9. Shoulder and Elbow MCQs

In reverse total shoulder arthroplasty, placing the glenosphere with an inferior tilt rather than neutral or superior tilt achieves which of the following biomechanical advantages?

What is the average version of the humeral head (with respect to the transepicondylar axis)? Review Topic

A 45-year-old female presents after a fall on an outstretched hand. Imaging reveals a terrible triad injury of the elbow.

During surgical intervention, what is the most widely accepted sequence of repair to restore elbow stability?

A 72-year-old male with severe rotator cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (rTSA). How does the rTSA implant alter the biomechanics of the shoulder joint compared to the native anatomy?

A 35-year-old male suffers a distal biceps tendon rupture and undergoes surgical repair via a two-incision technique. Compared to the single anterior incision technique, the two-incision approach is associated with a higher risk of which of the following complications?

A 27-year-old elite baseball pitcher presents with medial elbow pain during the late cocking and early acceleration phases of throwing. Clinical examination and MRI confirm an isolated tear of the anterior bundle of the ulnar collateral ligament (UCL). Which band of the anterior bundle is the primary restraint to valgus stress at 30 to 120 degrees of elbow flexion?

A 45-year-old male falls on an outstretched hand and sustains the injury shown in the radiograph.

During surgical reconstruction of this "terrible triad" of the elbow, the surgeon systematically addresses the structures. Following fixation of the coronoid process, management of the radial head, and repair of the lateral collateral ligament (LCL) complex, the elbow remains unstable in extension. What is the most appropriate next step in management?

A 28-year-old professional weightlifter presents with a dull, aching pain in his right posterior shoulder and neck. On examination, there is pronounced lateral winging of the scapula, which is exacerbated during resisted external rotation and shoulder abduction. He recently had a minor lymph node biopsy in the posterior triangle of his neck. Injury to which of the following nerves is the most likely cause of his scapular winging?

A 6-year-old boy presents to the emergency department after falling from monkey bars. Radiographs reveal a plastic deformation of the ulnar shaft and an anterior dislocation of the radial head. This corresponds to a Bado Type I Monteggia equivalent lesion.

What is the most appropriate initial management for this injury?

A 75-year-old female sustains a displaced 4-part proximal humerus fracture. Given her poor bone quality and fracture complexity, she undergoes a Reverse Total Shoulder Arthroplasty (RTSA). During the procedure, the tuberosities are repaired to the shaft and the prosthesis. Healing of which of the following structures is most strongly associated with improved external rotation and higher overall patient-reported functional outcome scores?

A 35-year-old male complains of a painful "clunk" and giving way of his right elbow when he pushes himself out of a chair with his arms. A lateral pivot-shift test of the elbow reproduces his symptoms. This condition is primarily caused by insufficiency of a specific ligamentous structure. What is the normal anatomic origin and insertion of the deficient ligament?

A 35-year-old weightlifter undergoes a single-incision anterior approach for a distal biceps tendon rupture repair using suture anchors. Postoperatively, he complains of numbness and tingling over the lateral aspect of his forearm. Which nerve was most likely injured, and what structure does it pierce to become superficial?

A 40-year-old woman falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow.

Which of the following describes the most universally accepted sequence of intraoperative repair for this injury?

Which of the following biomechanical changes is most directly responsible for restoring active elevation in a patient with rotator cuff arthropathy undergoing a reverse total shoulder arthroplasty?

A 32-year-old carpenter presents with right shoulder weakness and a dull ache in the shoulder blade. On physical examination, when the patient pushes against a wall with arms extended forward, the medial border of the right scapula becomes prominent. Injury to which nerve is the most likely cause of this finding?

A 30-year-old motorcyclist is involved in a high-speed collision and presents with severe swelling of the left shoulder and complete loss of motor and sensory function in the left upper extremity. An AP chest radiograph shows lateral displacement of the left scapula compared to the right, and an intact clavicle. Which associated injury has the highest immediate mortality risk in this condition?

In reverse total shoulder arthroplasty (rTSA), which of the following glenosphere configurations is most effective at minimizing the risk of inferior scapular notching?

A 65-year-old male with an irreparable posterosuperior rotator cuff tear and a positive Hornblower's sign undergoes a latissimus dorsi tendon transfer. During the harvest of the tendon, which neurovascular bundle is at greatest risk and must be carefully protected?

A 42-year-old female presents with persistent shoulder pain and weakness 4 weeks after undergoing a lymph node biopsy in the posterior cervical triangle. On physical exam, she demonstrates lateral winging of the scapula and an inability to actively abduct the shoulder past 90 degrees. Injury to which of the following nerves is the most likely cause?