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 fmaking fespecially fwith ftype ftype f2 facromioclavicular fjoint fseparation finjuries fas
fthe fdata fare fstill fnot fclear fas fto fwho fwould fbest fbe fserved fwith fsurgical fversus fnonsurgical
management. fThe factive fcompression ftest fas fdescribed fby fO’Brien fand fassociates fin f1998
fwas fequally fas feffective fat fassessing fthe facromioclavicular fjoint fas fit fwas ffor fassessment fof
fthe fintegrity fof fthe fsuperior flabrum. fThe fHawkins-Kennedy ftest fhas fdemonstrated futility fin
fthe fdiagnosis fof frotator fcuff fimpingement, fwherein fthe fgreater ftuberosity fcomes finto fcontact
fwith fthe fcoracoacromial fligament. fThe fDLST fhas fbeen fdescribed ffor fthe fdiagnosis fof
fsuperior flabral fanterior-posterior f(SLAP) ftears, fwherein fthe fpatient freports fpain fand fa fclick
ffelt fwith fmovement fof fthe fshoulder fthrough fan farc fof fabduction fwith fthe fshoulder
fexternally frotated. fThe fupper fcut ftest fhas fbeen fdescribed fin fthe fsetting fof fbiceps
ftendinopathy fand fSLAP ftears.
• Recommended fReadings
Simovitch fR, fSanders fB, fOzbaydar fM, fLavery fK, fWarner fJJ. fAcromioclavicular fjoint finjuries:
fdiagnosis fand fmanagement. fJ fAm fAcad fOrthop fSurg. f2009 fApr;17(4):207-19. fFull ftext
O'Brien fSJ, fPagnani fMJ, fFealy fS, fMcGlynn fSR, fWilson fJB. fThe factive fcompression ftest: fa
fnew fand feffective ftest ffor fdiagnosing flabral ftears fand facromioclavicular fjoint fabnormality.
fAm fJ fSports fMed. f1998 fSep-Oct;26(5):610-3. fPubMed
Kibler fWB, fSciascia fAD, fMorris fBJ, fDome fDC. fTreatment fof fSymptomatic
fAcromioclavicular fJoint fInstability fby fa fDocking fTechnique: fClinical fIndications, fSurgical
fTechnique, fand fOutcomes. fArthroscopy. f2017 fApr;33(4):696-708.e2. fdoi:
f10.1016/j.arthro.2016.08.023. fEpub f2016 fNov f17. fPubMed
Question f3 fof f100
Figure f1 fis fthe fradiograph fof fa f54-year-old fman fwho fhas fincreasing fweakness fand fnumbness fin
fhis flateral farm. fNo fprior fsurgery for finjury fis freported. fWhat fis fthe fmost fappropriate fnext
fdiagnostic ftest?
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 fmaking fespecially fwith ftype ftype f2 facromioclavicular fjoint fseparation finjuries fas
fthe fdata fare fstill fnot fclear fas fto fwho fwould fbest fbe fserved fwith fsurgical fversus fnonsurgical
management. fThe factive fcompression ftest fas fdescribed fby fO’Brien fand fassociates fin f1998
fwas fequally fas feffective fat fassessing fthe facromioclavicular fjoint fas fit fwas ffor fassessment fof
fthe fintegrity fof fthe fsuperior flabrum. fThe fHawkins-Kennedy ftest fhas fdemonstrated futility fin
fthe fdiagnosis fof frotator fcuff fimpingement, fwherein fthe fgreater ftuberosity fcomes finto fcontact
fwith fthe fcoracoacromial fligament. fThe fDLST fhas fbeen fdescribed ffor fthe fdiagnosis fof
fsuperior flabral fanterior-posterior f(SLAP) ftears, fwherein fthe fpatient freports fpain fand fa fclick
ffelt fwith fmovement fof fthe fshoulder fthrough fan farc fof fabduction fwith fthe fshoulder
fexternally frotated. fThe fupper fcut ftest fhas fbeen fdescribed fin fthe fsetting fof fbiceps
ftendinopathy fand fSLAP ftears.
• Recommended fReadings
Simovitch fR, fSanders fB, fOzbaydar fM, fLavery fK, fWarner fJJ. fAcromioclavicular fjoint finjuries:
fdiagnosis fand fmanagement. fJ fAm fAcad fOrthop fSurg. f2009 fApr;17(4):207-19. fFull ftext
O'Brien fSJ, fPagnani fMJ, fFealy fS, fMcGlynn fSR, fWilson fJB. fThe factive fcompression ftest: fa
fnew fand feffective ftest ffor fdiagnosing flabral ftears fand facromioclavicular fjoint fabnormality.
fAm fJ fSports fMed. f1998 fSep-Oct;26(5):610-3. fPubMed
Kibler fWB, fSciascia fAD, fMorris fBJ, fDome fDC. fTreatment fof fSymptomatic
fAcromioclavicular fJoint fInstability fby fa fDocking fTechnique: fClinical fIndications, fSurgical
fTechnique, fand fOutcomes. fArthroscopy. f2017 fApr;33(4):696-708.e2. fdoi:
f10.1016/j.arthro.2016.08.023. fEpub f2016 fNov f17. fPubMed
Question f3 fof f100
Figure f1 fis fthe fradiograph fof fa f54-year-old fman fwho fhas fincreasing fweakness fand fnumbness fin
fhis flateral farm. fNo fprior fsurgery for finjury fis freported. fWhat fis fthe fmost fappropriate fnext
fdiagnostic ftest?
