Shoulder And Elbow: Questions Mcqs AND EMQS

MCQs

1. The term internal impingement is used in throwers to describe a condition where the posterosuperior glenoid labrum impinges on which structure? a.          The anterior glenohumeral ligaments.
   2. The posterior glenohumeral ligaments.
   3. The biceps tendon.
   4. The anterior rotator cuff.
   5. The posterior rotator cuff.
2. The biomechanical advantage of a reverse total shoulder arthroplasty compared to a standard arthroplasty is what?
   1. Centre of rotation more superior.
   2. Centre of rotation more medial.
   3. Centre of rotation more lateral.
   4. Increased lateral humeral offset.
   5. Decreased deltoid muscle fibre tension.
3. Posterior glenohumeral dislocations occur more frequently than anterior dislocations in which group of patients? a. Rugby players.
   2. Ehlers–Danlos patients.
   3. Hypermobile patients.
   4. Epileptics.
   5. None of the above.
4. A football player sustains a suspected acromioclavicular joint (ACJ) separation. Which of the following is the most appropriate radiographic view to evaluate the ACJ?
   1. Stryker notch view.
   2. Serendipity view.
   3. Zanca view.
   4. Supraspinatus outlet view.
   5. Garth view.

 

 

5. When compared to the non-dominant side, which of the following shoulder motions is characteristically decreased in the throwing arm of athletes? a. Internal rotation ( IR ).
   2. External rotation ( ER ).
   3. Forward elevation.
   4. Abduction.
   5. Adduction.
6. Which of the following muscles have only a single nerve supply?
   1. Brachialis.
   2. Flexor digitorum profundus.
   3. Lumbricals.
   4. Brachioradialis.
   5. Pectoralis major.
7. With the arm in 90º of abduction, which of the following is considered the primary static restraint to anterior glenohumeral translation? a.         Negative intra-articular pressure.
   2. Superior glenohumeral ligament complex.
   3. Middle glenohumeral ligament complex.
   4. Inferior glenohumeral ligament complex.
   5. Shape of the bony articulation.
8. Following a traumatic anterior shoulder dislocation, what factor is associated with the highest risk for recurrent instability? a.      Dislocation of the dominant shoulder.
   2. Bilateral shoulder dislocation.
   3. Young age (<25 years old) at time of dislocation.
   4. Family history of shoulder instability.
   5. Joint laxity.
9. Which of the following is a known risk factor for the development of adhesive capsulitis of the shoulder? a. Epilepsy.
   2. Dupuytren’s contracture.
   3. Diabetes mellitus.
   4. Renal disease.
   5. All of the above.
10. Injury to the long thoracic nerve can present clinically as which of the following?
    1. Weak shoulder abduction.
    2. Trapezius palsy.
    3. Latissimus dorsi atrophy.
    4. Lateral scapular winging.
    5. Medial scapular winging.
11. Which of the following best describes a Buford complex?
    1. Normal anatomic variant characterized by a cord-like middle glenohumeral ligament (MGHL) and an absent anteroinferior labrum.
    2. Normal anatomic variant characterized by a cord-like MGHL and an absent anterosuperior labrum.
    3. Normal anatomic variant characterized by a cord-like superior glenohumeral ligament (SGHL) and an absent anterosuperior labrum.
    4. Abnormal finding characterized by a cord-like MGHL and an absent anterosuperior labrum.
    5. Abnormal finding characterized by a cord-like inferior glenohumeral ligament (IGHL) and an absent posteroinferior labrum.
12. Following a total shoulder arthroplasty through a deltopectoral approach, motion and strengthening are typically initially restricted because of which factor? a.      Risk of dislocation.
    2. Risk of loosening.
    3. Risk of glenoid fracture.
    4. Protect the subscapularis tendon.
    5. Protect the supraspinatus tendon.
13. In an anterior dislocation which nerve is most likely to be injured?
    1. Musculocutaneous.
    2. Suprascapular.
    3. Upper or lower subscapular.
    4. Axillary.
    5. Radial.
14. A 55-year-old patient has chronic pain over the lateral aspect of the elbow, exacerbated when playing backhand tennis stroke. On examination she has pain with resisted middle finger extension. Which muscle attachment is most likely involved? a. Brachioradialis.
    2. Extensor digitorum communis.
    3. Extensor carpi radialis longus.
    4. Extensor carpi radialis brevis.
    5. Anconeus.
15. Which of the following is the primary stabilizer to resist valgus stress in the flexed elbow?
    1. Ulno-humeral articulation.
    2. Radiocapitellar articulation.
    3. Flexor-pronator muscle mass.
    4. Anterior band of the medial ulnar collateral ligament.
    5. Posterior band of the medial ulnar collateral ligament.
16. The greatest stress on the medial ulnar collateral ligament of the elbow occurs during which phase of throwing? a. Wind-up.
    2. Early cocking.
    3. Late cocking.
    4. Ball release.
    5. Follow through.
17. A 31-year-old weightlifter reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint (ACJ). X-rays show osteopaenia of the distal clavicle. Initial treatment should include? a.             Glenohumeral joint injection.
    2. Periscapular muscle strengthening.
    3. Activity modification.
    4. Capsular release.
    5. Arthroscopic resection of the distal clavicle.
18. Avulsion of which ligament off its humeral insertion has historically been associated with recurrent instability and may require open repair? a. Inferior glenohumeral.
    2. Middle glenohumeral.
    3. Superior glenohumeral.
    4. Coracohumeral.
    5. Coracoacromial.
19. A 78-year old female sustains a four-part proximal humerus fracture and undergoes a shoulder hemiarthroplasty. Intraoperatively the lesser tuberosity was lateralized. What problem will this patient most likely have post-operatively? a.          Forward elevation weakness.
    2. Bicipital pain.
    3. Abduction deficit.
    4. External rotation deficit.
    5. Internal rotation deficit.
20. A patient is known to have a SLAP tear. An MRI shows a large cyst in the spinoglenoid notch. What additional finding on examination is the patient likely to display?
    1. Weakness in external rotation.
    2. Weakness in forward elevation.
    3. Weakness in internal rotation.
    4. Medial scapular winging.
    5. Lateral scapular winging.
21. What technical error leads to scapular notching after reverse total shoulder arthroplasty?
    1. Retroverted placement of the glenoid component.
    2. Superior placement of the glenoid component.
    3. Inferior placement of the glenoid component.
    4. Posterior placement of the glenoid component.
    5. Overtensioning of the soft tissue envelope.
22. What is the most common pathological arthroscopic finding following a traumatic anterior shoulder dislocation? a. Hill–Sachs lesion.
    2. Posterosuperior labral tear.
    3. Posteroinferior labral tear.
    4. Anterosuperior labral tear.
    5. Anteroinferior labral tear.
23. When approaching the proximal diaphyseal radius via the Henry approach ( volar), the forearm is supinated to minimize injury to what structure? a. Radial nerve.
    2. Lateral antebrachial cutaneous nerve.
    3. Posterior interosseous nerve.
    4. Ulnar nerve.
    5. Median nerve.
24. A patient sustains a midshaft clavicle fracture which heals with 2cm of shortening.

What is the most likely clinical outcome?

24. 1. Normal shoulder muscle strength and endurance.
    2. Decreased shoulder muscle strength and endurance.
    3. Decreased shoulder abduction.
    4. Decreased shoulder external rotation.
    5. Decreased shoulder adduction.
25. A 68-year-old female rheumatoid patient presents with a painful, stiff elbow. Plain radiographs show a Larsen grade IV. The most appropriate surgical option is? a. Arthroscopic synovectomy.
    2. Open synovectomy.
    3. Open synovectomy and radial head excision.
    4. Lateral elbow replacement.
    5. Total elbow replacement.
26. A 50-year-old male complains of acute shoulder pain and an inability to lift his arm over his head after an anterior shoulder dislocation. Examination reveals active forward elevation to 30º and grade 3/5 external rotation strength. An arthrogram shows extravasation of the dye into the subacromial space with no evidence of arthritis. What is the most appropriate treatment option? a. Shoulder hemiarthroplasty.
    2. Rotator cuff repair.
    3. Reverse total shoulder arthroplasty.
    4. Total shoulder arthroplasty.
    5. Physiotherapy.
27. A 35-year-old woman sustains an elbow fracture dislocation which includes a coronoid fracture involving more than 50%, and a comminuted radial head fracture. What is the most appropriate treatment?
    1. Closed reduction and early range of motion.
    2. Radial head resection and coronoid open reduction internal fixation.
    3. Radial head arthroplasty and coronoid open reduction internal fixation.
    4. Radial head resection and lateral collateral ligament reconstruction.
    5. Radial head arthroplasty, coronoid open reduction internal fixation and lateral collateral ligament repair.
28. What is the most common mode of failure of the lateral ulnar collateral ligament (LUCL) associated with an elbow dislocation? a.         Ligament avulsion off the humeral origin.
    2. Ligament avulsion off the ulnar insertion.
    3. Bony avulsion of the humeral origin.
    4. Bony avulsion of the ulnar insertion.
    5. Midsubstance rupture.
29. A patient sustains a displaced scapular neck fracture. What is the internervous plane for a posterior approach to the glenohumeral joint? a. Suprascapular-axillary.
    2. Suprascapular-subscapular.
    3. Long thoracic-spinal accessory.
    4. Lateral pectoral-axillary.
    5. Subscapular-musculocutaneous.
30. The optimal position of the shoulder for arthrodesis is?
    1. External rotation (ER) 30º, Flexion 30º, Abduction 30 º.
    2. ER 30º, Flexion 30º, Adduction 30 º.
    3. Internal rotation (IR) 30º, Flexion 30º, Abduction 30 º.
    4. IR 30º, Flexion 10º, Adduction 30 º.
    5. IR 30º, Flexion 40º, Abduction 30 º.

EMQs

1. Nerves in the arm
   1. Anterior interosseous nerve
   2. Spinal accessory nerve
   3. Long thoracic nerve
   4. Axillary nerve
   5. Median nerve
   6. Musculocutaneous nerve
   7. Radial nerve
   8. Ulnar nerve

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

1. 1. Damage to this nerve can result in lateral scapular winging.
   2. This is a supraclavicular branch of the brachial plexus.
   3. This is the nerve most at risk during placement of the anterolateral portal in elbow arthroscopy.
2. Structures around the shoulder
   1. Glenoid labrum
   2. Superior glenohumeral ligament ( SGHL )
   3. Middle glenohumeral ligament ( MGHL )
   4. Anterior band of the inferior glenohumeral ligament ( IGHL )
   5. Posterior band of the inferior glenohumeral ligament ( IGHL )
   6. Coracohumeral ligament ( CHL )
   7. Infraspinatus
   8. Subscapularis

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

2. 1. This is highly variable and poorly defined in up to 40% of the population.
   2. This is the primary restraint to anterior/inferior translation of the head with the shoulder abducted to 90º and in maximum external rotation.
   3. With the shoulder in external rotation, this is an important dynamic stabilizer to posterior subluxation.
3. Radiographic views
   1. Supraspinatus outlet view
   2. True anteroposterior ( AP )
   3. AP in internal rotation ( IR )
   4. Zanca view
   5. Axillary view
   6. Serendipity view
   7. Stryker notch view
   8. Garth view

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

3. 1. This is used to assess anteroposterior dislocations of the sternoclavicular joint.
   2. This is used to assess acromion morphology.
   3. This is used to assess for Hill–Sachs defect and taken with the patient supine with the palm of the hand of the affected extremity placed on top of the head with the fingers toward the back of the head.
4. Elbow conditions
   1. Lateral epicondylitis
   2. Medial epicondylitis
   3. Radiocapitellar osteoarthritis
   4. Posterolateral rotatory instability
   5. Lateral impingement
   6. Posterior interosseous syndrome
   7. Valgus instability
   8. Radial tunnel syndrome

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

4. 1. A 45-year-old patient complains of chronic lateral elbow pain. On examination pain is exacerbated by resisted forearm pronation and wrist flexion.
   2. A 48-year-old complains of chronic lateral elbow pain. On examination there is weakness and ulnar drift with wrist extension.
   3. A 42-year-old undergoes surgery for tennis elbow. Following surgery, she describes clicking and popping on the lateral aspect of the elbow. Examination reveals a positive lateral pivot shift.
5. Structures around the elbow a.            Lateral collateral ligament
   2. Lateral ulnar collateral ligament
   3. Medial collateral ligament
   4. Radial collateral ligament
   5. Annular ligament
   6. Posterolateral capsule
   7. Anterior capsule
   8. Ulnar collateral ligament

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

5. 1. This is typically the first ligament disrupted in an elbow dislocation.
   2. Disruption of this structure is the essential lesion responsible for posterolateral rotatory instability of the elbow.
   3. Valgus stability with the arm in pronation suggests this structure is intact.
6. Painful shoulder
   1. Subacromial impingement
   2. Suprascapular nerve entrapment
   3. Parsonage–Turner syndrome
   4. Thoracic outlet syndrome
   5. Acromioclavicular arthritis
   6. Supraspinatus calcific tendinitis
   7. Subcoracoid impingement
   8. SLAP lesion
   1. Adhesive capsulitis

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

6. 1. A 45-year-old diabetic presents with acute onset shoulder pain, constant in nature affecting sleep. Shoulder examination reveals limited active and passive movement, especially external rotation. Plain radiograph is unremarkable.
   2. A 35-year-old patient complains of anterior shoulder pain exacerbated by positioning the arm in adduction, forward flexion and an internally rotated position. A CT scan shows a coracohumeral distance of 5 mm.
   3. A 40-year-old patient with a clavicle malunion complains of tingling and numbness in her fingers mostly in the ring and small finger, made worse with overhead activity. Examination includes a positive Wright test.
7. Treatment for shoulder pathology
   1. Eccentric deltoid physiotherapy programme
   2. Arthroscopic capsular release
   3. Subscapularis repair
   4. Supraspinatus repair
   5. Arthroscopic subacromial decompression
   6. Hemiarthroplasty
   7. Latissimus dorsi tendon transfer
   8. Unconstrained total shoulder arthroplasty
   1. Reverse type total shoulder arthroplasty

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

7. 1. A 62-year-old man undergoes a total shoulder arthroplasty for osteoarthritis. He accidently uses his operative arm to rise from a chair 3 weeks after surgery and thereafter complains of anterior shoulder pain. Radiographs show anterior subluxation of the prosthesis.
   2. A 70-year-old patient with rheumatoid arthritis with a symptomatic arthritic cuff deficient shoulder.
   3. A 55-year-old man has an unrepairable posterosuperior rotator cuff tear. He has full passive range of movement but limited active movement. Clinically he has an intact subscapularis. X-rays show a centred humeral head with no degenerative change.
8. Surgical approaches
   1. Deltopectoral approach
   2. Henry approach
   3. Thompson approach
   4. Kocher approach
   5. Anterior approach to the elbow
   6. Posterior approach to the shoulder
   7. Lateral approach to the shoulder
   8. Kaplan approach

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

8. 1. This uses the internervous plane between the suprascapular nerve and the axillary nerve.
   2. This is the approach of choice for open reduction and internal fixation ( ORIF ) of a glenoid neck fracture.
   3. This does not utilize an internervous plane.
9. Special tests during shoulder examination
   1. Impingement injection test
   2. Lift-off test
   3. Hawkin’s sign
   4. Load-and-shift test
   5. Cross body adduction
   6. O’Briens test
   7. Speed’s test
   8. Hornblower’s sign
   1. External rotation lag sign
   10. Belly press

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

9. 1. When assessing subscapularis, this is more accurate for assessing the superior portion.
   2. Tests the integrity of teres minor.
   3. This tests for impingement by forcibly internally rotating the shoulder, driving the greater tuberosity further under the coracoacromial ligament.
10. Shoulder pathology
    1. Biceps tear
    2. Bankart lesion
    3. Pectoralis major rupture
    4. Spinoglenoid cyst
    5. Superior labrum anterior and posterior tear
    6. Adhesive capsulitis
    7. Humeral avulsion of the glenohumeral ligament (HAGL) lesion
    8. Subscapularis rupture
    1. Glenohumeral osteoarthritis

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

10. 1. A 36-year-old patient reports a sharp tearing sensation whilst bench-pressing. He subsequently develops bruising over the upper arm and weakness in adduction and internal rotation.
    2. An 18-year-old rugby player underwent surgery to repair a Bankart lesion for traumatic instability. Twelve months post-surgery, examination reveals stability, external rotation to 0º with the elbow at his side and to 40º at 90º of abduction. If his range of motion does not improve, he is at most risk of?
    3. A 34-year-old man underwent an open Bankart repair with capsulorrhaphy for recurrent anterior instability 6 months ago. In a recent fall, he describes a hyperabduction, external rotation injury. He now has anterior shoulder pain and the sensation of instability. Examination reveals a positive lift-off test and external rotation is 15º greater than the opposite side.
11. Arthroscopic findings in the shoulder
    1. SLAP type I
    2. SLAP type II
    3. SLAP type III
    4. SLAP type IV
    5. Rotator cuff articular side tear
    6. Biceps tendon fraying g       Peel-back lesion

1. 8. Anterior labral periasteal sleeve avulsion (ALPSA) lesion
   1. Biceps tendon subluxation

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

11. 1. The most common clinically significant type of SLAP lesion identified at arthroscopy.
    2. Describes a bucket handle tear of the labrum with a longitudinal tear extending into the biceps.
    3. Identifying this pathology at arthroscopy should raise the suspicion of a subscapularis tear.
12. Treatment of shoulder injuries
    1. Collar and cuff
    2. Manipulation under anaesthesia ( MUA )
    3. MUA and percutaneous K-wire fixation
    4. Open reduction and internal fixation ( ORIF )
    5. ORIF and bone grafting
    6. Hemiarthroplasty
    7. Shoulder resurfacing
    8. Unconstrained total shoulder replacement
    1. Reverse total shoulder replacement

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

12. 1. Two-part proximal humerus fracture with 6 mm displacement of the greater tuberosity fragment.
    2. Four-part head splitting proximal humerus fracture in a 55- year-old.
    3. Four-part valgus impacted proximal humerus fracture in a 45- year-old.
13. Anatomical spaces
    1. Triangular space
    2. Triangular interval
    3. Quadrangular space
    4. Cubital tunnel
    5. Suprascapular space
    6. Spinoglenoid notch
    7. Radial tunnel
    8. Subcoracoid space

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

13. 1. This contains the profunda brachii artery.
    2. This is immediately inferior to the quadrangular space.
    3. Its lateral border is the long head of triceps.
14. Treatment of elbow injuries
    1. Initial splintage, followed by range-of-motion exercises
    2. Aspiration of the haemarthrosis, followed by active range-of-motion exercises
    3. Fragment excision
    4. Open reduction and internal fixation ( ORIF )
    5. Radial head replacement
    6. Radial head excision
    7. Lateral elbow replacement
    8. Cubital tunnel release
    1. Lateral ligament reconstruction
    10. Medial ligament reconstruction
    11. Medial ligament repair

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

14. 1. A 25-year-old builder sustains a 3 mm displaced Mason type II radial head fracture. Examination reveals pain and catching that limits his range of motion to 45º of supination and 20º of pronation.
    2. A 32-year-old patient presents with an unreconstructable Mason type III radial head fracture. A lateral radiograph of the wrist shows a dorsally subluxed ulna.
    3. A 19-year-old javelin thrower presents with posteromedial elbow pain and complains that his throwing distance has reduced. He also complains of paraesthesia in the ring and little finger.
15. Paediatric elbow
    1. Capitellum
    2. Medial epicondyle
    3. Radial head
    4. Lateral epicondyle
    5. Lateral condyle
    6. Medial condyle
    7. Trochlea
    8. Coronoid
    1. Olecranon

Which of the options above is best described in each of the following statements? Each option may be used once, more than once or not at all.

1. 1. Non-union of which can result in tardy ulnar nerve palsy.
   2. Can be affected by osteochondritis dissecans.
   3. Ossifies at around the age of 8 years.

Shoulder and elbow: Mcqs AND EMQS Answers