9. Shoulder and Elbow MCQs

A 22-year-old competitive weightlifter presents with insidious onset of right shoulder pain, exacerbated by the bench press and cross-body adduction. Radiographs show subchondral cysts, osteopenia, and microfractures of the distal clavicle. What is the initial treatment of choice for this condition?

When obtaining a Zanca view to radiographically evaluate an acute acromioclavicular (AC) joint injury, what is the proper positioning of the X-ray beam?

A patient with a history of recurrent anterior shoulder instability undergoes an MR arthrogram. The radiologist notes a "U-shaped" dependent pouch of the axillary recess and extravasation of contrast into the soft tissues inferior to the glenohumeral joint. Which lesion does this specific finding describe?

An 18-year-old male sustains a shoulder dislocation and subsequent recurrent instability. An MR arthrogram demonstrates extravasation of contrast into the axilla with a normal-appearing anterior labrum. What is the most likely diagnosis?

A 31-year-old male is treated for an acute, first-time posterior shoulder dislocation. Following closed reduction, which immobilization position is most biomechanically favorable to promote healing of the posterior capsulolabral structures?

During physical examination of a 20-year-old female gymnast with multidirectional shoulder instability (MDI), a 'sulcus sign' is elicited in neutral rotation and adduction. Which primary capsuloligamentous structures are being evaluated with this specific test?

A 23-year-old rugby player has recurrent shoulder instability. Magnetic Resonance Imaging reveals a torn anterior glenohumeral ligament that has avulsed directly from the humeral neck, with an associated loss of the normal U-shaped axillary pouch. What is the proper acronym for this lesion?

A 29-year-old female presents with chronic shoulder pain, swelling, and mechanical catching. MRI demonstrates a lobulated intra-articular mass with a 'blooming' artifact. Which of the following MRI sequences best highlights this specific artifact?

A 30-year-old male sustains a severe shoulder dislocation. MRI arthrogram demonstrates extravasation of contrast into the axillary pouch with an intact anterior labrum. A 'J-sign' is noted on the coronal sequences.

What is the most likely diagnosis?

A 19-year-old gymnast is diagnosed with multidirectional instability (MDI) of the shoulder. She has failed 6 months of targeted physical therapy.

If surgical intervention is pursued, an arthroscopic capsular shift is performed. Closure of the rotator interval during this procedure primarily limits which motion?

A 55-year-old male sustains an acute anterior shoulder dislocation. Following closed reduction, he has profound weakness in external rotation and a positive Hornblower's sign, but imaging shows no rotator cuff tear. Which of the following concomitant injuries most likely explains these specific physical exam findings?

A 9-year-old patient presents with a displaced lateral condyle fracture. During open reduction and internal fixation (ORIF), the surgeon is meticulously clearing the fracture hematoma and preparing for reduction. Which of the following surgical maneuvers carries the highest risk of avascular necrosis (AVN) of the capitellum?

A 5-year-old child sustains a lateral condyle fracture. The fracture fragment, which is largely cartilaginous at this age, includes the lateral metaphysis and the entire capitellum. Which of the following statements accurately describes the anatomical and biomechanical considerations relevant to this injury?

A 7-year-old patient undergoes successful open reduction and internal fixation of a lateral condyle fracture. During the follow-up period, the patient develops a 'fishtail' deformity of the capitellum on radiographs. Which of the following complications is most consistent with this radiographic finding?

An 11-year-old gymnast sustains an acute elbow dislocation. Following a successful closed reduction in the emergency department, post-reduction radiographs reveal that the medial epicondyle is fractured and incarcerated within the ulnohumeral joint. What is the most appropriate management?

An 8-year-old girl falls onto an outstretched hand and presents with lateral elbow pain. Radiographs reveal a radial neck fracture with 45 degrees of angulation. The radial head is not displaced from the capitellum. What is the initial step in management?

A 4-year-old child falls on an outstretched hand. A radiograph similar to

demonstrates a lateral condyle fracture. If this fracture is left untreated and goes on to nonunion, which of the following is the most classic long-term complication?

A 7-year-old falls onto an outstretched hand and sustains a Bado Type I Monteggia fracture-dislocation (anterior dislocation of the radial head with a proximal ulna fracture). What is the critical first step in the management of this injury?