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 amaking aespecially awith atype atype a2 aacromioclavicular ajoint aseparation ainjuries aas
athe adata aare astill anot aclear aas ato awho awould abest abe aserved awith asurgical aversus
anonsurgical
management. aThe aactive acompression atest aas adescribed aby aO’Brien aand aassociates ain a1998
awas aequally aas aeffective aat aassessing athe aacromioclavicular ajoint aas ait awas afor aassessment
aof athe aintegrity aof athe asuperior alabrum. aThe aHawkins-Kennedy atest ahas ademonstrated
autility ain athe adiagnosis aof arotator acuff aimpingement, awherein athe agreater atuberosity acomes
ainto acontact awith athe acoracoacromial aligament. aThe aDLST ahas abeen adescribed afor athe
adiagnosis aof asuperior alabral aanterior-posterior a(SLAP) atears, awherein athe apatient areports
apain aand aa aclick afelt awith amovement aof athe ashoulder athrough aan aarc aof aabduction awith
athe ashoulder aexternally arotated. aThe aupper acut atest ahas abeen adescribed ain athe asetting aof
abiceps atendinopathy aand aSLAP atears.
• Recommended aReadings
Simovitch aR, aSanders aB, aOzbaydar aM, aLavery aK, aWarner aJJ. aAcromioclavicular ajoint ainjuries:
adiagnosis aand amanagement. aJ aAm aAcad aOrthop aSurg. a2009 aApr;17(4):207-19. aFull atext
O'Brien aSJ, aPagnani aMJ, aFealy aS, aMcGlynn aSR, aWilson aJB. aThe aactive acompression atest: aa
anew aand aeffective atest afor adiagnosing alabral atears aand aacromioclavicular ajoint aabnormality.
aAm aJ aSports aMed. a1998 aSep-Oct;26(5):610-3. aPubMed
Kibler aWB, aSciascia aAD, aMorris aBJ, aDome aDC. aTreatment aof aSymptomatic
aAcromioclavicular aJoint aInstability aby aa aDocking aTechnique: aClinical aIndications, aSurgical
aTechnique, aand aOutcomes. aArthroscopy. a2017 aApr;33(4):696-708.e2. adoi:
a10.1016/j.arthro.2016.08.023. aEpub a2016 aNov a17. aPubMed
Question a3 aof a100
Figure a1 ais athe aradiograph aof aa a54-year-old aman awho ahas aincreasing aweakness aand anumbness
ain ahis alateral aarm. aNo aprior asurgery aor ainjury ais areported. aWhat ais athe amost aappropriate anext
adiagnostic atest?
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 amaking aespecially awith atype atype a2 aacromioclavicular ajoint aseparation ainjuries aas
athe adata aare astill anot aclear aas ato awho awould abest abe aserved awith asurgical aversus
anonsurgical
management. aThe aactive acompression atest aas adescribed aby aO’Brien aand aassociates ain a1998
awas aequally aas aeffective aat aassessing athe aacromioclavicular ajoint aas ait awas afor aassessment
aof athe aintegrity aof athe asuperior alabrum. aThe aHawkins-Kennedy atest ahas ademonstrated
autility ain athe adiagnosis aof arotator acuff aimpingement, awherein athe agreater atuberosity acomes
ainto acontact awith athe acoracoacromial aligament. aThe aDLST ahas abeen adescribed afor athe
adiagnosis aof asuperior alabral aanterior-posterior a(SLAP) atears, awherein athe apatient areports
apain aand aa aclick afelt awith amovement aof athe ashoulder athrough aan aarc aof aabduction awith
athe ashoulder aexternally arotated. aThe aupper acut atest ahas abeen adescribed ain athe asetting aof
abiceps atendinopathy aand aSLAP atears.
• Recommended aReadings
Simovitch aR, aSanders aB, aOzbaydar aM, aLavery aK, aWarner aJJ. aAcromioclavicular ajoint ainjuries:
adiagnosis aand amanagement. aJ aAm aAcad aOrthop aSurg. a2009 aApr;17(4):207-19. aFull atext
O'Brien aSJ, aPagnani aMJ, aFealy aS, aMcGlynn aSR, aWilson aJB. aThe aactive acompression atest: aa
anew aand aeffective atest afor adiagnosing alabral atears aand aacromioclavicular ajoint aabnormality.
aAm aJ aSports aMed. a1998 aSep-Oct;26(5):610-3. aPubMed
Kibler aWB, aSciascia aAD, aMorris aBJ, aDome aDC. aTreatment aof aSymptomatic
aAcromioclavicular aJoint aInstability aby aa aDocking aTechnique: aClinical aIndications, aSurgical
aTechnique, aand aOutcomes. aArthroscopy. a2017 aApr;33(4):696-708.e2. adoi:
a10.1016/j.arthro.2016.08.023. aEpub a2016 aNov a17. aPubMed
Question a3 aof a100
Figure a1 ais athe aradiograph aof aa a54-year-old aman awho ahas aincreasing aweakness aand anumbness
ain ahis alateral aarm. aNo aprior asurgery aor ainjury ais areported. aWhat ais athe amost aappropriate anext
adiagnostic atest?
