ABSTRACT
Shoulder and Elbow Scored and Recorded Self-
Assessment Examination 2025
2025
,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
, in decision smaking sespecially swith stype stype s2 sacromioclavicular sjoint sseparation sinjuries sas
sthe sdata sare sstill snot sclear sas sto swho swould sbest sbe sserved swith ssurgical sversus
snonsurgical
management. sThe sactive scompression stest sas sdescribed sby sO’Brien sand sassociates sin s1998
swas sequally sas seffective sat sassessing sthe sacromioclavicular sjoint sas sit swas sfor sassessment
sof sthe sintegrity sof sthe ssuperior slabrum. sThe sHawkins-Kennedy stest shas sdemonstrated sutility
sin sthe sdiagnosis sof srotator scuff simpingement, swherein sthe sgreater stuberosity scomes sinto
scontact swith sthe scoracoacromial sligament. sThe sDLST shas sbeen sdescribed sfor sthe sdiagnosis
sof ssuperior slabral santerior-posterior s(SLAP) stears, swherein sthe spatient sreports spain sand sa
sclick sfelt swith smovement sof sthe sshoulder sthrough san sarc sof sabduction swith sthe sshoulder
sexternally srotated. sThe supper scut stest shas sbeen sdescribed sin sthe ssetting sof sbiceps
stendinopathy sand sSLAP stears.
• Recommended sReadings
Simovitch sR, sSanders sB, sOzbaydar sM, sLavery sK, sWarner sJJ. sAcromioclavicular sjoint sinjuries:
sdiagnosis sand smanagement. sJ sAm sAcad sOrthop sSurg. s2009 sApr;17(4):207-19. sFull stext
O'Brien sSJ, sPagnani sMJ, sFealy sS, sMcGlynn sSR, sWilson sJB. sThe sactive scompression stest: sa
snew sand seffective stest sfor sdiagnosing slabral stears sand sacromioclavicular sjoint sabnormality.
sAm sJ sSports sMed. s1998 sSep-Oct;26(5):610-3. sPubMed
Kibler sWB, sSciascia sAD, sMorris sBJ, sDome sDC. sTreatment sof sSymptomatic
sAcromioclavicular sJoint sInstability sby sa sDocking sTechnique: sClinical sIndications, sSurgical
sTechnique, sand sOutcomes. sArthroscopy. s2017 sApr;33(4):696-708.e2. sdoi:
s10.1016/j.arthro.2016.08.023. sEpub s2016 sNov s17. sPubMed
Question s3 sof s100
Figure s1 sis sthe sradiograph sof sa s54-year-old sman swho shas sincreasing sweakness sand snumbness sin
shis slateral sarm. sNo sprior ssurgery sor sinjury sis sreported. sWhat sis sthe smost sappropriate snext
sdiagnostic stest?
Shoulder and Elbow Scored and Recorded Self-
Assessment Examination 2025
2025
,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
, in decision smaking sespecially swith stype stype s2 sacromioclavicular sjoint sseparation sinjuries sas
sthe sdata sare sstill snot sclear sas sto swho swould sbest sbe sserved swith ssurgical sversus
snonsurgical
management. sThe sactive scompression stest sas sdescribed sby sO’Brien sand sassociates sin s1998
swas sequally sas seffective sat sassessing sthe sacromioclavicular sjoint sas sit swas sfor sassessment
sof sthe sintegrity sof sthe ssuperior slabrum. sThe sHawkins-Kennedy stest shas sdemonstrated sutility
sin sthe sdiagnosis sof srotator scuff simpingement, swherein sthe sgreater stuberosity scomes sinto
scontact swith sthe scoracoacromial sligament. sThe sDLST shas sbeen sdescribed sfor sthe sdiagnosis
sof ssuperior slabral santerior-posterior s(SLAP) stears, swherein sthe spatient sreports spain sand sa
sclick sfelt swith smovement sof sthe sshoulder sthrough san sarc sof sabduction swith sthe sshoulder
sexternally srotated. sThe supper scut stest shas sbeen sdescribed sin sthe ssetting sof sbiceps
stendinopathy sand sSLAP stears.
• Recommended sReadings
Simovitch sR, sSanders sB, sOzbaydar sM, sLavery sK, sWarner sJJ. sAcromioclavicular sjoint sinjuries:
sdiagnosis sand smanagement. sJ sAm sAcad sOrthop sSurg. s2009 sApr;17(4):207-19. sFull stext
O'Brien sSJ, sPagnani sMJ, sFealy sS, sMcGlynn sSR, sWilson sJB. sThe sactive scompression stest: sa
snew sand seffective stest sfor sdiagnosing slabral stears sand sacromioclavicular sjoint sabnormality.
sAm sJ sSports sMed. s1998 sSep-Oct;26(5):610-3. sPubMed
Kibler sWB, sSciascia sAD, sMorris sBJ, sDome sDC. sTreatment sof sSymptomatic
sAcromioclavicular sJoint sInstability sby sa sDocking sTechnique: sClinical sIndications, sSurgical
sTechnique, sand sOutcomes. sArthroscopy. s2017 sApr;33(4):696-708.e2. sdoi:
s10.1016/j.arthro.2016.08.023. sEpub s2016 sNov s17. sPubMed
Question s3 sof s100
Figure s1 sis sthe sradiograph sof sa s54-year-old sman swho shas sincreasing sweakness sand snumbness sin
shis slateral sarm. sNo sprior ssurgery sor sinjury sis sreported. sWhat sis sthe smost sappropriate snext
sdiagnostic stest?
