shoulder pain 2 years after a reverse total shoulder arthroplasty. Radiographs reveal inferior scapular notching past the inferior screw (Sirveaux grade 3). What design factor or surgical technique most significantly reduces the risk of this complication?

. Superior tilt of the glenosphere
. Medialization of the center of rotation
. Inferior translation and overhang of the glenosphere
. Decreased glenosphere size
. Superior translation of the glenosphere

Correct Answer & Explanation

. Superior tilt of the glenosphere

Explanation

Inferior translation and overhang of the glenosphere relative to the inferior glenoid rim minimizes scapular notching. Lateralization also decreases notching, whereas medialization and superior placement significantly increase the risk.

Question 3373

Topic: 9. Shoulder and Elbow

A 45-year-old male sustains a terrible triad injury of the elbow. Intraoperatively, after fixing the coronoid and replacing the radial head, the elbow remains unstable in extension. What is the next most appropriate step in the standard surgical algorithm?

. Repair the medial ulnar collateral ligament
. Repair the lateral ulnar collateral ligament (LUCL)
. Apply a hinged external fixator
. Perform a triceps fascial flap
. Cast the elbow in 90 degrees of flexion and pronation

Correct Answer & Explanation

. Repair the medial ulnar collateral ligament

Explanation

The standard surgical algorithm for a terrible triad is coronoid fixation, radial head fixation or replacement, followed immediately by LUCL repair. If the elbow remains unstable after LUCL repair, only then is the medial collateral ligament repaired or a hinged external fixator applied.

Question 3374

Topic: 9. Shoulder and Elbow
A 55-year-old diabetic female presents with 6 months of severe, progressive global shoulder stiffness. She lacks both active and passive range of motion, particularly in external rotation. Which histological finding is most characteristic of the affected tissue in this condition?
. Abundant neutrophils and bacteria
. Fibroblastic proliferation with type III collagen deposition
. Cartilage fragmentation and synovial hyperplasia
. Myxoid degeneration and calcific deposits
. Granulomatous inflammation with giant cells

Correct Answer & Explanation

. Fibroblastic proliferation with type III collagen deposition

Explanation

Adhesive capsulitis is characterized by fibroblastic proliferation, thickening of the joint capsule, and an increase in type III collagen. This leads to contracture of the coracohumeral ligament and rotator interval, severely limiting external rotation.

Question 3375

Topic: 9. Shoulder and Elbow

A 65-year-old male with primary glenohumeral osteoarthritis presents with a Walch B2 glenoid. What is the defining characteristic of a Walch B2 glenoid?

. Central erosion with a concentric wear pattern
. Biconcave shape with posterior subluxation of the humeral head
. Retroversion greater than 25 degrees with severe medial wear
. Superior humeral head migration with superior glenoid wear
. Dysplastic glenoid with severe hypoplasia

Correct Answer & Explanation

. Central erosion with a concentric wear pattern

Explanation

A Walch B2 glenoid is defined by a biconcave shape with posterior subluxation of the humeral head and posterior wear. It is a critical finding as it increases the risk of glenoid component loosening if not addressed during total shoulder arthroplasty.

Question 3376

Topic: 9. Shoulder and Elbow

A 40-year-old male golfer complains of chronic medial elbow pain exacerbated by wrist flexion and forearm pronation. He is scheduled for surgical debridement. The diseased tissue targeted for release originates primarily from which structure?

. Flexor carpi radialis
. Pronator teres
. Flexor carpi ulnaris
. Palmaris longus
. Flexor digitorum superficialis

Correct Answer & Explanation

. Flexor carpi radialis

Explanation

Medial epicondylitis primarily involves tendinosis of the pronator teres and flexor carpi radialis origins at the medial epicondyle. Surgical management involves debridement of this pathologic tissue.

Question 3377

Topic: 9. Shoulder and Elbow

A 65-year-old man presents 6 weeks after an anatomic total shoulder arthroplasty complaining of sudden anterior shoulder pain and weakness. On examination, he has passively increased external rotation compared to the contralateral side and increased lift-off test lag. What is the most likely diagnosis?

. Axillary nerve neurapraxia
. Subscapularis tendon rupture
. Glenoid component loosening
. Anterior dislocation
. Rotator interval disruption

Correct Answer & Explanation

. Axillary nerve neurapraxia

Explanation

Subscapularis failure is a known complication of anatomic total shoulder arthroplasty, typically presenting with increased passive external rotation and weakness in internal rotation. Early diagnosis and repair are recommended to prevent anterior instability.

Question 3378

Topic: 9. Shoulder and Elbow

A 35-year-old man falls on an outstretched hand, sustaining a varus posteromedial rotatory instability (VPMRI) injury of the elbow. Which of the following anatomic structures are characteristically injured in this specific pattern?

. Anteromedial facet of the coronoid and lateral collateral ligament (LCL)
. Coronoid tip, radial head, and LCL
. Coronoid base and medial collateral ligament (MCL)
. Olecranon, radial head, and MCL
. Radial head and central band of the interosseous membrane

Correct Answer & Explanation

. Anteromedial facet of the coronoid and lateral collateral ligament (LCL)

Explanation

VPMRI results from a varus force and axial load, leading to a fracture of the anteromedial facet of the coronoid and disruption of the LCL. Failure to recognize and fix the anteromedial facet leads to rapid post-traumatic arthrosis and joint subluxation.

Question 3379

Topic: Elbow & Forearm

Following a single-incision anterior repair of a distal biceps tendon rupture using a cortical button, the patient complains of numbness over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

. Superficial radial nerve
. Posterior interosseous nerve (PIN)
. Lateral antebrachial cutaneous nerve (LABCN)
. Median nerve
. Medial antebrachial cutaneous nerve

Correct Answer & Explanation

. Superficial radial nerve

Explanation

The LABCN is the most commonly injured nerve during a single-incision distal biceps repair. This is due to its anatomic proximity to the surgical field and the cephalic vein within the subcutaneous tissues.

Question 3380

Topic: Shoulder Arthroplasty & Arthritis

A 74-year-old woman undergoes a reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy. How does the biomechanical design of the RTSA primarily improve her active shoulder elevation?

. It lateralizes the center of rotation to increase the rotator cuff lever arm.
. It shifts the center of rotation medially and inferiorly, increasing the deltoid lever arm.
. It relies on the preserved coracoacromial arch to provide a fulcrum.
. It shifts the center of rotation superiorly to tension the remaining supraspinatus.
. It increases the tension on the conjoint tendon to act as an elevator.

Correct Answer & Explanation

. It lateralizes the center of rotation to increase the rotator cuff lever arm.

Explanation

RTSA medializes and inferiorizes the center of rotation of the shoulder joint. This significantly recruits more deltoid fibers and increases the deltoid's moment arm, allowing it to compensate for the absent rotator cuff.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page