Menu

9. Shoulder and Elbow MCQs

Practice Set 171 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 3401

Topic: 9. Shoulder and Elbow

A 42-year-old tennis player complains of persistent, severe lateral elbow pain that radiates down the dorsal forearm. The pain is not relieved by conservative measures for lateral epicondylitis. On examination, the point of maximum tenderness is located 4 cm distal to the lateral epicondyle over the mobile wad. Pain is exacerbated by resisted middle finger extension. What is the most likely site of anatomic compression in this condition?

. The extensor carpi radialis brevis origin
. The arcade of Frohse
. The ligament of Struthers
. The lacertus fibrosus
. The Osborne fascia

Correct Answer & Explanation

. The extensor carpi radialis brevis origin

Explanation

The clinical presentation is classic for Radial Tunnel Syndrome (RTS), a compressive neuropathy of the posterior interosseous nerve (PIN). It is distinguished from lateral epicondylitis by the location of maximal tenderness (distal to the lateral epicondyle in the muscle belly) and pain with resisted middle finger extension. The most common site of PIN compression in the radial tunnel is the proximal edge of the superficial layer of the supinator muscle, known as the arcade of Frohse.

Question 3402

Topic: 9. Shoulder and Elbow

A 68-year-old female presents with chronic shoulder pain, profound weakness, and an inability to actively elevate her arm past 60 degrees. Radiographs reveal a massive rotator cuff tear with superior migration of the humeral head and acromiohumeral interval of 3 mm. She has no active external rotation. What is the most appropriate surgical management?

. Arthroscopic rotator cuff repair
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty (RTSA)
. Hemiarthroplasty
. Superior capsule reconstruction

Correct Answer & Explanation

. Arthroscopic rotator cuff repair

Explanation

Reverse total shoulder arthroplasty (RTSA) is the treatment of choice for rotator cuff arthropathy with pseudoparalysis. Tendon transfers require an intact subscapularis and are contraindicated in the setting of glenohumeral arthritis.

Question 3403

Topic: Elbow & Forearm

In the surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), what is the most accepted sequence of reconstruction to restore stability?

. MCL repair, coronoid fixation, radial head repair, LCL repair
. Coronoid fixation, radial head repair/replacement, LCL repair, MCL repair (if needed)
. Radial head replacement, coronoid fixation, LCL repair, MCL repair
. LCL repair, coronoid fixation, radial head replacement, MCL repair
. Coronoid fixation, LCL repair, radial head repair, MCL repair

Correct Answer & Explanation

. MCL repair, coronoid fixation, radial head repair, LCL repair

Explanation

The standard protocol for a terrible triad injury works deep to superficial and medial to lateral: coronoid fixation first, followed by radial head repair or arthroplasty, and then LCL repair. The MCL is only addressed if the elbow remains grossly unstable after lateral sided repair.

Question 3404

Topic: Elbow & Forearm

A 45-year-old male falls from a height and sustains a terrible triad injury of the elbow. During surgical reconstruction, which of the following represents the most appropriate sequence of repair?

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

Correct Answer & Explanation

. LCL repair, then radial head fixation, then coronoid fixation

Explanation

The standard surgical protocol for a terrible triad injury follows a deep-to-superficial, inside-out approach. The coronoid is fixed first to restore anterior stability, followed by the radial head, and finally the lateral collateral ligament (LCL).

Question 3405

Topic: 9. Shoulder and Elbow

A 72-year-old female presents with pseudoparalysis of the shoulder and severe glenohumeral osteoarthritis. MRI shows massive, irreparable tears of the supraspinatus and infraspinatus. Which of the following is the most appropriate surgical treatment?

. Anatomic total shoulder arthroplasty
. Hemiarthroplasty
. Reverse total shoulder arthroplasty
. Latissimus dorsi tendon transfer
. Arthroscopic superior capsule reconstruction

Correct Answer & Explanation

. Anatomic total shoulder arthroplasty

Explanation

Reverse total shoulder arthroplasty is the gold standard for rotator cuff tear arthropathy complicated by pseudoparalysis. It restores elevation by medializing and distalizing the center of rotation, relying on the deltoid muscle.

Question 3406

Topic: 9. Shoulder and Elbow

A 65-year-old patient with a massive irreparable rotator cuff tear and intact subscapularis is considered for a Superior Capsular Reconstruction (SCR). Which of the following is considered a strict contraindication to performing an SCR?

. Hamada Grade 1 radiographic changes
. Intact deltoid muscle function
. Hamada Grade 4 glenohumeral osteoarthritis
. Goutallier Grade 2 fatty infiltration of the infraspinatus
. Active forward elevation of 120 degrees

Correct Answer & Explanation

. Hamada Grade 1 radiographic changes

Explanation

Superior Capsular Reconstruction (SCR) relies on restoring the superior constraints of the glenohumeral joint to prevent superior humeral migration. A strict contraindication to SCR is advanced glenohumeral osteoarthritis (Hamada Grade > 3), such as Hamada Grade 4 (narrowing of the glenohumeral joint space). These patients are better treated with a Reverse Total Shoulder Arthroplasty (RTSA).

Question 3407

Topic: 9. Shoulder and Elbow

A 20-year-old elite baseball pitcher presents with insidious onset of posterior shoulder pain. On physical examination, his dominant shoulder has 25 degrees of internal rotation (IR) and 130 degrees of external rotation (ER). His non-dominant shoulder has 65 degrees of IR and 90 degrees of ER. His total arc of motion is 155 degrees bilaterally. What is the best initial management for this patient?

. Sleeper stretch and cross-body adduction program
. Arthroscopic posterior capsular release
. Arthroscopic SLAP repair
. Anterior capsular plication
. Coracoid transfer procedure

Correct Answer & Explanation

. Sleeper stretch and cross-body adduction program

Explanation

This patient exhibits Glenohumeral Internal Rotation Deficit (GIRD). Throwers typically develop increased ER and decreased IR due to osseous adaptation (humeral retroversion) and posterior capsular contracture. Because his total arc of motion is symmetric (155 degrees), this is largely physiologic. However, to treat symptomatic posterior tightness and prevent progression to pathologic GIRD (where total arc is lost >5 degrees), the first-line treatment is physical therapy utilizing sleeper stretches and cross-body adduction stretches.

Question 3408

Topic: 9. Shoulder and Elbow
A 19-year-old tennis player complains of chronic, vague right shoulder pain and 'dead arm' symptoms. Examination from behind shows asymmetric scapular resting posture. During active arm elevation, the inferior angle of the scapula becomes notably prominent. This finding corresponds to which type of scapular dyskinesis (Kibler classification)?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

According to the Kibler classification of scapular dyskinesis: Type I is characterized by prominence of the inferior angle (indicating tightness of the pectoralis minor or weakness of the lower trapezius). Type II is characterized by prominence of the entire medial border. Type III presents as superior elevation of the scapula. Type IV is normal, symmetric motion.

Question 3409

Topic: 9. Shoulder and Elbow

When surgically managing a symptomatic lesion of the long head of the biceps (LHB) tendon in an active 45-year-old patient, a subpectoral biceps tenodesis is performed instead of a simple tenotomy. Which of the following outcomes is significantly lower with tenodesis compared to tenotomy?

. Incidence of cosmetic 'Popeye' deformity
. Postoperative shoulder stiffness
. Risk of complex regional pain syndrome
. Incidence of surgical site infection
. Rate of eventual return to sport

Correct Answer & Explanation

. Incidence of cosmetic 'Popeye' deformity

Explanation

Biceps tenotomy is simpler, allows faster immediate recovery, and avoids implant costs, but is associated with a significantly higher rate of a cosmetic 'Popeye' deformity (distal retraction of the muscle belly) and occasionally fatigue cramping in active individuals. Biceps tenodesis secures the tendon, thereby restoring resting muscle length, mitigating the Popeye deformity, and decreasing the risk of cramping.

Question 3410

Topic: 9. Shoulder and Elbow

A 21-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction using the docking technique. During the surgical approach, care must be taken to avoid injury to the medial antebrachial cutaneous nerve (MABC). The MABC typically runs in close proximity to which of the following structures in the medial elbow?

. Median nerve
. Ulnar nerve
. Basilic vein
. Cephalic vein
. Brachial artery

Correct Answer & Explanation

. Median nerve

Explanation

During the approach for UCL reconstruction, the medial antebrachial cutaneous nerve (MABC) must be identified and protected. Its anterior and posterior branches typically course parallel and in close proximity to the basilic vein in the subcutaneous tissues over the medial elbow. Neuroma of the MABC is a known complication of UCL reconstruction.

Question 3411

Topic: Elbow & Forearm

A 35-year-old male undergoes surgical repair of an acute distal biceps tendon rupture. The surgeon utilizes a traditional two-incision technique. Which of the following complications is significantly more common with this approach compared to a single anterior incision technique?

. Lateral antebrachial cutaneous nerve neuropraxia
. Posterior interosseous nerve palsy
. Radioulnar synostosis
. Brachial artery pseudoaneurysm
. Superficial radial nerve entrapment

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve neuropraxia

Explanation

The two-incision technique carries a higher risk of heterotopic ossification and radioulnar synostosis due to violation of the interosseous membrane. A single anterior incision has a higher risk of lateral antebrachial cutaneous nerve (LACN) injury.

Question 3412

Topic: 9. Shoulder and Elbow

During a standard deltopectoral approach to the shoulder, the cephalic vein is identified as a primary landmark. To minimize the risk of venous injury and postoperative bleeding, the cephalic vein is typically preserved and retracted with which structure, based on its primary venous tributaries?

. Retracted medially with the pectoralis major
. Retracted laterally with the deltoid
. Ligated routinely, as retraction causes inevitable avulsion
. Retracted medially with the conjoined tendon
. Retracted distally into the axilla

Correct Answer & Explanation

. Retracted medially with the pectoralis major

Explanation

Classic orthopedic teaching advocates retracting the cephalic vein laterally with the deltoid muscle during a deltopectoral approach. This is because the major and more numerous venous tributaries to the cephalic vein originate from the deltoid; retracting it medially places these short branches under tension, increasing the risk of avulsion and bleeding. However, some surgeons prefer medial retraction for better deltoid exposure, necessitating careful cauterization of lateral branches.

Question 3413

Topic: Elbow & Forearm

During a two-incision distal biceps tendon repair, the tendon is advanced to its native footprint on the radial tuberosity. To maximally restore supination strength, the anatomical footprint of the distal biceps tendon should be targeted on which aspect of the radial tuberosity?

. Anterior aspect
. Posterior-ulnar aspect
. Directly lateral aspect
. Distal-most aspect
. Proximal-radial aspect

Correct Answer & Explanation

. Anterior aspect

Explanation

The native footprint of the distal biceps tendon is located on the posterior and ulnar aspect of the radial tuberosity. Reattaching the tendon to this native, posterior-ulnar position acts as a mechanical cam, wrapping around the radius to maximize the moment arm for powerful supination. Anterior placement significantly reduces supination torque.

Question 3414

Topic: Shoulder Pathology
A patient undergoes surgical exploration for Thoracic Outlet Syndrome. The procedure involves evaluating the scalene triangle. Which of the following structures is located outside (anterior to) the scalene triangle?
. Subclavian artery
. Subclavian vein
. Upper trunk of the brachial plexus
. Middle trunk of the brachial plexus
. Lower trunk of the brachial plexus

Correct Answer & Explanation

. Subclavian vein

Explanation

The scalene triangle is bordered by the anterior scalene muscle, the middle scalene muscle, and the first rib. It contains the brachial plexus trunks and the subclavian artery. The subclavian vein passes anterior to the anterior scalene muscle and is therefore not within the scalene triangle.

Question 3415

Topic: Shoulder Pathology

A patient is diagnosed with neurogenic thoracic outlet syndrome. Surgical decompression is planned involving the interscalene triangle. Which structure courses anterior to the anterior scalene muscle, remaining outside the confines of the interscalene triangle?

. Subclavian artery
. Subclavian vein
. Lower trunk of the brachial plexus
. Middle trunk of the brachial plexus
. First rib

Correct Answer & Explanation

. Subclavian artery

Explanation

The interscalene triangle is bounded by the anterior scalene, middle scalene, and first rib. It contains the subclavian artery and the roots/trunks of the brachial plexus. The subclavian vein runs anterior and inferior to the insertion of the anterior scalene muscle, safely separating it from the artery.

Question 3416

Topic: Elbow & Forearm

After completing its motor innervation to the anterior compartment of the arm, the musculocutaneous nerve continues distally to provide sensory innervation to the lateral forearm. It emerges piercing the deep fascia to become the lateral antebrachial cutaneous nerve at which specific anatomical landmark?

. Medial to the distal biceps tendon
. Lateral to the distal biceps tendon
. Between the two heads of the pronator teres
. Posterior to the brachioradialis muscle belly
. Through the central substance of the lacertus fibrosus

Correct Answer & Explanation

. Medial to the distal biceps tendon

Explanation

The musculocutaneous nerve travels distally between the biceps and brachialis muscles and emerges lateral to the distal biceps tendon just above the elbow crease, where it pierces the deep fascia to become the lateral antebrachial cutaneous nerve.

Question 3417

Topic: 9. Shoulder and Elbow

The anterior bundle of the ulnar collateral ligament (UCL) of the elbow is the primary restraint to valgus stress. Where is its anatomical footprint on the ulna?

. The supinator crest of the ulna
. The medial margin of the olecranon tip
. The radial notch of the ulna
. The sublime tubercle at the anteromedial margin of the coronoid process
. The brachialis insertion on the ulnar tuberosity

Correct Answer & Explanation

. The supinator crest of the ulna

Explanation

The anterior bundle of the medial (ulnar) collateral ligament of the elbow originates from the anteroinferior surface of the medial epicondyle and inserts onto the sublime tubercle, which is located on the anteromedial aspect of the coronoid process of the ulna. It is the most critical restraint to valgus instability of the elbow.

Question 3418

Topic: Elbow & Forearm

The 'mobile wad of Henry' in the proximal lateral forearm comprises which three muscles?

. Pronator teres, Flexor carpi radialis, Palmaris longus
. Brachioradialis, Extensor carpi radialis longus, Extensor carpi radialis brevis
. Extensor digitorum communis, Extensor digiti minimi, Extensor carpi ulnaris
. Supinator, Abductor pollicis longus, Extensor pollicis brevis
. Brachialis, Biceps brachii, Coracobrachialis

Correct Answer & Explanation

. Pronator teres, Flexor carpi radialis, Palmaris longus

Explanation

The mobile wad of Henry refers to the three muscles located in the lateral compartment of the proximal forearm: the brachioradialis, extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB). These are often retracted together during the anterior (Henry) approach to the radius.

Question 3419

Topic: 9. Shoulder and Elbow

Reverse total shoulder arthroplasty (rTSA) relies heavily on altering glenohumeral biomechanics to compensate for a massive, irreparable rotator cuff tear. Which of the following best describes the biomechanical alteration achieved by the classic Grammont-style rTSA prosthesis?

. Lateralizes and superiorly translates the center of rotation
. Lateralizes and inferiorly translates the center of rotation
. Medializes and superiorly translates the center of rotation
. Medializes and inferiorly translates the center of rotation
. Maintains anatomic center of rotation but increases the deltoid moment arm

Correct Answer & Explanation

. Lateralizes and superiorly translates the center of rotation

Explanation

The Grammont design principles for reverse total shoulder arthroplasty biomechanically medialize and distalize (inferiorly translate) the center of rotation. This increases the moment arm of the deltoid muscle and recruits more deltoid fibers to elevate the arm in the absence of a functioning supraspinatus.

Question 3420

Topic: Elbow & Forearm

A 12-year-old baseball pitcher presents with chronic lateral elbow pain. Radiographs demonstrate focal radiolucency and fragmentation of the capitellum. What is the most likely diagnosis?

. Panner's disease
. Osteochondritis dissecans (OCD) of the capitellum
. Medial epicondyle apophysitis
. Radial head stress fracture
. Olecranon apophysitis

Correct Answer & Explanation

. Panner's disease

Explanation

OCD of the capitellum typically occurs in overhead athletes aged 11 to 15 years, presenting with lateral elbow pain and focal fragmentation. Panner's disease is an osteochondrosis of the entire capitellum but occurs in a younger age group (typically 7-10 years) and heals without fragmentation.

Test Yourself

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

On this Page