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Shoulder & elbow for FRCS (Tr & Orth)

Shoulder covers the rotator cuff and subacromial pain, instability and labral pathology, arthritis and the choice between anatomic and reverse arthroplasty, frozen shoulder, and the acromioclavicular joint, long head of biceps and scapula. Elbow covers instability and the stabilisers of the joint, stiffness and arthritis, tendinopathy, distal biceps rupture and the nerve compression syndromes around the elbow. In both joints the examination findings are specific enough to be the discriminator in a written question, so learn each test with the structure it isolates.

125 questions in the bank · 2 topics Updated 11 November 2026
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Topics in this domain

  • Shoulder75
  • Elbow50

What the paper tends to test

  • Cuff questions ask which tendon a clinical test isolates — the lift-off, belly-press and bear-hug tests for subscapularis, the external rotation lag sign for infraspinatus, the hornblower’s sign for teres minor.
  • Arthroplasty questions hinge on the cuff: anatomic replacement needs an intact, functioning cuff, while reverse replacement relies on the deltoid.
  • Instability questions test the Bankart and Hill-Sachs lesions and the amount of glenoid bone loss that makes a soft-tissue repair unreliable.
  • Elbow instability questions ask for the primary stabilisers and the injury pattern of the terrible triad.
  • Distal biceps questions test the hook test, the loss of supination strength and the nerves at risk in repair.
  • Nerve questions around the shoulder and elbow ask you to localise a lesion from the muscles that are spared.

Classic traps and discriminators

  • A posterior shoulder dislocation is the one that is missed: the arm is locked in internal rotation after a seizure or electric shock, the anteroposterior film can look near-normal, and an axillary or modified axial view makes the diagnosis.
  • Loss of passive external rotation with a normal radiograph is frozen shoulder; the same loss with an abnormal radiograph is arthritis or a missed posterior dislocation.
  • Compression of the suprascapular nerve at the spinoglenoid notch, typically by a cyst from a labral tear, wastes infraspinatus alone; compression at the suprascapular notch affects supraspinatus as well.
  • The anterior bundle of the medial collateral ligament is the primary restraint to valgus at the elbow and the radial head is a secondary restraint, so the radial head must be fixed or replaced, not simply excised, when the ligament is deficient.
  • The terrible triad is an elbow dislocation with fractures of the radial head and the coronoid; the lateral ulnar collateral ligament is torn and must be repaired, and treating it as a simple dislocation leads to recurrent instability.

Free shoulder & elbow practice questions

From the free sample — original, referenced, with the full explanation. Rate your confidence first.

19Shoulder & elbow·Shoulder
medium

A 66-year-old retired teacher has an MRI showing a 2 cm full-thickness tear of supraspinatus confined to the crescent of tendon just medial to the greater tuberosity. She has full active elevation with only slight weakness on resisted abduction.

Which mechanism best explains her preserved function?

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20Shoulder & elbow·Shoulder
easy

A 45-year-old woman wakes with excruciating shoulder pain and cannot move the arm. She is afebrile with normal inflammatory markers. Radiographs show a fluffy, ill-defined, cloud-like calcific deposit in supraspinatus that is fainter than the dense deposit seen on films six months earlier.

Which phase of calcific tendinitis does this represent?

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Interactive 3D: Brachial plexus

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Also in this domain: Shoulder & rotator cuff (coming soon)

Shoulder & elbow questions, answered

When is a reverse shoulder replacement chosen over an anatomic one?

When the rotator cuff cannot centre the humeral head: cuff tear arthropathy, a massive irreparable cuff tear with pseudoparalysis, and many fractures and revisions in older patients. The reverse design medialises and lowers the centre of rotation so that the deltoid can elevate the arm, which is why a functioning deltoid and axillary nerve are prerequisites.

What is the functional range of movement of the elbow?

The arc described by Morrey for most activities of daily living is about 30° to 130° of flexion, with 50° of pronation and 50° of supination. Loss of movement within that arc is the usual threshold for considering release of a stiff elbow.

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