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Question 201

Topic: Shoulder & Hip Sports

Which of the following arteries provides the primary blood supply to the supraspinatus tendon:

. Scapular circumflex artery
. Anterior humeral circumflex artery
. Suprascapular artery
. Thoracoacromial artery
. Posterior humeral circumflex artery

Correct Answer & Explanation

. Suprascapular artery


Explanation

The suprascapular artery provides the primary vascular supply to the supraspinatus tendon. The vascularity predominates on the bursal side, while the articular side is hypovascular.

Question 202

Topic: 5. Sports Medicine

What is the primary pathophysiologic mechanism thought to underlie the development of athletic pubalgia (sports hernia) in elite athletes?

. Weakness of the anterior abdominal wall leading to direct hernia
. Attenuation or tearing of the rectus abdominis insertion and transversalis fascia
. Entrapment of the ilioinguinal nerve at the superficial inguinal ring
. Avulsion of the adductor longus from the pubic symphysis
. Tearing of the external oblique aponeurosis

Correct Answer & Explanation

. Attenuation or tearing of the rectus abdominis insertion and transversalis fascia


Explanation

Athletic pubalgia involves a complex of injuries, primarily attenuation or tearing of the rectus abdominis insertion and the transversalis fascia at the pubis. This creates an imbalance with the strong adductor pull, exacerbating groin pain.

Question 203

Topic: 5. Sports Medicine

Which of the following factors most significantly increases the risk of developing myositis ossificans following a severe quadriceps contusion?

. Early initiation of passive stretching
. Application of ice during the first 24 hours
. Knee immobilization in 120 degrees of flexion
. Aspiration of the hematoma within 48 hours
. Premature return to sport and reinjury

Correct Answer & Explanation

. Premature return to sport and reinjury


Explanation

Premature return to play leading to reinjury, early aggressive massage, and passive stretching are known risk factors for myositis ossificans. Immobilization in 120 degrees of flexion actually optimizes outcomes and limits hematoma size.

Question 204

Topic: 5. Sports Medicine

Surgical repair is most strongly indicated for a proximal hamstring avulsion in an athlete when there is:

. A 1-cm retraction of a single tendon
. Complete 3-tendon avulsion with 3 cm of retraction
. Isolated biceps femoris tear at the musculotendinous junction
. Partial semimembranosus tear with ischial bursitis
. Avulsion of the semitendinosus with minimal displacement

Correct Answer & Explanation

. Complete 3-tendon avulsion with 3 cm of retraction


Explanation

Operative treatment is generally recommended for complete 3-tendon (conjoined tendon and semimembranosus) avulsions from the ischial tuberosity with >2 cm of retraction. This prevents profound weakness and sciatic nerve tethering.

Question 205

Topic: 5. Sports Medicine

A professional soccer player sustains an acute, complete proximal adductor longus avulsion. What is the most appropriate initial management for an isolated injury?

. Immediate open surgical repair
. Arthroscopic debridement of the pubic symphysis
. Nonoperative management with brief rest, ice, and progressive rehabilitation
. Platelet-rich plasma injection followed by immediate return to play
. Surgical tenotomy of the remaining adductor brevis

Correct Answer & Explanation

. Nonoperative management with brief rest, ice, and progressive rehabilitation


Explanation

Acute, isolated complete ruptures of the adductor longus in athletes are typically managed nonoperatively with excellent results. Surgery is rarely indicated unless there is a large bony avulsion or chronic pain recalcitrant to therapy.

Question 206

Topic: Shoulder & Hip Sports

In an athlete with femoroacetabular impingement (FAI), a Cam lesion typically damages the hip joint by causing:

. Direct linear compression of the superior labrum
. Delamination of the adjacent acetabular articular cartilage during flexion
. Pincer-type global overcoverage
. Ligamentum teres hypertrophy and rupture
. Avulsion of the anterior inferior iliac spine

Correct Answer & Explanation

. Delamination of the adjacent acetabular articular cartilage during flexion


Explanation

A Cam lesion creates shear forces during hip flexion and internal rotation. This leads to outside-in delamination of the adjacent anterosuperior acetabular cartilage and secondary labral tearing.

Question 207

Topic: Shoulder & Hip Sports

A dancer complains of a painful, audible snap on the lateral aspect of the hip when moving from flexion to extension. Which anatomical structure is primarily responsible for this external snapping hip?

. Iliopsoas tendon snapping over the iliopectineal eminence
. Iliofemoral ligament snapping over the anterior femoral head
. Iliotibial band snapping over the greater trochanter
. Gluteus medius tendon snapping over the piriformis
. Sciatic nerve subluxation over the ischial tuberosity

Correct Answer & Explanation

. Iliotibial band snapping over the greater trochanter


Explanation

External snapping hip (coxa saltans) is caused by the posterior border of the iliotibial band or the anterior border of the gluteus maximus snapping over the greater trochanter. Iliopsoas snapping causes internal snapping hip.

Question 208

Topic: General Sports & Tendon

A 35-year-old female runner presents with deep posterior gluteal pain radiating down the posterior thigh. MRI reveals edema in the quadratus femoris muscle. What is the most likely diagnosis?

. Piriformis syndrome
. Proximal hamstring avulsion
. Ischiofemoral impingement
. Pudendal nerve entrapment
. Gluteus medius tendinopathy

Correct Answer & Explanation

. Ischiofemoral impingement


Explanation

Ischiofemoral impingement results from a narrowed space between the lesser trochanter and the ischium. This leads to compression and characteristic MRI edema or atrophy of the quadratus femoris muscle.

Question 209

Topic: 5. Sports Medicine

In an athlete undergoing surgical repair for athletic pubalgia (core muscle injury), which anatomic structure is most frequently reinforced or repaired?

. Inguinal ligament to the pectineal line
. Rectus abdominis insertion to the pubis and the transversalis fascia
. Conjoint tendon to the pubic tubercle
. External oblique aponeurosis to the anterior superior iliac spine
. Adductor brevis origin

Correct Answer & Explanation

. Rectus abdominis insertion to the pubis and the transversalis fascia


Explanation

Surgery for athletic pubalgia typically involves repairing and reinforcing the insertion of the rectus abdominis and the transversalis fascia. This restores core stability and balances the pull of the adductor origin.

Question 210

Topic: Shoulder & Hip Sports

Which specific clinical test helps differentiate athletic pubalgia from femoroacetabular impingement (FAI) in a hockey player with vague groin pain?

. Flexion, adduction, and internal rotation (FADIR) test
. Resisted sit-up test
. Flexion, abduction, and external rotation (FABER) test
. Ober test
. Thomas test

Correct Answer & Explanation

. Resisted sit-up test


Explanation

The resisted sit-up test directly engages the rectus abdominis and is classically positive in athletic pubalgia. The FADIR test is sensitive for intra-articular hip pathology such as FAI and labral tears.

Question 211

Topic: 5. Sports Medicine

A football player sustains a severe quadriceps contusion. To minimize the risk of prolonged stiffness and myositis ossificans, how should the affected limb be immobilized in the first 24 hours?

. Knee in full extension
. Knee in 45 degrees of flexion
. Knee in 120 degrees of flexion
. Hip in full extension and knee in 90 degrees flexion
. Knee in 90 degrees flexion with external rotation

Correct Answer & Explanation

. Knee in 120 degrees of flexion


Explanation

Early immobilization of the knee in 120 degrees of flexion limits hematoma formation and maintains muscle length. This significantly reduces the time to return to play and the risk of myositis ossificans.

Question 212

Topic: Shoulder & Hip Sports

A 22-year-old dancer presents with a painful snapping sensation deep in her anterior groin when extending her hip from a flexed, abducted, and externally rotated position. Which anatomical structure is most likely involved?

. Iliotibial band over the greater trochanter
. Iliopsoas tendon over the iliopectineal eminence
. Rectus femoris over the anterior inferior iliac spine
. Gluteus maximus over the ischial tuberosity
. Hamstring origin over the ischial tuberosity

Correct Answer & Explanation

. Iliopsoas tendon over the iliopectineal eminence


Explanation

Internal snapping hip (coxa saltans interna) is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. It typically occurs when the hip is moved from a flexed, abducted, externally rotated position into extension.

Question 213

Topic: General Sports & Tendon

Which of the following is the most widely accepted indication for acute surgical repair of a proximal hamstring avulsion injury?

. Single tendon avulsion with 1 cm of retraction
. Conjoined tendon avulsion with 1 cm retraction in a recreational runner
. Semimembranosus avulsion with no retraction
. Avulsion of all three tendons with >2 cm of retraction
. Intramuscular tear of the biceps femoris at the musculotendinous junction

Correct Answer & Explanation

. Avulsion of all three tendons with >2 cm of retraction


Explanation

Acute surgical repair of proximal hamstring avulsions is strongly recommended for tears involving all three tendons (complete avulsion) with greater than 2 cm of retraction. This prevents significant loss of power, deformity, and chronic pain.

Question 214

Topic: Shoulder & Hip Sports

A 25-year-old hockey player diagnosed with athletic pubalgia undergoes surgical repair of the posterior inguinal wall but continues to experience significant groin pain postoperatively. Which concomitant condition was most likely missed during the initial evaluation?

. Femoroacetabular impingement (FAI)
. Osteitis pubis
. Lumbar radiculopathy
. Ischiofemoral impingement
. Greater trochanteric pain syndrome

Correct Answer & Explanation

. Femoroacetabular impingement (FAI)


Explanation

There is a highly recognized association between athletic pubalgia (core muscle injury) and femoroacetabular impingement (FAI). Failure to diagnose and concomitantly treat FAI is a leading cause of persistent groin pain after athletic pubalgia surgery.

Question 215

Topic: General Sports & Tendon

When performing an open repair of a proximal hamstring avulsion, the surgeon identifies the conjoined tendon. Which muscles form this specific anatomical structure at the ischial tuberosity?

. Semimembranosus and semitendinosus
. Long head of biceps femoris and semitendinosus
. Short head of biceps femoris and semimembranosus
. Adductor magnus and semitendinosus
. Long head of biceps femoris and semimembranosus

Correct Answer & Explanation

. Long head of biceps femoris and semitendinosus


Explanation

The proximal hamstring origin at the ischial tuberosity consists of the conjoined tendon (long head of the biceps femoris and the semitendinosus) and the distinct, more lateral and anterior origin of the semimembranosus.

Question 216

Topic: 5. Sports Medicine

In the surgical management of athletic pubalgia (core muscle injury), repair most commonly addresses the attenuation or tearing of which specific anatomical structure?

. Anterior inguinal ring
. External oblique aponeurosis
. Transversalis fascia and rectus abdominis insertion
. Inguinal ligament
. Iliopectineal ligament

Correct Answer & Explanation

. Transversalis fascia and rectus abdominis insertion


Explanation

Athletic pubalgia involves a weakening or tearing of the posterior inguinal wall, specifically the transversalis fascia, and often includes pathology at the insertion of the rectus abdominis and the origin of the adductor longus on the pubis.

Question 217

Topic: Shoulder & Hip Sports

A 21-year-old female runner complains of a painful, audible click on the lateral aspect of her hip when climbing stairs. On physical examination, the snapping is reproduced when the hip is actively flexed and extended while in a lateral decubitus position. Which test is most useful for confirming the tight structures involved in this pathology?

. Thomas test
. FADIR test
. Ober test
. FABER test
. Dial test

Correct Answer & Explanation

. Ober test


Explanation

This patient has external snapping hip syndrome, caused by a tight iliotibial (IT) band snapping over the greater trochanter. The Ober test assesses IT band tightness, which is the primary underlying cause of this condition.

Question 218

Topic: 5. Sports Medicine

Which of the following interventions has been shown to decrease the risk of developing myositis ossificans following a severe quadriceps contusion in an athlete?

. Immobilization in extension for 48 hours
. Early active pain-free knee flexion
. Aggressive passive stretching and massage
. Immediate return to play
. Application of heat modalities in the acute phase

Correct Answer & Explanation

. Early active pain-free knee flexion


Explanation

Early active pain-free knee flexion and avoiding aggressive passive stretching or massage decrease the risk of myositis ossificans. Immobilization in extension is strictly contraindicated as it leads to stiffness and worsened outcomes.

Question 219

Topic: 5. Sports Medicine

A 22-year-old sprinter feels a pop in his buttock during a race. MRI shows a complete proximal avulsion of the conjoint tendon of the biceps femoris and semitendinosus with 3 cm of retraction. What is the most appropriate management?

. Immediate weight bearing as tolerated
. Platelet-rich plasma (PRP) injection
. Surgical repair of the torn tendons
. Prolonged immobilization in a hip spica cast
. Fluoroscopic corticosteroid injection

Correct Answer & Explanation

. Surgical repair of the torn tendons


Explanation

Surgical repair is indicated for proximal hamstring avulsions involving 2 or more tendons with greater than 2 cm of retraction, especially in high-level athletes to restore function.

Question 220

Topic: Shoulder & Hip Sports

Internal snapping hip syndrome (coxa saltans interna) is most commonly caused by which of the following structures snapping over the iliopectineal eminence or femoral head?

. Iliotibial band
. Gluteus maximus
. Rectus femoris
. Iliopsoas tendon
. Sartorius

Correct Answer & Explanation

. Iliopsoas tendon


Explanation

Internal snapping hip is typically caused by the iliopsoas tendon snapping over the iliopectineal eminence or the anterior femoral head. It is often reproduced with active extension of the flexed, abducted, and externally rotated hip.