9. Shoulder and Elbow MCQs

A 19-year-old weightlifter experiences posterior shoulder pain and a sensation of instability during the bench press. Clinical examination reveals a positive jerk test. Magnetic resonance arthrography (MRA) demonstrates a tear of the posterior labrum and capsule. Which of the following capsuloligamentous structures is the primary restraint to posterior translation of the humerus when the shoulder is flexed to 90 degrees and internally rotated?

A 24-year-old military recruit complains of vague posterior shoulder pain and clicking. The physician suspects posterior instability. During physical examination, the patient's arm is elevated to 90 degrees of forward flexion and internally rotated. The examiner then applies a posterior force to the elbow while horizontally adducting the arm, producing a clunk and sudden pain. As the arm is returned to the starting position, a second clunk is felt. What is the name of this provocative test?

A 65-year-old female presents to the orthopedic clinic with a 3-month history of severe right shoulder pain and stiffness following a fall down the stairs. She was initially told she had a shoulder sprain. On examination, she has 0 degrees of external rotation and 45 degrees of forward elevation. Radiographs show a locked posterior dislocation with severe degenerative changes of the glenohumeral joint and a reverse Hill-Sachs lesion involving 50% of the articular surface. What is the most appropriate definitive management for this patient?

In the abducted and internally rotated shoulder, which of the following capsuloligamentous structures is the primary static restraint to posterior translation of the humeral head?

During the evaluation of a patient with multidirectional shoulder instability, an orthopedic surgeon considers the static stabilizers of the glenohumeral joint. When the shoulder is abducted to 90 degrees and internally rotated, which of the following capsuloligamentous structures serves as the primary static restraint to posterior translation?

A 28-year-old male presents to the urgent care clinic after a fall onto an outstretched hand. He complains of severe shoulder pain and restricted range of motion. An anteroposterior (AP) radiograph of the shoulder reveals a "lightbulb sign" and loss of the normal half-moon overlap between the humeral head and the glenoid. What is the most critical next step in the radiographic evaluation of this patient?

A 35-year-old man presents to the emergency department after experiencing a first-time grand mal seizure. He complains of severe left shoulder pain and an inability to move the arm. Radiographs reveal a posterior shoulder dislocation. In what position is the glenohumeral joint most vulnerable to posterior dislocation during a traumatic event or seizure?

A 19-year-old male presents with posterior shoulder pain. The examiner suspects a posteroinferior labral tear. The examiner elevates the patient's arm to 90 degrees of abduction in the scapular plane, applies an axial load to the elbow, and simultaneously applies a downward and posterior force to the proximal humerus while elevating the arm diagonally upward. The patient experiences sudden onset of posterior shoulder pain. Which of the following tests was performed?

During a biomechanical study of the glenohumeral joint, researchers selectively section various capsuloligamentous structures to determine their contribution to posterior stability. Which of the following structures is the primary static restraint to posterior translation of the humerus when the arm is flexed, adducted, and internally rotated?

An AP radiograph of a 30-year-old trauma patient reveals a 'rim sign' suspicious for a posterior shoulder dislocation. The rim sign is considered positive when the distance between the medial aspect of the humeral head and the anterior glenoid rim exceeds what measurement?

A 16-year-old female presents with the ability to painlessly dislocate her shoulder posteriorly on command. She demonstrates this by elevating her arm and contracting her muscles, then easily reduces it. Imaging shows no structural defects. What is the most appropriate initial management?

Biomechanical studies have demonstrated that the primary static restraint to posterior glenohumeral translation with the arm resting in 0 degrees of abduction and neutral rotation is which of the following structures?

An anteroposterior (AP) radiograph of a shoulder reveals a 'lightbulb sign'. This classic radiographic appearance is directly caused by which of the following anatomic positions of the humerus?

A 68-year-old male with chronic epilepsy presents with a missed posterior shoulder dislocation of 8 months duration. CT scan shows a reverse Hill-Sachs lesion involving 55% of the articular surface with severe secondary glenohumeral osteoarthritis. Which of the following is the most appropriate definitive treatment?

A patient undergoes an open posterior capsulorrhaphy for recalcitrant posterior instability. Postoperatively, if the posterior capsule is over-tightened during the repair, the patient is at greatest risk for clinically significant loss of which shoulder motion?

A biomechanical evaluation of a cadaveric shoulder is being performed. The shoulder is placed in 90 degrees of forward flexion and maximal internal rotation. Which structure acts as the primary static restraint to posterior translation in this specific position?

A 24-year-old weightlifter presents with vague posterior shoulder pain. On examination, with the arm in 90 degrees of forward flexion and internal rotation, an axial load is applied while horizontally adducting the arm. A sudden clunk is felt, followed by a second clunk when the arm is returned to the starting position. Injury to which anatomical structure is most strongly associated with this positive provocative test?

A 65-year-old male presents with a missed chronic posterior shoulder dislocation 6 months after a fall. CT imaging demonstrates a reverse Hill-Sachs lesion involving 55% of the humeral head articular surface and severe glenohumeral osteoarthritis. What is the most appropriate definitive treatment?

A 30-year-old male is evaluated in the trauma bay following an explosion. He securely holds his right arm internally rotated against his abdomen. The AP shoulder radiograph demonstrates a 'lightbulb' sign. What causes this specific radiographic appearance?

A 23-year-old male trips and falls forward onto an outstretched hand, sustaining an acute posterior shoulder dislocation. Which specific biomechanical position of the arm at the moment of impact most strongly predisposes the shoulder to this type of dislocation?