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9. Shoulder and Elbow MCQs

Practice Set 4 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 61

Topic: 9. Shoulder and Elbow

Elbow injury usually occurs during which phase of throwing:

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow through

Correct Answer & Explanation

. Acceleration

Explanation

Peak valgus stresses on the elbow occur during the acceleration phase of throwing making it the phase during which the elbow is most vulnerable to injury.

Question 62

Topic: 9. Shoulder and Elbow

Which of the following structures is the most important dynamic stabilizer of the elbow to valgus stresses during throwing:

. Anterior oblique component of the ulnar collateral ligament
. Posterior oblique component of the ulnar collateral ligament
. Flexor-pronator musculature
. Brachialis
. Biceps brachii

Correct Answer & Explanation

. Flexor-pronator musculature

Explanation

The flexor-pronator muscle mass on the medial side of the elbow dynamically resists valgus stresses during throwing. Compromise or fatigue of this muscle group with activity may be a predecessor to injury to the ligamentous stabilizing structures.

Question 63

Topic: 9. Shoulder and Elbow

During which phase of throwing is the flexor-pronator muscle mass most electrically active:

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow through

Correct Answer & Explanation

. Acceleration

Explanation

Peak valgus stresses on the elbow occur during the acceleration phase of throwing making it the phase during which the elbow is most vulnerable to injury. The flexor-pronator muscle mass peaks in activity during the acceleration phase to dynamically stabilize the elbow.

Question 64

Topic: 9. Shoulder and Elbow

Which of the following is the principal function of the biceps during throwing:

. Elbow flexion
. Shoulder stabilization
. Arm deceleration
. Humeral head depression
. Shoulder flexion

Correct Answer & Explanation

. Elbow flexion

Explanation

The function of the biceps at the shoulder is controversial, especially in the throwing athlete. The biceps may act as a secondary shoulder stabilizer, weak shoulder flexor, arm decelerator, or weak depressor of the humeral head. However, it is widely agreed upon that the biceps principal function during throwing is elbow flexion.

Question 65

Topic: 9. Shoulder and Elbow

When biomechanically comparing reconstruction of the anterior band of the medial collateral ligament of the elbow to the intact ligament, the reconstructed ligament behaves nearly identical to the intact ligament when subjected to valgus stress at all of the following degrees of elbow flexion except:

. 0°
. 30°
. 60°
. 90°
. 120°

Correct Answer & Explanation

. 120°

Explanation

Mullen and associates biomechanically compared reconstruction of the medial collateral ligament of the elbow to the intact ligament at 30°, 60°, 90°, and 120° of elbow flexion. They identified a significant difference in displacement with an applied valgus load at 120° of elbow flexion, leading them to conclude that medial collateral ligament reconstruction is a biomechanically sound procedure.

Question 66

Topic: 9. Shoulder and Elbow

A 32-year-old weightlifter presents with acute anterior shoulder pain and bruising after a heavy bench press. Examination reveals loss of the anterior axillary fold. If surgical repair is planned, where is the anatomic footprint of the ruptured tendon?

. Lateral lip of the bicipital groove
. Medial lip of the bicipital groove
. Lesser tuberosity
. Greater tuberosity
. Coracoid process

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

The pectoralis major inserts onto the lateral lip of the bicipital groove. Ruptures commonly occur at the musculotendinous junction or insertion and are treated surgically in young, active individuals.

Question 67

Topic: 9. Shoulder and Elbow

A 22-year-old collegiate baseball pitcher presents with medial elbow pain and decreased pitching velocity. An MRI arthrogram confirms a high-grade tear of the anterior bundle of the ulnar collateral ligament (UCL). Which phase of throwing places the highest valgus stress on the elbow?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Deceleration

Correct Answer & Explanation

. Acceleration

Explanation

The highest valgus stress on the elbow occurs during the acceleration phase of throwing. The anterior bundle of the UCL is the primary restraint to this extreme valgus force.

Question 68

Topic: 9. Shoulder and Elbow

A 50-year-old woman with type 1 diabetes presents with severe left shoulder pain and stiffness. Which of the following represents the typical sequence of motion loss in idiopathic adhesive capsulitis?

. Flexion, followed by internal rotation, followed by external rotation
. External rotation, followed by abduction, followed by internal rotation
. Internal rotation, followed by abduction, followed by external rotation
. External rotation, followed by internal rotation, followed by abduction
. Abduction, followed by external rotation, followed by internal rotation

Correct Answer & Explanation

. External rotation, followed by abduction, followed by internal rotation

Explanation

In adhesive capsulitis, the classic progression of passive motion loss begins with external rotation. This is characteristically followed by a loss of abduction, and finally internal rotation.

Question 69

Topic: 9. Shoulder and Elbow

Glenohumeral internal rotation deficit (GIRD) in an overhead throwing athlete is most commonly attributed to the pathologic contracture of which of the following capsular structures?

. Posteroinferior capsule
. Anterosuperior capsule
. Middle glenohumeral ligament
. Coracohumeral ligament
. Superior glenohumeral ligament

Correct Answer & Explanation

. Posteroinferior capsule

Explanation

GIRD is caused by contracture of the posteroinferior capsule, leading to a shift in the glenohumeral center of rotation. This results in increased external rotation and a corresponding loss of internal rotation.

Question 70

Topic: 9. Shoulder and Elbow

In an overhead baseball pitcher, the ulnar collateral ligament (UCL) of the elbow experiences the greatest amount of valgus stress during which phase of the throwing motion?

. Wind-up
. Early cocking
. Late cocking and early acceleration
. Deceleration
. Follow-through

Correct Answer & Explanation

. Late cocking and early acceleration

Explanation

The UCL experiences maximal valgus stress during the late cocking and early acceleration phases of throwing. This repetitive microtrauma can lead to attenuation and eventual rupture of the anterior bundle.

Question 71

Topic: Elbow & Forearm

A 14-year-old male baseball pitcher complains of lateral elbow pain. Radiographs reveal a radiolucency of the capitellum with a sclerotic margin. What is the most likely diagnosis?

. Panner disease
. Medial epicondyle apophysitis
. Osteochondritis dissecans of the capitellum
. Little League elbow
. Radial head fracture

Correct Answer & Explanation

. Osteochondritis dissecans of the capitellum

Explanation

Osteochondritis dissecans (OCD) of the capitellum typically occurs in adolescent throwers or gymnasts (ages 12-15) presenting with lateral elbow pain and radiolucent defects. Panner disease affects younger children (ages 7-10) and typically involves the entire capitellum without focal loose body formation.

Question 72

Topic: 9. Shoulder and Elbow

In treating overhead throwing athletes with symptomatic Glenohumeral Internal Rotation Deficit (GIRD), the primary anatomical target of the "sleeper stretch" is the:

. Anterior joint capsule
. Coracohumeral ligament
. Posterior band of the inferior glenohumeral ligament
. Superior glenohumeral ligament
. Pectoralis minor muscle

Correct Answer & Explanation

. Posterior band of the inferior glenohumeral ligament

Explanation

GIRD is characterized by a thickened and contracted posteroinferior capsule. Sleeper stretches specifically target this region, specifically the posterior band of the inferior glenohumeral ligament.

Question 73

Topic: 9. Shoulder and Elbow

A 45-year-old diabetic female presents with severe, progressive shoulder stiffness. Passive range of motion is globally restricted, with external rotation being the most limited. Radiographs are normal. What is the primary underlying pathological mechanism?

. Subacromial bursal hypertrophy and impingement
. Anterior labral detachment
. Glenohumeral synovial inflammation and capsular fibroplasia
. Chronic rotator cuff tendon avulsion
. Coracoclavicular ligament ossification

Correct Answer & Explanation

. Glenohumeral synovial inflammation and capsular fibroplasia

Explanation

Adhesive capsulitis (frozen shoulder) involves synovial inflammation leading to reactive capsular fibroplasia and contracture. This produces a global restriction of active and passive motion, particularly external rotation.

Question 74

Topic: 9. Shoulder and Elbow

Thermal shrinkage of the shoulder capsule imparts which of the following properties on the capsule:

. Increased strength
. Decreased compliance
. Increased collagen crosslinking
. Increased stiffness
. Decreased stiffness

Correct Answer & Explanation

. Decreased stiffness

Explanation

Thermal shrinkage reliably decreases capsular stiffness (increasing compliance). The resultant tissue is biomechanically weaker than normal tissue.

Question 75

Topic: 9. Shoulder and Elbow

Magnetic resonance imaging will demonstrate labral abnormalities in the throwing shoulder in approximately what percentage of asymptomatic professional baseball pitchers:

. 10%
. 30%
. 50%
. 75%
. 90%

Correct Answer & Explanation

. 75%

Explanation

Miniaci and colleagues discovered that 79% of asymptomatic professional baseball pitchers had labral abnormalities on magnetic resonance imaging. They further discovered that the incidence of labral lesions was similar between throwing and nonthrowing shoulders in this population.

Question 76

Topic: 9. Shoulder and Elbow
Which of the following statements is true regarding humeral retroversion in a thrower's dominant shoulder?
. Humeral retroversion in a thrower's dominant shoulder is the same as in the nondominant shoulder.
. Humeral retroversion in a thrower's dominant shoulder is less than humeral retroversion in the nondominant shoulder.
. Humeral retroversion in a thrower's dominant shoulder is greater than humeral retroversion in the nondominant shoulder.
. Humeral retroversion in a thrower's dominant shoulder is the same humeral retroversion in a nonthrower's dominant shoulder.
. Humeral retroversion in a thrower's dominant shoulder is less than humeral retroversion in a nonthrower's dominant shoulder.

Correct Answer & Explanation

. Humeral retroversion in a thrower's dominant shoulder is greater than humeral retroversion in the nondominant shoulder.

Explanation

Throwers have increased humeral retroversion in their dominant shoulder compared to their contralateral shoulder and to the dominant shoulder of nonthrowers. This represents an adaptive change that probably occurs through the physis (a pathologic expression of this adaptation probably exists in the form of proximal humeral epiphysealysis or little leaguer's shoulder) and has two benefits. First, humeral retroversion allows increased external rotation during throwing activities. Second, humeral retroversion acts as a protective mechanism against impingement of the greater tuberosity on the posterosuperior glenoid rim during throwing.

Question 77

Topic: 9. Shoulder and Elbow

An arthroscopic photo (Slide) looking from the posterior portal is presented. The arrows point to which structure:

. Superior glenohumeral ligament
. Inferior glenohumeral ligament
. Middle glenohumeral ligament
. C oracohumeral ligament
. C oracoacromial ligament

Correct Answer & Explanation

. Middle glenohumeral ligament

Explanation

The middle glenohumeral ligament is readily visualized crossing the subscapularis from the posterior arthroscopic portal. The middle glenohumeral ligament may be absent in as many as 30% of shoulders.

Question 78

Topic: 9. Shoulder and Elbow

An arthroscopic photo (Slide) of the shoulder looking from the posterior portal is presented. The large white structure at the top of the figure is the biceps tendon. The arrows point to which structure:

. Middle glenohumeral ligament
. Inferior glenohumeral ligament
. Superior glenoid labrum
. Anterior glenoid labrum
. Ligamentous pulley

Correct Answer & Explanation

. Ligamentous pulley

Explanation

The arrows point to the ligamentous pulley. The ligamentous pulley is responsible for stabilizing the biceps within the bicipital groove of the humerus. An intact ligamentous pulley precludes arthroscopic diagnosis of superior subscapularis tendon tears.

Question 79

Topic: Elbow & Forearm

A 13-year-old gymnast complains of lateral elbow pain and catching. Radiographs demonstrate a radiolucent defect in the capitellum with a sclerotic margin.

What fundamentally differentiates osteochondritis dissecans (OCD) of the capitellum from Panner's disease?

. Panner's disease primarily affects older adolescents
. OCD involves the entire capitellar ossific nucleus
. Panner's disease is a self-limiting osteochondrosis that does not typically produce loose bodies
. OCD always resolves with conservative rest and never requires surgery

Correct Answer & Explanation

. Panner's disease is a self-limiting osteochondrosis that does not typically produce loose bodies

Explanation

Panner's disease is an osteochondrosis of the capitellum typically seen in children under 10 years old and resolves nonoperatively without loose body formation. OCD affects older adolescents, involves a localized subchondral defect, and frequently produces loose bodies.

Question 80

Topic: 9. Shoulder and Elbow

A 25-year-old baseball pitcher presents with medial elbow pain during the late cocking and early acceleration phases of throwing. Valgus stress test is positive. Which band of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at 90 degrees of flexion?

. Anterior bundle
. Posterior bundle
. Transverse bundle
. Oblique bundle
. Annular ligament

Correct Answer & Explanation

. Anterior bundle

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow from 30 to 120 degrees of flexion and is the most commonly injured structure in overhead throwers.

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