9. Shoulder and Elbow MCQs

When performing an arthroscopic subacromial decompression, brisk bleeding may be encountered from the acromial branch of the thoracoacromial artery. This vessel typically runs in close proximity to which structure?

In a patient undergoing superior capsular reconstruction (SCR) for an irreparable posterosuperior rotator cuff tear, the graft is primarily designed to act as a static restraint against which abnormal kinematic motion?

A 72-year-old female presents with pseudoparalysis of the right shoulder and severe pain. Radiographs reveal superior migration of the humeral head with articulation against the acromion. MRI confirms a massive, retracted, irrepairable rotator cuff tear with significant fatty atrophy, but an intact deltoid muscle. What is the most appropriate definitive surgical option?

A 35-year-old man presents to the emergency department with severe shoulder pain following a generalized tonic-clonic seizure. His arm is locked in adduction and internal rotation. An AP radiograph shows a symmetric appearance of the proximal humerus without the normal overlap of the humeral head and glenoid. What is the most likely diagnosis?

A 40-year-old male sustains a seizure and complains of bilateral shoulder pain and inability to externally rotate his arms. Radiographs show a lightbulb sign. What is the most likely diagnosis?

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical exam reveals a 25-degree loss of internal rotation (GIRD) compared to the contralateral side. This deficit is most commonly attributed to contracture of the:

A 65-year-old male with a history of chronic shoulder aching feels a sudden pop with subsequent ecchymosis in his upper arm, creating a 'Popeye' deformity. He notes that his shoulder pain has actually improved since the event. What is the most appropriate treatment?

A 30-year-old bodybuilder feels a sudden "pop" in his anterior shoulder while performing a heavy bench press. Examination shows loss of the normal anterior axillary fold and weakness in internal rotation. MRI confirms a complete rupture of the pectoralis major. At which specific anatomical location do the majority of these ruptures occur?

A 68-year-old male presents with chronic right shoulder pain and the inability to actively raise his arm above 60 degrees. Passive range of motion is full. Radiographs show a high-riding humeral head with acromiohumeral articulation (Hamada grade 3). What is the most appropriate surgical intervention?

A 21-year-old collegiate pitcher undergoes evaluation for internal impingement. Which of the following capsuloligamentous structures is most likely contracted, contributing to glenohumeral internal rotation deficit (GIRD) in this athlete?

A 10-year-old girl falls on her outstretched hand and sustains an elbow dislocation. After closed reduction, radiographs show an intra-articular fragment. Which of the following physical exam findings is most likely associated with this incarcerated fracture fragment?

A 2-year-old girl presents with her arm held closely to her side in slight flexion and pronation. Her father reports pulling her by the arm to prevent a fall. Radiographs are normal. What anatomical structure is subluxated?

An 11-year-old boy sustains a posterolateral elbow dislocation and an associated fracture. Following closed reduction of the joint in the emergency department, post-reduction radiographs reveal that the medial epicondyle fragment is incarcerated within the ulnohumeral joint. What is the most appropriate management?

During clinical evaluation of glenohumeral instability, understanding the specific capsuloligamentous restraints is required. Which structure provides the primary restraint to inferior translation of the humerus when the arm is adducted in neutral rotation?

A patient sustains a traction injury to the upper trunk of the brachial plexus (C5-C6). Which physical exam finding is most likely to be present?

A 40-year-old man presents to the emergency department with severe shoulder pain and an inability to externally rotate his arm after suffering an electrical shock. An AP radiograph shows a 'lightbulb' sign. What is the most likely diagnosis?

A 62-year-old man sustains an acute anterior shoulder dislocation after falling on an outstretched hand. The dislocation is successfully reduced. Three weeks later, he complains of persistent, profound weakness in active external rotation and abduction. Deltoid sensation is intact. What is the most likely underlying pathology?

An 80-year-old woman sustains an anterior shoulder dislocation after a fall. The dislocation is successfully reduced in the emergency department. Three weeks later, she complains of profound weakness with active shoulder elevation and external rotation, though passive motion is preserved. Plain radiographs are normal. What is the most likely diagnosis?