4.3 of 67 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 55-year-old male with a history of right shoulder osteoarthritis underwent a total shoulder arthroplasty 7 months ago. The patient now complains of right shoulder pain, instability, and weakness. He denies any falls or other trauma since surgery. Physical exam is notable for weakness with the belly-press test and external rotation of the right shoulder to 110 degrees compared to 80 on the contralateral side. His radiograph is shown in Figure A. What is the likely cause of this patient's symptoms?
Missed intraoperative periprosthetic humeral shaft fracture
Glenoid component malpositioning
Lesser tuberosity nonunion
Oversizing of the humeral head
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A 65-year-old male underwent a right total shoulder arthroplasty procedure 5 years ago and is presenting with increasing shoulder pain and weakness. The patient denies any recent falls, fevers, or chills. The patient is unable to abduct the arm beyond 30 degrees but can be assisted passively to 120 degrees. Physical exam demonstrates a positive belly-press test and Jobe's test, but negative Hornblower's test and normal external rotation strength with the arm at the side. Figures A and B are the current radiographs. Current ESR and CRP are 21 mm/hr and 1.2 g/L,respectively. What is the most likely cause of the patient's symptoms and associated risk factor?
Osteolysis; high congruity of the glenoid component
Glenoid component loosening; insufficient bone stock
Prosthetic joint infection; male with acne
Supraspinatus and subscapularis tear; overstuffing of the glenohumeral joint
Supraspinatus and infraspinatus tear; undiagnosed prior rotator cuff tear
A 78-year-old male presents to clinic 4 weeks after left total shoulder arthroplasty. He has not been wearing his sling and reports that he developed increased pain after slipping in the shower. He used the arm to catch himself from falling. On examination, he can flex the shoulder to 70 degrees, limited by pain. Active external rotation with arm at the side is 50 degrees and active internal rotation is 5 degrees. Passive external rotation is to 80 degrees. A radiograph of the left shoulder is shown below in Figure A. What other complaint is the patient most likely to have?
Pain with palpation of the bicipital groove
Pain with palpation over the subdeltoid bursa
Sensory loss over the lateral shoulder
Sensation of shoulder instability with external rotation
Sensation of shoulder instability with internal rotation
A 62-year-old man complains of shoulder pain for 2 years. He has had 1 course of intra-articular sodium hyaluronate and 6 weeks of physical therapy with little relief. Examination reveals diminished arm flexion and abduction secondary to pain. Radiographs of his shoulder are shown in Figures A and B. According to the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines, what is the next best step?
Humeral head replacement arthroplasty
Hemiarthroplasty and ream-and-run glenoid procedure
Cuff tear arthropathy (CTA) prosthesis
Total shoulder arthroplasty with a metal-backed cemented glenoid component
Total shoulder arthroplasty with an all-polyethylene cemented glenoid component
Which of the following preoperative factors is a contraindication to total shoulder arthroplasty?
Passive external rotation less than 10 degrees
Eccentric posterior glenoid erosion
A 2-cm full-thickness supraspinatus tendon tear
A preganglionic brachial plexus injury
In which of the following clinical circumstances would it be appropriate to eccentrically ream the anterior glenoid?
72-year-old male undergoing a shoulder arthroplasty due to rotator cuff arthropathy
65-year-old female with a glenoid retroversion of 13-degrees undergoing shoulder arthroplasty
70-year-old female with humeral anteversion of 13-degrees undergoing shoulder arthroplasty
65-year-old female with glenoid retroversion of 25-degrees undergoing shoulder arthroplasty
59-year-old male with significant glenoid bone stock deficiency and severe osteoarthritis
Which of the following statements regarding propionibacterium acnes infections after shoulder arthroplasty is incorrect?
It is usually associated with fevers
Cultures need to be held for 14 days
It colonizes the shoulder at increased rates compared to the knee and hip
Men have a higher bacterial burden than females
It is an important cause of clinical implant failure
During a total shoulder arthoplasty (TSA), which of the following technical maneuvers would most likely place the rotator cuff tendons at risk of injury?
Excessive retraction on the deltoid muscle during a delto-pectoral approach
Palpation of the rotator cuff insertion prior to humeral head resection
A humeral cut with 30 degrees of retroversion
Excessive bone removal with the humeral neck osteotomy
A humeral cut with 45 degrees of inclination
A 65 year-old man has progressive debilitating pain and crepitus in his shoulder. Active forward elevation is 120 degrees and external rotation strength is normal. Radiograph and CT scan are shown in Figures A and B. Which treatment will likely give him the best outcome in 3 years.
Arthroscopic capsular release
Humeral head arthroplasty with glenoid bone grafting followed by staged glenoid component implantation
Reverse total shoulder replacement
Total shoulder arthroplasty
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 are significant for anterior dislocation of the prosthesis. What is the most likely mechanism for this complication?
long head biceps rupture
During the initial rehabilitation phase following total shoulder arthroplasty through a delto-pectoral approach, motion and strengthening are typically restricted because of which factor?
Protection of the subscapularis tendon
Protect of the supraspinatus tendon
Risk of dislocation
Risk of loosening
The placement of a standard all-polyethylene glenoid component for shoulder arthroplasty is contraindicated in which of the following scenarios?
Irreparable rotator cuff tear
Previous glenoid resurfacing
Which of the following factors has the greatest influence on early postoperative restrictions following total shoulder arthroplasty through a deltopectoral approach?
Release of the superior border of the pectoralis
Strength of the capsular repair
Strength of the subscapularis repair
Presence of glenoid retroversion
Quality of the patients' bone
A 75-year-old right-hand dominant female has persistent right shoulder pain for the past 5 years. An axial CT scan is shown in the Figure A. If a total shoulder arthroplasty is planned, what other procedure must be performed based on this patient's imaging?
rule out infection
bone grafting of the glenoid
rotator cuff repair
humeral head biopsy
A 47-year-old male with a history of a Putti-Platt procedure 20 years ago presents with right shoulder pain with decreased range-of-motion. Radiograph is shown in Figure A. What is the most accurate diagnosis?
Arthritis from poor placement of coracoid transfer
A 72-year-old male who underwent right total shoulder arthroplasty 8 months ago is unable to lift his right hand off his back and has weakness with internal rotation. What is the most likely diagnosis?
Long head of biceps rupture
Subscapularis nerve palsy
Standard postoperative recovery