Free Test MCQs/SBAs Upper Limb Pathology

Best Answer: D .
Failure of the subscapularis tendon is likely given examination findings and anterior subluxation of the humeral component on axillary radiograph. Subscapularis failure is a well-described complication after anatomic total shoulder arthroplasty (aTSA). The subscapularis is detached during the initial deltopectoral approach to the shoulder and is then repaired at the end of the case. There are different methods of detaching the subscapularis, including a peel, tenotomy, and lesser tuberosity osteotomy. Despite the type of approach, subscapularis failure is a feared complication, as the glenohumeral joint loses its anterior-posterior force couple. Anterior subluxation or gross dislocation can be seen on an axillary radiograph. In some cases, if acute, revision subscapularis repair or augmentation may be performed but otherwise, revision to reverse total shoulder arthroplasty may be required. Figure is an axillary radiograph depicting an aTSA which is subluxated anteriorly. Incorrect Answers: Answer 1: There are no signs of infection on examination; rather, his exam and radiographs reflect a tear of the subscapularis. Answer 2: There is no evidence of glenoid loosening on radiographs or based on the history/examination. Answer 3: Empty can strength is 5/5, suggestive of an intact supraspinatus. Answer 5: Sensation over the entire upper extremity is intact which would likely not be the case if there were an axillary neuropraxia. Additionally, the patient may have some weakness in abduction given deltoid innervation of the axillary nerve

Best Answer: D
Progressive weakness is a common sign with a large differential diagnosis. Nerve, muscle, and joint problems should be excluded when a patient has diffuse weakness and atrophy. Fascioscapulohumeral dystrophy is a rare disease characterized by facial muscle weakness and proximal shoulder muscle weakness. The weakness is usually bilateral, and scapular winging is common. If the scapular winging becomes pronounced, elevation of the shoulder can be affected. In severe cases, scapulothoracic fusion or pectoralis muscle transfer to the scapula may be indicated. Duchenne muscular dystrophy is typically severe and progressive. The other diagnoses are not compatible with the history or the physical findings.

Best Answer: E .
The patient has end-stage rotator cuff tear arthropathy. The radiograph shows complete proximal humeral migration (acromiohumeral interval of 0 mm), severe glenohumeral arthritis, and acetabularization of the acromion. In addition, she has "pseudoparalysis" with active elevation of only 30 degrees. Reverse shoulder arthroplasty affords her the best opportunity for pain relief and functional improvement. The other procedures have mixed results but typically are better for pain relief than they are for functional gains

Best answer : A .
On a sagittal MRI image, the long head of the biceps can be seen in cross section in this interval between the subscapularis and supraspinatus.

Best answer :E .
This child has congenital proximal radioulnar synostosis . There are no apparent fractures. Observation is all that is necessary. CPRUS is a rare condition arising as a failure of longitudinal segmentation. The cartilaginous anlage between the radius-ulna during the 7th week in utero leaves a persistent bridge of tissue. The average age of diagnosis is 6 years and there is a positive family history in 20% of cases. The average position of the forearm is 30 degrees of pronation. Surgery is rarely indicated. Surgical recommendations include positioning the dominant forearm in 10-20° pronation and the nondominant forearm in neutral rotation (bilateral) or 30° of pronation (unilateral cases).

Best Answer: D .
This patient exhibits a positive "belly press" test. As he attempts to press on his abdomen, his wrist goes into flexion and his arm goes into extension because of subscapularis insufficiency.

Best Answer: E .
The MRI shows a disruption of the humeral attachment of the ulnar collateral ligament. The ulnar collateral ligament of the elbow is the most frequently observed ligamentous elbow injury in cricket players. Recommended treatment in the throwing athlete is reconstruction of the ulnar collateral ligament with an autogenous palmaris longus graft .