100 High-Yield Orthopedic MCQs: Shoulder & Elbow | Mock Exam 251

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. MRI reveals a 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. What is the most appropriate definitive management?

A 72-year-old woman is 3 years status post a reverse total shoulder arthroplasty. Radiographs show inferior scapular notching extending past the inferior glenoid screw. Which surgical factor most effectively minimizes the risk of this complication?

A 45-year-old falls onto an outstretched hand resulting in a terrible triad injury of the elbow. During surgical reconstruction, what is the generally recommended sequence of repair?

In evaluating a displaced proximal humerus fracture in an elderly patient, which radiographic parameter is the strongest predictor of humeral head ischemia and potential avascular necrosis?

Following a two-incision surgical repair of a distal biceps tendon rupture, the patient reports inability to extend the fingers and thumb, with radial deviation during wrist extension. Which nerve was most likely injured?

A 30-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness in external rotation. Exam reveals isolated infraspinatus atrophy. Supraspinatus strength is normal. Where is the most likely site of nerve compression?

A 26-year-old mechanic sustains a traction injury to his neck and shoulder. He demonstrates medial scapular winging that worsens when pushing against a wall. Which nerve is injured and which muscle is affected?

A 32-year-old bodybuilder feels a pop in his anterior axilla while performing a heavy bench press. Exam reveals an asymmetrical axillary fold. MRI confirms a complete tear of the pectoralis major. Which anatomical structure is most commonly injured in this mechanism?

A 40-year-old man sustains a closed spiral fracture of the distal third of the humeral shaft (Holstein-Lewis fracture) with an intact radial nerve on initial exam. Following closed reduction and splinting, he develops a complete radial nerve palsy. What is the most appropriate management?

A 75-year-old female with rheumatoid arthritis undergoes a total elbow arthroplasty (TEA) for a comminuted distal humerus fracture. Postoperatively, she is counseled on permanent activity restrictions. What is the recommended lifelong weight-lifting restriction for this patient?

A 68-year-old male presents with pseudoparalysis of the shoulder. MRI shows a massive, retracted rotator cuff tear. Which of the following MRI findings is the strongest predictor of an irreparable tear?

A 35-year-old male develops severe heterotopic ossification (HO) and elbow stiffness 6 months following operative fixation of a distal humerus fracture. He has normal nerve function. What is the optimal timing for surgical excision of the HO?

A 62-year-old male with primary glenohumeral osteoarthritis presents for shoulder arthroplasty. CT imaging demonstrates a Walch B2 glenoid with 20 degrees of retroversion. What is the primary concern if an uncorrected anatomic total shoulder arthroplasty is performed?

A 28-year-old cyclist sustains a type IIB distal clavicle fracture according to the Neer classification. What is the primary reason this fracture pattern is associated with a high rate of nonunion with conservative management?

A 21-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft (Tommy John surgery). The sublime tubercle is the anatomical insertion point for which band of the UCL?

A 42-year-old male presents with a locked posterior shoulder dislocation after a seizure. CT reveals an anteromedial humeral head defect (reverse Hill-Sachs) involving 35% of the articular surface. Which surgical intervention is most appropriate?

Which of the following baseplate and glenosphere configurations in reverse total shoulder arthroplasty is most effective at minimizing the risk of scapular notching?

A 55-year-old male presents with a massive, irreparable posterosuperior rotator cuff tear. He demonstrates severe shoulder weakness and an inability to actively externally rotate his arm, with a positive hornblower sign. Which of the following procedures is most appropriate?

In the surgical management of a terrible triad injury of the elbow, which of the following is the generally recommended sequence of repair to restore stability?

According to the Hertel criteria, which combination of radiographic findings in a proximal humerus fracture is the strongest predictor for the development of avascular necrosis?

A 28-year-old volleyball player presents with isolated weakness of the infraspinatus muscle and vague posterior shoulder pain. MRI reveals a paralabral cyst. Where is the most likely location of the nerve compression?

A 40-year-old woman develops lateral winging of the scapula and a drooping shoulder three weeks after a posterior triangle neck lymph node biopsy. Which nerve was most likely injured, and what is the preferred definitive tendon transfer if nonoperative management fails?

A 45-year-old male undergoes a single-incision anterior repair of a distal biceps tendon rupture. Postoperatively, he complains of numbness and paresthesia along the lateral aspect of his forearm. Which nerve was most likely injured?

A 32-year-old sustains a highly comminuted, unsalvageable radial head fracture along with severe wrist pain and distal radioulnar joint (DRUJ) instability. What is the most appropriate management strategy?

Which glenosphere modification minimizes the risk of scapular notching in reverse total shoulder arthroplasty?

In the surgical management of a terrible triad injury of the elbow, what is the most widely accepted sequential order of repair?

During a Latarjet procedure for recurrent anterior shoulder instability, which nerve is at greatest risk of iatrogenic injury during coracoid osteotomy and mobilization?

Which of the following complications is significantly more common following a two-incision technique for distal biceps tendon repair compared to a single anterior incision?

According to Hertel's criteria, which of the following radiographic findings is the most reliable predictor of humeral head ischemia in a proximal humerus fracture?

A 45-year-old female undergoes radial head replacement for a comminuted fracture. Postoperatively, she exhibits restricted elbow flexion and lateral elbow pain. If overstuffing of the radiocapitellar joint is present, what associated radiographic finding is most likely?

During reconstruction of chronic acromioclavicular joint instability, anatomic placement of the coracoclavicular ligament grafts is critical. What are the average distances of the conoid and trapezoid insertions from the distal end of the clavicle?

Which structure forms the roof of the cubital tunnel and is implicated as the primary site of ulnar nerve compression in most cases of cubital tunnel syndrome?

A 32-year-old female presents with shoulder weakness and lateral scapular winging 4 weeks after an excisional lymph node biopsy in the posterior cervical triangle. Which nerve is most likely injured, and which muscle is denervated?

When treating a comminuted intra-articular distal humerus fracture (AO/OTA 13-C3) with parallel locked plating, which biomechanical principle is essential for construct stability?

A 72-year-old male who underwent a reverse total shoulder arthroplasty (RTSA) 6 months ago presents with new-onset lateral shoulder pain. Radiographs reveal a Levy Type II fracture at the base of the acromion. What is the most appropriate initial management?

A 25-year-old male undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he demonstrates weakness in elbow flexion and decreased sensation over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

A 45-year-old female sustains an elbow dislocation, a Regan-Morrey Type II coronoid fracture, and a Mason Type III radial head fracture. During the surgical reconstruction of this "terrible triad" injury, which structure is typically repaired last to restore stability?

In a 4-part proximal humerus fracture, which single radiographic factor is most strongly associated with subsequent avascular necrosis of the humeral head according to Hertel's criteria?

A 32-year-old elite volleyball player presents with posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst. Where is the cyst most likely located?

A 30-year-old bodybuilder feels a pop in his anterior axilla while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. For an anatomic repair, where should the avulsed tendon be reattached?

A 38-year-old female sustains a Dubberley Type 3B capitellum fracture (involving the capitellum and trochlea with posterior condylar comminution). What surgical approach provides the most optimal exposure for fixation of the posterior comminution?

A 55-year-old male presents with chronic pseudoparalysis of the shoulder due to a massive, irreparable posterosuperior rotator cuff tear. He has an intact subscapularis and preserved deltoid function. Which tendon transfer is most appropriate to restore active external rotation and forward elevation?

During an anterior single-incision repair of a distal biceps tendon rupture using cortical button fixation, the patient develops postoperative weakness in thumb and finger extension, but normal, radially deviated wrist extension. Which nerve was likely injured?

A 19-year-old male sustains a posterior sternoclavicular joint dislocation during a rugby match. He complains of mild dysphagia and shortness of breath. After confirming the diagnosis with a CT scan, what is the most appropriate next step in management?

A 45-year-old female with type 1 diabetes presents with insidious onset of shoulder pain and stiffness. Which of the following best describes the typical natural history of her condition?

A 65-year-old female with primary glenohumeral osteoarthritis has a Walch B2 glenoid with 25 degrees of retroversion and posterior humeral head subluxation. What is the most reliable surgical option to correct the deformity and minimize early glenoid component loosening?

A 22-year-old collegiate baseball pitcher complains of posteromedial elbow pain and a loss of throwing velocity. Exam reveals a flexion contracture of 10 degrees and pain with forced passive elbow extension. A moving valgus stress test is negative. What is the most likely diagnosis?

A 40-year-old male presents with chronic anterior shoulder pain. MRI shows a subscapularis tear and medial subluxation of the long head of the biceps tendon. Which anatomic structure must be compromised for the biceps tendon to subluxate medially?

Following severe elbow trauma, a patient develops severe stiffness. Radiographs confirm extensive anterior heterotopic ossification (HO). When planning surgical excision of the HO, what is the most appropriate timing for the intervention?

A 72-year-old female presents with progressive shoulder pain 2 years after a reverse total shoulder arthroplasty. Radiographs reveal inferior scapular notching past the inferior screw (Sirveaux grade 3). What design factor or surgical technique most significantly reduces the risk of this complication?

A 45-year-old male sustains a terrible triad injury of the elbow. Intraoperatively, after fixing the coronoid and replacing the radial head, the elbow remains unstable in extension. What is the next most appropriate step in the standard surgical algorithm?

A 32-year-old bodybuilder feels a pop in his anterior axilla while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. MRI confirms a complete rupture of the pectoralis major tendon. Which segment of the muscle is most commonly injured in this mechanism?

A 45-year-old male undergoes surgical repair of a chronic distal biceps rupture using a two-incision technique. Postoperatively, he demonstrates weakness in wrist extension and finger extension, but normal triceps strength. Which nerve was most likely injured during the procedure?

A 55-year-old diabetic female presents with 6 months of severe, progressive global shoulder stiffness. She lacks both active and passive range of motion, particularly in external rotation. Which histological finding is most characteristic of the affected tissue in this condition?

A 65-year-old male with primary glenohumeral osteoarthritis presents with a Walch B2 glenoid. What is the defining characteristic of a Walch B2 glenoid?

A 28-year-old male presents with severe elbow stiffness 6 months after internal fixation of a distal humerus fracture. Radiographs show mature heterotopic ossification (HO) blocking flexion. What is the optimal surgical timing and prophylaxis strategy for HO excision?

In the evaluation of chronic massive rotator cuff tears, the Goutallier classification is used to assess fatty infiltration on CT or MRI. What does Goutallier stage 3 signify?

A 29-year-old elite volleyball player complains of vague, deep, posterior shoulder pain and weakness in external rotation. MRI reveals an isolated paralabral cyst at the spinoglenoid notch. Which physical examination finding is most expected?

A 42-year-old recreational tennis player has a symptomatic Type II SLAP tear that has failed 6 months of conservative management. What is the most appropriate surgical intervention given his age and activity level?

A 68-year-old female sustains a 3-part proximal humerus fracture. She demonstrates isolated weakness of the deltoid and decreased sensation over the lateral shoulder. Which structural pathway does the injured nerve traverse to innervate these areas?

A 40-year-old male golfer complains of chronic medial elbow pain exacerbated by wrist flexion and forearm pronation. He is scheduled for surgical debridement. The diseased tissue targeted for release originates primarily from which structure?

During an arthroscopic anterior shoulder stabilization for recurrent instability, the surgeon notes an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion. How does this lesion uniquely differ from a classic Bankart lesion?

A 52-year-old female undergoes an anterior subcutaneous transposition of the ulnar nerve for severe cubital tunnel syndrome. During the proximal dissection, a fascial band located roughly 8 cm proximal to the medial epicondyle must be meticulously released to prevent kinking of the transposed nerve. What is this structure called?

A 65-year-old man presents 6 weeks after an anatomic total shoulder arthroplasty complaining of sudden anterior shoulder pain and weakness. On examination, he has passively increased external rotation compared to the contralateral side and increased lift-off test lag. What is the most likely diagnosis?

A 35-year-old man falls on an outstretched hand, sustaining a varus posteromedial rotatory instability (VPMRI) injury of the elbow. Which of the following anatomic structures are characteristically injured in this specific pattern?

A 42-year-old recreational tennis player has persistent shoulder pain despite 6 months of conservative management. MRI reveals an isolated Type II Superior Labrum Anterior Posterior (SLAP) tear. What is the most appropriate surgical management for this patient?

A 28-year-old cyclist sustains a midshaft clavicle fracture. Which of the following radiographic findings is considered a relative indication for open reduction and internal fixation to prevent symptomatic nonunion and poor functional outcome?

A 29-year-old elite volleyball player presents with insidious onset of right shoulder weakness. Examination reveals isolated atrophy of the infraspinatus with weakness in external rotation, but normal strength in forward elevation and abduction. Where is the most likely location of nerve compression?

A 68-year-old man presents with a massive, retracted, and irreparable posterosuperior rotator cuff tear. He has significant weakness in external rotation, a positive hornblower's sign, but intact forward elevation and a functional subscapularis. Which tendon transfer is most appropriate?

A 62-year-old woman sustains a 3-part proximal humerus fracture. Which of the following radiographic criteria is the most reliable predictor of subsequent avascular necrosis (AVN) of the humeral head?

Following a single-incision anterior repair of a distal biceps tendon rupture using a cortical button, the patient complains of numbness over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

A 74-year-old woman undergoes a reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy. How does the biomechanical design of the RTSA primarily improve her active shoulder elevation?

A 30-year-old professional baseball pitcher undergoes ulnar collateral ligament (UCL) reconstruction using a palmaris longus autograft. What is the most frequently reported complication following this procedure?

A 40-year-old weightlifter presents with a sudden 'pop' and pain in his anterior chest wall while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. If surgical repair is pursued, to which anatomic footprint should the torn tendon be reattached?

A 34-year-old man suffers an anterior shoulder dislocation with an associated Hill-Sachs lesion. On preoperative MRI, the glenoid track is calculated. The lesion is determined to be "off-track." What are the biomechanical implications of this finding?

A 70-year-old woman with severe rheumatoid arthritis presents with an acute, highly comminuted, osteopenic distal humerus fracture. A total elbow arthroplasty (TEA) is planned. Which of the following is an absolute contraindication for using an unlinked (resurfacing) TEA implant?

A 50-year-old man presents with persistent elbow pain and lateral-sided snapping. He previously underwent surgery for lateral epicondylitis involving an aggressive release of the common extensor origin. Examination shows varus instability when the elbow is tested in supination. What structure has been iatrogenically compromised?

A 24-year-old man sustains a Grade V acromioclavicular (AC) joint separation. During anatomic coracoclavicular (CC) ligament reconstruction, where should the conoid and trapezoid bone tunnels be sequentially placed on the clavicle relative to the distal end?

A 45-year-old mechanic sustains a highly comminuted Mason Type III radial head fracture and an Essex-Lopresti injury. The radial head is deemed unsalvageable. What is the most appropriate management of the radial head?

A 40-year-old weightlifter undergoes a single-incision distal biceps tendon repair. Postoperatively, he is unable to extend his thumb and fingers at the MCP joints, but wrist extension is preserved with radial deviation. Which nerve was most likely injured during the procedure?

A 35-year-old male presents with a locked posterior shoulder dislocation after a seizure. CT reveals an anteromedial humeral head impression fracture (reverse Hill-Sachs lesion) involving 35% of the articular surface. What is the most appropriate surgical management?

A 28-year-old cyclist sustains a Grade V acromioclavicular (AC) joint separation. During surgical reconstruction, anatomical restoration of the coracoclavicular ligaments is planned. Which of the following accurately describes the native anatomy of these ligaments?

Following surgical treatment of a terrible triad injury of the elbow involving radial head replacement, LCL repair, and coronoid fixation, the elbow remains persistently unstable in extension. What is the most appropriate next step in management?

A 29-year-old volleyball player complains of vague posterior shoulder pain and weakness with external rotation. MRI demonstrates a paralabral cyst in the spinoglenoid notch. Which of the following clinical findings is most likely present?

When performing open reduction and internal fixation of a proximal humerus fracture using a locking plate, what is the most important technical factor to prevent varus collapse?

A 42-year-old falls from a ladder, sustaining a comminuted, unsalvageable radial head fracture. Wrist pain is also noted, and distal radioulnar joint (DRUJ) instability is confirmed. Which of the following is strictly contraindicated in this patient's management?

A 34-year-old woman presents with a complex coronal shear fracture of the capitellum with extensive posterior comminution extending into the trochlea (Dubberley Type 3B). Which surgical approach provides the most optimal visualization for reduction and fixation of this articular extension?

A 68-year-old male with cuff tear arthropathy and pseudoparalysis of the shoulder is scheduled for a reverse total shoulder arthroplasty. To optimize deltoid function and tension, how does the classic Grammont reverse shoulder design biomechanically alter the center of rotation?

A 25-year-old professional baseball pitcher presents with shoulder pain during the late cocking phase of throwing. Arthroscopy reveals a Type II SLAP tear. What is the primary biomechanical mechanism causing this specific injury in throwing athletes?

A 65-year-old rheumatoid arthritis patient undergoes a semiconstrained linked total elbow arthroplasty. Postoperatively, what is the most common long-term complication leading to revision surgery in this patient population?

A 32-year-old male feels a "pop" in his anterior chest while bench pressing. Examination reveals loss of the anterior axillary fold. MRI confirms a complete rupture of the sternoclavicular head of the pectoralis major tendon. Where is the anatomical insertion site of this torn tendon head on the humerus relative to the clavicular head?

A 12-year-old gymnast sustains an elbow dislocation that is successfully reduced in the emergency department. Post-reduction radiographs show a displaced medial epicondyle fracture. Which of the following is an absolute indication for open reduction and internal fixation?

A 30-year-old overhead laborer presents with vague posterior shoulder pain and numbness over the lateral deltoid. MRI shows isolated fatty infiltration and atrophy of the teres minor. Which vascular structure is most likely being compressed alongside the affected nerve?

A 14-year-old elite baseball pitcher presents with dominant shoulder pain during throwing. Radiographs demonstrate widening of the proximal humeral physis. What is the most appropriate initial management?

An active 55-year-old male undergoes arthroscopic rotator cuff repair with a concomitant subpectoral biceps tenodesis. Compared to a biceps tenotomy, what is the primary biomechanical and clinical advantage of tenodesis?

A 28-year-old sustains a transverse, non-comminuted olecranon fracture and undergoes tension band wiring. Six months later, the fracture has healed but the patient complains of posterior elbow pain directly over the hardware. What is the most likely cause of this complication?