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Shoulder & Elbow 2015 Flashcards

1
Q
  1. A 72-year-old man with cuff tear arthropathy is scheduled for a reverse total shoulder arthroplasty. Which examination finding most strongly indicates the need for a concomitant latissimus dorsi transfer?
  2. Pseudoparalysis
  3. Anterosuperior escape
  4. Positive drop arm sign
  5. Positive Hornblower’s test result
  6. Passive external rotation to 0 degrees
A
  1. Positive Hornblower’s test result

RECOMMENDED READINGS

Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998 Jul;80(4):624-8. PubMed PMID: 9699824.

Puskas GJ, Catanzaro S, Gerber C. Clinical outcome of reverse total shoulder arthroplasty combined with latissimus dorsi transfer for the treatment of chronic combined pseudoparesis of elevation and external rotation of the shoulder. J Shoulder Elbow Surg. 2014 Jan;23(1):49-57. doi: 10.1016/j.jse.2013.04.008. Epub 2013 Jun 18. PubMed PMID: 23790326.

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2
Q
  1. An 82-year-old right-hand-dominant man has progressive pain in his left shoulder and loss of overhead function. He underwent a reverse total shoulder arthroplasty for rotator cuff–deficient arthritis 30 months ago. Radiographs taken at the current visit are shown in Figures 26a through 26c, and select images from a CT scan are shown in Figures 26d through 26f. Infection workup findings are negative. Examination reveals 70 degrees of forward elevation with pain with 20 degrees of external rotation. Axillary nerve function is intact. Definitive treatment should consist of
  2. retention of the glenoid component with a reverse humeral stem revision.
  3. removal of both glenoid and humeral components (“resection arthroplasty”).
  4. removal of the glenoid component with humeral stem revision to hemiarthroplasty.
  5. in situ placement of the larger glenosphere component with revision reverse humeral stem.
  6. revision glenoid baseplate with superiorly placed bone graft with revision reverse humeral stem.
A
  1. revision glenoid baseplate with superiorly placed bone graft with revision reverse humeral stem.

RECOMMENDED READINGS

Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013 Oct;22(10):1359-70. doi: 10.1016/j.jse.2013.02.004. Epub 2013 May 22. PubMed PMID: 23706884.

Holcomb JO, Cuff D, Petersen SA, Pupello DR, Frankle MA. Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009 Sep- Oct;18(5):717-23. doi: 10.1016/j.jse.2008.11.017. Epub 2009 Mar 17. PubMed PMID: 19278872.

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3
Q
  1. Figures 34a and 34b are the radiographs of a 22-year-old woman who sustained an elbow injury after a fall. In the emergency department, her skin is noted to be intact. There is no tenderness over the medial elbow or the distal radioulnar joint. What is the best treatment option?
  2. Radial head arthroplasty
  3. Long-arm cast for 3 weeks
  4. Excision of the fracture fragments
  5. Open reduction and internal fixation (ORIF)
  6. Early motion with a functional brace
A
  1. Open reduction and internal fixation (ORIF)

RECOMMENDED READINGS

Pike JM, Grewal R, Athwal GS, Faber KJ, King GJ. Open reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries? Clin Orthop Relat Res. 2014 Jul;472(7):2120-7. doi: 10.1007/s11999-014-3519-8. PubMed PMID: 24585322; PubMed Central PMCID: PMC4048425.

Yoon A, King GJ, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? Clin Orthop Relat Res. 2014 Jul;472(7):2105-12. doi: 10.1007/ s11999-014-3541-x. PubMed PMID: 24577616; PubMed Central PMCID: PMC4048435.

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4
Q
  1. Video 41 is viewed from the posterior portal during shoulder arthroscopy. The instrument is introduced through the anterior portal. Based on these video findings, which examination maneuver would most likely elicit an abnormality of the indicated structure?
  2. Speed test
  3. O’Brien test
  4. Belly press test
  5. Hornblower’s test
  6. Cross-body adduction
A
  1. Belly press test

RECOMMENDED READINGS

Faruqui S, Wijdicks C, Foad A. Sensitivity of physical examination versus arthroscopy in diagnosing subscapularis tendon injury. Orthopedics. 2014 Jan;37(1):e29-33. PubMed PMID: 24683653.

Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg. 2013 Sep;22(9):1186-92. doi: 10.1016/j.jse.2012.12.002. Epub 2013 Feb 20. PubMed PMID:23434234.

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5
Q
  1. Figures 53a through 53e are the radiographs and CT scans of a 78-year-old man who is seen in the emergency department with persistent left shoulder pain 3 weeks after a fall. He had full function of his left shoulder prior to the fall. He lives alone, and his medical history includes diabetes and hypertension. Examination reveals pain with any attempted shoulder motion. He is neurovascularly intact in the left upper extremity. What is the best next step?
  2. Hemiarthroplasty with biceps tenodesis
  3. Unconstrained total shoulder arthroplasty
  4. Reverse shoulder arthroplasty with tuberosity repair
  5. Percutaneous pinning
  6. Open reduction and internal fixation with locked plating
A
  1. Reverse shoulder arthroplasty with tuberosity repair

RECOMMENDED READINGS

Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br. 2007 Apr;89(4):516-20. PubMed PMID: 17463122.

Jobin CM, Galdi B, Anakwenze OA, Ahmad CS, Levine WN. Reverse shoulder arthroplasty for the management of proximal humerus fractures. J Am Acad Orthop Surg. 2015 Mar;23(3):190-201. doi: 10.5435/JAAOS-D-13-00190. Epub 2015 Jan 28. Review. PubMed PMID: 25630370.

Anakwenze OA, Zoller S, Ahmad CS, Levine WN. Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review. J Shoulder Elbow Surg. 2014 Apr;23(4):e73-80. doi: 10.1016/j. jse.2013.09.012. Epub 2014 Jan 7. Review. PubMed PMID: 24406120.

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6
Q
  1. A 24-year-old man underwent closed reduction for an elbow dislocation 3 months ago. Now, he continues to experience elbow discomfort and feelings of instability. When his forearm is supinated and a valgus force is applied, his pain is recreated as the elbow is brought from flexion to extension. He also has difficulty getting out of a chair with his forearms supinated. He has completed a course of physical therapy without experiencing improvement. Which soft-tissue structure shown in Figure 66 requires reconstruction?
  2. A
  3. B
  4. C
  5. D
  6. E
A
  1. E

RECOMMENDED READINGS

O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991 Mar;73(3):440-6. PubMed PMID: 2002081.

Sanchez-Sotelo J, Morrey BF, O’Driscoll SW. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2005 Jan;87(1):54-61. PubMed PMID: 15686238.

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7
Q
  1. Figures 85a and 85b are the radiographs of a 32-year-old man who had an arthroscopic superior labral repair 5 months ago. Three-suture anchors were used to complete the repair, and all were placed through an anterior rotator interval portal. He has severe posterior shoulder pain with limited overhead elevation and “weakness.” Examination reveals active forward elevation limited to 120 degrees by pain, but he has full passive range of motion, and the belly press test finding is within normal limits. The patient has weakness of external rotation by the side. What is the most likely cause of his symptoms?
  2. Rotator cuff tear
  3. Adhesive capsulitis
  4. Axillary nerve injury
  5. Suprascapular nerve injury
  6. Posttraumatic arthritis
A
  1. Suprascapular nerve injury

RECOMMENDED READINGS

Morgan RT, Henn RF 3rd, Paryavi E, Dreese J. Injury to the suprascapular nerve during superior labrum anterior and posterior repair: is a rotator interval portal safer than an anterosuperior portal? Arthroscopy. 2014 Nov;30(11):1418-23. doi: 10.1016/j.arthro.2014.06.006. Epub 2014 Aug 12. PubMed PMID: 25125380.

Koh KH, Park WH, Lim TK, Yoo JC. Medial perforation of the glenoid neck following SLAP repair places the suprascapular nerve at risk: a cadaveric study. J Shoulder Elbow Surg. 2011 Mar;20(2):245-50. doi: 10.1016/j.jse.2010.06.004. Epub 2010 Oct 16. PubMed PMID: 20951610.

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8
Q

89.

Figure 89 is the clinical photograph of a 42-year-old woman who has had gradual-onset atraumatic elbow pain for 2 months. She has pain with daily activities and especially when her elbow is extended. Her elbow is tender to palpation in the area shown in the photograph, but elbow radiograph findings are normal. What is the best next step?

  1. Elbow immobilization
  2. Cortisone injection
  3. Ligament reconstruction
  4. Tendon repair
  5. Tendon gliding exercises
A
  1. Tendon gliding exercises

RECOMMENDED READINGS

Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6;309(5):461-9. doi: 10.1001/jama.2013.129. PubMed PMID: 23385272.

Dines JS, Bedi A, Williams PN, Dodson CC, Ellenbecker TS, Altchek DW, Windler G, Dines DM. Tennis Injuries: Epidemiology, Pathophysiology, and Treatment. J Am Acad Orthop Surg. 2015 Mar;23(3):181- 189. Epub 2015 Feb 9. Review. PubMed PMID: 25667400.

Boyer MI, Hastings H 2nd. Lateral tennis elbow: “Is there any science out there?” J Shoulder Elbow Surg. 1999 Sep-Oct;8(5):481-91. Review. PubMed PMID: 10543604.

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9
Q
  1. A 52-year-old otherwise healthy woman elects to undergo an arthroscopic right shoulder rotator cuff repair with decompression in the beach chair position. She receives an uncomplicated interscalene regional block using nerve stimulation localization that is supplemented with laryngeal mask airway. Twenty minutes into surgery, the anesthesiologist informs you that the patient has become hypotensive (mean arterial pressure 40-60 mm Hg) and tachycardic despite repeated use of vasopressors. Decreased breath sounds are noted in the upper lung fields on the right. In addition to halting the surgery, the most appropriate next step is a
  2. CT angiogram.
  3. venous duplex ultrasound.
  4. portable chest radiograph.
  5. critical care consultation.
  6. transesophageal echocardiogram.
A
  1. portable chest radiograph.

RECOMMENDED READINGS

Bryan NA, Swenson JD, Greis PE, Burks RT. Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications. J Shoulder Elbow Surg. 2007 Jul- Aug;16(4):388-95. Epub 2007 May 15. PubMed PMID: 1750724.

Mandim BL, Alves RR, Almeida R, Pontes JP, Arantes LJ, Morais FP. Pneumothorax post brachial plexus block guided by ultrasound: a case report. Rev Bras Anestesiol. 2012 Sep-Oct;62(5):741-7. doi: 10.1016/ S0034-7094(12)70173-3. PubMed PMID: 22999407.

Lee HC, Dewan N, Crosby L. Subcutaneous emphysema, pneumomediastinum, and potentially life-threatening tension pneumothorax. Pulmonary complications from arthroscopic shoulder decompression. Chest. 1992 May;101(5):1265-7. PubMed PMID: 1582282.

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10
Q
  1. During arthroscopic evaluation of a 44-year-old mechanic’s shoulder, the pathology noted in Figure 116 is seen. What is the best treatment option?
  2. Labral repair
  3. Biceps tenodesis
  4. Rotator cuff repair
  5. Rotator cuff debridement
  6. Subacromial decompression
A
  1. Rotator cuff repair

RECOMMENDED READINGS

Cordasco FA, Backer M, Craig EV, Klein D, Warren RF. The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med. 2002 Mar-Apr;30(2):257-60. PubMed PMID: 11912097.

Payne LZ, Altchek DW, Craig EV, Warren RF. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. Am J Sports Med. 1997 May-Jun;25(3):299-305. PubMed PMID: 9167807.

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11
Q
  1. The examination finding demonstrated in Video 131 is consistent with a tear of which structure?
  2. Infraspinatus
  3. Subscapularis
  4. Pectoralis major
  5. Superior labrum
  6. Long head of the biceps
A
  1. Infraspinatus

RECOMMENDED READINGS

Castoldi F, Blonna D, Hertel R. External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34. doi: 10.1016/j. jse.2008.11.007. Epub 2009 Feb 14. PMID: 19223205.

Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998 Jul;80(4):624-8. PMID: 9699824.

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12
Q
  1. Figures 149a through 149e are the radiographs and MR images of a 78-year-old woman who has pain in her left shoulder. The pain is worse at night and seems to “come and go”. She has functional restrictions for simple activities of daily living. Her treatment to date has consisted of occasional acetaminophen, which temporarily eases the pain. Examination reveals 140 degrees of overhead elevation and 30 degrees of external rotation with a 10-degree external rotation lag. There is moderate pain at the extremes of motion and weakness to resistance. What is the best next step?
  2. Injection of corticosteroids followed by physical therapy
  3. Trial of immobilization with referral to pain management
  4. Reverse total shoulder arthroplasty with latissimus dorsi transfer
  5. Arthroscopic capsular release with manipulation under anesthesia
  6. Arthroscopic partial rotator cuff repair with concomitant interpositional allograft
A
  1. Injection of corticosteroids followed by physical therapy

© 2015 American Academy of Orthopaedic Surgeons 2015 Orthopaedic In-Training Examination

RECOMMENDED READINGS

Laudicina L, D’Ambrosia R. Management of irreparable rotator cuff tears and glenohumeral arthritis. Orthopedics. 2005 Apr;28(4):382-8; quiz 389-90. Review. PubMed PMID: 15887585.

Izquierdo R, Voloshin I, Edwards S, Freehill MQ, Stanwood W, Wiater JM, Watters WC 3rd, Goldberg MJ, Keith M, Turkelson CM, Wies JL, Anderson S, Boyer K, Raymond L, Sluka P; American Academy of Orthopaedic Surgeons. Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg. 2010 Jun;18(6):375-82. PubMed PMID: 20511443.

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13
Q
  1. Figure 167 is an intraoperative view from the accessory anterolateral portal of a 31-year-old man who underwent arthroscopic surgery on his right shoulder. The surgery was performed in the lateral decubitus position. During the first 3 weeks after surgery, the repair will be protected by avoiding repetitive passive
  2. abduction to 90 degrees in the scapular plane.
  3. internal rotation with the shoulder adducted.
  4. adduction with the shoulder flexed at shoulder level.
  5. external rotation with the shoulder adducted.
  6. external rotation to 45 degrees with the shoulder abducted.
A
  1. adduction with the shoulder flexed at shoulder level.

RECOMMENDED READINGS

Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003 Aug;85-A(8):1479-87. PubMed PMID: 12925627.

Millett PJ, Clavert P, Hatch GF 3rd, Warner JJ. Recurrent posterior shoulder instability. J Am Acad Orthop Surg. 2006 Aug;14(8):464-76. Review. PubMed PMID: 16885478.

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14
Q
  1. Figures 178a and 178b are the plain radiographs of a 36-year-old woman who has right elbow stiffness. She sustained an injury to her right elbow 7 months ago. Injury radiographs are shown in Figures 178c and 178d. She underwent a protracted course of occupational therapy that included use of a static splint. Examination reveals elbow range of motion from 15 degrees of extension and flexion of 90 degrees. There is no pain in the midrange of her motion arc, but there is pain at the extremes. During an open release of her elbow to restore elbow flexion, release of which structure is necessary?
  2. Posterior oblique band of the medial collateral ligament
  3. Triceps tendon insertion
  4. Lateral ulnar collateral ligament
  5. Anterior capsule
  6. Anterior band of the medial collateral ligament
A
  1. Posterior oblique band of the medial collateral ligament

RECOMMENDED READINGS

Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983 Sep-Oct;11(5):315-9. PubMed PMID: 6638246.

Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991 Oct;(271):170-9. PubMed PMID: 1914292.

Wada T, Ishii S, Usui M, Miyano S. The medial approach for operative release of post-traumatic contracture of the elbow. J Bone Joint Surg Br. 2000 Jan;82(1):68-73. PubMed PMID: 10697317.

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15
Q
  1. Figures 185a through 185d are the radiographs and MR image of a 55-year-old man who had arthroscopic repair of an acute, traumatic, massive 2-tendon rotator cuff tear involving the supraspinatus and infraspinatus 4 months ago. He did well initially with formal physical therapy, but during the last month has noted increasing shoulder pain and decreasing range of motion. Examination reveals he has active forward elevation of about 100 degrees. He has well-preserved passive range of motion, weakness of external rotation by his side, and positive impingement signs. Hornblower’s and belly press test findings are normal, and an infection workup is negative. What is the best next step?
  2. Revision rotator cuff repair
  3. Continued physical therapy
  4. Hemiarthroplasty
  5. Latissimus dorsi transfer
  6. Reverse total shoulder arthroplasty
A
  1. Revision rotator cuff repair

RECOMMENDED READINGS

Denard PJ, Burkhart SS. Arthroscopic revision rotator cuff repair. J Am Acad Orthop Surg. 2011 Nov;19(11):657-66. Review. PubMed PMID: 22052642.

Lambers Heerspink FO, Dorrestijn O, van Raay JJ, Diercks RL. Specific patient-related prognostic factors for rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2014 Jul;23(7):1073-80. doi: 10.1016/j.jse.2014.01.001. Epub 2014 Apr 13. Review. PubMed PMID: 24725900.

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16
Q
  1. An active 65-year-old woman slipped on ice, fell down 2 steps, and injured her right shoulder. Prior to the injury her shoulder “was normal,” and she denies any history of shoulder pain or injury. She sustained a distal radius fracture 1 year ago after sustaining a simple mechanical fall, which was treated with cast immobilization. Examination reveals that her skin is intact and the deltoid contracts well. Radiographs demonstrate a displaced 4-part proximal humeral fracture with a fracture through the anatomic neck that has a 2-mm posteromedial metaphyseal extension. The head fragment is in 90 degrees of varus. What is the best treatment option?
  2. Hemiarthroplasty
  3. Percutaneous pinning
  4. Unconstrained total shoulder arthroplasty
  5. Open reduction and internal fixation (ORIF)
  6. Sling immobilization and physical therapy
A
  1. Hemiarthroplasty

RECOMMENDED READINGS

Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009 Jul;91(7):1689-97. doi: 10.2106/JBJS.H.00133. PubMed PMID: 19571092.

Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008 Nov;90(11):1407-13. doi: 10.1302/0301-620X.90B11.21070. Review. PubMed PMID: 18978256.

17
Q
  1. Which diagnosis most favorably influences implant survivorship among patients who undergo total elbow arthroplasty?
  2. Rheumatoid arthritis
  3. Posttraumatic arthritis
  4. Primary osteoarthritis
  5. Distal humeral nonunion
  6. Acute distal humeral fracture
A
  1. Rheumatoid arthritis

© 2015 American Academy of Orthopaedic Surgeons 2015 Orthopaedic In-Training Examination

Question 213

Which diagnosis most favorably influences implant survivorship among patients who undergo total elbow arthroplasty?

  1. Rheumatoid arthritis
  2. Posttraumatic arthritis
  3. Primary osteoarthritis
  4. Distal humeral nonunion
  5. Acute distal humeral fracture

PREFERRED RESPONSE: 1

RECOMMENDED READINGS

Aldridge JM 3rd, Lightdale NR, Mallon WJ, Coonrad RW. Total elbow arthroplasty with the Coonrad/ Coonrad-Morrey prosthesis. A 10- to 31-year survival analysis. J Bone Joint Surg Br. 2006 Apr;88(4):509- 14. PubMed PMID: 16567787.

Skyttä ET, Eskelinen A, Paavolainen P, Ikävalko M, Remes V. Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register. Acta Orthop. 2009 Aug;80(4):472-7. doi: 10.3109/17453670903110642. PubMed PMID: 19562563; PubMed Central PMCID: PMC2823192.

Cil A, Veillette CJ, Sanchez-Sotelo J, Morrey BF. Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg Am. 2008 Sep;90(9):1939-50. doi: 10.2106/JBJS.G.00690. PubMed PMID: 18762655.

Schneeberger AG, Adams R, Morrey BF. Semiconstrained total elbow replacement for the treatment of post-traumatic osteoarthrosis. J Bone Joint Surg Am. 1997 Aug;79(8):1211-22. PubMed PMID: 9278082.

Kozak TK, Adams RA, Morrey BF. Total elbow arthroplasty in primary osteoarthritis of the elbow. J Arthroplasty 1998;13(7):837-842. PMID: 9802675.

Kamineni S, Morrey BF. Distal humeral fractures treated with noncustom total elbow replacement. Surgical technique. J Bone Joint Surg Am 2005;87 Suppl 1(Pt 1):41-50. PMID:15743846.

18
Q
  1. Under the Physician Payments Sunshine Act, what is the annual monetary value limit for items given to physicians by orthopaedic implant companies? (These companies must report this type of activity to the Centers for Medicare and Medicaid Services.)
  2. $10
  3. $25
  4. $50
  5. $100
  6. $200
A
  1. $10

RECOMMEND READINGS

Peterson RN. What the sunshine law brings to light. AAOS NOW March 2013, page 1,

19
Q
  1. A 55-year-old woman has had pain in her left shoulder for 3 months with no preceding trauma. Examination reveals substantial reduction in her left shoulder motion, both actively and passively. MR imaging reveals space reduction in the axillary recess. Which comorbidity is associated with a much worse prognosis and poorer outcomes of both nonsurgical and surgical treatment?
  2. Diabetes mellitus
  3. Crohn’s disease
  4. Renal disease
  5. Congestive obstructive pulmonary disease
  6. Breast cancer
A
  1. Diabetes mellitus

RECOMMENDED READINGS

Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011 Sep;19(9):536-42. Review. PubMed PMID: 21885699.

Arkkila PE, Kantola IM, Viikari JS, Rönnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996 Dec;55(12):907-14. PubMed PMID: 9014585; PubMed Central PMCID: PMC1010343.

20
Q
  1. A 55-year-old woman had successful reduction of an anterior shoulder dislocation 2 weeks ago. Examination reveals she is unable to actively elevate her arm. Her passive range of motion is equal to uninjured shoulder motion. What is the function of the structure that is most likely injured?
  2. Scapular protraction and inferior rotation
  3. Scapular elevation and superior rotation
  4. Flexion and supination of the forearm
  5. Extension of the humerus
  6. Compression of the humeral head against the glenoid
A
  1. Compression of the humeral head against the glenoid

RECOMMENDED READINGS

Neviaser RJ, Neviaser TJ, Neviaser JS. Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg Am. 1988 Oct;70(9):1308-11. PubMed PMID: 3182884.

Jouve F, Graveleau N, Nové-Josserand L, Walch G. [Recurrent anterior instability of the shoulder associated with full thickness rotator cuff tear: results of surgical treatment]. Rev Chir Orthop Reparatrice Appar Mot. 2008 Nov;94(7):659-69. doi: 10.1016/j.rco.2008.03.032. Epub 2008 May 12. French. PubMed PMID: 18984123.

21
Q
  1. A 45-year-old man has a painful shoulder after a fall and difficulty elevating his arm above waist level. Shoulder radiograph findings are normal. His belly press sign is positive, but there is no external rotation lag. His deltoid contracts strongly. Which other examination finding would most likely be positive?
  2. Neer test
  3. Lift-off test
  4. Apprehension test
  5. Hornblower’s test
  6. Increased passive internal rotation
A
  1. Lift-off test

RECOMMENDED READINGS

Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991 May;73(3):389-94. PubMed PMID: 1670434.

Barth J, Audebert S, Toussaint B, Charousset C, Godeneche A, Graveleau N, Joudet T, Lefebvre Y, Nove- Josserand L, Petroff E, Solignac N, Scymanski C, Pitermann M, Thelu CE; French Arthroscopy Society. Diagnosis of subscapularis tendon tears: are available diagnostic tests pertinent for a positive diagnosis? Orthop Traumatol Surg Res. 2012 Dec;98(8 Suppl):S178-85. doi:10.1016/j.otsr.2012.09.008. Epub 2012 Nov 9. PubMed PMID: 23142297.

22
Q
  1. What is the most likely risk factor for recurrent shoulder instability after arthroscopic anterior shoulder stabilization?
  2. Female gender
  3. Athletic throwing activity
  4. Age older than 20 years
  5. Unidirectional instability
  6. Attritional glenoid bone loss
A
  1. Attritional glenoid bone loss

RECOMMENDED READINGS

Ahmed I, Ashton F, Robinson CM. Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am. 2012 Jul 18;94(14):1308-15. doi: 10.2106/JBJS.J.01983. PubMed PMID: 22810402.

Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007 Nov;89(11):1470-7. PubMed PMID: 17998184.

23
Q
  1. When performing a primary anatomic total shoulder arthroplasty for glenohumeral osteoarthritis, selecting an appropriately sized humeral head component is important to avoid either overstuffing the joint or leaving it too lax. Which relationship between thickness of the humeral head and radius of the curvature most closely replicates normal anatomy?
  2. Approximately 30% radius of curvature
  3. Approximately 40% radius of curvature
  4. Approximately 50% radius of curvature
  5. Approximately 70% radius of curvature
  6. Approximately 90% radius of curvature
A
  1. Approximately 70% radius of curvature

RECOMMENDED READINGS

Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997 Sep;79(5):857-65. PubMed PMID: 9331050.

Robertson DD, Yuan J, Bigliani LU, Flatow EL, Yamaguchi K. Three-dimensional analysis of the proximal part of the humerus: relevance to arthroplasty. J Bone Joint Surg Am. 2000 Nov;82-A(11):1594-602. PubMed PMID: 11097450.

24
Q
A

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