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5. Sports Medicine MCQs

Practice Set 110 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2181

Topic: Shoulder & Hip Sports

A 25-year-old male presents with an anterior shoulder dislocation following a rugby tackle. Post-reduction, he reports numbness over the lateral aspect of his shoulder. If this nerve injury persists, which muscle's function will most likely demonstrate profound weakness on subsequent examination?

. Supraspinatus
. Pectoralis major
. Subscapularis
. Infraspinatus
. Teres minor

Correct Answer & Explanation

. Supraspinatus

Explanation

The patient has an axillary nerve palsy, which is the most common nerve injury associated with anterior shoulder dislocations. The axillary nerve innervates the deltoid and the teres minor. The teres minor is an external rotator of the shoulder. The supraspinatus and infraspinatus are innervated by the suprascapular nerve, while the subscapularis is innervated by the upper and lower subscapular nerves.

Question 2182

Topic: Knee Sports

A 30-year-old male sustains a high-energy traumatic knee dislocation.

Following reduction, he presents with a foot drop and numbness over the dorsum of the foot. Which specific ligamentous injury pattern is most highly associated with this neurologic deficit?

. Isolated ACL tear
. Posteromedial corner injury
. Isolated PCL tear
. Posterolateral corner injury
. MCL and ACL tear

Correct Answer & Explanation

. Isolated ACL tear

Explanation

Common peroneal nerve injury is a frequent complication of knee dislocations, occurring in up to 25-30% of cases. It is most highly associated with injuries to the posterolateral corner (PLC) and lateral collateral ligament (LCL) because the mechanism of injury (varus stress and hyperextension) strongly stretches the nerve as it wraps around the fibular neck.

Question 2183

Topic: Shoulder & Hip Sports

A 35-year-old male sustains a severely displaced scapular fracture with a fracture line extending deep into the spinoglenoid notch. He complains of persistent shoulder weakness. Which specific physical examination finding is most characteristic of nerve entrapment at this anatomic location?

. Weakness in shoulder abduction and external rotation
. Weakness in shoulder internal rotation
. Numbness over the lateral deltoid
. Weakness in isolated external rotation, with preserved abduction
. Winging of the scapula

Correct Answer & Explanation

. Weakness in shoulder abduction and external rotation

Explanation

The suprascapular nerve innervates the supraspinatus muscle as it passes through the suprascapular notch, and then travels through the spinoglenoid notch to innervate the infraspinatus. Entrapment or injury at the spinoglenoid notch affects only the infraspinatus (causing weakness in external rotation), while sparing the supraspinatus (preserving abduction).

Question 2184

Topic: Shoulder & Hip Sports

A 70-year-old female sustains a primary anterior shoulder dislocation. After a successful and atraumatic closed reduction, she demonstrates persistent, profound weakness in active external rotation and active shoulder abduction. However, sensation over the lateral deltoid remains completely intact. What is the most likely etiology of her weakness?

. Axillary nerve palsy
. Suprascapular nerve palsy
. Rotator cuff tear
. Brachial plexus injury
. Deltoid rupture

Correct Answer & Explanation

. Axillary nerve palsy

Explanation

In older adults (particularly those over 40, and risk increases significantly over 60), anterior shoulder dislocations have a high association with massive rotator cuff tears. These tears present with profound weakness that can mimic a nerve palsy. The intact sensation over the deltoid makes an axillary nerve injury less likely, pointing strongly to a structural cuff failure.

Question 2185

Topic: Knee Sports
A 31-year-old female sustains an anterior knee dislocation (KD-III) following a trampoline injury. Vascular exam is normal, but she has a complete foot drop and cannot actively extend her toes. Where is the most likely anatomic site of nerve tethering causing this injury?
. Popliteal fossa
. Fibular neck
. Anterior compartment of the lower leg
. Sciatic notch
. Medial malleolus

Correct Answer & Explanation

. Fibular neck

Explanation

Knee dislocations have a high rate of common peroneal nerve injury (especially posterolateral corner injuries). The nerve is firmly tethered at the fibular neck as it wraps around the bone, making it highly susceptible to traction.

Question 2186

Topic: 5. Sports Medicine
A 22-year-old male sustains a traumatic knee dislocation (KD-III). Vascular examination is normal, but he exhibits a complete common peroneal nerve palsy. Assuming a closed injury with a grossly stable reduction, what is the most appropriate initial management of the nerve injury?
. Immediate exploration and primary nerve repair
. Immediate sural nerve autografting
. Observation with baseline electromyography (EMG) at 6 weeks
. Early nerve transfer using the tibial nerve motor branches
. Acute tendon transfer of the tibialis posterior

Correct Answer & Explanation

. Observation with baseline electromyography (EMG) at 6 weeks

Explanation

Peroneal nerve palsies associated with knee dislocations are typically traction injuries (neuropraxia/axonotmesis). Observation is indicated initially, with EMG obtained at 6 weeks to 3 months to monitor for subclinical reinnervation.

Question 2187

Topic: Shoulder & Hip Sports
During a posterior approach to the glenoid with retraction as shown in Figure 33, care should be taken during superior retraction to avoid injury to which of the following structures?
. Axillary artery
. Axillary nerve
. Branch of the circumflex scapular artery
. Profunda brachii artery
. Suprascapular nerve and artery

Correct Answer & Explanation

. Suprascapular nerve and artery

Explanation

During a posterior approach to the shoulder for either a scapular fracture, glenoid fracture, or posterior shoulder pathology, the interval between the teres minor and infraspinatus is split. Excessive superior retraction on the infraspinatus, or excessive dissection superomedially under the infraspinatus muscle and tendon can cause injury to the suprascapular nerve and/or artery. During dissection in this interval, the axillary artery and axillary nerve are well protected. A branch of the circumflex scapular artery ascends between the teres minor and infraspinatus muscle, but it is at risk during dissection on the scapula in the mid portion of the interval and not during superior retraction. The profunda brachii artery is not present in this interval.

Question 2188

Topic: Knee Sports

In the native knee, femoral rollback (the posterior translation of the contact point of the femur on the tibia during flexion) is primarily driven by the tension of which of the following ligaments?

. Anterior cruciate ligament
. Poster cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Anterolateral ligament

Correct Answer & Explanation

. Poster cruciate ligament

Explanation

Femoral rollback is primarily driven by the tension in the posterior cruciate ligament (PCL) as the knee flexes. This kinematic mechanism allows for increased knee flexion by clearing the posterior femoral condyles from impinging on the posterior tibia.

Question 2189

Topic: 5. Sports Medicine
Figure 47 shows a transverse MRI scan of a patient’s left shoulder. The findings reveal which of the following abnormalities?
. Subscapularis tear
. Coracoid fracture
. Osteonecrosis of the humeral head
. Posterior labral tear
. Hill-Sachs lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

The MRI scan shows a defect in the posterior aspect of the humeral head, commonly referred to as a Hill-Sachs lesion. This is an impaction fracture of the humeral head that occurs during anterior shoulder dislocation. The abnormality on this image is an irregularity of the posterior humeral head; the humeral head otherwise has a homogenous appearance. The coracoid, subscapularis, and posterior labrum are normal.

Question 2190

Topic: Knee Sports

A 55-year-old female presents with acute knee pain after performing a deep squat. MRI demonstrates a complete radial tear of the medial meniscus posterior root.

Biomechanically, this injury pattern most closely mimics which of the following conditions?

. Partial meniscectomy
. Total meniscectomy
. Anterior cruciate ligament rupture
. Posterior cruciate ligament rupture
. Medial collateral ligament rupture

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete tear of the medial meniscus posterior root disrupts the hoop stresses of the meniscus. Biomechanical studies have demonstrated that this leads to extrusion of the meniscus under load, rendering the knee biomechanically equivalent to a total meniscectomy. This results in significantly increased peak contact pressures in the medial compartment, rapidly predisposing the patient to osteoarthritis if left untreated.

Question 2191

Topic: Knee Sports
An 18-year-old female with recurrent patellar dislocations is scheduled for medial patellofemoral ligament (MPFL) reconstruction. Correct placement of the femoral tunnel is critical to ensure anisometry is minimized. Fluoroscopically, the correct femoral attachment (Schöttle point) is best identified by which of the following landmarks on a true lateral radiograph?
. Anterior to the posterior femoral cortex line and distal to Blumensaat line
. 1 mm anterior to the posterior femoral cortex line and just proximal to the posterior extension of Blumensaat line
. 5 mm anterior to the posterior femoral cortex line and distal to Blumensaat line
. Posterior to the posterior femoral cortex line and proximal to Blumensaat line
. Anterior to the anterior femoral cortex

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortex line and just proximal to the posterior extension of Blumensaat line

Explanation

The Schöttle point is a highly reliable radiographic landmark for the femoral origin of the MPFL. On a true lateral radiograph, it is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and just proximal to the posterior point of Blumensaat line. Proper placement prevents the graft from becoming inappropriately tight or loose during knee range of motion.

Question 2192

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with chronic groin pain that worsens with deep hip flexion and internal rotation. A standing AP pelvis radiograph demonstrates a 'crossover sign'. A frog-leg lateral radiograph shows an alpha angle of 65 degrees.

Which of the following morphologies is predominantly present?

. Cam morphology only
. Pincer morphology only
. Combined Cam and Pincer morphology
. Developmental dysplasia of the hip
. Perthes-like deformity

Correct Answer & Explanation

. Combined Cam and Pincer morphology

Explanation

The patient exhibits findings of both Cam and Pincer morphology, which is the most common presentation of femoroacetabular impingement (FAI). The 'crossover sign' indicates acetabular retroversion or focal overcoverage (Pincer morphology). An alpha angle greater than 50-55 degrees on a lateral radiograph indicates an aspherical femoral head-neck junction (Cam morphology). Thus, it is a combined FAI.

Question 2193

Topic: Knee Sports

A 30-year-old male sustains an isolated posterior cruciate ligament (PCL) injury during a motor vehicle collision. On physical examination, the posterior drawer test is utilized to assess posterior tibial translation. At what degree of knee flexion is the PCL subjected to the highest in situ forces, making it the most reliable position for this test?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The primary restraint to posterior tibial translation is the posterior cruciate ligament (PCL). Biomechanical studies have shown that the PCL experiences the highest in situ forces at 90 degrees of knee flexion. Consequently, the posterior drawer test is performed at 90 degrees of flexion to most accurately assess the integrity of the PCL. The anterolateral bundle is the larger, tighter bundle in flexion.

Question 2194

Topic: Knee Sports

A 22-year-old female undergoes an anterior cruciate ligament (ACL) reconstruction. Post-operatively, she complains of a persistent lack of full knee extension. Imaging reveals that the graft is impinging against the intercondylar roof. What is the most likely technical error leading to this complication?

. Femoral tunnel placed too anterior
. Tibial tunnel placed too anterior
. Tibial tunnel placed too posterior
. Femoral tunnel placed too posterior
. Graft tensioned in full flexion

Correct Answer & Explanation

. Tibial tunnel placed too anterior

Explanation

A tibial tunnel that is placed too far anteriorly will result in the graft impinging on the intercondylar roof (Blumensaat line) during knee extension, leading to a loss of full extension and potential graft abrasion/failure. Conversely, a femoral tunnel placed too anteriorly results in a graft that becomes unphysiologically tight in flexion, limiting knee flexion.

Question 2195

Topic: 5. Sports Medicine

A 38-year-old recreational athlete sustains an acute Achilles tendon rupture. He opts for non-operative management utilizing an early functional rehabilitation protocol. Compared to traditional open surgical repair, what does high-level literature demonstrate regarding rerupture rates when early functional rehabilitation is strictly followed?

. Non-operative management has a significantly higher rerupture rate
. Non-operative management has a significantly lower rerupture rate
. The rerupture rates are statistically similar
. Functional rehabilitation increases rerupture risk compared to cast immobilization
. Non-operative management leads to a significantly higher rate of deep vein thrombosis

Correct Answer & Explanation

. The rerupture rates are statistically similar

Explanation

Historically, non-operative management of Achilles tendon ruptures (via prolonged cast immobilization) was associated with higher rerupture rates than surgical repair. However, modern level I evidence (such as the Willits et al. trial) has shown that when non-operative treatment is combined with a strict early functional rehabilitation protocol (early weight-bearing in a functional brace), the rerupture rates are statistically similar to operative repair, while avoiding surgical complications like infection and nerve injury.

Question 2196

Topic: Knee Sports

A 14-year-old male presents with knee pain and catching. Radiographs reveal a classic osteochondritis dissecans (OCD) lesion.

What is the most common anatomic location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing portion of the medial femoral condyle
. Trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle, accounting for roughly 70-80% of cases. A helpful mnemonic is 'LAME' (Lateral Aspect of Medial Epicondyle/condyle). The underlying etiology is thought to be repetitive microtrauma to a susceptible area of subchondral bone.

Question 2197

Topic: Knee Sports

A 25-year-old male suffers a varus blow to his anteromedial knee while his foot is planted. Examination demonstrates increased external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side, but symmetrical tibial rotation at 90 degrees of flexion. Which structure is predominantly injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Isolated Posterolateral corner (PLC)
. Combined PCL and PLC tear
. Medial collateral ligament

Correct Answer & Explanation

. Isolated Posterolateral corner (PLC)

Explanation

The physical exam described is the Dial test. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If the test were positive at both 30 and 90 degrees, it would suggest a combined PLC and posterior cruciate ligament (PCL) injury, as the PCL becomes the primary restraint to external rotation at 90 degrees.

Question 2198

Topic: Knee Sports

A 28-year-old male presents with right knee pain following a dashboard mechanism injury. On examination, the posterior drawer test is negative. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side. At 90 degrees of knee flexion, external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Posterior cruciate ligament (PCL) only
. Posterior cruciate ligament (PCL) and Posterolateral corner (PLC)
. Posterolateral corner (PLC) only
. Anterior cruciate ligament (ACL) and Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL) only

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

The dial test is used to evaluate the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10-15 degrees difference from the contralateral side) at 30 degrees of flexion with symmetric rotation at 90 degrees indicates an isolated PLC injury. If the dial test is positive at both 30 degrees and 90 degrees of flexion, it suggests a combined injury to both the PLC and the PCL. The negative posterior drawer test further confirms the PCL is intact.

Question 2199

Topic: Shoulder & Hip Sports

A 24-year-old male professional soccer player complains of chronic groin pain exacerbated by kicking. Physical examination reveals a positive impingement test (pain with flexion, adduction, and internal rotation). Radiographs display a "pistol-grip" deformity of the proximal femur and an alpha angle of 68 degrees. What is the primary pathoanatomy responsible for this condition?

. Pincer impingement secondary to focal acetabular retroversion
. Cam impingement due to reduced femoral head-neck offset
. Subspine impingement from a prominent anterior inferior iliac spine
. Ischiofemoral impingement causing quadratus femoris edema
. Internal snapping hip syndrome from the iliopsoas tendon

Correct Answer & Explanation

. Cam impingement due to reduced femoral head-neck offset

Explanation

The clinical picture describes femoroacetabular impingement (FAI). The radiographic findings of a pistol-grip deformity and an elevated alpha angle (>50-55 degrees) are pathognomonic for Cam-type impingement. This is caused by a loss of the normal concave junction between the femoral head and neck (reduced head-neck offset), which creates an aspherical head that abrades the acetabular cartilage during flexion and internal rotation. Pincer impingement is caused by acetabular overcoverage (e.g., coxa profunda, acetabular retroversion, positive crossover sign).

Question 2200

Topic: 5. Sports Medicine

A 42-year-old weekend athlete sustains an acute Achilles tendon rupture. He is managed nonoperatively with a functional rehabilitation protocol. Based on recent Level I evidence, which of the following statements is true regarding nonoperative functional rehabilitation compared to operative management?

. It carries a higher risk of deep infection and wound complications
. It results in a significantly higher tendon re-rupture rate
. It has similar re-rupture rates but significantly lower soft-tissue complication rates
. It allows for a faster return to competitive sports
. It permanently decreases maximum plantar flexion strength by 50%

Correct Answer & Explanation

. It has similar re-rupture rates but significantly lower soft-tissue complication rates

Explanation

Historically, nonoperative treatment with cast immobilization had a higher re-rupture rate than surgery. However, modern Level I evidence (such as the Willits trial) demonstrates that nonoperative treatment utilizing early functional rehabilitation (early weight-bearing in a functional brace) yields re-rupture rates that are not significantly different from operative management, while entirely avoiding the surgical risks of wound breakdown, infection, and sural nerve injury.

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