9. Shoulder and Elbow MCQs

A 45-year-old woman presents with a 'drooping' right shoulder and weakness in overhead activities three months after undergoing a posterior triangle lymph node biopsy. On physical examination, her right scapula demonstrates lateral winging when she is asked to abduct her arm against resistance. Which nerve has most likely been injured?

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical examination demonstrates a 25-degree loss of internal rotation in the throwing shoulder compared to the contralateral side, with a concomitant increase in external rotation. What is the primary pathoanatomic cause of this Glenohumeral Internal Rotation Deficit (GIRD)?

In planning a Reverse Total Shoulder Arthroplasty (RTSA), the surgeon aims to minimize the risk of inferior scapular notching. According to biomechanical principles, which glenosphere positioning strategy is most effective for preventing this complication?

Which of the following bony anatomical variants of the scapula is most strongly associated with the development of snapping scapula syndrome?

During the pathophysiological development of primary adhesive capsulitis, the profound fibroblastic proliferation and subsequent capsular contracture are most strongly driven by elevated levels of which cytokine?

A 40-year-old female presents to the emergency department with acute, agonizing right shoulder pain that prevents her from sleeping or moving her arm. Radiographs reveal an ill-defined, amorphous, cloudy opacity superior to the greater tuberosity. During which pathophysiologic phase of her disease process is she currently presenting?

A 35-year-old overhead athlete is diagnosed with glenohumeral internal rotation deficit (GIRD) and symptomatic internal impingement. Despite 6 months of targeted physical therapy, symptoms persist. If surgery is performed, which structure is typically targeted for release to address the primary pathomechanics?

In the setting of reverse total shoulder arthroplasty (RTSA), scapular notching is a well-documented and frequent complication. Which surgical technique modification most effectively reduces the incidence of inferior scapular notching?

Which of the following surgical strategies best minimizes the risk of scapular notching during a reverse total shoulder arthroplasty (RTSA)?

A 68-year-old female undergoes an anatomic total shoulder arthroplasty (TSA) for severe primary osteoarthritis. Preoperative CT showed a B2 glenoid with 20 degrees of retroversion. What is the most common mechanism of long-term failure in this patient?

A 55-year-old female with diabetes presents with insidious onset of severe, diffuse shoulder pain and significant loss of both active and passive range of motion, particularly external rotation. An MRI is obtained to rule out other pathology. What is the classic MRI finding associated with this condition?

A 38-year-old female presents to the emergency department with acute, excruciating right shoulder pain. Radiographs reveal an amorphous, cloudy calcium deposit in the supraspinatus tendon. What phase of calcific tendinitis is associated with this severe, acute pain presentation?

A 32-year-old patient presents with lateral winging of the scapula. The scapula is translated laterally, rotated downward, and the deformity is accentuated by resisted shoulder abduction. Which nerve is most likely injured in this patient?

A 70-year-old male with a massive, irreparable posterosuperior rotator cuff tear presents with pseudoparalysis of the shoulder. He is considered for a reverse total shoulder arthroplasty (RTSA). How does the Grammont-style RTSA design biomechanically alter the shoulder to restore active elevation?

A 55-year-old male undergoes closed reduction for a traumatic posterior elbow dislocation. Radiographs reveal the presence of a 'terrible triad' injury of the elbow. What are the classic components of this injury?

An 82-year-old female with severe osteoporosis sustains a 4-part proximal humerus fracture with head-split components. She lives independently and is active. What is the most reliable surgical option to restore overhead elevation and function?

A 72-year-old female presents with a 4-part proximal humerus fracture. Radiographs show a calcar segment of 3 mm and disruption of the medial hinge. She is medically fit and lives independently. What is the most appropriate surgical treatment?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain and diminished throwing velocity. He demonstrates a positive moving valgus stress test, and MRI confirms a full-thickness tear of the ulnar collateral ligament (UCL). Which distinct anatomical structure forms the primary restraint to valgus stress at the elbow?

The anterior bundle of the medial ulnar collateral ligament (UCL) of the elbow is the primary restraint to valgus stress. Which specific sub-portion of the anterior bundle is most taut in full elbow extension?