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 making especially with type type 2 acromioclavicular joint separation injuries as the
data are still not clear as to who would best be served with surgical versus nonsurgical
management. The active compression test as described by O’Brien and associates in 1998 was
equally as effective at assessing the acromioclavicular joint as it was for assessment of the
integrity of the superior labrum. The Hawkins-Kennedy test has demonstrated utility in the
diagnosis of rotator cuff impingement, wherein the greater tuberosity comes into contact with the
coracoacromial ligament. The DLST has been described for the diagnosis of superior labral
anterior-posterior (SLAP) tears, wherein the patient reports pain and a click felt with movement
of the shoulder through an arc of abduction with the shoulder externally rotated. The upper cut
test has been described in the setting of biceps tendinopathy and SLAP tears.
• Recommended Readings
Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries:
diagnosis and management. J Am Acad Orthop Surg. 2009 Apr;17(4):207-19. Full text
O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new
and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J
Sports Med. 1998 Sep-Oct;26(5):610-3. PubMed
Kibler WB, Sciascia AD, Morris BJ, Dome DC. Treatment of Symptomatic Acromioclavicular
Joint Instability by a Docking Technique: Clinical Indications, Surgical Technique, and
Outcomes. Arthroscopy. 2017 Apr;33(4):696-708.e2. doi: 10.1016/j.arthro.2016.08.023. Epub
2016 Nov 17. PubMed
Question 3 of 100
Figure 1 is the radiograph of a 54-year-old man who has increasing weakness and numbness in his
lateral arm. No prior surgery or injury is reported. What is the most appropriate next diagnostic test?
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 making especially with type type 2 acromioclavicular joint separation injuries as the
data are still not clear as to who would best be served with surgical versus nonsurgical
management. The active compression test as described by O’Brien and associates in 1998 was
equally as effective at assessing the acromioclavicular joint as it was for assessment of the
integrity of the superior labrum. The Hawkins-Kennedy test has demonstrated utility in the
diagnosis of rotator cuff impingement, wherein the greater tuberosity comes into contact with the
coracoacromial ligament. The DLST has been described for the diagnosis of superior labral
anterior-posterior (SLAP) tears, wherein the patient reports pain and a click felt with movement
of the shoulder through an arc of abduction with the shoulder externally rotated. The upper cut
test has been described in the setting of biceps tendinopathy and SLAP tears.
• Recommended Readings
Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries:
diagnosis and management. J Am Acad Orthop Surg. 2009 Apr;17(4):207-19. Full text
O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new
and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J
Sports Med. 1998 Sep-Oct;26(5):610-3. PubMed
Kibler WB, Sciascia AD, Morris BJ, Dome DC. Treatment of Symptomatic Acromioclavicular
Joint Instability by a Docking Technique: Clinical Indications, Surgical Technique, and
Outcomes. Arthroscopy. 2017 Apr;33(4):696-708.e2. doi: 10.1016/j.arthro.2016.08.023. Epub
2016 Nov 17. PubMed
Question 3 of 100
Figure 1 is the radiograph of a 54-year-old man who has increasing weakness and numbness in his
lateral arm. No prior surgery or injury is reported. What is the most appropriate next diagnostic test?
