9. Shoulder and Elbow MCQs

A 68-year-old female with severe rotator cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (RTSA). To minimize the risk of inferior scapular notching postoperatively, how should the glenosphere ideally be positioned during the procedure?

During a routine diagnostic shoulder arthroscopy, you identify a cord-like middle glenohumeral ligament (MGHL) that inserts directly into the superior labrum at the base of the biceps anchor, and you note an absent anterosuperior labrum from the 1 o'clock to 3 o'clock position. This anatomic variant is known as a Buford complex. What is the most appropriate surgical management for this specific structural finding?

A 68-year-old female presents with severe right shoulder pain, an inability to actively forward elevate her arm past 45 degrees, and a positive hornblower's sign. Radiographs show no significant glenohumeral osteoarthritis but a highly superiorly migrated humeral head. MRI reveals a massive, retracted, and fatty-infiltrated tear of the supraspinatus and infraspinatus. Her deltoid function is completely intact. What is the most appropriate surgical intervention?

A 60-year-old man undergoes an anatomic total shoulder arthroplasty via a standard deltopectoral approach. The subscapularis tendon is detached from the lesser tuberosity for exposure and subsequently repaired. At his 3-month postoperative visit, he complains of anterior shoulder pain and weakness. Which physical examination finding would most specifically indicate a structural failure of his subscapularis repair?

In a reverse total shoulder arthroplasty (RTSA), medialization and distalization of the center of rotation achieves which of the following biomechanical advantages?

A 65-year-old male has active forward elevation of his right arm to only 45 degrees, though passive elevation is 160 degrees. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus. To determine if a reverse total shoulder arthroplasty (RTSA) is indicated, an injection of local anesthetic into the subacromial space is performed. What is the rationale for this test?

A 72-year-old male with severe rotator cuff tear arthropathy undergoes a reverse total shoulder arthroplasty (RTSA). The surgeon decides to use a lateralized glenosphere construct. Which of the following is a biomechanical consequence of lateralizing the glenosphere in an RTSA?

An elite baseball pitcher is diagnosed with a Type II Superior Labrum Anterior to Posterior (SLAP) tear. The 'peel-back' mechanism is considered the primary biomechanical etiology for this injury in overhead throwers. In which phase of the throwing motion does this peel-back force peak?

Which of the following best describes the biomechanical rationale of a reverse total shoulder arthroplasty (RTSA) in the setting of rotator cuff tear arthropathy?

A 61-year-old woman with a long-standing history of rheumatoid arthritis reports progressive elbow pain for the past 12 months. She denies any recent trauma to the elbow; however, she notes increasing pain and decreased joint motion that are now compromising her function. Radiographs are shown in Figures 57a and 57b. What is the most appropriate treatment at this time? Review Topic

Which of the following best describes the biomechanical rationale of a reverse total shoulder arthroplasty in the setting of rotator cuff tear arthropathy?

A 24-year-old athlete presents with medial scapular winging noticeable during forward elevation of the arm. EMG confirms an isolated nerve injury. Which muscle is primarily affected and what is the typical mechanism of injury?

What is the primary static restraint to superior translation of the humeral head in a patient with a massive, irreparable rotator cuff tear?

In a patient presenting with early idiopathic adhesive capsulitis of the shoulder, which physical exam finding is typically the earliest and most specific hallmark?

During shoulder arthroscopy, the 'comma sign' is an important anatomical landmark indicating a subscapularis tear. This structure is formed by the avulsion and medial retraction of the:

A reverse total shoulder arthroplasty (rTSA) improves active elevation in patients with rotator cuff tear arthropathy primarily through which of the following biomechanical alterations?

A 35-year-old female presents with severe elbow pain after falling onto an outstretched hand. The lateral elbow radiograph demonstrates a 'double-arc sign.' What does this classic radiographic finding indicate regarding the distal humerus fracture pattern?

In the surgical management of a 'terrible triad' injury of the elbow, which of the following sequences represents the generally accepted standard protocol for reconstruction?

A 35-year-old female undergoes surgery for a 'terrible triad' elbow injury. Following radial head arthroplasty, lateral collateral ligament (LCL) repair, and non-operative management of a Type 1 coronoid tip fracture, the elbow readily subluxates posteriorly at 30 degrees of extension. What is the most appropriate next step?

A 35-year-old female sustains a "terrible triad" injury of the elbow. Operative intervention is planned to restore stability. According to standard biomechanical principles and established protocols, what is the most appropriate sequence of surgical reconstruction?