4.0 of 82 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 69-year-old patient who underwent a right reverse total shoulder arthroplasty 2 years ago for rotator cuff arthropathy presents with mild right shoulder pain and stiffness. He denies any fevers, chills, or recent falls/trauma. A radiograph of the right shoulder is shown in Figure A. Which of the following has been implicated in the development of this condition and what are the potential negative sequelae?
Deltopectoral approach; no impact in functional outcomes
Inferior glenosphere placement; glenoid component loosening
Preoperative superior glenoid erosion; decreased ROM, strength, and Constant scores
Over-reaming of the glenoid; increased dislocation rates
Superolateral approach; increased incidence of aspetic loosening
Select Answer to see Preferred Response
A 73-year-old man with a history of a left shoulder hemiarthroplasty 10 years ago sustains a fall and presents the the emergency room with acute pain and weakness in his left shoulder. Injury radiographs are shown in Figure A. He undergoes successful closed reduction of the left shoulder. On routine follow up 3 months later, he is still unable to elevate his arm beyond 30 degrees despite rigorous physical therapy. New radiographs depict anterosuperior escape. What is the structure likely injured and what is the treatment that would result in the most predictable outcome?
Rotator cuff; Isolated rotator cuff repair
Rotator cuff; Rotator cuff repair and conversion to anatomic total shoulder arthroplasty
Rotator cuff; Conversion to a reverse total shoulder arthroplasty
Labrum; Isolated labral repair
Labrum; Conversion to anatomic total shoulder arthroplasty
When performing a routine reverse shoulder arthroplasty, which technique would increase the moment of the deltoid compared to the native, rotator cuff-deficient shoulder?
Using a glenosphere with 10 degree inferior tilt
Switching to more constrained polyethylene component
Switching to a humeral prosthesis with a smaller neck-shaft angle
Switching to a short-stemmed humeral component
Placing the glenosphere more inferiorly
A 63-year-old patient that underwent a hemiarthroplasty 6 years ago presents with increasing right shoulder pain. The patient denies any fevers or drainage from the previous incision. On exam, the patient has forward flexion to 100 degrees and abduction to 30 degrees. There is weakness with resisted external rotation with the arm at the side. Radiograph of the right shoulder is shown in Figure A. An MRI of the right shoulder is shown in Figure 2. What is the best treatment option?
2-stage revision arthroplasty
Conversion to anatomic total shoulder arthroplasty
Conversion to a reverse total shoulder arthroplasty
Rotator cuff repair
A 55-year-old male returns for followup 3 months after reverse shoulder arthroplasty. He reports limited function of his right shoulder but no antecedent trauma. A radiograph of his shoulder is shown in Figure A. All of the following variables are associated with this complication EXCEPT:
History of malunited proximal humerus fracture
Proximal humeral bone loss
Failed primary arthroplasty
Fixed preoperative glenohumeral dislocation
Reverse total shoulder arthroplasty improves kinematics in the rotator cuff deficient joint by what directional change to the center of rotation?
A 75-year-old male with 2 previous rotator cuff repairs has persistent shoulder pain and active forward elevation to 60 degrees. He has normal deltoid function with a positive lift-off test. Radiographs and coronal MRI of his shoulder are found in Figures A through C. Which of the following treatment options is most appropriate?
Revision supraspinatus repair
Total shoulder arthroplasty
Reverse total shoulder arthroplasty
An 79-year-old male presents with longstanding left shoulder pain and difficulty with raising his arm over his head. His exam shows wasting of the deltoid and obvious scapular dysrhythmia on the left side. He lacks the ability to do any forward flexion or external rotation in his left shoulder. He can internally rotate without difficulty. His radiograph and MRI images are seen in figures A and B respectively. He wants to know if he is a candidate for a reverse shoulder arthroplasty (RSA). Which of the following answer choices is the MOST appropriate response?
He is a candidate for RSA due to rotator cuff tear arthropathy
He is a candidate for RSA due to ability to internally rotate
He is not a candidate for RSA due to deltoid dysfunction
He is not a candidate for RSA due to massive rotator cuff tear
He is not a candidate for RSA due to his age
Superior placement of the baseplate during reverse shoulder arthroplasty is a known technical risk factor for which of the following complications?
Inferior acromial erosion
Humeral component loosening
Inferior scapular notching
Superior scapular notching
Deltoid denervation is a contraindication to which of the following procedures?
C5-6 anterior cervical diskectomy and fusion
Arthroscopic subacromial decompression
What technical error leads to scapular notching after reverse total shoulder arthroplasty?
Superior placement of the glenoid component
Retroverted placement of the glenoid component
Inferior placement of the glenoid component
Overtensioning of the soft tissue envelope
Inferior tilt of the glenoid component
A 76-year-old man has a two-year history of shoulder pain which no longer responds to non-operative treatments. A radiograph is shown in Figure A. He has forward flexion to 80 degrees and abduction to 70 degrees. An example of his belly push examination is shown in Figure B. What is the most appropriate surgical procedure?
Arthroscopic debridement and subacromial decompression
Open rotator cuff repair
Reverse shoulder arthroplasty
Which of the following patients would be the most appropriate candidate for a reverse total shoulder replacement?
A 71-year-old man with a massive rotator cuff tear, glenohumeral arthritis, and forward elevation to 40 degrees
A 45-year-old man who has failed 3 rotator cuff repairs and has glenohumeral arthritis
A 65-year-old man with glenoid wear and pain 10 years following a hemiarthroplasty
A 72-year-old man with severe glenohumeral arthritis and an intact rotator cuff
A 30-year-old man with a locked posterior shoulder dislocation
Early reverse total shoulder designs (before the development of the Grammont-style prosthesis) had a high failure rate due to early loosening of the glenoid component. What biomechanical feature accounted for this problem?
Glenoid component did not have a neck
Humeral component too horizontal
Center of rotation too lateral
Center of rotation too anterior
Center of rotation too inferior
Which of the following patient scenarios is most appropriate for reverse total shoulder arthroplasty?
A 40-year-old laborer severe glenohumeral arthritis and irrepairable rotator cuff tear.
A 40-year-old with a painful proximal humerus malunion.
A 75-year-old woman with severe arthritis and active overhead motion.
A 75-year-old man with painful arthritis and a massive irrepairable rotator cuff tear
Failed hemiarthroplasty due to significant glenoid wear.