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 dmaking despecially dwith dtype dtype d2 dacromioclavicular djoint dseparation dinjuries
das dthe ddata dare dstill dnot dclear das dto dwho dwould dbest dbe dserved dwith dsurgical dversus
dnonsurgical
management. dThe dactive dcompression dtest das ddescribed dby dO’Brien dand dassociates din
d1998 dwas dequally das deffective dat dassessing dthe dacromioclavicular djoint das dit dwas dfor
dassessment dof dthe dintegrity dof dthe dsuperior dlabrum. dThe dHawkins-Kennedy dtest dhas
ddemonstrated dutility din dthe ddiagnosis dof drotator dcuff dimpingement, dwherein dthe dgreater
dtuberosity dcomes dinto dcontact dwith dthe dcoracoacromial dligament. dThe dDLST dhas dbeen
ddescribed dfor dthe ddiagnosis dof dsuperior dlabral danterior-posterior d(SLAP) dtears, dwherein
dthe dpatient dreports dpain dand da dclick dfelt dwith dmovement dof dthe dshoulder dthrough dan darc
dof dabduction dwith dthe dshoulder dexternally drotated. dThe dupper dcut dtest dhas dbeen ddescribed
din dthe dsetting dof dbiceps dtendinopathy dand dSLAP dtears.
• Recommended dReadings
Simovitch dR, dSanders dB, dOzbaydar dM, dLavery dK, dWarner dJJ. dAcromioclavicular djoint dinjuries:
ddiagnosis dand dmanagement. dJ dAm dAcad dOrthop dSurg. d2009 dApr;17(4):207-19. dFull dtext
O'Brien dSJ, dPagnani dMJ, dFealy dS, dMcGlynn dSR, dWilson dJB. dThe dactive dcompression dtest:
da dnew dand deffective dtest dfor ddiagnosing dlabral dtears dand dacromioclavicular djoint
dabnormality. dAm dJ dSports dMed. d1998 dSep-Oct;26(5):610-3. dPubMed
Kibler dWB, dSciascia dAD, dMorris dBJ, dDome dDC. dTreatment dof dSymptomatic
dAcromioclavicular dJoint dInstability dby da dDocking dTechnique: dClinical dIndications, dSurgical
dTechnique, dand dOutcomes. dArthroscopy. d2017 dApr;33(4):696-708.e2. ddoi:
d10.1016/j.arthro.2016.08.023. dEpub d2016 dNov d17. dPubMed
Question d3 dof d100
Figure d1 dis dthe dradiograph dof da d54-year-old dman dwho dhas dincreasing dweakness dand dnumbness
din dhis dlateral darm. dNo dprior dsurgery dor dinjury dis dreported. dWhat dis dthe dmost dappropriate dnext
ddiagnostic dtest?
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 dmaking despecially dwith dtype dtype d2 dacromioclavicular djoint dseparation dinjuries
das dthe ddata dare dstill dnot dclear das dto dwho dwould dbest dbe dserved dwith dsurgical dversus
dnonsurgical
management. dThe dactive dcompression dtest das ddescribed dby dO’Brien dand dassociates din
d1998 dwas dequally das deffective dat dassessing dthe dacromioclavicular djoint das dit dwas dfor
dassessment dof dthe dintegrity dof dthe dsuperior dlabrum. dThe dHawkins-Kennedy dtest dhas
ddemonstrated dutility din dthe ddiagnosis dof drotator dcuff dimpingement, dwherein dthe dgreater
dtuberosity dcomes dinto dcontact dwith dthe dcoracoacromial dligament. dThe dDLST dhas dbeen
ddescribed dfor dthe ddiagnosis dof dsuperior dlabral danterior-posterior d(SLAP) dtears, dwherein
dthe dpatient dreports dpain dand da dclick dfelt dwith dmovement dof dthe dshoulder dthrough dan darc
dof dabduction dwith dthe dshoulder dexternally drotated. dThe dupper dcut dtest dhas dbeen ddescribed
din dthe dsetting dof dbiceps dtendinopathy dand dSLAP dtears.
• Recommended dReadings
Simovitch dR, dSanders dB, dOzbaydar dM, dLavery dK, dWarner dJJ. dAcromioclavicular djoint dinjuries:
ddiagnosis dand dmanagement. dJ dAm dAcad dOrthop dSurg. d2009 dApr;17(4):207-19. dFull dtext
O'Brien dSJ, dPagnani dMJ, dFealy dS, dMcGlynn dSR, dWilson dJB. dThe dactive dcompression dtest:
da dnew dand deffective dtest dfor ddiagnosing dlabral dtears dand dacromioclavicular djoint
dabnormality. dAm dJ dSports dMed. d1998 dSep-Oct;26(5):610-3. dPubMed
Kibler dWB, dSciascia dAD, dMorris dBJ, dDome dDC. dTreatment dof dSymptomatic
dAcromioclavicular dJoint dInstability dby da dDocking dTechnique: dClinical dIndications, dSurgical
dTechnique, dand dOutcomes. dArthroscopy. d2017 dApr;33(4):696-708.e2. ddoi:
d10.1016/j.arthro.2016.08.023. dEpub d2016 dNov d17. dPubMed
Question d3 dof d100
Figure d1 dis dthe dradiograph dof da d54-year-old dman dwho dhas dincreasing dweakness dand dnumbness
din dhis dlateral darm. dNo dprior dsurgery dor dinjury dis dreported. dWhat dis dthe dmost dappropriate dnext
ddiagnostic dtest?
