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9. Shoulder and Elbow MCQs

Practice Set 6 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 101

Topic: 9. Shoulder and Elbow

In an overhead throwing athlete, the "peel-back" mechanism contributing to Type II Superior Labrum Anterior to Posterior (SLAP) tears predominantly occurs in which shoulder position?

. Maximum forward flexion
. Abduction and internal rotation
. Abduction and maximal external rotation
. Adduction and external rotation
. Maximum extension

Correct Answer & Explanation

. Abduction and maximal external rotation

Explanation

The peel-back mechanism occurs during the late cocking phase of throwing, when the shoulder is in abduction and maximal external rotation. This position causes the biceps vector to shift posteriorly, creating a torsional force that peels the superior labrum off the glenoid.

Question 102

Topic: 9. Shoulder and Elbow

In a collegiate baseball pitcher, the primary restraint to valgus stress of the elbow at 90 degrees of flexion is the:

. Posterior bundle of the ulnar collateral ligament
. Anterior bundle of the ulnar collateral ligament
. Radial collateral ligament
. Flexor-pronator mass
. Radiocapitellar joint

Correct Answer & Explanation

. Anterior bundle of the ulnar collateral ligament

Explanation

The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow from 30 to 120 degrees of flexion. It is the most commonly injured ligament in overhead throwing athletes.

Question 103

Topic: 9. Shoulder and Elbow

A 25-year-old professional baseball pitcher presents with gradual onset of medial elbow pain during the late cocking phase of throwing. MRI confirms a full-thickness tear of the anterior bundle of the ulnar collateral ligament (UCL). During UCL reconstruction, the surgeon must be aware that the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion is the:

. Posterior bundle of the UCL
. Transverse ligament
. Anterior band of the anterior bundle of the UCL
. Posterior band of the anterior bundle of the UCL
. Flexor-pronator mass

Correct Answer & Explanation

. Anterior band of the anterior bundle of the UCL

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow from 30 to 120 degrees of flexion. Within it, the anterior band is most taut in extension to mid-flexion, bearing the primary load during the throwing motion.

Question 104

Topic: 9. Shoulder and Elbow

When evaluating an overhead throwing athlete for Glenohumeral Internal Rotation Deficit (GIRD), adaptive changes to the shoulder capsule are typically observed. GIRD is primarily attributed to contracture of which capsular structure?

. Anterior-inferior capsule
. Posterior-inferior capsule
. Superior glenohumeral ligament
. Middle glenohumeral ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Posterior-inferior capsule

Explanation

GIRD is clinically characterized by a loss of internal rotation compared to the contralateral shoulder. It is primarily caused by contracture and thickening of the posterior-inferior capsule resulting from repetitive deceleration forces during throwing.

Question 105

Topic: 9. Shoulder and Elbow

The primary restraint to anterior translation of the abducted and externally rotated glenohumeral joint is the:

. Coracohumeral ligament
. Superior glenohumeral ligament
. Middle glenohumeral ligament
. Inferior glenohumeral ligament
. Subscapularis muscle

Correct Answer & Explanation

. Inferior glenohumeral ligament

Explanation

The inferior glenohumeral ligament is the primary restraint to anterior translation of the abducted and externally rotated glenohumeral joint. The Bankart lesion is an avulsion of the inferior glenohumeral ligament and represents the primary pathoanatomy of traumatic anterior shoulder dislocation.

Question 106

Topic: 9. Shoulder and Elbow

When testing an elbow for insufficiency of the medial collateral ligament, valgus stress should be applied with the elbow positioned at:

. Full extension
. 30° of flexion
. 45° of flexion
. 60° of flexion
. 90° of flexion

Correct Answer & Explanation

. 30° of flexion

Explanation

When testing the medial collateral ligament of the elbow, it is important to apply valgus stress with the elbow flexed approximately 20° to 30° to disengage the olecranon from the olecranon fossa. It is always important to examine and compare the injured and uninjured side.

Question 107

Topic: 9. Shoulder and Elbow

The following structure is most responsible for anterior stability of the glenohumeral joint with the arm in 45° of abduction:

. Inferior glenohumeral ligament
. Middle glenohumeral ligament
. Superior glenohumeral ligament
. Coracohumeral ligament
. Subscapularis muscle and tendon

Correct Answer & Explanation

. Middle glenohumeral ligament

Explanation

The middle glenohumeral ligament, although absent in up to one third of shoulders, is the largest contributor to anterior stability of the shoulder with the arm abducted 45°. The inferior glenohumeral ligament is the primary restraint to anterior instability with the arm abducted to 90° and externally rotated.

Question 108

Topic: 9. Shoulder and Elbow

The following structure is most responsible for resisting inferior translation of the glenohumeral joint with the arm at the side:

. Inferior glenohumeral ligament
. Middle glenohumeral ligament
. C oracoacromial ligament
. Coracohumeral ligament
. Subscapularis muscle and tendon

Correct Answer & Explanation

. Coracohumeral ligament

Explanation

The coracohumeral ligament coupled with the superior glenohumeral ligament provides the primary restraint to inferior translation of the glenohumeral joint with the arm at the side. The coracohumeral ligament also provides restraint to external rotation with the arm at the side.

Question 109

Topic: 9. Shoulder and Elbow

Maximal external rotation of the shoulder occurs during which phase of pitching:

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

Correct Answer & Explanation

. Late cocking

Explanation

The pitching motion can be divided into 6 phases: wind-up, early cocking, late cocking, acceleration, deceleration, and follow through. Maximal external rotation at the shoulder occurs during late cocking.

Question 110

Topic: 9. Shoulder and Elbow
A 35-year-old avid rock climber complains of persistent anterior elbow pain with climbing, particularly when pulling himself up with his arms. The following muscle would most likely show increased activity on an electromyogram:
. Long head of the biceps brachii
. Short head of the biceps brachii
. Brachialis
. Flexor carpi radialis
. Flexor carpi ulnaris

Correct Answer & Explanation

. Brachialis

Explanation

Brachialis tendonitis, or climber's elbow, causes pain in the anterior elbow with the forearm in the pronated and flexed position. An electromyogram typically shows increased activity in the brachialis muscle.

Question 111

Topic: 9. Shoulder and Elbow

A 16-year-old baseball pitcher complains of dominant-sided elbow pain when pitching. He has recently been removed from the pitching rotation because of "control" problems. Physical examination reveals pain when a supinated, flexed, and valgus stressed elbow is brought into progressive extension. The most likely diagnosis is:

. Posterolateral rotatory instability
. Ulnar collateral ligament tear
. Ulnar nerve entrapment
. Posteromedial impingement
. Radial nerve entrapment

Correct Answer & Explanation

. Posteromedial impingement

Explanation

The process described is posteromedial impingement syndrome of the elbow. It typically presents as vague elbow pain with loss of control in pitchers. The valgus extension overload test typically elicits pain and sometimes crepitus. The pathological changes in posteromedial impingement syndrome start with chondromalacia on the medial aspect of the trochlear groove and may progress to osteophyte formation and loose bodies necessitating arthroscopic debridement.

Question 112

Topic: 9. Shoulder and Elbow

This slide is a computed tomogram of the dominant shoulder of a 45-year- old male tennis player. The most likely diagnosis is:

. Osteosarcoma
. Synovial osteochondromatosis
. Anterior glenoid fracture
. Synovial cell sarcoma
. Rotator cuff tear arthropathy

Correct Answer & Explanation

. Synovial osteochondromatosis

Explanation

Synovial osteochondromatosis is a rare condition typically affecting middle- aged men. The computed tomogram demonstrates the osteocartilaginous nodules. Early in the disease, arthroscopic removal of loose bodies and synovectomy usually results in an acceptable outcome. In cases of progressive disease resulting in secondary shoulder arthrosis, shoulder arthroplasty may be required.

Question 113

Topic: 9. Shoulder and Elbow

With the arm resting at the side in 0 degrees of abduction, what is the primary static restraint to inferior translation of the glenohumeral joint?

. Superior glenohumeral ligament and coracohumeral ligament
. Middle glenohumeral ligament
. Inferior glenohumeral ligament complex
. Posterior band of the inferior glenohumeral ligament
. Biceps anchor

Correct Answer & Explanation

. Superior glenohumeral ligament and coracohumeral ligament

Explanation

In the adducted shoulder (0 degrees of abduction), the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL) are the primary static restraints to inferior translation. The inferior glenohumeral ligament becomes the primary restraint at 90 degrees of abduction.

Question 114

Topic: Elbow & Forearm

Posterolateral rotatory instability (PLRI) of the elbow typically follows a traumatic dislocation or iatrogenic injury. This condition is primarily characterized by insufficiency of which of the following ligamentous structures?

. Radial collateral ligament
. Lateral ulnar collateral ligament
. Annular ligament
. Accessory collateral ligament
. Quadrate ligament

Correct Answer & Explanation

. Lateral ulnar collateral ligament

Explanation

PLRI is the most common pattern of chronic elbow instability and is caused by an injury or deficiency of the lateral ulnar collateral ligament (LUCL). The LUCL serves as the primary restraint to posterolateral rotatory subluxation of the radius relative to the humerus.

Question 115

Topic: 9. Shoulder and Elbow

Which of the following positions represents the close-packed position of the glenohumeral joint?

. Maximum abduction and internal rotation
. Maximum abduction and external rotation
. 90 degrees abduction and neutral rotation
. Maximum forward flexion and internal rotation
. Adduction and internal rotation

Correct Answer & Explanation

. Maximum abduction and external rotation

Explanation

The close-packed position for the glenohumeral joint is maximum abduction and external rotation. In this position, the capsuloligamentous structures (specifically the inferior glenohumeral ligament complex) are maximally taut.

Question 116

Topic: 9. Shoulder and Elbow

During a classic deltopectoral approach to the shoulder, the cephalic vein is typically retracted in which direction to preserve its primary draining tributaries?

. Medially
. Laterally
. Superiorly
. Inferiorly
. It is always ligated

Correct Answer & Explanation

. Laterally

Explanation

The cephalic vein is usually retracted laterally with the deltoid muscle during the deltopectoral approach. This is because its primary draining tributaries arise from the deltoid, and lateral retraction prevents their avulsion.

Question 117

Topic: 9. Shoulder and Elbow

Consider the biomechanical principles shown in the diagram.

In the setting of a reverse total shoulder arthroplasty, lateralization of the glenosphere primarily achieves which of the following?

. Increases the deltoid moment arm
. Decreases scapular notching
. Increases sheer stress on the baseplate
. Decreases tension on the remaining rotator cuff
. Moves the center of rotation medially

Correct Answer & Explanation

. Decreases scapular notching

Explanation

Lateralization of the glenosphere in reverse total shoulder arthroplasty provides better clearance and significantly decreases inferior scapular notching. However, it can increase shear forces at the baseplate-bone interface.

Question 118

Topic: 9. Shoulder and Elbow

The primary restraint to inferior translation of the glenohumeral joint with the arm in 0 degrees of abduction is the:

. Middle glenohumeral ligament
. Inferior glenohumeral ligament
. Superior glenohumeral ligament and coracohumeral ligament
. Short head of the biceps
. Anterior joint capsule

Correct Answer & Explanation

. Superior glenohumeral ligament and coracohumeral ligament

Explanation

At 0 degrees of abduction, the superior glenohumeral ligament and coracohumeral ligament are the primary restraints to inferior translation. The inferior glenohumeral ligament becomes the primary restraint at 90 degrees of abduction.

Question 119

Topic: 9. Shoulder and Elbow

A 24-year-old baseball pitcher presents with medial elbow pain. Clinical evaluation demonstrates valgus instability of the elbow. The anterior bundle of the ulnar collateral ligament (UCL), which is the primary restraint to this stress, inserts onto which of the following structures?

. Coronoid process
. Sublime tubercle
. Radial tuberosity
. Olecranon process
. Lateral epicondyle

Correct Answer & Explanation

. Sublime tubercle

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress at the elbow from 30 to 120 degrees of flexion. It originates from the medial epicondyle and inserts onto the sublime tubercle of the proximal ulna.

Question 120

Topic: Elbow & Forearm

A 35-year-old male presents with posterolateral rotatory instability (PLRI) of the elbow after a traumatic dislocation. The primary ligamentous restraint deficient in this condition is the lateral ulnar collateral ligament (LUCL). What is the normal insertion site of the LUCL?

. Radial tuberosity
. Coronoid process
. Olecranon tip
. Supinator crest of the ulna
. Annular ligament

Correct Answer & Explanation

. Radial tuberosity

Explanation

The lateral ulnar collateral ligament (LUCL) originates on the lateral epicondyle and blends with the annular ligament before inserting onto the supinator crest of the proximal ulna. It acts as the primary restraint against PLRI.

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