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Orthopedic Shoulder And Review | Dr Hutaif Shoulder & E -...

Updated: Feb 2026 41 Views
Orthopedic Shoulder And Review | Dr Hutaif Shoulder & E -...

Key Medical Takeaway

For anyone wondering about Orthopedic MCQS online Shoulder and Elbow 017, Shoulder arthroplasty RTSA (Reverse Total Shoulder Arthroplasty) is a surgical solution for complex shoulder conditions like irreparable rotator cuff tears or severe arthritis. Orthopedic care addresses various musculoskeletal challenges, from treating specific elbow fractures involving the anteromedial coronoid facet to managing long-term joint damage. Treatment aims to restore function and prevent debilitating progressive arthritis.

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Orthopedic MCQS online Shoulder and Elbow 017

QUESTION 1
Orthopedic MCQS online Shoulder and Elbow 017
SHOULDER AND ELBOW SELF-
SCORED SELF-ASSESSMENT EXAMINATION
_AAOS 2017_
CLINICAL SITUATION FOR QUESTIONS 1 THROUGH 4
A 55-year-old man falls on his outstretched arm and sustains the injury shown in the 3-dimensional CT scans in Figures 1a and 1b.
**Question 1 of 100**
Which ligamentous structure attaches to the fracture fragment?









1
Lateral ulnar collateral ligament
2
Radial collateral ligament
3
Posterior medial collateral ligament (MCL)
4
Anterior MCL _
QUESTION 2
of 100
Figures 5a through 5d are the radiographs of a 55-year-old healthy woman who fell down a flight of steps while sleepwalking. When the surgeon replace the radial head, the elbow dislocates posteriorly at 60 degrees of flexion as it is brought out from full flexion. What is the best next step?



1
Only repair the lateral collateral ligament (LCL)
2
Do nothing further and place the elbow in 90 degrees of flexion
3
Repair the posterior band of the medial collateral ligament (MCL)
4
Repair the coronoid and reassess for stability
QUESTION 3
of 100
A 70-year-old man has a 1-year history of progressive right shoulder pain, motion loss, and weakness associated with rotator cuff arthropathy. He has failed nonsurgical treatment. During the informed consent process, the patient is counseled regarding his treatment options, and the surgeon recommends that he undergo a right reverse total shoulder arthroplasty (rTSA). The patient must be informed about the complications associated with this type of procedure, the most common of which is
1
infection.
2
prosthetic joint instability.
3
neurologic injury.
4
scapular notching.
QUESTION 4
of 100
A 24-year-old right-hand-dominant professional baseball pitcher has valgus extension overload (VEO) syndrome of the right elbow, as seen in Figure 7. Which letter in the figure corresponds to the typical area of osteophyte formation in this condition?
1
A
2
B
3
C
4
D
QUESTION 5
of 100
In rotator cuff tear arthropathy with pseudoparalysis, forward elevation of the humerus away from the body is prohibited because of
1
deltoid atony.
2
loss of the glenoid concavity.
3
loss of the humeral head depression of the biceps tendon.
4
loss of compressive force on the humeral head.
QUESTION 6
of 100
The patient fails nonsurgical treatment and undergoes shoulder arthroscopy. At the time of surgery, the area marked by the asterisk in Figure 9 is visualized from the posterolateral portal. This anatomic structure impinges on which other structure during late cocking of the throwing phase?
1
Biceps tendon
2
Posterior band of the inferior glenohumeral ligament
3
Hill-Sachs lesion
4
Undersurface of the supraspinatus and infraspinatus tendons
QUESTION 7
of 100
Which image seen during arthroscopic treatment is most likely associated with this patient’s condition?
A
b c
d


1
Figure 10a
2
Figure 10b
3
Figure 10c
4
Figure 10d
QUESTION 8
of 100
Which organism is most likely responsible for a periprosthetic shoulder infection?
1
A gram-positive aerotolerant anaerobic _Bacillus_
2
A gram-negative anaerobic _Bacillus_
3
Aerobic gram-positive _cocci_ in clusters
4
Aerobic gram-positive _cocci_ in pairs
QUESTION 9
of 100
For humeral shaft fractures, the characteristic most associated with radial nerve palsy is
1
open fracture.
2
distal one-third humeral shaft fracture.
3
proximal one-third humeral shaft fracture.
4
closed, comminuted humeral shaft fracture.
QUESTION 10
of 100
An 18-year-old female collegiate swimmer has a 1-year history of posterior shoulder pain and popping and a bilateral 2-cm sulcus sign.
1
Isolated posterior instability with a posterior labral tear
2
Multidirectional instability
3
Anterior shoulder subluxation
4
Thoracic outlet syndrome
5
Superior labrum anterior to posterior (SLAP) tear
QUESTION 11
of 100
A 16-year-old high school football player has anterior shoulder pain after tackling an opponent with his arm in abduction and external rotation.
1
Isolated posterior instability with a posterior labral tear
2
Multidirectional instability
3
Anterior shoulder subluxation
4
Thoracic outlet syndrome
5
Superior labrum anterior to posterior (SLAP) tear
QUESTION 12
of 100
A 21-year-old collegiate baseball player experiences posterior shoulder pain in the lead shoulder while batting.
1
Isolated posterior instability with a posterior labral tear
2
Multidirectional instability
3
Anterior shoulder subluxation
4
Thoracic outlet syndrome
5
Superior labrum anterior to posterior (SLAP) tear
QUESTION 13
of 100
A 23-year-old professional baseball pitcher experiences worsening pain in the throwing shoulder. Examination reveals increased external rotation, decreased internal rotation, and loss of total arc of motion in the throwing arm compared to the opposite side.
1
Isolated posterior instability with a posterior labral tear
2
Multidirectional instability
3
Anterior shoulder subluxation
4
Thoracic outlet syndrome
5
Superior labrum anterior to posterior (SLAP) tear
QUESTION 14
of 100
A 14-year-old Little League pitcher who plays in 2 leagues concurrently has pain in his throwing shoulder while pitching but not at rest.
1
Isolated posterior instability with a posterior labral tear
2
Multidirectional instability
3
Anterior shoulder subluxation
4
Thoracic outlet syndrome
5
Superior labrum anterior to posterior (SLAP) tear
QUESTION 15
of 100
A 41-year-old right-hand-dominant man has been treated nonsurgically for right elbow arthritis. His radiographs reveal end-stage ulnohumeral arthritis with complete loss of the joint space. He reports pain during the mid-arc of elbow flexion and extension. During the last 8 years, he has attempted activity modification, medication, physical therapy, and multiple cortisone injections. His symptoms have progressed, resulting in constant pain, loss of a functional range of motion, and an inability to perform many activities of daily living. Secondary to his age and activity demands, he undergoes a soft-tissue interposition arthroplasty of his elbow with an Achilles allograft. Which presurgical finding correlates with elevated risk for postsurgical complications?
1
Inflammatory elbow arthritis
2
A presurgical flexion-extension elbow arc of approximately 50 degrees
3
Retained distal humerus hardware on presurgical radiographs
4
Evidence of presurgical elbow instability
QUESTION 16
of 100
Left shoulder MR imaging results are shown in Figure 19 for a 22-year-old, right-hand-dominant collegiate athlete who reports a 6-month history of weakness in his right arm that first was noticed during weight training. He reports the weakness seems worse now than several months ago. He denies any specific traumatic event, has altered his weight-lifting activities, and has tried over-the-counter ibuprofen without experiencing any benefit. Upon examination of the bilateral upper extremities, there is no appreciable deformity or atrophy. He demonstrates full active shoulder range of motion, and there is no weakness with abduction in the plane of the scapula. Belly press test findings are normal, but there is weakness in external rotation with the arm in adduction. He does not demonstrate anterior apprehension, and there is no instability with load and shift testing. He has normal sensation and pulses to the upper extremity. A standard radiographic shoulder series yields unremarkable results. What is the best surgical option?
1
Arthroscopic labral debridement and biceps tenodesis
2
Shoulder arthroscopy with undersurface cuff debridement and acromioplasty
3
Cyst decompression at the spinoglenoid notch with possible labral repair
4
Cyst decompression at the suprascapular notch with possible labral repair
QUESTION 17
of 100
A 65-year-old patient undergoes revision total shoulder arthroplasty. Intraoperative culture results held for 5 days are negative. Five days after surgery, this afebrile patient experiences increasing pain, modest redness, and decreased motion. His postsurgical erythrocyte sedimentation rate is 25 mm/h (reference range, 0-20 mm/h), and his white blood cell level is normal. What is the best next step?



1
Additional imaging
2
Anti-inflammatory medications
3
Physical therapy
4
Ask microbiology to hold the intraoperative cultures for 2 weeks
QUESTION 18
of 100
Which radiographic finding indicates likely radial head replacement?
1
2 or fewer fragments of the radial head
2
Age younger than 21 years
3
Wrist pain and asymmetry of the ipsilateral distal radioulnar joint
4
Anteromedial coronoid comminution
QUESTION 19
of 100
Following radial head replacement, the elbow exhibits persistent laxity to valgus stress in extension. What is the best next step to regain stability?
1
Posterior capsular repair
2
Anterior capsular repair
3
Fixation of the type I coronoid fracture
4
Repair of the medial collateral ligament (MCL)
QUESTION 20
of 100
A 45-year-old woman has a 3-month history of left shoulder pain. Her symptoms have failed to improve despite receiving an injection and participating in 2 months of physical therapy focusing on rotator cuff strengthening. An examination reveals no weakness, atrophy, or scapular winging. She has anterior and posterior shoulder tenderness and full symmetric forward elevation and abduction, but internal rotation on the left is decreased. She has pain with internal rotation in 90 degrees of forward elevation and an increased distance between the antecubital fossa and coracoid process with cross-chest adduction when compared to the contralateral side. Radiographs reveal a type II acromion. What is the most appropriate next step?
1
MR imaging
2
MRI arthrogram
3
Posterior capsular stretching exercises
4
Arthroscopic subacromial decompression and acromioplasty
QUESTION 21
of 100
A 55-year-old man falls from a ladder and dislocates his nondominant shoulder. He undergoes a sedated reduction in the emergency department without complications. Postreduction radiographs reveal a small Hill-Sachs lesion and no other bony abnormalities. Six weeks after the dislocation, he has persistent pain at rest and forward elevation and external rotation weakness. He has no abnormal sensation. What is the best next step?
1
Physical therapy with electrical stimulation and iontophoresis
2
Corticosteroid injection
3
MR imaging of the shoulder
4
Electromyography (EMG) of the arm
QUESTION 22
of 100
A right-hand-dominant 45-year-old man sustained an injury to the anterior aspect of his right elbow during sudden elbow flexion while trying to lift a heavy load 3 days ago. He reports the sensation of a sudden, sharp pain at the time of injury, which has since subsided. He has ecchymosis in the anterior and medial elbow regions and has difficulty with resisted forearm supination with the elbow in a flexed position. A diagnosis of an acute distal biceps tendon rupture is made, and, after having a discussion with the patient, surgical treatment is chosen. During surgical reattachment, what is the relationship of the distal biceps tendon within the antecubital fossa to the median nerve and recurrent radial artery before the tendon attaches to the bicipital tuberosity?
1
The tendon travels lateral (radial) to the median nerve and posterior (deep) to the recurrent radial artery
2
The tendon travels lateral (radial) to the median nerve and anterior (superficial) to the recurrent radial artery
3
The tendon travels medial (ulnar) to the median nerve and posterior (deep) to the recurrent radial artery
4
The tendon travels medial (ulnar) to the median nerve and anterior (superficial) to the recurrent radial artery
QUESTION 23
of 100
Figure 26 is the MR image of a 55-year-old man who sustained an acute traumatic injury to his right shoulder and loss of active range of motion. He was initially evaluated by his primary care physician and treated with physical therapy without success. He was referred to an orthopaedist for surgical consultation 8 weeks after sustaining the injury. The orthopaedic surgeon performs a successful arthroscopic repair but notes poor tendon quality at the repair site. The treating surgeon keeps the patient in a sling full time for 6 weeks without formal therapy. One year after surgery, in comparison to early therapy, this rehabilitation program will likely result in

1
no difference in terminal range of motion.
2
a lower functional outcome score.
3
a clinically significant reduction in passive forward flexion and external rotation.
4
a higher retear rate of the rotator cuff repair. ![img](/media/upload/c3fd0cf0-8de8-482d-80bf-6d6cd63a4bb0.jpg)
QUESTION 24
of 100
A 44-year-old right-hand-dominant mechanic has left lateral elbow pain. He was injured at work 6 months ago when he sustained a hyperextension injury to his left arm when a tire fell off of a truck. He experienced immediate left lateral elbow pain and swelling. Initial radiograph findings in the emergency department were normal. He was given a sling, which he continues to use. He tried to do physical therapy, but he stopped after 1 visit because he said it made his pain worse. He denies any numbness or tingling but has not been able to return to work. He was given an injection in the region of the lateral epicondyle 1 month ago, which did not improve his symptoms. Upon examination, he is maximally tender to palpation about 5 cm distal to the lateral epicondyle. Active range of motion is limited by pain. He has lateral elbow pain with resisted wrist extension and resisted middle finger extension. Which test would most likely confirm a diagnosis?

1
MR imaging
2
Electromyography (EMG)
3
Bone scan
4
Lidocaine injection test
QUESTION 25
of 100
The radiograph shows components that are
1
subluxed.
2
fractured.
3
loose and potentially infected.
4
normal.
QUESTION 26
of 100
The next step in this patient’s workup should be
1
aspiration.
2
observation.
3
physical therapy.
4
revision to total shoulder arthroplasty.
QUESTION 27
of 100
If aspiration findings are negative or equivocal, the diagnosis can be established with
1
arthroscopy.
2
a bone scan.
3
a serum white blood cell level.
4
a C-reactive protein level.
QUESTION 28
of 100
If the culture results are positive, which treatment will most likely resolve the infection?
1
Arthroscopic debridement
2
Intravenous antibiotics
3
Single-stage revision
4
Double-stage revision
QUESTION 29
of 100
Figures 32a through 32c are the radiograph and CT scans of a 75-year-old smoker with hypertension who sustained a ground-level fall without loss of consciousness with impact to her
left upper extremity 1 week ago. She states that she lived independently at home with her husband prior to her fall. What is the most appropriate next step?


1
Hemiarthroplasty
2
Initial sling immobilization with subsequent physical therapy
3
Open reduction and internal fixation
4
Reverse total shoulder arthroplasty (rTSA)
QUESTION 30
of 100
What is the role of the long head of the biceps brachii tendon in providing stability to the humeral head?
1
It provides no stability to the humeral head
2
Its stabilizing function is greatest with the shoulder forward elevated 120 degrees
3
It decreases superior translation of the humeral head only
4
It decreases anterior, inferior, and superior translation of the humeral head
QUESTION 31
of 100
An arthroscopic image taken from the posterior portal with the patient in the lateral decubitus position is shown in Figure 34. The most appropriate treatment of this abnormality is
1
anterior labral repair with suture anchors.
2
superior labral repair with suture anchors.
3
biceps tenotomy.
4
no treatment.
QUESTION 32
of 100
The surgeon orders MR imaging to confirm the diagnosis. How should the patient position his arm to increase study sensitivity?
1
Extended elbow, abducted shoulder, and supinated forearm
2
Extended elbow, adducted shoulder, and pronated forearm
3
Flexed elbow, abducted shoulder, and pronated forearm
4
Flexed elbow, abducted shoulder, and supinated forearm
QUESTION 33
of 100
If the patient chooses nonsurgical treatment, which functional loss should he anticipate?
1
10% loss of flexion strength
2
40% loss of supination strength
3
60% loss of flexion strength
4
80% loss of supination strength
QUESTION 34
of 100
The patient elects surgical intervention. You proceed with an anterior single-incision primary repair. When comparing single- and double-incision approach complication rates, the single-incision approach is associated with
1
a lower risk for forearm synostosis.
2
a higher incidence of lateral antebrachial cutaneous nerve palsy.
3
improved objective outcome scores.
4
stronger isometric forearm supination strength.
QUESTION 35
of 100
If surgical intervention is delayed for 3 months and intraoperatively the surgeon finds that primary repair can be performed but hyperflexion of the elbow to 90 degrees is necessary, what is the likely long-term consequence?
1
30% loss of elbow flexion strength
2
60-degree elbow flexion contracture
3
Inability to pronate the forearm past neutral
4
No significant loss of elbow range of motion
QUESTION 36
of 100
Figures 39a and 39b are the radiographs of a 60-year-old woman with elbow pain at the extremes of motion; occasional locking; flexion/extension, 30-130; pronation/supination, 60/70; and no pain on forearm rotation. She injured her elbow as a teenager and had surgery at that time. What is the best next step?

1
Debridement, capsular excision, and loose body removal
2
Unconstrained total elbow arthroplasty (TEA)
3
Radial head excision
4
Elbow arthrodesis
QUESTION 37
of 100
A 26-year-old recreational athlete sustained an initial dislocation 1 year ago and was treated nonsurgically. He recently sustained a second dislocation and is scheduled for surgical repair. Plain radiographs and MR images reveal no bony defect. What is the difference in recurrence rate after open and arthroscopic repair?
1
Recurrence after open surgery is twice that of arthroscopic repair
2
Recurrence after arthroscopic surgery is twice that of open repair
3
Recurrence after arthroscopic repair generally occurs at an earlier time than after open repair
4
There is no difference in recurrence after open and arthroscopic repair
QUESTION 38
of 100
After discussing his diagnosis along with surgical and nonsurgical treatment options, the patient wishes to proceed with surgical intervention. He has done some online research and has questions about which procedure will produce the best outcome. Based on the current literature, what is the optimal next procedure?

1
Arthroscopic glenohumeral debridement with biceps tenotomy
2
Hemiarthroplasty
3
Total shoulder arthroplasty (TSA)
4
Reverse TSA (rTSA)
QUESTION 39
of 100
During the patient’s presurgical history and physical visit, he tells the nurse that he has a history of rheumatoid arthritis for which management by his primary care physician is required. With this new information in hand, which finding is most commonly seen on imaging during presurgical planning?
1
Glenoid medicalization
2
Posterior glenoid wear
3
Posterior subluxation of the humeral head
4
Inferior osteophytes at the humeral head
QUESTION 40
of 100
Following a successful shoulder arthroplasty and hospital discharge, the patient returns for his 1-month follow-up. His staples were removed at his 2-week visit. At today’s visit his wound appears benign, and he denies drainage or fevers. He reports he was doing well until last week, at which time he reached out to close the car door, which resulted in new anterior shoulder pain. His postsurgical radiograph is shown in Figure 43. What is the most likely cause of this new finding?
1
Supraspinatus tear
2
Subscapularis tear
3
Glenoid component loosening
4
Infection
QUESTION 41
of 100
A healthy 65-year-old woman undergoes anatomic total shoulder arthroplasty to address osteoarthritis. The surgery is uncomplicated. What is the most common indication for future revision?
1
Infection
2
Periprosthetic fracture
3
Glenoid component loosening
4
Rotator cuff tearing
QUESTION 42
of 100
A 68-year-old right-hand-dominant woman has experienced progressive right elbow pain and loss of motion for several years. She has failed nonsurgical treatment and elects to undergo a total elbow arthroplasty (TEA). In comparison to a linked prosthesis, an unlinked prosthesis has which reported distinction with extended follow-up?
1
Improved longevity in comparison to the linked prosthesis
2
A significantly larger flexion-extension arc
3
A higher incidence of postsurgical instability
4
Lower frequency of ulnar nerve dysfunction
QUESTION 43
of 100
Figures 46a and 46b are the radiographs of a 60-year-old man with gradual onset of right shoulder pain and motion loss 1 year after undergoing an uncomplicated right total shoulder arthroplasty
(TSA) for end-stage osteoarthritis. He denies trauma to his right shoulder and constitutional symptoms, but admits to difficulty performing activities of daily living. His surgical wound site is benign. He demonstrates active and passive forward flexion to 90 degrees, abduction to 60 degrees, external rotation to 30 degrees, and internal rotation to the lumbosacral junction. His rotator cuff strength is graded as normal and symmetrical to his unaffected left shoulder. Based upon the current evaluation, what is the most appropriate next step?

1
Revision TSA
2
Infection workup
3
CT scan of the shoulder
4
Observation and physical therapy
QUESTION 44
of 100
What is the most common coexisting pathology in this scenario?
1
Ulnar neuropathy at the cubital tunnel
2
Lateral epicondylitis
3
Triceps tendinosis
4
Posterolateral rotatory instability
QUESTION 45
of 100
The patient’s symptoms fail to improve after a 6-month course of nonsurgical treatment. His inability to return to his full job duties after surgery is most likely related to
1
poor job satisfaction.
2
his smoking habit.
3
representation by an attorney.
4
ligament instability.
QUESTION 46
of 100
Figure 49 is the radiograph of a 54-year-old man who has increasing weakness and numbness in his lateral arm. No prior surgery or injury is reported. What is the most appropriate next diagnostic test?
1
MR imaging of the shoulder
2
MR imaging of the cervical spine
3
Chest CT scan
4
Chest radiograph
QUESTION 47
of 100
When a patient has acute or chronic anterior shoulder instability, a bony or glenoid reconstructive procedure should be considered in which clinical setting?
1
Associated humeral avulsion of the glenohumeral ligament (HAGL) lesion
2
Nonengaging Hill-Sachs lesion
3
Glenoid bone loss of at least 25%
4
Anterior labral periosteal sleeve avulsion (ALPSA)
QUESTION 48
of 100
Figure 51 is the MR image of a 23-year-old Minor League pitcher who has dominant elbow pain. He reports a pop while throwing and loss of velocity and control. He has failed nonsurgical treatment that included rest and physical therapy. What is the most common complication following surgical treatment of this injury?
1
Infection
2
Medial epicondyle fracture
3
Arthrofibrosis
4
Ulnar nerve irritation
QUESTION 49
of 100
What most accurately describes treatment of displaced proximal humerus fractures involving the humeral neck for elderly patients?
1
Hemiarthroplasty provides better clinical outcome measures at 2 years
2
Early physiotherapy improves outcomes at 2 years
3
Complication rates are higher after surgical treatment than with a sling
4
Surgical treatment increases risk for future surgery
QUESTION 50
of 100
A 35-year-old high school volleyball coach has an acute 1-day history of right elbow pain and swelling in the antecubital fossa. He was moving equipment when his symptoms began. He describes considerable weakness with forearm supination and elbow flexion. Upon examination, he has a proximal “Popeye” deformity. In surgery, attention is first focused on identifying the ruptured tendon stump. During the anterior exposure, a nerve is appreciated just lateral of midline as it appears in between the brachialis and biceps stump. It continues distally under the cephalic vein and disappears distally down the forearm. This anatomic structure is the




1
radial nerve.
2
lateral antebrachial cutaneous nerve.
3
superficial branch of the radial nerve.
4
median nerve.
QUESTION 51
of 100
The likely detached ligamentous lesion is tightest when the position of the shoulder is
1
45-degree abduction, internal rotation.
2
45-degree abduction, external rotation.
3
90-degree abduction, external rotation.
4
90-degree abduction, internal rotation.
QUESTION 52
of 100
For patients who sustain their first anterior glenohumeral dislocation during sports activity, which associated injury is most commonly expected at the time of the initial dislocation?
1
Rotator cuff tear
2
Axillary nerve palsy
3
Greater tuberosity fracture
4
Biceps tendon rupture
QUESTION 53
of 100
At the time of arthroscopy, the posterior humeral head Hill-Sachs lesion substantially engages with the glenoid; CT and arthroscopic findings reveal minimal glenoid bone loss. In addition to arthroscopic Bankart repair, arthroscopic Hill-Sachs remplissage with suture anchors is performed. In combined Bankart repair with Hill-Sachs remplissage vs Bankart repair alone, which complication is of highest potential concern?
1
Increase in shoulder external rotation of approximately 10 degrees vs the uninjured shoulder
2
Increased rate of recurrent dislocation
3
Loss of shoulder external rotation of approximately 10 degrees vs the uninjured shoulder
4
Lower rate of return to previous level of sports participation
QUESTION 54
of 100
If the site of the pathologic lesion is revealed in Figure 54f and not in Figure 54e after traumatic anterior shoulder dislocation, the mechanism of shoulder injury is likely

1
axial loading of the glenohumeral joint.
2
isolated hyperabduction.
3
combined 45-degree abduction and external rotation.
4
combined hyperabduction and external rotation.
QUESTION 55
of 100
A 71-year-old woman with a history of rheumatoid arthritis has right elbow pain. Her rheumatologist has referred her for failure of medical treatment. Figures 58a and 58b are her anteroposterior and lateral radiographs. What is the best next step?

1
An arthroscopic synovectomy, which will provide long-term pain relief
2
An interposition arthroplasty, which will be reliable for pain relief at the expense of a permanent 5-pound lifting restriction
3
Total elbow arthroplasty (TEA); the infection rate will be lower than if performed for posttraumatic arthritis
4
A TEA, which likely will provide better longevity than if performed for posttraumatic arthritis
QUESTION 56
of 100
Figure 59 is the MR image of a 17-year-old high school wrestler who has had multiple subluxation episodes of his right shoulder. Physical therapy has not controlled his symptoms, and he was unable to finish the wrestling season because of pain and instability. CT scanning is suggested. What is the advantage of a CT scan?

1
Bone loss is more reliably visualized than with MR imaging
2
Soft-tissue damage is more reliably imaged with a CT scan
3
Atrophy is better assessed using the Goutallier classification
4
Multidirectional instability can be ruled out
QUESTION 57
of 100
A 70-year-old woman with a 4-part proximal humerus fracture dislocation and history of failed rotator cuff repair
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 58
of 100
A 35-year-old man with a 2-part anterior proximal humerus fracture-dislocation
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 59
of 100
A 55-year-old man with a 4-part proximal humerus fracture with intra-articular comminution and a large greater tuberosity fragment
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 60
of 100
A 37-year-old man with an irreducible posterior 2-part proximal humerus fracture dislocation
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 61
of 100
A 65-year-old woman with a nondisplaced surgical neck proximal humerus fracture
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 62
of 100
A 75-year-old man with a 4-part proximal humerus fracture and comminuted tuberosities
1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 63
of 100
A 50-year-old woman with a 2-part surgical neck proximal humerus fracture and metaphyseal comminution

1
Initial period of sling immobilization followed by physical therapy
2
Open reduction and internal fixation with or without bone grafting
3
Reverse total shoulder arthroplasty (rTSA)
4
Hemiarthroplasty
5
Unconstrained (TSA)
QUESTION 64
of 100
Which radiographic parameter places this patient at highest risk for osteonecrosis?
1
3-part displaced valgus-type fracture pattern
2
3-part displaced varus-type fracture pattern
3
Anterior fracture extension disrupting the bicipital groove
4
Posteromedial metaphyseal head extension of less than 8 mm
QUESTION 65
of 100
What is the most common complication following open reduction locking plate osteosynthesis of this injury?
1
Intra-articular screw penetration
2
Posttraumatic avascular necrosis (AVN)
3
Nonunion
4
Subacromial plate impingement
QUESTION 66
of 100
When considering arthroplasty options, which statement is true regarding hemiarthroplasty or rTSA?
1
Midterm objective outcome scores following hemiarthroplasty are superior
2
Results following rTSA are less dependent on anatomic tuberosity healing
3
rTSA is associated with a lower complication rate
4
Patients who undergo hemiarthroplasty report a higher average visual analog pain score
QUESTION 67
of 100
If a patient develops posttraumatic osteonecrosis after undergoing head preservation treatment, which radiographic findings help to predict a lower likelihood of successful conversion to an anatomic shoulder arthroplasty?
1
Valgus malunion of the head shaft angle
2
Varus malunion of the greater tuberosity, necessitating osteotomy
3
Intra-articular screw penetration
4
Cephalic collapse of the humeral head
QUESTION 68
of 100
Figures 71a and 71b are the radiographs of a 65-year-old right-hand-dominant woman who sustained a Mason type III radial head fracture 3 years ago. She was treated with radial head replacement, but she never regained normal function and now has pain. What do the radiographs reveal?



1
No visible pathology
2
Osteomyelitis with loosening of the implant
3
Posttraumatic changes with an “overstuffed” radial head
4
Evidence of fibrodysplasia ossificans progressiva
QUESTION 69
of 100
Based on his radiograph findings, what is the best next step?
1
Sling and physical therapy
2
Narcotic analgesics
3
Axillary radiograph
4
Electromyography
QUESTION 70
of 100
The patient is placed in a sling. Figure 73 is the MR image obtained 5 days later. What is the best next step?

1
Immediate closed reduction under anesthesia
2
Physical therapy
3
Nonsteroidal anti-inflammatory medications
4
Limited work duty recommendation ![img](/media/upload/c0dea3c1-661c-4b29-ab13-8284c305b1bf.jpg)
QUESTION 71
of 100
What is the most common long-term problem associated with the condition seen in Figure 73?
1
Neurologic injury
2
Persistent pain
3
Recurrent instability
4
Rotator cuff pathology
QUESTION 72
of 100
What is the best next treatment step?
1
Rotator cuff repair
2
Posterior labral repair
3
Acromioplasty
4
Anterior Bankart repair
QUESTION 73
of 100
A 49-year-old man has a recalcitrant history of atraumatic right elbow pain. He describes sharp stabbing pain just anterior and distal to the lateral epicondyle that is exacerbated by grabbing, lifting, and pulling activities. He denies any paresthesias. Upon examination, he expresses reproducible pain with resisted wrist extension, particularly with the elbow fully extended. He states that he was “diagnosed with tennis elbow” and has undergone 15 months of unsuccessful nonsurgical treatment including cortisone injections, physical therapy, and activity modification. After extensive consultation, he elects to proceed with surgical debridement. A histological examination of the debrided tissue likely would reveal
1
pooling of premature lymphocytes.
2
macrophage infiltration.
3
mature hypertrophic blood vessels.
4
angiofibroblastic hyperplasia.
QUESTION 74
of 100
A 60-year-old man has elbow pain and an effusion. You send an aspirate for evaluation. Which result would lead you to diagnose inflammatory arthritis?
1
Total protein = 2.1 g/dL, glucose = 90 mg/dL, white blood cells (WBC) = 63/mm3
2
Total protein = 2.99 g/dL, glucose = 90 mg/dL, WBC = 1000/mm3
3
Total protein = 6.0 g/dL, glucose = 10 mg/dL, WBC = 100000/mm3
4
Total protein = 4.20 g/dL, glucose = 40 mg/dL, WBC = 40000/mm3
QUESTION 75
of 100
A 20-year-old collegiate pitcher sustains a medial collateral ligament (MCL) rupture of his throwing elbow for which surgical reconstruction is necessary. The goal of surgery is anatomic restoration of the MCL. Which statement best describes the kinematics of the native MCL?

1
The posterior bundle demonstrates the greatest change in tension from flexion to extension.
2
The posterior bundle is isometric.
3
The anterior bundle becomes tight in flexion and lax in extension.
4
The anterior and posterior bundles are isometric.
QUESTION 76
of 100
What is the most likely cause of her symptoms?
1
Infection
2
Rotator cuff tear
3
Implant loosening
4
Implant instability
QUESTION 77
of 100
She completes the necessary testing and wishes to proceed with revision surgery. The most appropriate surgical option in this scenario involves implant removal and
1
unconstrained total shoulder arthroplasty (TSA).
2
resection arthroplasty.
3
reverse total shoulder arthroplasty (rTSA).
4
hemiarthroplasty.
QUESTION 78
of 100
Intraoperative frozen section analysis reveals 10 neutrophils per high-power field and a positive gram stain result. What is the best next step?
1
Implant removal, irrigation and debridement, and resection arthroplasty
2
Implant removal, irrigation and debridement, and rTSA
3
Implant removal, irrigation and debridement, and revision hemiarthroplasty
4
Implant removal, irrigation and debridement, and antibiotic cement spacer placement
QUESTION 79
of 100
A 78-year-old woman falls from standing, resulting in a displaced proximal humerus fracture with a dysvascular head. Treatment of the fracture with arthroplasty is indicated. Which statement best describes the outcome differences between hemiarthroplasty and reverse total shoulder arthroplasty (rTSA)?
1
Hemiarthroplasty is more likely to yield good internal rotation.
2
rTSA is associated with more implant-related complications.
3
rTSA is likely to yield better forward elevation.
4
Infection rates are higher for rTSA in this setting.
QUESTION 80
of 100
When using antibiotic-laden polymethylmethacrylate (PMMA) to treat osteomyelitis, vancomycin and tobramycin are heat stable and have not produced systemic toxicity at various levels. Which dose is closest to the highest recommended concentration for each drug?


1
2 grams each per 40 mg PMMA
2
3.6 grams each per 40 mg PMMA
3
10 grams each per 40 mg PMMA
4
20 grams each per 40 mg PMMA
QUESTION 81
of 100
What is the most appropriate next step?
1
Arthroscopic labral repair
2
Repeat MR imaging with contrast
3
Examination under anesthesia
4
Nonsteroidal anti-inflammatory drugs and physical therapy
QUESTION 82
of 100
Diagnosis of SLAP tears is difficult because
1
MR imaging is not performed without contrast.
2
examination findings are unreliable.
3
surgeons tend to agree on the pathology at arthroscopy.
4
SLAP lesions are uncommon in older individuals.
QUESTION 83
of 100
In this age group, symptomatic SLAP lesions are best treated with
1
biceps tenodesis.
2
open labral repair.
3
arthroscopic labral repair.
4
repair with bioabsorbable tacks.
QUESTION 84
of 100
A 65-year-old man has a 6-month history of diffuse left shoulder pain. He does not recall a previous shoulder or neck injury. Pain is worse with use of his shoulder and when he rolls over on the affected side at night. An examination reveals isolated atrophy of the infraspinatus without scapular winging. He has good strength in internal rotation and isolated supraspinatus testing.
There is weakness with resisted external rotation. Radiographs reveal degenerative change at the acromioclavicular joint. MR imaging of the left shoulder most likely would reveal
1
a suprascapular notch cyst.
2
a degenerative labral tear and spinoglenoid notch cyst.
3
a medial subluxation of the biceps tendon.
4
supraspinatus and infraspinatus tears retracted to the level of the glenoid.
QUESTION 85
of 100
When using antibiotic-laden polymethylmethacrylate (PMMA) beads, the elution characteristics produce which profile?
1
Rapid release during the initial 24 hours, followed by a period of rapid decrease, transitioning to a more steady decrease to very low levels by 5 weeks
2
Rapid release during the initial 24 hours, followed by a period of rapid decrease, transitioning to a more steady decrease to very low levels by 10 weeks
3
Rapid release during the initial 24 hours, followed by a period of gradual decrease, transitioning to a more steady decrease to very low levels by 1 week
4
Rapid release during the initial 72 hours, followed by a period of gradual decrease, transitioning to a more rapid decrease to very low levels by 7 weeks
QUESTION 86
of 100
A 62-year-old man experiences pain in his right shoulder (Figures 89a through 89c).



1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF) ![img](/media/upload/3577c141-fdfd-440e-8a18-f23ce25fc5b1.jpg) ![img](/media/upload/a3fd5bc3-8ee0-4bdc-a5d6-b17b60932a77.jpg) ![img](/media/upload/580d66dc-68d7-4175-8bfe-0c7bb8cbe42d.jpg)
QUESTION 87
of 100
A 58-year-old man has right shoulder pain. An examination reveals full range of motion in all planes but 4/5 forward elevation strength (Figures 90a and 90b).


1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 88
of 100
A 78-year-old woman with an acute shoulder injury (Figures 91a and 91b).

1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 89
of 100
A 55-year-old man experiences right shoulder pain 2 years after undergoing hemiarthroplasty for osteoarthritis. His laboratory values indicate normal C-reactive protein, erythrocyte sedimentation rate, and white blood cell count levels. He undergoes a shoulder aspiration and culture and an arthroscopic biopsy; all findings are negative. Belly-press and bear-hug test results are normal (Figures 92a and 92b).


1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF) ![img](/media/upload/28420b66-ea25-42e7-9a6b-8ad3e9f00e31.jpg) ![img](/media/upload/677da0d4-46b8-477f-9e13-808603dab05e.jpg)
QUESTION 90
of 100
A 72-year-old woman experiences left shoulder pain and dysfunction. An examination demonstrates 45 degrees of active forward elevation with 2/5 strength. The deltoid fires in the anterior, middle, and posterior heads (Figure 93).
1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 91
of 100
A 40-year-old male laborer with an acute left shoulder injury (Figures 94a and 94b).

1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 92
of 100
A 71-year-old woman has had 2 previous rotator cuff repairs to her right shoulder. An examination reveals 70 degrees of active forward elevation and 3/5 strength. An infection workup is negative (Figures 95a through 95c).


1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 93
of 100
A 35-year-old active woman with rheumatoid arthritis experiences right shoulder pain following an extended course of corticosteroids (Figures 96a and 96b).

1
Humeral head resurfacing/shoulder hemiarthroplasty
2
Anatomic total shoulder arthroplasty (TSA)
3
Reverse total shoulder arthroplasty (rTSA)
4
Rotator cuff repair
5
Open reduction and internal fixation (ORIF)
QUESTION 94
of 100
A 78-year-old woman falls and sustains a displaced proximal humerus fracture with a dysvascular humeral head. Which best describes her likely outcome if she chooses treatment with total shoulder arthroplasty (TSA)?
1
Hemiarthroplasty is associated with lower infection rates than reverse total shoulder arthroplasty (rTSA)
2
rTSA provides better internal rotation than hemiarthroplasty
3
rTSA is associated with lower revision surgery rates than hemiarthroplasty
4
Periprosthetic fracture rates are higher for hemiarthroplasty than for rTSA
QUESTION 95
of 100
Three months ago, a 33-year-old right-hand-dominant man fell on his right shoulder. He also sustained an anterior shoulder dislocation while playing football 12 years ago that was treated with an arthroscopic Bankart repair. He reports he did well after surgery until 5 years ago, at which time he sustained a right anterior shoulder dislocation and underwent a revision arthroscopic Bankart repair and capsular shift. After rehabilitating his shoulder, he states that he was doing well until 3 months ago when he fell. He feels that the shoulder is “sliding out” when he puts his arm in an abducted and externally rotated position. The symptoms remain unchanged despite participating in 2 months of physical therapy. Apprehension test findings are positive, and his symptoms improve with Jobe relocation testing. He has full range of motion without weakness. A CT arthrogram reveals 20% loss of bone of the anterior inferior glenoid but no Bankart tear. There is a nonengaging Hill-Sachs lesion. What is the most appropriate treatment?
1
Revision arthroscopic Bankart repair with remplissage
2
Open Bankart repair with capsular shift
3
Transfer of the coracoid to the anterior glenoid
4
Injection of platelet-rich plasma
QUESTION 96
of 100
A 28-year-old man is subjected to a blast and sustains the fragmentary injury shown in the plain radiographs in Figures 99a and 99b. He lacks distal radial nerve function. His wounds have associated soft-tissue damage, although they do not appear grossly contaminated, and tissue loss would not prevent either primary or delayed closure. Which surgical plan is associated with the lowest rate of revision surgery and complications?

1
Open reduction and intramedullary fixation
2
Primary closure and coaptation splinting
3
Nerve exploration and intramedullary fixation
4
Nerve exploration and internal fixation
QUESTION 97
of 100
A 63-year-old right-hand-dominant woman has a nontraumatic history of gradually progressive right shoulder pain. She describes a constant nagging pain that radiates to her deltoid insertion and has difficulty with overhead activities. Her examination and imaging studies confirm a rotator cuff tear. What is the mostly likely initiating anatomic location of her tear?
1
Anterior portion of the supraspinatus tendon adjacent to the biceps tendon
2
15 mm posterior to the biceps tendon near the supraspinatus/infraspinatus junction
3
Superior portion of the subscapularis tendon
4
30 mm posterior to the biceps tendon near the supraspinatus/infraspinatus junction
Dr. Mohammed Hutaif
Written & Medically Reviewed by
Dr. Mohammed Hutaif
Consultant Orthopedic & Spine Surgeon
Keywords
Prof. Mohammed Hutaif Orthopedic Surgeon Yemen abstract at pubmed pubmed pmid view pmid view abstract total shoulder arthroplasty
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