9. Shoulder and Elbow MCQs

A 72-year-old woman returns for a 3-year follow-up after a reverse total shoulder arthroplasty (RTSA). Radiographs show a radiolucent area on the scapular neck that extends past the inferior screw of the baseplate but does not reach the central peg. Which Sirveaux grade of scapular notching does this represent, and what baseplate positioning strategy could have minimized this complication?

A 68-year-old man with primary osteoarthritis is planned for an anatomic total shoulder arthroplasty. Preoperative CT reveals a Walch B2 glenoid with 25 degrees of retroversion and posterior humeral head subluxation. What is the primary concern with performing a standard anatomic total shoulder arthroplasty with asymmetric anterior glenoid reaming to correct the version?

A 65-year-old male presents with chronic right shoulder pain, pseudoparalysis of elevation, and a positive Hornblower's sign. He has an absent active external rotation in adduction. Which of the following is the most appropriate surgical intervention?

A 35-year-old male complains of a prominent right shoulder blade after heavy weightlifting. Examination demonstrates lateral winging of the scapula that worsens with resisted active abduction. Injury to which of the following nerves is the most likely cause?

In a patient undergoing a primary reverse total shoulder arthroplasty (rTSA) utilizing a classic Grammont-style prosthesis, how is the center of rotation of the glenohumeral joint altered compared to its native anatomical position to improve the biomechanical advantage of the deltoid muscle?

By which primary biomechanical mechanism does a Grammont-style reverse total shoulder arthroplasty (rTSA) restore active forward elevation in a patient with severe rotator cuff arthropathy?

A 76-year-old female sustains a displaced 4-part proximal humerus fracture. Radiographs demonstrate a disrupted medial calcar hinge with 3 mm of medial metaphyseal extension on the head fragment. She has pre-existing advanced rotator cuff arthropathy. What is the treatment of choice?

In a 72-year-old patient with a 4-part proximal humerus fracture undergoing reverse total shoulder arthroplasty, the tuberosities are repaired around the prosthesis. Which factor is most critical for tuberosity healing and optimizing postoperative external rotation?

When preparing the glenoid for an anatomic total shoulder arthroplasty, a surgeon notes a Walch B2 morphology. What defines a B2 glenoid, and what is the primary risk if it is not corrected?

A 55-year-old active laborer presents with an irreparable posterosuperior rotator cuff tear. Physical examination reveals an inability to actively externally rotate the shoulder with the arm adducted and a positive Hornblower's sign. Radiographs show minimal glenohumeral arthritis. Which of the following tendon transfers is biomechanically superior for restoring active external rotation in this patient?

During the surgical management of a 'terrible triad' injury of the elbow (elbow dislocation, radial head fracture, coronoid fracture), which of the following represents the generally recommended sequence of structural reconstruction?

During an ulnar collateral ligament (UCL) reconstruction in an overhead throwing athlete, accurate tunnel placement is crucial to recreate the anterior bundle of the UCL. What are the correct anatomical landmarks for the origin and insertion of the anterior bundle?

A 68-year-old male with massive rotator cuff tear arthropathy presents with an inability to actively elevate his arm and severe external rotation weakness. On physical examination, he has a positive Hornblower's sign and an external rotation lag sign. He is planned for a reverse total shoulder arthroplasty (RTSA). Which of the following is the most appropriate concurrent procedure to optimize his postoperative function?

A 40-year-old male sustains a 'terrible triad' injury of the elbow following a fall on an outstretched hand. During operative intervention, what is the most widely accepted standard surgical sequence for reconstruction to restore elbow stability?

A 45-year-old female presents with a 'terrible triad' injury of the elbow. Intraoperatively, the surgeon sequentially repairs the coronoid process, the radial head, and the lateral ulnar collateral ligament (LUCL). Upon testing, the elbow remains persistently unstable in full extension. What is the most appropriate next step in management?

A 75-year-old female with a complex 4-part proximal humerus fracture undergoes a reverse total shoulder arthroplasty (RTSA). Which specific technical factor during glenoid component placement most significantly decreases the risk of postoperative scapular notching?

Which of the following surgical techniques is most effective in minimizing the risk of scapular notching during a reverse total shoulder arthroplasty?

A 45-year-old male sustains a terrible triad injury of the elbow. During surgical reconstruction, after fixation of the coronoid and radial head arthroplasty, the elbow remains persistently unstable in extension. What is the next most appropriate step in management?

A 22-year-old collegiate pitcher is diagnosed with true neurogenic thoracic outlet syndrome (TOS). In this condition, the compression typically involves a cervical rib or fibrous band compressing which specific component of the brachial plexus?