Menu

9. Shoulder and Elbow MCQs

Practice Set 79 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 1561

Topic: 9. Shoulder and Elbow

A 74-year-old man has had worsening left shoulder pain for the past 3 years. Extensive nonsurgical management has provided only minimal relief. Examination reveals limitations in motion due to pain but good rotator cuff strength. Radiographs are shown in Figures 53a and 53b. What surgical procedure is most appropriate?

. Arthroscopic removal of osteophytes and soft-tissue release
. Soft-tissue interpositional arthroplasty
. Reverse total shoulder arthroplasty
. Hemiarthroplasty
. Total shoulder arthroplasty

Correct Answer & Explanation

. Total shoulder arthroplasty

Explanation

The patient has end-stage shoulder arthritis with posterior glenoid erosion and large humeral osteophyte formation. Since the rotator cuff is likely intact, the reverse total shoulder arthroplasty is unnecessary. All the remaining procedures may provide symptomatic relief in appropriate patients; however, for most patients, total shoulder arthroplasty has been associated with the most predictive pain relief and functional improvements. Bryant D, Litchfield R, Sandow M, et al: A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder: A systemic review and meta-analysis. J Bone Joint Surg Am 2005;87:1947-1956. Edwards TB, Kadakia NR, Boulahia A, et al: A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: Results of a multicenter study. J Shoulder Elbow Surg 2003;12:207-213.

Question 1562

Topic: 9. Shoulder and Elbow

Manipulation under anesthesia for resistant frozen shoulder should be avoided in patients with

. idiopathic onset.
. gout.
. hyperthyroidism.
. hypothyroidism.
. severe osteoporosis.

Correct Answer & Explanation

. severe osteoporosis.

Explanation

Severe osteoporosis is a contraindication to manipulation under anesthesia in patients with a resistant frozen shoulder because of the higher risk of humeral fracture. Manipulation is considered for frozen shoulder in patients who are symptomatic despite undergoing a reasonable course of appropriate physical therapy. Harryman DT II: Shoulder: Frozen and stiff. Instr Course Lect 1997;42:247-257.

Question 1563

Topic: 9. Shoulder and Elbow
Which of the following best describes the most common anatomic variation seen in the glenoid labrum and the middle glenohumeral ligament in the anterosuperior quadrant of the shoulder?
. Labrum attached to the glenoid rim and a flat/broad middle glenohumeral ligament
. Sublabral hole with the labrum absent and a flat/broad middle glenohumeral ligament
. Sublabral hole with a cord-like labrum and a flat/broad middle glenohumeral ligament
. Anterosuperior labrum confluent with a cord-like middle glenohumeral ligament and no labral attachment to bone
. Anterosuperior labrum confluent with a cord-like middle glenohumeral ligament and glenoid deficiency

Correct Answer & Explanation

. Anterosuperior labrum confluent with a cord-like middle glenohumeral ligament and no labral attachment to bone

Explanation

Wide variations in the anatomy of the anterosuperior portion of the labrum and the middle glenohumeral ligament have been reported and are more common than previously thought. The labrum attached to the glenoid rim and a flat/broad middle glenohumeral ligament is the most common "normal" variation. A cord-like middle glenohumeral ligament is often associated with the presence of a sublabral hole. An anterosuperior labrum confluent with a cord-like middle glenohumeral ligament and no labral attachment to bone is the configuration of the Buford complex. The prevalence of each variation from one recent study is as follows: #1: 86.6%; #2: 3.3%; #3: 8.6%; and #4: 1.5%. Rao AG, Kim TK, Chronopoulos E, et al: Anatomical variants in the anterosuperior aspect of the glenoid labrum. J Bone Joint Surg Am 2003;85:653-659. Ilahi OA, Labbe MR, Cosculluela P: Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy 2002;18:882-886.

Question 1564

Topic: 9. Shoulder and Elbow

Figure 16 shows the radiograph of a 23-year-old man who has severe right shoulder pain after his motorcyle hit a bridge guardrail. He is neurologically intact. Nonsurgical management will most likely result in

Trauma Board Review 2000: High-Yield MCQs (Set 2) - Figure 10

. nonunion of the clavicle or glenoid.
. thoracic outlet syndrome.
. less than 50% range of motion compared with the contralateral shoulder.
. less than 50% strength compared with the contralateral shoulder.
. high patient satisfaction and good shoulder function.

Correct Answer & Explanation

. high patient satisfaction and good shoulder function.

Explanation

Internal fixation of the clavicle, glenoid, or both has been recommended for fractures of the clavicle and glenoid neck (floating shoulders). Recently, the inherent instability of these dual fractures has been questioned in a biomechanical model without further disruption of the coracoclavicular or acromioclavicular ligamentous structures. Nonsurgical management of the majority of combined scapular/glenoid fractures in patients with less than 10 mm of displacement has resulted in excellent shoulder function and will most likely achieve an excellent result in this patient. Egol KA, Connor PM, Karunakar MA, Sims SH, Bosse MJ, Kellam JF: The floating shoulder: Clinical and functional results. J Bone Joint Surg Am 2001;83:1188-1194. Williams GR Jr, Naranja J, Klimkiewicz J, et al: The floating shoulder: A biomechanical basis for classification and management. J Bone Joint Surg Am 2001;83:1182-1187.

Question 1565

Topic: 9. Shoulder and Elbow

A 21-year-old collegiate pitcher has had pain in his dominant shoulder for the past 3 months despite management consisting of rest, rehabilitation, and an analysis of throwing mechanics. An arthroscopic photograph from the posterior portal is shown in Figure 10. The biceps anchor to the bone was not detached to probing. Treatment of the lesion to the left of the cannula should consist of arthroscopic

Shoulder 2002 Practice Questions: Set 1 (Solved) - Figure 24

. biceps tenodesis.
. suture repair.
. capsulorraphy.
. debridement.
. release of the biceps tendon.

Correct Answer & Explanation

. debridement.

Explanation

The lesion is a variation of a type I superior labrum anterior and posterior lesion; therefore, appropriate treatment is simple debridement. Biceps tenodesis or release is not indicated because the biceps tendon and anchor are intact. There is no indication for labral repair or capsulorraphy. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 261-270.

Question 1566

Topic: 9. Shoulder and Elbow

A fracture of the radial head is surgically exposed using a posterolateral approach to the elbow. Once the radial head is exposed, how should the arm be positioned to best protect the posterior interosseous nerve from injury?

. Full elbow flexion and wrist extension
. Full forearm supination
. Full elbow extension and wrist extension
. Forearm pronation
. Neutral forearm rotation

Correct Answer & Explanation

. Forearm pronation

Explanation

As long as the dissection stays proximal to the annular ligament, the posterior interosseous nerve is not at risk for injury. However, to ensure that the nerve is as far removed from the surgical field as possible, the forearm should be placed in pronation. Forearm supination of any degree will bring the nerve toward the surgical field. A neutral position of the forearm or elbow extension with wrist extension will not protect the posterior interosseous nerve. Hoppenfeld S, deBoer P: Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, Lippincott-Raven, 1992, p 100.

Question 1567

Topic: 9. Shoulder and Elbow

A 45-year-old man reports that he awoke 2 weeks ago with severe pain in his right arm. Examination reveals weakness in the biceps, brachialis, and wrist extensors. There is decreased sensation in the thumb and index finger and a diminished brachioradialis reflex. Assuming this patient has a posterolateral herniated nucleus pulposus, what level is involved?

Spine Surgery 2009 Practice Questions: Set 1 (Solved) - Figure 8

. C2-3
. C3-4
. C4-5
. C5-6
. C6-7

Correct Answer & Explanation

. C5-6

Explanation

This is a classic C6 nerve injury, and it is most likely the result of a herniated nucleus pulposus at C5-6. The C5 nerve root controls the elbow flexors, shoulder abductors, and external rotators. The C7 nerve root controls the elbow extensors, wrist pronators, and the triceps reflex. Standaert CJ: The patient history and physical examination: Cervical, thoracic and lumbar, in Herkowitz HN, Garfin SR, Eismont FJ, et al (eds): Rothman-Simeone The Spine, ed 5. Philadelphia, PA, Saunders Elsevier, 2006, vol 1, pp 171-186.

Question 1568

Topic: 9. Shoulder and Elbow

Figures 29a and 29b show the radiographs of a 13-year-old competitive gymnast who has had elbow pain for the past 2 weeks. The pain is worse with tumbling activities. Examination reveals a mild effusion and slight limitation of extension and forearm rotation with no locking. Initial management should consist of

. elbow arthroscopy.
. arthrotomy and internal fixation of the lesion.
. cessation of gymnastic activities.
. use of an elbow brace and continued gymnastic activities.
. open drilling of the lesion.

Correct Answer & Explanation

. cessation of gymnastic activities.

Explanation

The radiographs show a lesion in the capitellum that is consistent with osteochondritis dissecans. There is no evidence of a loose body at this time. Initial management should consist of cessation of gymnastic activities. Nonsteroidal anti-inflammatory drugs and ice may help to alleviate acute symptoms; most symptoms usually resolve in 6 to 12 weeks. The patient may then begin range-of-motion and strengthening exercises, with a slow return to activities once full range of motion and good strength have been achieved. However, the prognosis for a return to high-level competitive gymnastics is guarded. Surgery is indicated for intra-articular loose bodies, a locked elbow, or failure of nonsurgical management. Surgery may be done either open or arthroscopically. Loose bodies should be removed, and cartilage flaps should be debrided. The results of bone grafting and internal fixation generally have been poor. Drilling the base of the defect may stimulate replacement with fibrocartilage, but the benefits of this procedure are not well documented. Maffulli N, Chan D, Aldridge MJ: Derangement of the articular surfaces of the elbow in young gymnasts. J Pediatr Orthop 1992;12:344-350. Bauer M, Jonsson K, Josefsson PO, Linden B: Osteochondritis dissecans of the elbow: A long-term follow-up study. Clin Orthop 1992;284:156-160.

Question 1569

Topic: 9. Shoulder and Elbow

A 44-year-old man who sustained an elbow dislocation 3 months ago now reports pain and restricted elbow motion. Radiographs are shown in Figures 27a and 27b. Management should consist of

. closed reduction and casting.
. static splinting.
. open reduction and lateral collateral ligament reconstruction.
. open reduction and lateral collateral ligament repair.
. open reduction, application of a hinged external fixator, and radial head arthroplasty.

Correct Answer & Explanation

. open reduction, application of a hinged external fixator, and radial head arthroplasty.

Explanation

The treatment of choice for an ankylosed chronically dislocated elbow is surgical reduction. Open reduction with application of an external fixator provides excellent results for this complex problem. Radial head arthroplasty is indicated for a radial head fracture that cannot be reconstructed. Attempts at closed reduction will be unsuccessful and should not be attempted in a stiff elbow. In chronic dislocations, direct reinsertion of injured ligaments is not feasible because of soft-tissue contracture. Jupiter J, Ring D: Treatment of unreduced elbow dislocation with hinged external fixation. J Bone Joint Surg Am 2002;84:1630-1635.

Question 1570

Topic: 9. Shoulder and Elbow

A 23-year-old baseball pitcher reports pain in the posterior aspect of his dominant shoulder during the late cocking phase of throwing. With the dominant shoulder positioned in 90 degrees of abduction from the body and with the scapula stabilized, examination reveals 135 degrees of external rotation and 20 degrees of internal rotation. Examination of the opposite shoulder reveals 100 degrees of external rotation and 75 degrees of internal rotation. Both shoulders are stable on examination. Radiographs and MRI scans are unremarkable. What is the primary cause of his pain?

Upper Extremity 2005 Practice Questions: Set 1 (Solved) - Figure 5

. Posterior capsular tightness
. Tightness of the rotator cuff interval
. Anterior inferior glenohumeral ligament laxity
. Excessive retroversion of the proximal humerus
. Subacromial impingement

Correct Answer & Explanation

. Posterior capsular tightness

Explanation

Internal impingement of the shoulder is a leading cause of shoulder pain in the throwing athlete. The primary lesion in pathologic internal impingement is excessive tightening of the posterior band of the inferior glenohumeral ligament complex. To obtain an accurate assessment of true glenohumeral rotation, the scapula is stabilized during examination. A loss of 20 degrees or more of internal rotation, as measured with the shoulder positioned in 90 degrees of abduction, indicates excessive tightness of the posterior band of the inferior glenohumeral ligament complex. Burkhart SS, Morgan CD, Kibler WB: The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics. Arthroscopy 2003;19:404-420.

Question 1571

Topic: 9. Shoulder and Elbow

Figure 6 shows the radiograph of a 14-year-old baseball player who felt a pop and had an immediate onset of pain in his elbow after a hard throw from the outfield. The best course of action should be to

Sports Medicine 2001 Practice Questions: Set 1 (Solved) - Figure 17

. obtain stress radiographs of the elbow.
. obtain an MRI scan of the elbow.
. apply a splint and initiate early range-of-motion exercises.
. apply a cast in 90 degrees of flexion for 4 weeks.
. perform open reduction and internal fixation.

Correct Answer & Explanation

. perform open reduction and internal fixation.

Explanation

The valgus stress at the elbow caused by throwing strains the medial collateral ligament. The medial epicondyle, on which the ligament inserts, is the last ossification center to fuse to the distal humerus, and acute avulsion of the medial epicondyle can occur in adolescents. If the elbow is allowed to heal in a displaced position, valgus instability and loss of elbow extension may result. Valgus instability is especially problematic for the throwing athlete. Surgical treatment with rigid internal fixation is the treatment of choice for displaced medial epicondyle avulsion fractures. Valgus instability is prevented, and the rigid fixation allows for early range of motion. Case SL, Hennrikus WL: Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. Am J Sports Med 1997;25:682-686.

Question 1572

Topic: Elbow & Forearm

A 39-year-old woman fell onto her flexed elbow and sustained a comminuted displaced radial head and neck fracture. Radiographs confirm concentric reduction of the ulnohumeral joint. Examination reveals pain with compression of the radius and ulna at the wrist. What is the best treatment for the radial head fracture?

. Long arm cast for 2 weeks, followed by range of motion
. Early range of motion
. Metallic radial head arthroplasty
. Silastic radial head arthroplasty
. Excision of the radial head

Correct Answer & Explanation

. Metallic radial head arthroplasty

Explanation

Patients with comminuted radial neck and head fractures and associated wrist pain have a significant injury to the elbow and forearm. Nonsurgical management is an option, but initial casting will result in stiffness and early range of motion is likely to be unsuccessful secondary to pain. Surgical treatment with open reduction and internal fixation, although possible, is technically demanding and results are unpredictable with comminuted fractures. Excision alone in the face of wrist pain may lead to radial shortening. The treatment of choice is excision and metallic radial head arthroplasty. Silastic implants have been associated with synovitis and wear debris. Furry KL, Clinkscales CM: Comminuted fractures of the radial head: Arthroplasty versus internal fixation. Clin Orthop 1998;353:40-52.

Question 1573

Topic: Elbow & Forearm

A 54-year-old woman sustained an elbow injury 3 months ago that was treated with open reduction and internal fixation. She now reports pain and limited elbow motion. Radiographs are shown in Figures 10a and 10b. Treatment should now consist of

. occupational therapy.
. open reduction of the radial head and annular ligament reconstruction.
. excision of the radial head.
. ulnar osteotomy and closed reduction of the radial head.
. ulnar osteotomy and open reduction of the radial head.

Correct Answer & Explanation

. ulnar osteotomy and open reduction of the radial head.

Explanation

Radiographs reveal malunion of a Monteggia fracture-dislocation. Dislocation of the posterior radial head is caused by the malunited ulnar fracture. The deformity includes shortening with an apex posterior angulation. In the acute setting, open reduction of the radial head rarely is necessary; however, in chronic dislocations, open reduction is required. Without ulnar osteotomy, recurrent radial head dislocation is likely.

Question 1574

Topic: 9. Shoulder and Elbow

A 79-year-old woman with polyarticular rheumatoid arthritis has had progressively increasing right shoulder pain for the past year, and nonsurgical management has failed to provide relief. Her neurologic examination is entirely normal, but she is unable to elevate her arm against gravity. An AP radiograph is shown in Figure 13. Treatment should consist of

Shoulder 2002 Practice Questions: Set 1 (Solved) - Figure 30

. glenohumeral arthrodesis.
. total shoulder arthroplasty.
. humeral arthroplasty.
. open synovectomy and rotator cuff repair.
. anterior acromioplasty and rotator cuff repair.

Correct Answer & Explanation

. humeral arthroplasty.

Explanation

Because the patient has end-stage rheumatoid arthritis with glenoid and rotator cuff deficiency, humeral arthroplasty is the treatment of choice. When a patient has an intact rotator cuff and there is sufficient glenoid bone stock to implant a glenoid component, total shoulder arthroplasty is the preferred method because it appears to provide more predictable pain relief. Glenohumeral arthrodesis is generally avoided when there is a functional deltoid or rotator cuff. Open synovectomy is appropriate in early rheumatoid disease before articular changes are present. Anterior acromioplasty with coracoacromial ligament resection is avoided in patients with rheumatoid arthritis because this procedure compromises the coracoacromial arch and may result in anterosuperior instability. Neer CS II, Watson KC, Stanton FJ: Recent experience in total shoulder replacement. J Bone Joint Surg Am 1982;64:319-337. Neer CS II: Glenohumeral arthroplasty, in Neer CS II (ed): Shoulder Reconstruction. Philadelphia, PA, WB Saunders, 1990, pp 143-271. Pollock RG, Deliz ED, McIlveen ST, et al: Prosthetic replacement in rotator cuff deficient shoulders. J Shoulder Elbow Surg 1992;1:173-186.

Question 1575

Topic: 9. Shoulder and Elbow

A 25-year-old man injured his dominant shoulder after falling on his outstretched arm 4 months ago. Examination reveals that he cannot lift his arm above 90 degrees, and he has pronounced medial scapular winging. Management should consist of

Shoulder Board Review 2002: High-Yield MCQs (Set 2) - Figure 16

. spinal accessory nerve exploration with repair.
. long thoracic nerve exploration with repair.
. a sling for comfort, followed by shoulder strengthening exercises.
. scapulothoracic arthrodesis.
. split pectoralis major transfer.

Correct Answer & Explanation

. a sling for comfort, followed by shoulder strengthening exercises.

Explanation

Serratus anterior palsy or long thoracic nerve palsy is usually caused by traction injury to the nerve, blunt injury, or iatrogenic injury. The palsy results in winging of the scapula and medial rotation of the inferior pole of the scapula. A patient with this injury will usually recover in 12 to 18 months. Initial treatment should include observation and shoulder strengthening exercises. Nerve exploration with repair has not proven beneficial in changing the outcome. Many orthopaedic surgeons favor using a split pectoralis major transfer for symptomatic patients. Electrodiagnostic studies are helpful in confirming the diagnosis. Post M: Pectoralis major transfer for winging of the scapula. J Shoulder Elbow Surg 1995;4:1-9.

Question 1576

Topic: 9. Shoulder and Elbow

A 2-week-old infant has had diminished movement of the right upper extremity since birth. Examination reveals weakness of shoulder abduction and external rotation, elbow flexion, and forearm supination. Both pupils are equally round and responsive to light. The remainder of the examination is normal. Radiographs of the upper limb show a healing middle-third clavicle fracture. Management should consist of

. cervical spine radiographs.
. MRI of the shoulder.
. decompressive osteotomy of the clavicle.
. microsurgical repair of the brachial plexus.
. observation and range-of-motion exercises.

Correct Answer & Explanation

. observation and range-of-motion exercises.

Explanation

The patient has a classic Erb's palsy with weakness of the muscles innervated by the fifth and sixth cervical roots. Horner syndrome, a poor prognostic indicator for recovery, is absent in this infant. All infants with brachial plexus birth palsies initially should be monitored for spontaneous recovery during the first 3 to 6 months of life. During this period of observation, glenohumeral motion, especially external rotation, should be maintained. Many infants will begin to show recovery within the first 6 to 8 weeks after birth and continue on to normal function. The timing of microsurgery is controversial. A recent study found that the outcome of microsurgical repair in patients who had no recovery of biceps function within 3 months after birth was similar compared to those who had recovery of biceps function between 3 and 6 months and no microsurgical repair. The author concluded that microsurgical repair was effective in improving function in those infants who had no evidence of recovery of biceps function within the first 6 months of life. Waters PM: Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am 1999;81:649-659.

Question 1577

Topic: 9. Shoulder and Elbow

A 22-year-old patient underwent successful reduction of a posterolateral elbow dislocation. Management should now consist of

. splinting for 5 weeks.
. active range-of-motion exercises after 1 to 3 days.
. delayed passive stretching at 2 weeks.
. open medial collateral ligament reconstruction.
. open lateral collateral ligament reconstruction.

Correct Answer & Explanation

. active range-of-motion exercises after 1 to 3 days.

Explanation

The elbow usually is stable after reduction in most elbow dislocations. Ross and associates reported that supervised motion begun immediately after reduction was effective in uncomplicated dislocations. The elbow will become stiff if immobilization is applied for an extended period of time. Immediate open treatment is not indicated for a simple elbow dislocation. Ross G, McDevitt ER, Chronister R, et al: Treatment of simple elbow dislocation using an immediate motion protocol. Am J Sports Med 1999;27:308-311.

Question 1578

Topic: Shoulder Pathology

Figure 17 shows the clinical photograph of a 45-year-old female tennis player who has right arm pain and weakness with elevation after undergoing a cervical biopsy several months ago. The cause of her shoulder weakness is damage to the

Sports Medicine Board Review 2004: High-Yield MCQs (Set 2) - Figure 11

. spinal accessory nerve, causing shoulder elevation with the scapula translated and the inferior angle rotated medially.
. spinal accessory nerve, causing shoulder depression with the scapula translated laterally and the inferior angle rotated laterally.
. long thoracic nerve, causing shoulder elevation with the scapula translated medially and the inferior angle rotated medially.
. long thoracic nerve, causing shoulder depression with the scapula translated laterally and the inferior angle rotated laterally.
. thoracodorsal nerve, causing shoulder depression with the scapula translated laterally and the inferior angle rotated laterally.

Correct Answer & Explanation

. spinal accessory nerve, causing shoulder elevation with the scapula translated and the inferior angle rotated medially.

Explanation

The patient has primary scapulotrapezius winging caused by surgical damage to the spinal accessory nerve during a lymph node biopsy. Other causes include blunt trauma, traction, and penetrating injuries. With spinal accessory palsy, the shoulder appears depressed and laterally translated because of unopposed serratus anterior muscle function. With primary serratus anterior winging that is the result of long thoracic nerve palsy, the scapula assumes a position of elevation and medial translation with the inferior angle rotated medially. The thoracodorsal nerve innervates the latissimus dorsi and is not associated with scapular winging. Kuhn JE, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surg 1995;3:319-325.

Question 1579

Topic: 9. Shoulder and Elbow

A 45-year-old man sustains an acute closed posterolateral elbow dislocation. The elbow is reduced, and examination reveals that the elbow dislocates posteriorly at 35 degrees with the forearm placed in supination. What is the best course of action?

Upper Extremity Board Review 2005: High-Yield MCQs (Set 2) - Figure 24

. Cast immobilization for 6 weeks
. Hinged brace with early range of motion in supination
. Hinged brace with early range of motion in pronation
. Primary ligament repair
. Lateral collateral ligament reconstruction with tendon graft

Correct Answer & Explanation

. Hinged brace with early range of motion in supination

Explanation

Most closed simple dislocations are best managed with early range of motion. Posterior dislocation typically occurs through a posterolateral rotatory mechanism. When placed in pronation, the elbow has greater stability when the medial ligamentous structures are intact. In traumatic dislocations, MRI rarely provides additional information that will affect treatment. In elbows that remain unstable, primary repair is preferred over ligament reconstruction. Cast immobilization increases the risk of arthrofibrosis.

Question 1580

Topic: 9. Shoulder and Elbow

An 18-year-old football player is injured after making a tackle with his left shoulder. He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. Motor examination reveals weakness to shoulder abduction and external rotation as well as elbow flexion. He has decreased reflexes of the biceps tendon on the left side but full, nontender range of motion of the cervical spine. What anatomic site has been injured?

. Fourth cervical nerve root
. Upper trunk of the brachial plexus
. Middle trunk of the brachial plexus
. Lateral cord of the brachial plexus
. Axillary nerve

Correct Answer & Explanation

. Upper trunk of the brachial plexus

Explanation

The athlete has symptoms referable to the axillary, musculocutaneous, and suprascapular nerves resulting from an injury to the upper trunk of the brachial plexus. This portion of the plexus is formed by contributions of the fourth through sixth cervical nerve roots. This area is often contused or stretched following a tackling maneuver that results in either depression of the shoulder from contact at Erb's point or traction of the upper plexus from forced stretching of the neck to the contralateral side. Schenck CD: Anatomy of the innervation of the upper extremity, in Torg JS (ed): Athletic Injuries to the Head, Neck, and Face, ed 2. St Louis, MO, Mosby-Year Book, 1991.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page