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 2241
Topic: 5. Sports Medicine
A 12-year-old male presents with vague knee pain. Radiographs show an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms a 1.5 cm lesion with no fluid behind it. The physes are widely open. What is the most appropriate initial management?
Correct Answer & Explanation
. Restriction of sports and weight-bearing modification
Explanation
In skeletally immature patients with a stable OCD lesion (intact cartilage, no fluid behind the lesion on MRI), non-operative management with activity restriction is highly successful and is the appropriate first-line treatment.
Question 2242
Topic: Shoulder & Hip Sports
A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 26% anterior glenoid bone loss.
What is the most appropriate surgical intervention to prevent further dislocations in this athlete?
Correct Answer & Explanation
. Latarjet procedure
Explanation
The Latarjet procedure (coracoid transfer) is the treatment of choice for anterior shoulder instability in the presence of critical anterior glenoid bone loss (>20-25%). Arthroscopic or open Bankart repairs have unacceptably high failure rates in patients with significant bone loss, especially in young contact athletes, because soft tissue repair alone cannot restore the osseous articular arc.
Question 2243
Topic: Shoulder & Hip Sports
During a physical examination of the shoulder, a patient is asked to place the palm of their hand on their opposite shoulder, with the elbow kept elevated. The examiner then applies a downward force to the patient's forearm while the patient resists. This test is highly specific for evaluating a tear of which structure?
Correct Answer & Explanation
. Upper border of the subscapularis
Explanation
The physical examination maneuver described is the Bear-Hug test. It is highly sensitive and specific for diagnosing tears of the upper border of the subscapularis. The Belly-Press test is another subscapularis test, but the Bear-Hug test is considered more sensitive for upper subscapularis tears. The Lift-Off test requires internal rotation behind the back, evaluating the lower subscapularis.
Question 2244
Topic: Shoulder & Hip Sports
A 25-year-old professional volleyball player presents with insidious onset, painless weakness of the right shoulder. Physical examination reveals isolated atrophy of the infraspinatus fossa, with normal bulk of the supraspinatus. At which anatomic location is the nerve compression most likely occurring?
Correct Answer & Explanation
. Suprascapular notch
Explanation
Isolated atrophy and weakness of the infraspinatus point to compression of the suprascapular nerve at the spinoglenoid notch. The suprascapular nerve innervates the supraspinatus muscle after passing through the suprascapular notch, then travels around the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.
Question 2245
Topic: Shoulder & Hip Sports
A 22-year-old elite rugby player with recurrent anterior shoulder instability undergoes a Latarjet procedure due to 25% anterior glenoid bone loss. The procedure relies on a "triple blocking" effect. Which of the following provides the most significant contribution to the dynamic stability (the "sling effect") conferred by the Latarjet procedure when the arm is abducted and externally rotated?
Correct Answer & Explanation
. The conjoint tendon acting as a sling across the inferior capsule and lower subscapularis
Explanation
The Latarjet procedure confers stability through a "triple blocking" mechanism: 1) The osseous block of the coracoid extending the glenoid articular arc; 2) The dynamic "sling effect" of the conjoint tendon (short head of biceps and coracobrachialis) acting on the inferior capsule and lower subscapularis when the arm is in abduction and external rotation; 3) The capsular repair (often using the CA ligament stump). Biomechanical studies show that the dynamic "sling effect" of the conjoint tendon provides 50% to 70% of the stabilizing force.
Question 2246
Topic: Shoulder & Hip Sports
A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and weakness. On examination, there is isolated weakness in external rotation with the arm at the side, but abduction is normal. MRI shows a paralabral cyst. Which of the following is true regarding this condition?
Correct Answer & Explanation
. The condition is often associated with a posterior superior labral tear
Explanation
Isolated weakness of the infraspinatus indicates suprascapular nerve entrapment at the spinoglenoid notch. A paralabral cyst in this location is typically associated with a posterosuperior labral tear (SLAP). Entrapment at the suprascapular notch affects both supraspinatus and infraspinatus. The suprascapular artery does not typically pass through the spinoglenoid notch with the nerve (it usually runs superficial to the spinoglenoid ligament).
Question 2247
Topic: Shoulder & Hip Sports
A 22-year-old competitive rugby player undergoes evaluation for recurrent anterior shoulder instability. A 3D CT scan reveals a 20% anterior glenoid bone loss and a Hill-Sachs lesion. According to the 'glenoid track' concept, an 'off-track' Hill-Sachs lesion is defined by which of the following?
Correct Answer & Explanation
. The medial margin of the Hill-Sachs lesion is medial to the glenoid track
Explanation
The glenoid track is defined as 83% of the intact glenoid width minus the anterior glenoid bone loss. An 'off-track' Hill-Sachs lesion occurs when the medial margin of the Hill-Sachs lesion extends further medial than the medial boundary of the glenoid track. This indicates that the lesion will 'engage' the anterior rim of the glenoid during abduction and external rotation, increasing the risk of recurrent dislocation. Such lesions typically require a Latarjet procedure or Remplissage.
Question 2248
Topic: 5. Sports Medicine
A 26-year-old baseball pitcher presents with pain deep in his throwing shoulder and a 'dead arm' sensation. MR arthrogram reveals a SLAP lesion. During diagnostic arthroscopy, the superior labrum and biceps anchor are found to be detached from the superior glenoid. What type of SLAP tear is this according to the Snyder classification?
Correct Answer & Explanation
. Type II
Explanation
The Snyder classification of SLAP (Superior Labrum Anterior to Posterior) tears: Type I: Fraying and degeneration of the superior labrum with an intact biceps anchor. Type II: Detachment of the superior labrum and biceps anchor from the superior glenoid. Type III: Bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV: Bucket-handle tear of the superior labrum that extends into the biceps tendon. Type II is the most common type requiring surgical repair or biceps tenodesis.
Question 2249
Topic: Shoulder & Hip Sports
A 22-year-old male collegiate wrestler presents with recurrent anterior shoulder instability. Advanced imaging reveals an anterior glenoid bone defect measuring 28% of the glenoid width, along with an engaging Hill-Sachs lesion. Which of the following surgical procedures is most appropriate?
Correct Answer & Explanation
. Latarjet procedure (coracoid transfer)
Explanation
For patients with critical anterior glenoid bone loss (>20-25%), a soft tissue repair alone (Bankart) has unacceptably high failure rates. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore stability via both the bone block and the sling effect of the conjoint tendon.
Question 2250
Topic: Shoulder & Hip Sports
During arthroscopic evaluation of a 22-year-old baseball pitcher, a superior labral anterior-posterior (SLAP) tear is identified with detachment of the biceps anchor. Which of the following physical examination findings was most likely positive preoperatively?
Correct Answer & Explanation
. Active compression (O'Brien) test
Explanation
The O'Brien (active compression) test is commonly used to evaluate for SLAP tears. Pain deep in the shoulder with internal rotation that is relieved by external rotation is considered a positive result for labral pathology.
Question 2251
Topic: Shoulder & Hip Sports
A 24-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Which of the following is the most frequent long-term complication associated with this procedure?
Correct Answer & Explanation
. Development of glenohumeral osteoarthritis
Explanation
The Latarjet procedure is highly effective for preventing recurrent instability in patients with significant anterior glenoid bone loss. However, long-term follow-up studies have shown a high incidence of glenohumeral osteoarthritis. This is often associated with lateral overhang of the coracoid graft, which causes impingement and wear on the humeral head. Graft nonunion, hardware complications, and nerve injuries occur but at lower rates compared to the long-term development of osteoarthritis.
Question 2252
Topic: Shoulder & Hip Sports
An 18-year-old athlete undergoes arthroscopic anterior stabilization for recurrent anterior shoulder instability. Intraoperatively, he is found to have an 'off-track' engaging Hill-Sachs lesion. Which of the following procedures should be added to the Bankart repair?
Correct Answer & Explanation
. Latarjet procedure
Explanation
An 'off-track' Hill-Sachs lesion engages the anterior glenoid rim during abduction and external rotation, significantly increasing the risk of recurrent dislocation if treated with a Bankart repair alone. A remplissage procedure (insetting the infraspinatus tendon and capsule into the defect) converts the defect to an extra-articular lesion and prevents engagement.
Question 2253
Topic: Shoulder & Hip Sports
When evaluating a patient with recurrent anterior shoulder instability, which imaging modality is considered the gold standard for quantifying anterior glenoid bone loss?
Correct Answer & Explanation
. 3D CT scan with humeral head subtraction
Explanation
3D CT reconstruction with the humeral head digitally subtracted provides the most accurate and reliable quantification of glenoid bone loss. This precise measurement is critical for deciding between a soft tissue stabilization (Bankart) and a bone-grafting procedure (Latarjet).
Question 2254
Topic: Shoulder & Hip Sports
Which of the following patients is the most classic and appropriate candidate for a primary Reverse Total Shoulder Arthroplasty (RSA)?
Correct Answer & Explanation
. A 70-year-old female with a massive irreparable rotator cuff tear and pseudoparalysis
Explanation
RSA is strictly indicated for patients with cuff tear arthropathy or massive irreparable rotator cuff tears with pseudoparalysis. The reverse prosthesis relies on the deltoid muscle for active elevation, effectively bypassing the deficient rotator cuff.
Question 2255
Topic: 5. Sports Medicine
A 42-year-old male presents to the emergency department after a seizure. He complains of right shoulder pain and an inability to externally rotate the arm. Radiographs reveal a posterior shoulder dislocation.
A CT scan is obtained after closed reduction and demonstrates an anteromedial impaction fracture of the humeral head (reverse Hill-Sachs lesion) involving 25% of the articular surface. Which of the following is the most appropriate surgical treatment?
Correct Answer & Explanation
. Arthroscopic posterior Bankart repair alone
Explanation
The size of the reverse Hill-Sachs lesion dictates treatment. Defects < 20% are often stable and can be managed non-operatively or with a soft-tissue transfer (McLaughlin procedure). Defects between 20% and 40% typically require structural fill, most commonly via transfer of the lesser tuberosity with the attached subscapularis tendon (Modified McLaughlin procedure) or osteochondral allograft. Defects > 40-50% in a younger patient may require massive allograft, but often necessitate arthroplasty.
Question 2256
Topic: Shoulder & Hip Sports
A 35-year-old male with a history of poorly controlled seizures presents with a locked internal rotation deformity of his right shoulder. A CT scan confirms a posterior shoulder dislocation with an impaction fracture of the anterior humeral head (reverse Hill-Sachs lesion) involving 35% of the articular surface. The dislocation is <3 weeks old. What is the most appropriate surgical management?
Correct Answer & Explanation
. Open reduction and transfer of the lesser tuberosity into the defect
Explanation
For a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, the modified McLaughlin procedure (transfer of the lesser tuberosity and subscapularis tendon into the defect) is the recommended treatment to restore stability.
Question 2257
Topic: Shoulder & Hip Sports
A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness. Physical exam reveals isolated atrophy of the infraspinatus with preserved supraspinatus bulk. Weakness is noted in external rotation, but abduction is normal. An MRI is most likely to show a paralabral cyst located in which of the following areas?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
Isolated atrophy and weakness of the infraspinatus indicate compression of the suprascapular nerve at the spinoglenoid notch, often secondary to a paralabral cyst associated with a posterior or SLAP labral tear. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.
Question 2258
Topic: Shoulder & Hip Sports
A 21-year-old male rugby player has a history of recurrent anterior shoulder dislocations. Imaging demonstrates a 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. He is scheduled for a Latarjet procedure. Which of the following structures is transferred along with the coracoid process to the anterior glenoid?
Correct Answer & Explanation
. Pectoralis minor
Explanation
The Latarjet procedure involves the transfer of the coracoid process, along with the attached conjoint tendon (short head of the biceps and coracobrachialis), to the anterior defect of the glenoid. This provides both a bony block and a dynamic 'sling' effect from the conjoint tendon over the subscapularis when the arm is abducted and externally rotated.
Question 2259
Topic: 5. Sports Medicine
A 45-year-old male with chronic kidney disease presents after a fall with an inability to actively extend his elbow against gravity. Examination reveals a palpable gap proximal to the olecranon. Radiographs show a small fleck of bone avulsed from the olecranon. What is the most appropriate management?
Correct Answer & Explanation
. Immobilization in 90 degrees of flexion for 6 weeks
Explanation
The clinical presentation is classic for a complete triceps tendon rupture, which is highly associated with medical comorbidities like chronic kidney disease, hyperparathyroidism, or anabolic steroid use. The presence of an extensor lag and palpable gap is an indication for surgical repair. Primary repair is typically performed using transosseous tunnels or suture anchors.
Question 2260
Topic: 5. Sports Medicine
A 28-year-old male overhead athlete complains of posterior shoulder pain and paresthesias in the lateral aspect of his arm. An MRI reveals atrophy of the teres minor muscle. Angiography shows occlusion of the posterior humeral circumflex artery with shoulder abduction and external rotation. The affected nerve in this syndrome passes through a space bordered by which of the following structures?
Correct Answer & Explanation
. Teres minor (superior), Teres major (inferior), Long head of triceps (medial), Humeral shaft (lateral)
Explanation
Quadrilateral space syndrome involves the compression of the axillary nerve and the posterior circumflex humeral artery. The anatomic boundaries of the quadrilateral space are the teres minor (superiorly), teres major (inferiorly), long head of the triceps (medially), and the surgical neck of the humerus (laterally). Compression often leads to teres minor atrophy, deltoid weakness, and lateral arm numbness.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.