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9. Shoulder and Elbow MCQs

Practice Set 3 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 41

Topic: 9. Shoulder and Elbow

Which of the following pitch types is associated with the development of shoulder pain in baseball pitchers between the ages of 9 and 14 years:

. Fastball
. C hange-up
. C urveball
. Slider
. Knuckle ball

Correct Answer & Explanation

. C urveball

Explanation

A study following 476 young baseball pitchers for one season demonstrated that the use of the curveball in this age group was associated with a 52% increased risk of the development of shoulder pain.

Question 42

Topic: 9. Shoulder and Elbow

Which of the following pitch types is associated with the development of elbow pain in baseball pitchers between the ages of 9 and 14 years:

. Fastball
. C hange-up
. C urveball
. Slider
. Knuckle ball

Correct Answer & Explanation

. Slider

Explanation

A study following 476 young baseball pitchers for one season demonstrated that use of the slider in this age group was associated with an 86% increased risk of the development of elbow pain.

Question 43

Topic: 9. Shoulder and Elbow

It is recommended to limit youth baseball pitchers (9 to 14 years of age) to how many pitches per game

. 25
. 50
. 75
. 100
. 125

Correct Answer & Explanation

. 75

Explanation

In young baseball pitchers, high pitch counts are associated with increased risk of shoulder pain. Based on a study of 476 youth baseball pitchers, it is recommended to limit pitch counts to 75 pitches per gam.

Question 44

Topic: 9. Shoulder and Elbow

It is recommended to limit youth baseball pitchers (9 to 14 years of age) to how many game situation pitches per baseball season:

. 200
. 400
. 600
. 800
. 1000

Correct Answer & Explanation

. 600

Explanation

In young baseball pitchers, high pitch counts are associated with increased risk of shoulder pain. Based on a study of 476 youth baseball pitchers, it is recommended to limit pitch counts to 600 game situation pitches per season.

Question 45

Topic: 9. Shoulder and Elbow

Which of the following statements is true regarding traumatic anterior shoulder instability:

. Abnormal glenohumeral translation occurs mainly in the provocative position of 90° abduction and external rotation, and this translation is corrected by contraction of the dynamic shoulder stabilizers.
. Abnormal glenohumeral translation occurs in multiple arm positions, and this translation is corrected by contraction of the dynamic shoulder stabilizers.
. Abnormal glenohumeral translation occurs mainly in the provocative position of 90° abduction and external rotation, and this translation is not corrected by contraction of the dynamic shoulder stabilizers.
. Abnormal glenohumeral translation occurs in multiple arm positions, and this translation is not corrected by contraction of the
. No abnormal glenohumeral translation occurs in traumatic shoulder instability.

Correct Answer & Explanation

. Abnormal glenohumeral translation occurs mainly in the provocative position of 90° abduction and external rotation, and this translation is corrected by contraction of the dynamic shoulder stabilizers.

Explanation

dynamic shoulder stabilizers. A study evaluating glenohumeral translation and muscle activity related traumatic and atraumatic shoulder instability demonstrated that patients with traumatic shoulder instability have abnormal glenohumeral translation mainly in the provocative position of 90° abduction and external rotation. This translation is corrected by contraction of the dynamic shoulder stabilizers.

Question 46

Topic: Elbow & Forearm

Which of the following is the most common radiographic finding in patients with lateral epicondylitis:

. Soft tissue calcification at the lateral aspect of the elbow
. Coronoid osteophyte
. Olecranon osteophyte
. Intraosseous cyst
. Osteochondritis dessicans

Correct Answer & Explanation

. Soft tissue calcification at the lateral aspect of the elbow

Explanation

In a radiographic analysis of 294 patients with lateral epicondylitis, 20 patients had lateral soft tissue calcification, 14 patients had coronoid osteophytes, nine patients had olecranon osteophytes, two patients had intraosseous cysts, and two patients had osteochondritis dessicans. The author concluded that routine radiography is not warranted in the initial management of lateral epicondylitis.

Question 47

Topic: Shoulder Pathology

Which two muscles act as the primary force couple to produce upward rotation of the scapula during arm elevation?

. Rhomboid major and latissimus dorsi
. Upper trapezius and serratus anterior
. Pectoralis minor and levator scapulae
. Supraspinatus and middle deltoid
. Infraspinatus and teres minor

Correct Answer & Explanation

. Upper trapezius and serratus anterior

Explanation

Upward rotation of the scapula is primarily driven by the force couple of the trapezius (upper and lower parts) and the serratus anterior. Weakness in the serratus anterior causes scapular winging and disrupts this kinematic chain.

Question 48

Topic: 9. Shoulder and Elbow

A baseball pitcher complains of deep shoulder pain during the late cocking phase of throwing. A physical exam reveals a positive O'Brien's test. Which of the following best describes the "peel-back" mechanism for this injury?

. Posterior superior labral shift during maximal external rotation
. Anterior inferior labral traction during follow-through
. Superior capsular contracture displacing the biceps anchor
. Inferior glenohumeral ligament failure causing labral avulsion
. Coracohumeral ligament impingement on the superior labrum

Correct Answer & Explanation

. Posterior superior labral shift during maximal external rotation

Explanation

The peel-back mechanism occurs during abduction and maximal external rotation (late cocking phase). The biceps vector shifts posteriorly, transmitting torsional force to the superior labrum, frequently causing a Type II SLAP tear.

Question 49

Topic: Shoulder Pathology

A 28-year-old bodybuilder presents with a dull ache in his right shoulder and difficulty lifting heavy weights overhead. On examination, lateral winging of the scapula is observed. Injury to which of the following nerves is the most likely cause?

. Long thoracic nerve
. Suprascapular nerve
. Spinal accessory nerve
. Axillary nerve
. Dorsal scapular nerve

Correct Answer & Explanation

. Spinal accessory nerve

Explanation

Lateral winging of the scapula is caused by weakness of the trapezius muscle, which is innervated by the spinal accessory nerve (CN XI). In contrast, medial winging is caused by serratus anterior weakness due to a long thoracic nerve palsy.

Question 50

Topic: Shoulder Pathology

A 25-year-old bodybuilder presents with a dull ache in his right shoulder and difficulty lifting weights overhead. Physical examination reveals lateral winging of the scapula. Injury to which of the following nerves is the most likely cause?

. Long thoracic nerve
. Spinal accessory nerve
. Suprascapular nerve
. Axillary nerve
. Dorsal scapular nerve

Correct Answer & Explanation

. Spinal accessory nerve

Explanation

Lateral scapular winging is caused by trapezius muscle dysfunction, which is secondary to a spinal accessory nerve (CN XI) injury. In contrast, long thoracic nerve injury causes serratus anterior dysfunction, presenting as medial scapular winging.

Question 51

Topic: 9. Shoulder and Elbow

A 45-year-old recreational golfer complains of medial elbow pain. The pain is exacerbated by resisted wrist flexion and forearm pronation. This tendinopathy most commonly involves the origin of which muscle group?

. Flexor carpi ulnaris
. Flexor digitorum superficialis
. Pronator teres and flexor carpi radialis
. Palmaris longus
. Brachioradialis

Correct Answer & Explanation

. Pronator teres and flexor carpi radialis

Explanation

Medial epicondylitis (golfer's elbow) is an overuse tendinopathy that primarily affects the common flexor origin, most specifically involving the origins of the pronator teres and the flexor carpi radialis.

Question 52

Topic: Elbow & Forearm

A 21-year-old baseball pitcher is scheduled for an ulnar collateral ligament (UCL) reconstruction (Tommy John surgery). What is the most commonly utilized and historically preferred autograft for this procedure?

. Bone-patellar tendon-bone
. Semitendinosus
. Palmaris longus
. Plantaris
. Extensor carpi radialis brevis

Correct Answer & Explanation

. Palmaris longus

Explanation

The palmaris longus tendon is the most frequently used and historically standard autograft for UCL reconstruction due to its expendability and appropriate dimensions. If absent, alternative grafts like the gracilis or plantaris are used.

Question 53

Topic: 9. Shoulder and Elbow

Which tendon is commonly involved in "tennis elbow"?

. Flexor carpi ulnaris
. Extensor carpi radialis brevis
. Biceps brachii
. Triceps brachii
. Pronator teres

Correct Answer & Explanation

. Extensor carpi radialis brevis

Explanation

Tennis elbow, or lateral epicondylitis, is an overuse injury primarily affecting the origin of the extensor carpi radialis brevis muscle at the lateral epicondyle of the humerus.

Question 54

Topic: Elbow & Forearm

A 14-year-old elite baseball pitcher presents with chronic lateral elbow pain and catching. Imaging reveals an advanced osteochondral defect (OCD) of the capitellum. The vulnerability of the capitellum to avascular necrosis is primarily due to its blood supply, which consists of:

. An extensive collateral network from the radial recurrent artery
. Vessels derived strictly from the anterior joint capsule
. A highly vascularized central physis
. End arteries entering posteriorly with poor collateral circulation
. A single end artery entering the anterior articular surface

Correct Answer & Explanation

. End arteries entering posteriorly with poor collateral circulation

Explanation

The capitellum is supplied by limited intraosseous vessels derived from end arteries entering posteriorly. This lack of collateral circulation makes the capitellum extremely susceptible to ischemic injury and osteochondritis dissecans from repetitive valgus-extension overload.

Question 55

Topic: 9. Shoulder and Elbow

The most common significant complication specifically associated with surgical repair of a type II Superior Labrum Anterior Posterior (SLAP) tear in an overhead throwing athlete is:

. Recurrent anterior instability
. Postoperative stiffness and loss of external rotation
. Axillary nerve palsy
. Suprascapular nerve entrapment
. Hardware migration into the glenohumeral joint

Correct Answer & Explanation

. Postoperative stiffness and loss of external rotation

Explanation

Postoperative stiffness, particularly loss of external rotation in abduction, is the most common complication following SLAP repairs. This stiffness profoundly limits the "late cocking" phase required in overhead throwing athletes.

Question 56

Topic: 9. Shoulder and Elbow

Which structural component of the ulnar collateral ligament (UCL) complex of the elbow is the primary restraint to valgus stress between 30 and 120 degrees of flexion?

. Posterior bundle
. Transverse bundle
. Anterior bundle
. Radial collateral ligament
. Annular ligament

Correct Answer & Explanation

. Anterior bundle

Explanation

The anterior bundle of the ulnar collateral ligament is the primary restraint to valgus stress at the elbow from roughly 30 to 120 degrees of flexion. The posterior bundle functions primarily as a secondary restraint.

Question 57

Topic: 9. Shoulder and Elbow
When applying valgus stress, over which arc of motion is the anterior band of the anterior oblique component of the ulnar collateral ligament of the elbow under tension?
. 0° to 20°
. 0° to 45°
. 0° to 85°
. 55° to 115°
. 55° to 145°

Correct Answer & Explanation

. 0° to 85°

Explanation

Biomechanical studies demonstrate that the anterior band of the oblique component of the ulnar collateral ligament of the elbow is at greatest tension from full extension to 85° of elbow flexion.

Question 58

Topic: 9. Shoulder and Elbow

When applying valgus stress, over which arc of motion is the posterior band of the anterior oblique component of the ulnar collateral ligament of the elbow under tension:

. 0° to 35°
. 0° to 65°
. 0° to 85°
. 55° to 85°
. 55° to 145°

Correct Answer & Explanation

. 55° to 145°

Explanation

Biomechanical studies demonstrate that the posterior band of the oblique component of the ulnar collateral ligament of the elbow is at greatest tension from 55° to full elbow flexion.

Question 59

Topic: 9. Shoulder and Elbow

Which of the following structures is the main stabilizer of the elbow to valgus stress:

. Anterior oblique component of the ulnar collateral ligament
. Posterior oblique component of the ulnar collateral ligament
. Transverse oblique component of the ulnar collateral ligament
. Ulnohumeral articulation
. Radiohumeral articulation

Correct Answer & Explanation

. Anterior oblique component of the ulnar collateral ligament

Explanation

The anterior oblique component of the ulnar collateral ligament is the most important stabilizer of the elbow to valgus stress. The most important secondary stabilizer is the radiohumeral articulation. The transverse oblique component of the ulnar collateral ligament imparts little stability to the elbow.

Question 60

Topic: 9. Shoulder and Elbow

Disruption of which of the following ligaments represents the primary lesion in posterolateral rotatory instability of the elbow:

. Radial collateral ligament
. Radial ulnohumeral ligament
. Annular ligament
. Accessory radial collateral ligament
. Ulnohumeral articulation

Correct Answer & Explanation

. Radial ulnohumeral ligament

Explanation

Of Driscoll and associates demonstrated that the radial ulnohumeral ligament must be disrupted to produce posterolateral rotator instability of the elbow.

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