ABSTRACT
Shoulder and Elbow Scored and Recorded Self-
Assessment Examination 2026
2026
,Question 1 of 100
Figure 1 is the radiograph of a 27-year-old man who is involved in a motorcycle collision and
sustains a right femoral and tibial shaft fracture, in addition to the injury shown in Figure 1. All
fractures are closed. In addition to intramedullary nailing of the tibia and femur, appropriate
treatment and weight-bearing status of the humeral shaft fracture should include
Figure 1
A. fracture bracing with full weight bearing.
B. coaptation splinting with non-weight bearing.
C. plate fixation with full weight bearing.
D. plate fixation with non-weight bearing for 4 weeks, followed by full weight bearing.
,Correct Answer: C
• Discussion
Bell and associates and Tingstad and associates both showed that immediate, full weight bearing
through the upper extremity can be safely allowed for a humeral shaft fracture fixed using a plate
and screw construct. Tingstad and associates showed no difference in malunion or nonunion rate
following non-weight bearing or full weight bearing. Because he is a polytrauma patient, the
patient would benefit from operative fixation of his humerus to expedite recovery and facilitate
mobilization. A coaptation splint and a fracture brace would be appropriate treatment options for
a non-polytrauma patient, but in neither case would full weight bearing generally be allowed
immediately following the injury.
• Recommended Readings
Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated
fractures of the humeral shaft. J Trauma. 2000 Aug;49(2):278-80. PubMed
Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft
fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br.
1985 Mar;67(2):293-6. PubMed
Question 2 of 100
A 23-year-old left-hand dominant professional football player sustains a left shoulder injury after being
tackled and lands directly on his shoulder 1 month ago. The patient was diagnosed with a Rockwood
type 2 acromioclavicular separation. Following physical therapy, his symptoms have improved. He has
good scapular control and shoulder strength. What physical examination test would help determine the
contribution of the acromioclavicular joint injury to his residual symptoms?
A. O'Brien test
B. Hawkins-Kennedy test
C. Dynamic labral shear test (DLST)
D. Upper cut test
Correct Answer: A
• Discussion
The clinical scenario describes an athlete who is recovering from a type 2 acromioclavicular joint
separation. The goal of this question is to stress the importance of the physical examination to
guide treatment decisions, as well as recovery. It is important to recognize which factors can aid
, inKdecisionKmakingKespeciallyKwithKtypeKtypeK2KacromioclavicularKjointKseparationKinjuriesKasKthe
KdataKareKstillKnotKclearKasKtoKwhoKwouldKbestKbeKservedKwithKsurgicalKversusKnonsurgical
management.KTheKactiveKcompressionKtestKasKdescribedKbyKO’BrienKandKassociatesKinK1998KwasK
equallyKasKeffectiveKatKassessingKtheKacromioclavicularKjointKasKitKwasKforKassessmentKofKtheKinte
grityKofKtheKsuperiorKlabrum.KTheKHawkins-
KennedyKtestKhasKdemonstratedKutilityKinKtheKdiagnosisKofKrotatorKcuffKimpingement,KwhereinKthe
KgreaterKtuberosityKcomesKintoKcontactKwithKtheKcoracoacromialKligament.KTheKDLSTKhasKbeenKd
escribedKforKtheKdiagnosisKofKsuperiorKlabralKanterior-
posteriorK(SLAP)Ktears,KwhereinKtheKpatientKreportsKpainKandKaKclickKfeltKwithKmovementKofKtheK
shoulderKthroughKanKarcKofKabductionKwithKtheKshoulderKexternallyKrotated.KTheKupperKcutKtestKh
asKbeenKdescribedKinKtheKsettingKofKbicepsKtendinopathyKandKSLAPKtears.
• RecommendedKReadings
SimovitchKR,KSandersKB,KOzbaydarKM,KLaveryKK,KWarnerKJJ.KAcromioclavicularKjointKinjuries:Kdiagn
osisKandKmanagement.KJKAmKAcadKOrthopKSurg.K2009KApr;17(4):207-19.KFullKtext
O'BrienKSJ,KPagnaniKMJ,KFealyKS,KMcGlynnKSR,KWilsonKJB.KTheKactiveKcompressionKtest:KaKnew
KandKeffectiveKtestKforKdiagnosingKlabralKtearsKandKacromioclavicularKjointKabnormality.KAmKJKSp
ortsKMed.K1998KSep-Oct;26(5):610-3.KPubMed
KiblerKWB,KSciasciaKAD,KMorrisKBJ,KDomeKDC.KTreatmentKofKSymptomaticKAcromioclavicularK
JointKInstabilityKbyKaKDockingKTechnique:KClinicalKIndications,KSurgicalKTechnique,KandKOutco
mes.KArthroscopy.K2017KApr;33(4):696-
708.e2.Kdoi:K10.1016/j.arthro.2016.08.023.KEpubK2016KNovK17.KPubMed
Question 3 of 100
K K K
FigureK1KisKtheKradiographKofKaK54-year-
oldKmanKwhoKhasKincreasingKweaknessKandKnumbnessKinKhisKlateralKarm.KNoKpriorKsurgeryKorKinjuryKisKrep
orted.KWhatKisKtheKmostKappropriateKnextKdiagnosticKtest?
Shoulder and Elbow Scored and Recorded Self-
Assessment Examination 2026
2026
,Question 1 of 100
Figure 1 is the radiograph of a 27-year-old man who is involved in a motorcycle collision and
sustains a right femoral and tibial shaft fracture, in addition to the injury shown in Figure 1. All
fractures are closed. In addition to intramedullary nailing of the tibia and femur, appropriate
treatment and weight-bearing status of the humeral shaft fracture should include
Figure 1
A. fracture bracing with full weight bearing.
B. coaptation splinting with non-weight bearing.
C. plate fixation with full weight bearing.
D. plate fixation with non-weight bearing for 4 weeks, followed by full weight bearing.
,Correct Answer: C
• Discussion
Bell and associates and Tingstad and associates both showed that immediate, full weight bearing
through the upper extremity can be safely allowed for a humeral shaft fracture fixed using a plate
and screw construct. Tingstad and associates showed no difference in malunion or nonunion rate
following non-weight bearing or full weight bearing. Because he is a polytrauma patient, the
patient would benefit from operative fixation of his humerus to expedite recovery and facilitate
mobilization. A coaptation splint and a fracture brace would be appropriate treatment options for
a non-polytrauma patient, but in neither case would full weight bearing generally be allowed
immediately following the injury.
• Recommended Readings
Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated
fractures of the humeral shaft. J Trauma. 2000 Aug;49(2):278-80. PubMed
Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft
fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br.
1985 Mar;67(2):293-6. PubMed
Question 2 of 100
A 23-year-old left-hand dominant professional football player sustains a left shoulder injury after being
tackled and lands directly on his shoulder 1 month ago. The patient was diagnosed with a Rockwood
type 2 acromioclavicular separation. Following physical therapy, his symptoms have improved. He has
good scapular control and shoulder strength. What physical examination test would help determine the
contribution of the acromioclavicular joint injury to his residual symptoms?
A. O'Brien test
B. Hawkins-Kennedy test
C. Dynamic labral shear test (DLST)
D. Upper cut test
Correct Answer: A
• Discussion
The clinical scenario describes an athlete who is recovering from a type 2 acromioclavicular joint
separation. The goal of this question is to stress the importance of the physical examination to
guide treatment decisions, as well as recovery. It is important to recognize which factors can aid
, inKdecisionKmakingKespeciallyKwithKtypeKtypeK2KacromioclavicularKjointKseparationKinjuriesKasKthe
KdataKareKstillKnotKclearKasKtoKwhoKwouldKbestKbeKservedKwithKsurgicalKversusKnonsurgical
management.KTheKactiveKcompressionKtestKasKdescribedKbyKO’BrienKandKassociatesKinK1998KwasK
equallyKasKeffectiveKatKassessingKtheKacromioclavicularKjointKasKitKwasKforKassessmentKofKtheKinte
grityKofKtheKsuperiorKlabrum.KTheKHawkins-
KennedyKtestKhasKdemonstratedKutilityKinKtheKdiagnosisKofKrotatorKcuffKimpingement,KwhereinKthe
KgreaterKtuberosityKcomesKintoKcontactKwithKtheKcoracoacromialKligament.KTheKDLSTKhasKbeenKd
escribedKforKtheKdiagnosisKofKsuperiorKlabralKanterior-
posteriorK(SLAP)Ktears,KwhereinKtheKpatientKreportsKpainKandKaKclickKfeltKwithKmovementKofKtheK
shoulderKthroughKanKarcKofKabductionKwithKtheKshoulderKexternallyKrotated.KTheKupperKcutKtestKh
asKbeenKdescribedKinKtheKsettingKofKbicepsKtendinopathyKandKSLAPKtears.
• RecommendedKReadings
SimovitchKR,KSandersKB,KOzbaydarKM,KLaveryKK,KWarnerKJJ.KAcromioclavicularKjointKinjuries:Kdiagn
osisKandKmanagement.KJKAmKAcadKOrthopKSurg.K2009KApr;17(4):207-19.KFullKtext
O'BrienKSJ,KPagnaniKMJ,KFealyKS,KMcGlynnKSR,KWilsonKJB.KTheKactiveKcompressionKtest:KaKnew
KandKeffectiveKtestKforKdiagnosingKlabralKtearsKandKacromioclavicularKjointKabnormality.KAmKJKSp
ortsKMed.K1998KSep-Oct;26(5):610-3.KPubMed
KiblerKWB,KSciasciaKAD,KMorrisKBJ,KDomeKDC.KTreatmentKofKSymptomaticKAcromioclavicularK
JointKInstabilityKbyKaKDockingKTechnique:KClinicalKIndications,KSurgicalKTechnique,KandKOutco
mes.KArthroscopy.K2017KApr;33(4):696-
708.e2.Kdoi:K10.1016/j.arthro.2016.08.023.KEpubK2016KNovK17.KPubMed
Question 3 of 100
K K K
FigureK1KisKtheKradiographKofKaK54-year-
oldKmanKwhoKhasKincreasingKweaknessKandKnumbnessKinKhisKlateralKarm.KNoKpriorKsurgeryKorKinjuryKisKrep
orted.KWhatKisKtheKmostKappropriateKnextKdiagnosticKtest?
