Abstract
Shoulder/Elbow II Structured SBA Questions
Shoulder/Elbow II Structured SBA Questions
1. A 10-year-old boy who is a keen javelin thrower complains of progressive medial elbow pain of his throwing arm for the last 6 months. Examination reveals medial-sided elbow tenderness. The x-ray and MRI images are shown in Figure 11.1(a) and (b).
Figure 11.1 (a) Anteroposterior (AP) radiograph and (b) MRI image elbow
What is the most appropriate management option?
2. A 65-year-old female with recurrent left olecranon bursitis started on ciprofloxacin treatment presents with a sudden, sharp pain in the elbow after trying to lift a heavy shopping bag. On clinical examination, she has a tender olecranon process with an extension lag of terminal 30 degrees. The left lateral elbow x-ray is shown in Figure 11.2.
Figure 11.2 Lateral radiograph elbow
What is the most appropriate management option?
3. A 43-year-old man had a sudden onset of elbow pain while at the gym. Over time, the swelling and discomfort have settled. He reports that he is required to use power tools at work to tighten screws. He retains good power of flexion. MRI image is shown in Figure 11.3.
Figure 11.3 MRI elbow coronal image
Which structure is involved here?
4. A 32-year-old male sustains a distal biceps rupture while lifting a heavy bag and elects to undergo surgical repair.
What is the most likely neurological deficit to occur as a complication of using a two-incision technique surgical approach?
5. A 50-year-old tennis player has chronic pain over the lateral aspect of the elbow. He notes pain when using a heavy racket. On examination, he has pain with resisted wrist extension while the elbow is fully extended.
What does the pathoanatomy of this condition most likely demonstrate?
6. A 52-year-old female had two steroid and local anaesthetic injections for a diagnosis of tennis elbow made by her GP and physiotherapist. She presents with lateral elbow pain and tenderness that worsens with extension and rotation. She also has episodes of weak grip with sleep interference.
What is the next most appropriate line of treatment?
7. An 8-year-old boy was admitted from the ED after falling off a bicycle. He sustained a left elbow extension type supracondylar fracture (Figure 11.4). It was difficult to perform an objective assessment of the neurological status in the hand, as he was quite distressed at presentation. He was taken to theatre for an MUA and cast application. The following day, he complains of some weakness at the left hand.
Figure 11.4 Anteroposterior (AP) and lateral radiographs displaced supracondylar humerus fracture
What is the most likely finding on clinical examination?
8. A 44-year-old man was involved in RTA and sustained a complex fracture dislocation of the elbow. The fracture was fixed, and ligaments repaired. Six months later the patient reports symptoms of elbow instability with everyday activities. It has been decided to offer reconstruction using a double loop tendon graft technique to improve stability.
All the following structures are augmented with this technique except for?
9. A 7-year-old girl fell 2 feet off a bunk bed onto her left elbow. The injury caused severe pain and deformity and was managed surgically. Clinic follow-up was patchy, as several follow-up appointments were missed due to illness and holidays. At 12 months the child was reviewed in clinic. Radiographs are shown in Figure 11.5 with the right side for comparison.
Which of the following statements is true?
The resultant deformity is a combination of varus, extension and external rotation of the distal fragment
10. An 8-year-old boy who is a football player sustains an injury to his right elbow. Investigations demonstrated the fracture shown in Figure 11.6.
Figure 11.6 Anteroposterior (AP) and lateral radiographs right elbow
Which of the following statements is true?
11. During surgical treatment of an olecranon fracture with a tension-band wiring using transcortical fixation, what muscle function is at risk with over-penetration of the proximal anterior cortex of the ulna with the Kirchner wire?
12. A 10-year-old boy sustained a displaced grade 3 supracondylar fracture while jumping off a trampoline. His hand was pulseless and cold. MUA and closed wiring were performed, and the hand has now turned pink; however, it is still pulseless.
What is the most appropriate next step in management?
13. A 42-year-old man sustained a right elbow injury while playing football 3 months previously. His elbow radiograph is shown in Figure 11.7. He underwent surgery to the elbow. Postoperatively he was mobilised in a hinged brace. On examination today, his arc of elbow flexion is 85 degrees with 35 degrees of flexion deformity. His DASH Outcome Measure score is 45 points.
Figure 11.7 Lateral radiograph right elbow
What initial treatment option would most likely be the first line treatment of choice for the greatest improvement in his DASH score and function?
14. A 11-year-old gymnast presented with a history of several weeks pain and stiffness in the elbow, often with a history of repeated valgus stress. Symptoms were increased by activity and relieved by rest. He has an effusion and a painful click on passive elbow rotation. He has lost approximately 20° of extension.
What is the most likely finding on MRI?
A decreased signal intensity of the capitellum is seen on a T1 series and an increased signal intensity is shown on a T2 series
Increased T2-weighted signal intensity in the common extensor tendon, compatible with lateral epicondylitis
Sagittal T2-weighted FS MR image demonstrates characteristic ‘kissing contusions’ on the posterior capitellum and anterior radial head and disruption of the posterior joint capsule. There is also posterior subluxation of the radial head
15. A 7-year-old boy underwent ORIF for a severely displaced lateral condyle fracture of his elbow 4 years previously. There were no immediate complications post-surgery. He was brought back to the outpatient department with ongoing problems.
He is most likely to present with which of the following?
16. An 8-year-old girl presented with Grade 3 supracondylar fracture at 1700. She was taken to theatre overnight and underwent percutaneous cross K-wire fixation. She was sent home in the morning. She presented to the ED the same evening complaining that she cannot feel her little finger.
What is the most appropriate immediate management?
17. A 30-year-old man presented with an 8-week history of fall onto his elbow. He is complaining of recurrent elbow popping, clicking, cluncking and locking.
All the following structures are likely to have been injured except?
18. All of the following are true about radial neck fractures except which?
19. A 45-year-old male presents to you with sensitivity in his right elbow. He reports that the pain occurs on the posteromedial aspect of the elbow, and it is particularly bad when he flexes his elbow, such as when he is using his cell phone. He describes the feeling as a 5 out of 10 ‘aching’ pain and says that it is sometimes accompanied by a sharp tingling sensation in his little and ring fingers. There is a feeling of clicking and something rolling with flexion and extension.
Which of the following should the surgeon avoid during surgical repair?
20. A 36-year-old left-handed female taxi driver presents to clinic with a 6-month history of progressive loss of manual dexterity and increasing numbness on the medial border of the right hand. Symptoms increase with a busy day in the taxi. There is no increase in symptoms with overhead activities. She sustained an elbow fracture as a child.
Clinical features suggestive of the diagnosis would include which of the following?
21. A 22-year-old right-handed professional javelin thrower attends the outpatient clinic with a 1-month history of right elbow pain. The pain is localised to the medial side of the elbow, and his pain is exacerbated by overhead throwing activities. He denies any locking or catching within the elbow. Clinical examination demonstrates focal tenderness over the medial epicondyle. There is significant pain when a valgus stress is applied to the elbow.
The most likely diagnosis is which of the following?
22. A 23-year-old body builder and regular gym user attends clinic complaining of several months’ history of tingling and numbness of his right little finger. Examination reveals weakness of pinch.
The most likely site of nerve compression would be which of the following?
23. A 53-year-old male patient attends follow-up OP clinic after an MRI scan has been ordered for right shoulder pain. The scan reports a full-thickness tear.
Concerning rotator cuff tears, which of the following is true?
Related posts:
Chapter 6 – Knee II Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 19 – Structure and Function of Connective Tissue Structured SBA
Chapter 5 – Knee Structured I SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 15 – Hand II Structured SBA
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
