Shoulder and Elbow
Core concepts
Shoulder and elbow questions test anatomy, biomechanics, and the balance between stability and mobility. Know the rotator cuff: anatomy, tear patterns, and the indications for repair versus debridement or reverse arthroplasty. Master shoulder instability: Bankart and Hill-Sachs lesions, the glenoid track, and the choice between arthroscopic and open stabilization. Understand the AC joint and clavicle fractures (Neer and Rockwood classifications) and the indications for surgery. For the elbow, know the terrible triad, radial head fractures (Mason), and the role of the lateral ulnar collateral ligament. Review elbow arthroplasty indications and the complications of stiffness and heterotopic ossification. Also know the nerve anatomy around the shoulder (axillary, suprascapular) and elbow (ulnar, radial, median).
Traps
Examiners test the difference between anterior and posterior instability and the risk of recurrence in young athletes. Another trap is missing a concomitant injury in the terrible triad (coronoid, radial head, LCL). Do not forget that a reverse shoulder arthroplasty depends on a functional deltoid.
Rule of thumb
In the terrible triad, restore the coronoid and radial head, then repair the lateral ligament complex; the elbow is stable only when all constraints are addressed.
Worked example
A young athlete with recurrent anterior dislocation and a large Hill-Sachs lesion: assess the glenoid track; if the lesion is off-track, consider a Latarjet or bone graft rather than soft tissue repair alone.