9. Shoulder and Elbow MCQs

A 60-year-old man hears a pop in his anterior arm while lifting a heavy box. He presents with a visible bulge in the distal anterior arm ('Popeye' deformity). If this injury is treated nonoperatively, what is the most significant functional deficit the patient can expect?

A 25-year-old male is struck on the anterior shoulder during a rugby match. He presents to the ER with shortness of breath, mild stridor, and dysphagia. Examination shows an obvious deformity at the base of the neck. What is the next most appropriate step in management?

What is the most common cause of scapular notching following a reverse total shoulder arthroplasty?

A 32-year-old weightlifter feels a "pop" in his anterior shoulder during a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness with internal rotation. Which portion of the pectoralis major is most commonly injured in this scenario?

A 16-year-old male presents with dyspnea and dysphagia after a wrestling match. Physical examination shows a palpable defect at the medial end of the clavicle. Which of the following is the most appropriate next step in management?

By what primary biomechanical mechanism does a reverse total shoulder arthroplasty (RTSA) restore active forward elevation in patients with rotator cuff tear arthropathy?

When performing a reverse total shoulder arthroplasty (RTSA), optimal positioning of the glenoid baseplate is critical to prevent scapular notching. Which of the following baseplate configurations is most effective in minimizing this complication?

Six weeks after an uncomplicated anatomic total shoulder arthroplasty via a deltopectoral approach, a 68-year-old male presents with new-onset anterior shoulder pain, increased passive external rotation compared to his 2-week visit, and marked weakness in internal rotation. What is the most likely diagnosis?

Adhesive capsulitis of the shoulder is characterized by dense fibrosis and contracture of the glenohumeral capsule. Which of the following cytokines is most strongly implicated in the fibroblastic proliferation seen in this condition?

A 75-year-old female presents with severe pseudoparalysis and severe glenohumeral arthritis secondary to massive rotator cuff arthropathy. Radiographs reveal the 'snowcap' sign. Which of the following findings is an absolute contraindication to performing a shoulder hemiarthroplasty in this patient?

A 34-year-old male falls on an outstretched hand, sustaining a comminuted radial head fracture and severe wrist pain. Clinical exam reveals distal radioulnar joint (DRUJ) instability. What surgical intervention is absolutely contraindicated in the management of this specific injury pattern?

A 6-year-old boy presents with an anteriorly displaced radial head dislocation and a midshaft ulnar fracture. Following closed reduction of the ulna, the radial head remains irreducible. What is the most likely anatomic structure blocking reduction?

A 45-year-old male falls from a ladder, sustaining a highly comminuted radial head fracture, proximal radius shaft migration, and acute wrist pain. Radiographs demonstrate distal radioulnar joint (DRUJ) widening. The radial head is deemed unreconstructible. What is the most appropriate surgical management?

A 40-year-old male falls from a height, sustaining a comminuted radial head fracture, wrist pain, and positive ulnar variance on wrist radiographs. Diagnosis of an Essex-Lopresti injury is made. What is the most appropriate surgical management for the proximal radioulnar injury?

A 78-year-old active female presents with a complex, comminuted four-part proximal humerus fracture with significant displacement and severe osteopenia. She has a pre-existing rotator cuff tear that was symptomatic prior to her fall. She is physiologically fit for surgery and desires the best possible functional outcome. Considering the patient's age, fracture pattern, bone quality, and pre-existing rotator cuff pathology, which surgical option is most likely to provide predictable pain relief and functional improvement?

An 82-year-old female sustains a displaced 4-part proximal humerus fracture. She lives independently and is medically optimized for surgery. When comparing hemiarthroplasty to reverse total shoulder arthroplasty (RTSA) for this patient, which of the following is the most significant advantage of RTSA?

When performing a reverse total shoulder arthroplasty for a comminuted 4-part proximal humerus fracture, meticulous repair of the greater tuberosity is attempted. If the greater tuberosity successfully heals to the shaft and implant, which clinical outcome is most significantly improved compared to when it resorbs?

A 75-year-old female undergoes reverse total shoulder arthroplasty (rTSA) for an unreconstructible 4-part proximal humerus fracture. Regarding the management of the tuberosities in this setting, which of the following statements is true?