5. Sports Medicine MCQs

A 74-year-old woman with rheumatoid arthritis has pain in the shoulder that has failed to respond to nonsurgical management. AP and axillary radiographs are shown in Figures 24a and 24b. Active forward elevation is 120 degrees and external rotation is 30 degrees. At the time of surgery, a 1-cm rotator cuff tear is found, which is repairable. Which of the following treatment options will result in the most predictable pain relief and function? Review Topic

As a baseball player dives to catch a line drive in the outfield, the ball strikes the tip of the player’s finger when extended, causing forcible flexion to avulse the extensor tendon from the distal phalanx. Following evaluation and normal radiographic findings, initial management should include

Figure 7 shows a sagittal T1-weighted MRI scan. What muscle/tendon is identified by the arrow?

Figure 50 shows the cross table lateral radiograph of a 31-year-old paratrooper who has recalcitrant groin pain. The pain is worse after activities such as standing or sitting (driving). Examination reveals that pain can be reproduced by internal rotation of the leg with the hip and knee in 90 degrees of flexion. Extensive nonsurgical management has failed to provide relief. What is the treatment of choice?

A 37-year-old racquet player had dominant shoulder pain for 1 year, and cortisone injections provided only temporary relief. Because MRI findings did not reveal a rotator cuff tear, he underwent arthroscopic treatment including subacromial decompression and spur removal below the distal clavicle. Three years following surgery, he now reports that the pain has returned. What is the most likely cause of his pain?

A 32-year-old man with worsening left knee pain has a 13-degree varus knee deformity and a history of a complete anterior cruciate ligament (ACL) tear treated nonsurgically. He previously underwent an arthroscopic partial medial meniscectomy. He continues to experience pain and instability. What is the most appropriate treatment at this time?

When compared with fresh-frozen bone allograft, freeze-dried bone allograft (FDBA) is characterized by

Figure 11 shows a consecutive sequence of MRI scans obtained in a 12-year-old boy who has had increasing lateral knee pain and catching for the past 6 months. Examination reveals pain localized to the lateral joint line. Range-of-motion testing reveals a 5-degree lack of full extension on the involved side. Plain radiographs and laboratory values are within normal limits. What is the most appropriate management?

What type of nerve palsy is most common following elbow arthroscopy?

A patient sustains a transection of the posterior cord of the brachial plexus from a knife injury. This injury would affect all of the following muscles EXCEPT?

A 27-year-old woman underwent shoulder arthroscopy for multidirectional instability 3 years ago. She was unable to regain shoulder range of motion despite therapy and has had progressively worsening pain. A current axillary radiograph is shown in Figure 100. In reviewing the medical records from the index procedure, what factor may be significant in contributing to her current condition? Review Topic

A 38-year-old left hand-dominant bodybuilder reports ecchymosis in the left axilla and anterior brachium after sustaining an injury while bench pressing 3 weeks ago. Coronal and axial MRI scans are shown in Figures 16a and 16b. What treatment method yields the best long-term results?

Which of the following actions best enhances performance when an athlete is participating in a 10K race?

A 17-year-old high school long-distance runner is seeking advice before running a marathon for the first time. What advice should be given regarding his fluid, carbohydrate, and electrolyte intake around the time of the race?

A 42-year-old man has increasing pain and, to a lesser extent, some occasional left knee instability. Several years earlier he sustained a noncontact twisting injury to his knee. He had some initial soreness and pain but was able to resume his normal activities while avoiding sports. On examination, the patient has medial joint line pain, a grade 2+ Lachman, and a slight varus thrust. His radiographs reveal mild-to-moderate medial compartment osteoarthritis with varus alignment. What surgical treatment strategy likely will alleviate his pain? Review Topic

Figures below depict the AP and lateral radiographs obtained from a 64-year-old man with long-standing right knee osteoarthritis and pain that is unresponsive to nonsurgical treatment. The patient undergoes navigated cruciate-retaining right total knee arthroplasty. After surgery, this patient continues to experience pain and swelling of the knee with recurrent effusions. He returns to the office reporting continued pain 2 years after surgery. He describes instability, particularly when descending stairs. On examination, range of motion of 0° to 120° is observed, with no extensor lag. Slope of the tibial component is 7°. The knee is stable to varus and valgus stress in extension, but flexion instability is present in both the anterior-posterior direction and the varus-valgus direction. Bracing leads to a slight decrease in symptoms but is not well tolerated. Isokinetic testing demonstrates decreased knee extension velocity at mid push. Radiographs demonstrate well-aligned and fixed knee implants. An infection work-up is negative. What is the most appropriate surgical intervention at this time?

A 22-year-old collegiate soccer player undergoes an arthroscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Postoperatively, she successfully regains full knee flexion but struggles with a persistent 10-degree loss of terminal knee extension. Which of the following technical errors during graft tunnel placement is the most likely cause of this complication?

A 19-year-old rugby player is evaluated for recurrent anterior shoulder instability. A 3D CT reconstruction of the shoulder demonstrates anterior glenoid bone loss estimated at 28%. Which of the following is the most appropriate surgical treatment to prevent further recurrence?

A 52-year-old female presents with acute medial knee pain after a squatting maneuver. MRI demonstrates a complete radial tear at the posterior root of the medial meniscus, with 4 mm of meniscal extrusion. If left untreated, what is the primary biomechanical consequence of this specific meniscal injury?

A 13-year-old gymnast presents with vague, activity-related knee pain and a sensation of catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. Where is the classic and most frequent anatomical location for an OCD lesion in the knee?