Menu

9. Shoulder and Elbow MCQs

Practice Set 182 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 3621

Topic: Elbow & Forearm

During your examination of a patient with lateral elbow pain, you find tenderness over the medial epicondyle in addition to the lateral epicondyle. What is the most appropriate interpretation of this finding?

. It suggests a bilateral lateral epicondylitis.
. It indicates a likely misdiagnosis of lateral epicondylitis.
. It suggests a concomitant medial epicondylitis or Golfer's elbow, or a more generalized overuse syndrome.
. It is a normal finding and should be disregarded.
. It is indicative of an underlying systemic inflammatory condition.

Correct Answer & Explanation

. It suggests a concomitant medial epicondylitis or Golfer's elbow, or a more generalized overuse syndrome.

Explanation

Tenderness over both the medial and lateral epicondyles suggests either a concomitant medial epicondylitis (Golfer's elbow) or a more generalized overuse syndrome affecting both common flexor and extensor origins. It does not indicate a misdiagnosis of lateral epicondylitis (if lateral symptoms are present) but points to additional pathology. It is not a normal finding and, while systemic conditions can cause widespread tendinopathy, it's not the primary inference from focal tenderness at both epicondyles.

Question 3622

Topic: Elbow & Forearm

Which of the following findings on a plain radiograph of the elbow is LEAST likely to be associated with lateral epicondylitis?

. Normal bony anatomy.
. Small calcifications at the lateral epicondyle.
. Subtle periosteal reaction at the lateral epicondyle.
. Loose bodies within the radiohumeral joint.
. Degenerative changes of the radiohumeral joint.

Correct Answer & Explanation

. Loose bodies within the radiohumeral joint.

Explanation

Loose bodies within the radiohumeral joint are indicative of an intra-articular pathology such as osteochondritis dissecans or advanced osteoarthritis, and are not typically associated with lateral epicondylitis itself. Plain radiographs are often normal in lateral epicondylitis. Occasionally, small calcifications or subtle periosteal reaction can be seen at the lateral epicondyle. Degenerative changes of the radiohumeral joint are a differential diagnosis that may present with lateral elbow pain but are not a finding of lateral epicondylitis itself.

Question 3623

Topic: Elbow & Forearm

Which activity would place the most significant biomechanical stress on the common extensor origin, predisposing to lateral epicondylitis?

. Forehand stroke in tennis with proper technique.
. Backhand stroke in tennis with inadequate wrist stabilization.
. Swimming laps using a freestyle stroke.
. Lifting light weights with the elbow flexed.
. Performing biceps curls with correct form.

Correct Answer & Explanation

. Backhand stroke in tennis with inadequate wrist stabilization.

Explanation

A backhand stroke in tennis, especially with inadequate wrist stabilization (leading to excessive wrist extension on impact or forceful wrist extension to generate power), places significant tensile and eccentric load on the common extensor origin, particularly the ECRB. This is a classic precipitating factor for lateral epicondylitis. Forehand strokes, swimming, and most gym exercises (if done with proper form) typically load other muscle groups or distribute forces differently.

Question 3624

Topic: Elbow & Forearm

Which of the following statements about the efficacy of corticosteroid injections for lateral epicondylitis is most accurate?

. They provide excellent long-term pain relief and are superior to physical therapy.
. They offer reliable short-term pain relief but often have worse long-term outcomes than other non-operative treatments.
. They are contraindicated in all cases due to tendon rupture risk.
. They stimulate tendon healing and collagen repair.
. They are the only effective treatment for severe cases.

Correct Answer & Explanation

. They offer reliable short-term pain relief but often have worse long-term outcomes than other non-operative treatments.

Explanation

Corticosteroid injections for lateral epicondylitis typically provide good short-term (e.g., 6-week) pain relief. However, numerous studies have shown that they often have worse long-term outcomes (e.g., recurrence rates) compared to watchful waiting, physical therapy, or even placebo. They do not stimulate tendon healing or collagen repair; in fact, they may potentially weaken tendon structure with repeated injections. They are not contraindicated in all cases but should be used judiciously, and are not the only effective treatment for severe cases (surgery or biologics are options).

Question 3625

Topic: Elbow & Forearm

When evaluating a patient for lateral epicondylitis, palpation of the lateral epicondyle reveals maximal tenderness just anterior to its most prominent point. This finding is most consistent with pathology of which structure?

. Common flexor origin
. Lateral ulnar collateral ligament
. Extensor Carpi Radialis Brevis (ECRB) origin
. Olecranon bursa
. Radial head articular cartilage

Correct Answer & Explanation

. Extensor Carpi Radialis Brevis (ECRB) origin

Explanation

Maximal tenderness just anterior and distal to the most prominent point of the lateral epicondyle is the classic location for pathology involving the Extensor Carpi Radialis Brevis (ECRB) origin, which is the primary structure involved in lateral epicondylitis. The common flexor origin is on the medial epicondyle. The lateral ulnar collateral ligament is more posterior and inferior. The olecranon bursa is posterior. The radial head articular cartilage would cause tenderness with palpation and pain with rotation, but the specified location points more specifically to the ECRB tendon origin.

Question 3626

Topic: Elbow & Forearm

Which of the following is considered an absolute contraindication to a corticosteroid injection for lateral epicondylitis?

. History of diabetes mellitus.
. Current oral anticoagulant therapy.
. Pain for less than 6 weeks.
. Infection at the injection site.
. Previous failed corticosteroid injection.

Correct Answer & Explanation

. Infection at the injection site.

Explanation

Infection at the injection site is an absolute contraindication to any injection, including corticosteroids, due to the risk of spreading infection into deeper tissues or the joint. Diabetes mellitus is a relative contraindication (steroids can elevate blood glucose). Oral anticoagulant therapy requires careful consideration due to bleeding risk but is not an absolute contraindication if benefits outweigh risks and precautions are taken. Pain duration less than 6 weeks might make a steroid injection less appropriate (favoring other conservative methods), but it's not an absolute contraindication. A previous failed injection often prompts consideration of alternative treatments rather than another steroid injection, but again, not an absolute contraindication from a safety perspective.

Question 3627

Topic: Elbow & Forearm

What is the term for the degenerative changes observed in chronic tendinopathy, such as lateral epicondylitis?

. Tendinitis
. Tenosynovitis
. Tendinosis
. Bursitis
. Arthritis

Correct Answer & Explanation

. Tendinosis

Explanation

The term 'tendinosis' accurately describes the degenerative changes (collagen disorganization, angiofibroblastic hyperplasia, absence of inflammatory cells) seen in chronic tendinopathy. 'Tendinitis' implies acute inflammation, which is generally not the primary pathological process in chronic cases. 'Tenosynovitis' refers to inflammation of the tendon sheath. 'Bursitis' is inflammation of a bursa, and 'Arthritis' is joint inflammation.

Question 3628

Topic: Elbow & Forearm

What is the typical long-term outcome for most patients with lateral epicondylitis managed conservatively?

. Progressive worsening of symptoms requiring eventual surgery.
. Complete resolution of symptoms within 3 months in all patients.
. Resolution of symptoms within 1-2 years in the vast majority of patients, with or without intervention.
. Chronic, debilitating pain requiring lifelong pain management.
. Recurrent episodes requiring repeated injections indefinitely.

Correct Answer & Explanation

. Resolution of symptoms within 1-2 years in the vast majority of patients, with or without intervention.

Explanation

The natural history of lateral epicondylitis is generally favorable. The vast majority of patients (80-95%) will experience resolution of symptoms within 1-2 years, even with conservative management or sometimes even watchful waiting. While symptoms can be protracted and recurrences can happen, it typically does not lead to progressive worsening requiring surgery in most, nor does it typically become a lifelong debilitating condition. Complete resolution within 3 months for all patients is overly optimistic, and indefinite repeated injections are not standard practice.

Question 3629

Topic: Elbow & Forearm

Which specific population is at a disproportionately higher risk of developing lateral epicondylitis?

. Children involved in gymnastics.
. Adolescent baseball pitchers.
. Middle-aged manual laborers and tennis players.
. Elderly individuals with sedentary lifestyles.
. Individuals with rheumatoid arthritis.

Correct Answer & Explanation

. Middle-aged manual laborers and tennis players.

Explanation

Middle-aged manual laborers (due to repetitive gripping and tool use) and tennis players (particularly due to improper backhand technique or overuse) are classic populations at higher risk for developing lateral epicondylitis. Children and adolescents are more prone to apophysitis or osteochondritis dissecans. Elderly sedentary individuals have a lower risk. While rheumatoid arthritis can cause tendinopathy, it's a systemic condition and not the specific demographic at disproportionately higher risk for this specific, typically mechanical, tendinopathy.

Question 3630

Topic: 9. Shoulder and Elbow

When answering a question about the 'critical shoulder angle' (CSA), what is its primary clinical significance in the context of shoulder pathology?

. It predicts the risk of anterior glenohumeral dislocation.
. It correlates with the likelihood of biceps tendon pathology.
. It is an indicator of the severity of glenohumeral osteoarthritis.
. It is associated with the development of rotator cuff tears and glenohumeral impingement.
. It determines the appropriate size of a shoulder arthroplasty implant.

Correct Answer & Explanation

. It is associated with the development of rotator cuff tears and glenohumeral impingement.

Explanation

The Critical Shoulder Angle (CSA) is a radiographic measurement that has been correlated with both rotator cuff tears and glenohumeral osteoarthritis. A high CSA (>35 degrees) is associated with an increased risk of rotator cuff tears due to an overlateralized acromion, leading to increased impingement. A low CSA (<30 degrees) is associated with an increased risk of glenohumeral osteoarthritis. It reflects the morphology of the acromion and its relationship with the glenoid.

Question 3631

Topic: 9. Shoulder and Elbow

When an examiner asks you to describe the optimal patient position and technique for reducing an anterior shoulder dislocation, what critical step should you emphasize to ensure patient comfort and successful reduction?

. Rapid, forceful traction.
. Administering intravenous sedation and adequate analgesia.
. External rotation and adduction maneuvers.
. Internal rotation with a fulcrum.
. Performing the Kocher maneuver without assistance.

Correct Answer & Explanation

. Administering intravenous sedation and adequate analgesia.

Explanation

Ensuring adequate sedation and analgesia is paramount before attempting any reduction maneuver for an acute shoulder dislocation. Muscle spasm is the primary impediment to reduction, and good pain control and relaxation significantly increase the likelihood of a successful, gentle reduction, reducing patient distress and risk of iatrogenic injury. While various techniques exist (e.g., Stimson, traction-countertraction, external rotation), none are likely to be successful or safe without proper patient relaxation.

Question 3632

Topic: 9. Shoulder and Elbow

When discussing reverse total shoulder arthroplasty (RTSA) indications, what is the most significant patient-specific factor that makes RTSA the preferred option over conventional total shoulder arthroplasty (TSA)?

. Younger patient age.
. Primary glenohumeral osteoarthritis with intact rotator cuff.
. Severe osteoporosis.
. Irreparable rotator cuff tear with pseudoparalysis.
. Recurrent anterior instability.

Correct Answer & Explanation

. Irreparable rotator cuff tear with pseudoparalysis.

Explanation

Reverse total shoulder arthroplasty (RTSA) is specifically designed for patients with irreparable rotator cuff tears and associated glenohumeral arthropathy (rotator cuff tear arthropathy), where the rotator cuff can no longer effectively center the humeral head. The reverse design medializes the center of rotation and recruits the deltoid for elevation, effectively bypassing the deficient rotator cuff. Primary GH OA with an intact cuff is an indication for TSA. Younger age and osteoporosis are relative considerations, and recurrent instability is generally treated with instability repairs or bone block procedures.

Question 3633

Topic: 9. Shoulder and Elbow

When discussing the options for managing a patient with a massive, irreparable rotator cuff tear in a younger, active individual without significant arthropathy, what surgical procedure should you prioritize over reverse total shoulder arthroplasty?

. Debridement and tenodesis of the biceps.
. Superior capsular reconstruction (SCR).
. Latissimus dorsi transfer.
. Acromioplasty and bursectomy.
. Glenoid osteotomy.

Correct Answer & Explanation

. Superior capsular reconstruction (SCR).

Explanation

For massive, irreparable rotator cuff tears in younger, active patients without significant arthropathy, the goal is often to restore function and postpone arthroplasty. Superior Capsular Reconstruction (SCR) using an allograft or autograft is a recognized technique to restore the superior capsule and improve glenohumeral stability and force couples, often leading to improved function and pain relief. Latissimus dorsi transfer is used for posterior-superior cuff deficiency. Debridement and biceps tenodesis are palliative. RTSA is more for older, lower-demand patients with arthropathy.

Question 3634

Topic: Shoulder Arthroplasty & Arthritis

When formulating a management plan for a proximal humerus fracture in an elderly, low-demand patient, what is the most appropriate initial approach for a Neer two-part surgical neck fracture with minimal displacement?

. Open reduction internal fixation (ORIF).
. Reverse total shoulder arthroplasty (RTSA).
. Sling immobilization and early passive range of motion.
. Hemiarthroplasty.
. External fixation.

Correct Answer & Explanation

. Sling immobilization and early passive range of motion.

Explanation

For most minimally displaced two-part proximal humerus fractures, especially in elderly, low-demand patients, non-operative management with sling immobilization followed by early gentle passive and then active range of motion is the preferred initial treatment. Studies have shown comparable functional outcomes to surgical intervention with fewer complications. ORIF, hemiarthroplasty, and RTSA are reserved for displaced or comminuted fractures, or specific patient profiles.

Question 3635

Topic: 9. Shoulder and Elbow

An examiner asks about the 'suprapatellar spur' in the context of the shoulder. What is the correct anatomical term for this entity, and what does it typically signify?

. Os acromiale, signifying chronic impingement.
. Acromial spur, signifying rotator cuff tear.
. Coracoacromial ligament calcification, signifying impingement.
. Osteophyte on the inferior aspect of the acromion, signifying subacromial impingement.
. Humeral head osteophyte, signifying glenohumeral osteoarthritis.

Correct Answer & Explanation

. Osteophyte on the inferior aspect of the acromion, signifying subacromial impingement.

Explanation

The term 'suprapatellar spur' is a misnomer in the shoulder. The most common 'spur' discussed in the context of shoulder pathology is an osteophyte or spur originating from the inferior aspect of the acromion. This acromial spur is strongly associated with subacromial impingement syndrome and is often indicative of chronic impingement, contributing to rotator cuff irritation and tearing. An os acromiale is a separate ossification center, not a spur. Coracoacromial ligament calcification can occur, but an acromial spur is a distinct bony projection.

Question 3636

Topic: 9. Shoulder and Elbow

You are discussing a patient who underwent a rotator cuff repair and is now experiencing persistent stiffness despite aggressive rehabilitation, raising suspicion of adhesive capsulitis. When considering surgical intervention, what procedure would be most appropriate for this post-operative complication?

. Revision rotator cuff repair.
. Open capsular release.
. Arthroscopic capsular release.
. Subacromial decompression.
. Manipulation under anesthesia followed by intensive therapy.

Correct Answer & Explanation

. Arthroscopic capsular release.

Explanation

For post-operative stiffness (adhesive capsulitis) refractory to non-operative management, an arthroscopic capsular release is the most appropriate surgical intervention. This procedure involves incising the tightened capsule to restore glenohumeral range of motion. Manipulation under anesthesia is often combined with arthroscopic release or performed alone. Open capsular release is rarely performed for stiffness. Revision rotator cuff repair or subacromial decompression would not address the stiffness itself.

Question 3637

Topic: 9. Shoulder and Elbow

You are asked about the 'cuff tear arthropathy'. What is the defining characteristic that differentiates it from primary glenohumeral osteoarthritis?

. Loss of joint space on plain radiographs.
. Presence of osteophytes.
. Superior migration of the humeral head.
. Pain with overhead activities.
. Positive apprehension test.

Correct Answer & Explanation

. Superior migration of the humeral head.

Explanation

Cuff tear arthropathy is a specific form of degenerative arthritis that develops in the setting of a massive, irreparable rotator cuff tear. Its defining characteristic on radiographs is superior migration of the humeral head due to the unopposed pull of the deltoid, leading to articulation between the humeral head and the undersurface of the acromion, often with associated erosive changes. While joint space loss and osteophytes can be present, superior migration is the hallmark that distinguishes it from primary glenohumeral OA where the humeral head remains centered.

Question 3638

Topic: 9. Shoulder and Elbow

When discussing the indications for a reverse total shoulder arthroplasty, what specific feature of the shoulder joint makes it uniquely suited for patients with rotator cuff deficiency?

. Its inherent stability due to strong glenohumeral ligaments.
. The large articular surface area of the humeral head.
. The ability to medialize the center of rotation, recruiting the deltoid for elevation.
. The robust blood supply to the rotator cuff tendons.
. Its reliance on capsular tension for stability.

Correct Answer & Explanation

. The ability to medialize the center of rotation, recruiting the deltoid for elevation.

Explanation

The reverse total shoulder arthroplasty (RTSA) design medializes and distalizes the center of rotation of the shoulder. This biomechanical alteration increases the deltoid's moment arm, allowing it to act as the primary elevator and abductor of the arm, effectively compensating for an irreparable rotator cuff deficiency. This unique feature is what makes RTSA particularly suitable for rotator cuff tear arthropathy. The other options describe general shoulder anatomy or physiology but not the specific design advantage of RTSA.

Question 3639

Topic: 9. Shoulder and Elbow

An examiner asks about the 'SLAP' lesion. Which anatomical structure is primarily involved?

. Superior glenohumeral ligament.
. Inferior glenohumeral ligament.
. Anterior labrum.
. Posterior labrum.
. Superior labrum and biceps anchor.

Correct Answer & Explanation

. Superior labrum and biceps anchor.

Explanation

SLAP stands for Superior Labrum Anterior and Posterior. Therefore, a SLAP lesion primarily involves the superior glenoid labrum and the attachment of the long head of the biceps tendon, which anchors to this superior labrum. It is a spectrum of injuries, but all involve this superior labral-biceps anchor complex.

Question 3640

Topic: Shoulder Arthroplasty & Arthritis

You are asked about the management of a patient with a chronic, retracted rotator cuff tear who develops severe pseudoparalysis (inability to actively elevate the arm). What is the most appropriate surgical option to restore function?

. Arthroscopic debridement and bursectomy.
. Primary rotator cuff repair.
. Reverse total shoulder arthroplasty (RTSA).
. Latissimus dorsi tendon transfer.
. Hemiarthroplasty.

Correct Answer & Explanation

. Reverse total shoulder arthroplasty (RTSA).

Explanation

For a chronic, retracted rotator cuff tear leading to severe pseudoparalysis (meaning the patient cannot actively elevate the arm), reverse total shoulder arthroplasty (RTSA) is often the most reliable surgical option to restore active elevation and improve pain. The RTSA design bypasses the deficient rotator cuff by utilizing the deltoid for arm elevation. Primary repair is often not feasible due to retraction and chronicity, and debridement is palliative. Latissimus dorsi transfer can be considered but is typically for younger patients without arthropathy. Hemiarthroplasty doesn't address the cuff deficiency biomechanically.

Test Yourself

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

On this Page