9. Shoulder and Elbow MCQs

A 72-year-old female presents with chronic shoulder pain and limited active elevation. Radiographs show an acromiohumeral distance (AHD) of 3 mm and characteristic 'acetabularization' of the acromion. There is no evidence of glenohumeral joint space narrowing. According to the Hamada classification for cuff tear arthropathy, what grade is this?

A 55-year-old female with poorly controlled type 1 diabetes presents with insidious onset of profound shoulder stiffness and pain. She is diagnosed with adhesive capsulitis (frozen shoulder). Histological and biochemical analysis of the capsule in this condition is most likely to show an upregulation of which of the following cytokines?

A 75-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for a severely displaced 4-part proximal humerus fracture. Compared to a hemiarthroplasty performed for the same indication, RTSA provides which primary functional advantage?

A 28-year-old male presents with shoulder weakness and a dull ache following a severe blunt trauma to the base of his posterior neck during a wrestling match. Physical examination reveals a drooping shoulder and lateral winging of the scapula that worsens with shoulder abduction. The winged scapula is translated laterally and superiorly. Injury to which nerve is most likely responsible?

A 70-year-old woman undergoes a reverse total shoulder arthroplasty (rTSA) for cuff tear arthropathy. At her 2-year follow-up, radiographs show a Grade 2 scapular notching. Which of the following surgical design factors or techniques is most effective in minimizing the risk of scapular notching in rTSA?

A 30-year-old competitive weightlifter feels a sudden 'pop' in his anterior shoulder while performing a heavy bench press. Examination reveals a loss of the anterior axillary fold. When a pectoralis major rupture occurs, which of the following describes the most common pathoanatomic failure pattern?

A 19-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction. Which bundle of the UCL is the primary restraint to valgus stress during the late cocking and early acceleration phases of throwing, and is the primary structure reconstructed?

A 13-year-old male baseball pitcher complains of lateral elbow pain. Radiographs reveal a radiolucent lesion with a sclerotic margin on the capitellum, and MRI demonstrates a detached osteochondral fragment. He has open physes. Which of the following most accurately differentiates osteochondritis dissecans (OCD) of the capitellum from Panner's disease?

A 22-year-old collegiate baseball pitcher undergoes evaluation for medial elbow pain and a positive moving valgus stress test. The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at what degrees of elbow flexion?

A 36-year-old woman dislocated her elbow 6 months ago. The elbow was congruently reduced and rehabilitated. She continues to have a sense of painful clunking in her elbow when she pushes up from a chair with forearm supination, but not pronation. What structure did not heal properly?

A 35-year-old man sustained a mid-shaft humerus fracture resulting in a high radial nerve palsy that has shown no clinical or electromyographic signs of recovery at 12 months. In a standard set of tendon transfers (such as the Jones transfer) designed to restore hand and wrist function, which donor tendon is classically transferred to restore wrist extension?

In the standard flexor carpi radialis (FCR) tendon transfer utilized for a high radial nerve palsy, which muscle is typically transferred to the extensor pollicis longus (EPL) to restore thumb extension?

A patient with an isolated, irreparable high radial nerve palsy requires tendon transfers to restore wrist extension, finger extension, and thumb extension. Which of the following is the most standard and reliable donor muscle to restore wrist extension?

During exploration of a brachial plexus injury 5 months post-trauma, a neuroma-in-continuity is identified at the upper trunk. Intraoperative nerve stimulation across the neuroma yields a reproducible nerve action potential (NAP). What is the most appropriate next step in management?

In brachial plexus reconstruction for a complete C5-C6 root avulsion, transferring the distal spinal accessory nerve to the suprascapular nerve is considered. Which of the following muscles must have confirmed, robust baseline function prior to sacrificing the distal spinal accessory nerve?

In a patient with a chronic, irreversible radial nerve palsy, a standard tendon transfer procedure is planned to restore functional wrist and digit extension. To restore wrist extension, which of the following donor-recipient tendon transfers is most commonly utilized?

A surgeon plans to use a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) vascularized bone graft for a scaphoid nonunion. During the dissection, the pedicle must be identified between the first and second dorsal extensor compartments. Which of the following pairs of tendons correctly defines the anatomic borders of these two compartments?

A patient with a high radial nerve palsy requires tendon transfers to restore wrist, finger, and thumb extension. To restore wrist extension, the Pronator Teres (PT) is most commonly transferred to the Extensor Carpi Radialis Brevis (ECRB) rather than the Extensor Carpi Radialis Longus (ECRL). What is the primary biomechanical rationale for selecting the ECRB?

In a reverse total shoulder arthroplasty, moving the center of rotation medially and distally compared to the native shoulder achieves which of the following biomechanical outcomes?