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5. Sports Medicine MCQs

Practice Set 114 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 2261

Topic: Shoulder & Hip Sports

A 42-year-old male sustains a severe blunt trauma to his left shoulder in a motor vehicle accident. Radiographs and CT scans reveal a multi-part fracture of the scapular body extending into the glenoid neck. In evaluating the glenoid neck fracture, the glenopolar angle (GPA) is measured. Which of the following statements regarding the glenopolar angle is most accurate?

. The normal GPA is between 10 and 20 degrees.
. A severely decreased GPA (e.g., <20 degrees) is an indication for operative management to prevent poor functional outcomes.
. It is measured on an axillary radiograph by a line from the superior to inferior glenoid rim and a line to the medial scapular border.
. An increased GPA (>45 degrees) is an absolute indication for surgery.
. Nonoperative treatment of scapular neck fractures with a GPA of 15 degrees typically results in normal rotator cuff mechanics.

Correct Answer & Explanation

. The normal GPA is between 10 and 20 degrees.

Explanation

The glenopolar angle (GPA) assesses the rotational malalignment of the glenoid. It is measured on a true AP (Grashey) view or 3D CT. The angle is formed by a line drawn from the highest point of the glenoid cavity to the lowest point, and a second line drawn from the highest point of the glenoid cavity to the most inferior angle of the scapular body. The normal range is 30 to 45 degrees. A decreased GPA (<20-22 degrees) is associated with poor functional outcomes due to altered rotator cuff mechanics and is generally an indication for open reduction and internal fixation.

Question 2262

Topic: Shoulder & Hip Sports

A 32-year-old professional volleyball player presents with insidious onset of vague posterior shoulder pain and profound weakness in external rotation. He has full, painless passive range of motion. Examination reveals isolated atrophy of the infraspinatus with a normal-appearing supraspinatus. MRI is most likely to show a cyst in which of the following locations?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Triangular space

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated atrophy and weakness of the infraspinatus indicate compression of the suprascapular nerve at the spinoglenoid notch (after it has already given off its motor branches to the supraspinatus). This is commonly caused by a paralabral cyst associated with a posterior or SLAP labral tear. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Question 2263

Topic: Shoulder & Hip Sports

A 55-year-old male presents with shoulder pain and weakness following a fall on an extended arm. On examination, he is able to passively rotate his arm internally behind his back. When the examiner pulls the patient's hand away from the back and asks the patient to maintain this position, the patient's hand falls back against his lumbar spine. What is this test called and what muscle is it testing?

. Belly-press test; Supraspinatus
. Lift-off test; Subscapularis
. Internal rotation lag sign; Subscapularis
. Hornblower's sign; Teres minor
. Bear-hug test; Pectoralis major

Correct Answer & Explanation

. Internal rotation lag sign; Subscapularis

Explanation

The test described is the Internal Rotation Lag Sign (IRLS). The examiner passively brings the patient's hand away from the back (maximal internal rotation) and asks the patient to hold it there. An inability to maintain the hand away from the back (a 'lag') indicates a subscapularis tear. The lift-off test requires the patient to actively push the hand away from the back against resistance, which tests the same muscle but is a different maneuver.

Question 2264

Topic: 5. Sports Medicine
A 28-year-old overhead athlete undergoes shoulder arthroscopy. The surgeon identifies a bucket-handle tear of the superior labrum. The biceps anchor remains firmly attached to the glenoid. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

According to the Snyder classification of SLAP (Superior Labrum Anterior to Posterior) tears: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor from the glenoid. Type III is a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the superior labrum that extends into the biceps tendon.

Question 2265

Topic: Shoulder & Hip Sports

A 25-year-old male with recurrent anterior shoulder instability and 25% glenoid bone loss undergoes a Latarjet procedure. Which of the following nerves is at greatest risk of injury during the coracoid osteotomy and transfer?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The Latarjet procedure involves the transfer of the coracoid process and its attached conjoint tendon (short head of the biceps and coracobrachialis) to the anterior glenoid neck. The musculocutaneous nerve enters the coracobrachialis muscle typically 3-5 cm distal to the coracoid tip. Retraction of the conjoint tendon or careless dissection medial/distal to the coracoid places this nerve at significant risk during the initial exposure and osteotomy.

Question 2266

Topic: 5. Sports Medicine

A 22-year-old male undergoes diagnostic shoulder arthroscopy for recurrent anterior instability. The surgeon visualizes an avulsion of the anterior labroligamentous complex from the glenoid, but notes that the labrum is medially displaced and healed to the medial scapular neck with intact anterior scapular periosteum. What is the correct term for this lesion?

. Classic Bankart lesion
. Perthes lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Classic Bankart lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior labrum is avulsed but the periosteum remains intact, allowing the labrum to roll medially and heal in a displaced position on the anterior glenoid neck. A classic Bankart involves a complete tear of the labrum and periosteum. A Perthes lesion is a nondisplaced tear of the labrum with an intact strip of periosteum. GLAD is a Glenolabral Articular Disruption. HAGL is a Humeral Avulsion of the Glenohumeral Ligament.

Question 2267

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer has a massive, irreparable posterosuperior rotator cuff tear (supraspinatus and infraspinatus). He has preserved forward elevation but severe weakness in external rotation (Hornblower's sign positive). He has no glenohumeral arthritis. Which of the following is the classic tendon transfer utilized to restore active external rotation in this specific scenario?

. Pectoralis major transfer
. Subscapularis transfer
. Latissimus dorsi transfer
. Biceps tenodesis
. Coracobrachialis transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

For massive irreparable posterosuperior cuff tears with isolated loss of active external rotation and an intact subscapularis, the latissimus dorsi transfer (LDT) has historically been the workhorse to restore active external rotation and depress the humeral head. The latissimus (normally an internal rotator) is redirected to the greater tuberosity to function as an external rotator.

Question 2268

Topic: Shoulder & Hip Sports

A 13-year-old elite baseball pitcher presents with anterior shoulder pain worsening with throwing. Examination shows proximal humerus tenderness but normal ROM. Radiographs reveal widening of the proximal humeral physis. What is the most appropriate initial management?

. Immediate surgical pinning
. Corticosteroid injection into the subacromial space
. Absolute rest from throwing for 3 months followed by a gradual return
. Physical therapy focusing on internal rotation stretching only
. MRI arthrogram to rule out SLAP tear

Correct Answer & Explanation

. Immediate surgical pinning

Explanation

'Little Leaguer's shoulder' is a stress fracture (epiphysiolysis) of the proximal humeral physis due to repetitive rotational torque. Treatment is strictly non-operative, requiring complete rest from throwing (usually 3 months) until clinical and radiographic resolution, followed by a structured return-to-throwing protocol.

Question 2269

Topic: Shoulder & Hip Sports

A 35-year-old male sustained a seizure and presents with a locked posterior shoulder dislocation. CT shows a reverse Hill-Sachs lesion involving 35% of the humeral head articular surface. Which of the following is the most appropriate surgical treatment?

. Closed reduction and sling immobilization
. Arthroscopic posterior Bankart repair
. Open reduction and lesser tuberosity/subscapularis transfer
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Closed reduction and sling immobilization

Explanation

For locked posterior dislocations with an anteromedial humeral head defect (reverse Hill-Sachs) involving 20-40% of the articular surface, a modified McLaughlin procedure (transfer of the subscapularis and lesser tuberosity into the defect) or osteochondral allografting is recommended to prevent engagement and recurrent instability.

Question 2270

Topic: Shoulder & Hip Sports
A 28-year-old overhead athlete is diagnosed with a Type IV SLAP lesion following an MRI arthrogram. Which of the following accurately describes a Type IV SLAP tear?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the glenoid
. Bucket-handle tear of the superior labrum with an intact biceps anchor
. Bucket-handle tear of the superior labrum extending into the long head of the biceps tendon
. SLAP tear with a concomitant anterior Bankart lesion

Correct Answer & Explanation

. Bucket-handle tear of the superior labrum extending into the long head of the biceps tendon

Explanation

According to Snyder's classification of SLAP tears: Type I is fraying; Type II is detachment of the superior labrum and biceps anchor; Type III is a bucket-handle tear of the labrum with an intact biceps anchor; Type IV is a bucket-handle tear of the labrum that extends into the biceps tendon.

Question 2271

Topic: Shoulder & Hip Sports
A 52-year-old man underwent arthroscopic repair of a 1-cm supraspinatus tendon tear 3 weeks ago. He was doing well until he fell down three stairs. One week after the fall he continues to report pain similar to his preoperative pain. An MRI scan reveals a minimally retracted 1-cm supraspinatus tendon tear in the same location as his original tear. Management should now consist of
. Continued physical therapy that focuses on stretching and advances to strengthening in 4 weeks.
. A cortisone injection into the subacromial space.
. Revision rotator cuff repair.
. A sling with an abduction pillow for 2 weeks, followed by a stretching program.
. Open rotator cuff debridement without repair.

Correct Answer & Explanation

. Revision rotator cuff repair.

Explanation

The patient has retorn his rotator cuff repair. This traumatic retear is different from a chronic tear and should be treated similar to an acute rotator cuff tear. Because the patient is younger than age 65 and has a small, single tendon tear, a revision rotator cuff repair is indicated with an expected tendon healing rate of greater than 95%. A physical therapy program is not indicated, and further delay in repair compromises his functional recovery. A cortisone injection is not indicated for this repairable tendon tear. Immobilization will not allow the tendon to heal once it has retorn. A debridement procedure is not indicated on this repairable tendon tear; this procedure is indicated in painful, chronic, irreparable tendon tears.

Question 2272

Topic: Shoulder & Hip Sports
Which of the following clinical findings is commonly associated with symptomatic partial-thickness rotator cuff tears?
. Negative impingement signs
. Abnormal lift-off test
. External rotation lag sign
. Painful arc with active range of motion
. Mismatch in active and passive motion

Correct Answer & Explanation

. Painful arc with active range of motion

Explanation

In symptomatic partial-thickness rotator cuff tears, a painful arc with active range of motion is common, impingement signs are usually positive, and the lift-off test is normal. Active and passive range of motion measurements are often equal, although active range of motion can be painful. External rotation lag signs are often seen with larger full-thickness tears.

Question 2273

Topic: 5. Sports Medicine

When counseling a 20-year-old athlete regarding anterior cruciate ligament (ACL) reconstruction, you discuss the biomechanical properties of different autografts. Which of the following statements accurately compares the biomechanical characteristics of a quadrupled (4-strand) hamstring autograft to the native ACL?

. The 4-strand hamstring autograft has a lower ultimate load to failure than the native ACL.
. The native ACL has higher stiffness than the 4-strand hamstring autograft.
. The 4-strand hamstring autograft has both a higher ultimate load to failure and higher stiffness than the native ACL.
. The ultimate load to failure is equivalent, but the native ACL has superior stiffness.
. Bone-patellar tendon-bone autograft has greater ultimate load and stiffness than the 4-strand hamstring autograft.

Correct Answer & Explanation

. The 4-strand hamstring autograft has a lower ultimate load to failure than the native ACL.

Explanation

Biomechanical studies have shown that a quadrupled (4-strand) hamstring tendon graft has an ultimate load to failure of approximately 4090 N and a stiffness of 776 N/mm. In contrast, the native ACL has an ultimate load to failure of roughly 2160 N and a stiffness of 242 N/mm. A 10-mm bone-patellar tendon-bone (BPTB) graft has an ultimate load of ~2977 N and a stiffness of ~620 N/mm. Therefore, the 4-strand hamstring autograft has both a significantly higher ultimate load to failure and higher stiffness compared to the native ACL.

Question 2274

Topic: Knee Sports

A 28-year-old male presents with chronic knee instability following a football injury 9 months ago. Physical examination reveals a positive Lachman test, a positive pivot shift, and significant laxity to varus stress at 30 degrees of flexion. His dial test is asymmetric at 30 and 90 degrees. Standing full-length radiographs demonstrate a mechanical axis passing through the medial compartment (varus morphotype). What is the most appropriate initial surgical management?

. Simultaneous arthroscopic ACL reconstruction and open posterolateral corner (PLC) reconstruction
. High tibial osteotomy (HTO), with delayed ligamentous reconstruction if symptomatic instability persists
. Isolated ACL reconstruction, followed by a derotational brace for 12 weeks
. Isolated PLC reconstruction to restore varus stability, followed by physical therapy
. Simultaneous HTO, ACL reconstruction, and PLC reconstruction

Correct Answer & Explanation

. Simultaneous arthroscopic ACL reconstruction and open posterolateral corner (PLC) reconstruction

Explanation

In the setting of chronic combined ACL and posterolateral corner (PLC) deficiency coupled with varus mechanical alignment, performing ligamentous reconstruction alone without addressing the bony malalignment results in exceptionally high failure rates due to excessive tensile forces on the grafts. The standard of care is a staged approach: an initial High Tibial Osteotomy (HTO) to correct the varus alignment (shifting the mechanical axis laterally), followed by delayed ACL/PLC reconstruction. Often, the bony correction provides sufficient stability that the patient may not require the second-stage ligament reconstruction.

Question 2275

Topic: 5. Sports Medicine

A 25-year-old male undergoes a primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Seven months postoperatively, he complains of localized anterior knee pain, an audible 'clunk,' and a mechanical block to terminal extension (lacks 15 degrees). MRI demonstrates a nodular, heterogeneous mass anterior to the tibial tunnel in the intercondylar notch. What technical error during the initial surgery most directly caused this complication?

. Placement of the femoral tunnel too anteriorly
. Placement of the tibial tunnel too anteriorly
. Tensioning the graft while the knee was in full flexion
. Inadequate removal of the infrapatellar fat pad
. Harvesting a graft that was too wide for the intercondylar notch

Correct Answer & Explanation

. Placement of the femoral tunnel too anteriorly

Explanation

The patient has developed a 'cyclops lesion,' which is a localized form of anterior arthrofibrosis consisting of a fibrovascular nodule that forms anterior to the ACL graft. Clinically, it presents with a loss of terminal knee extension and sometimes an audible clunk. The primary technical error associated with the formation of a cyclops lesion is placing the tibial tunnel too far anteriorly. This anterior placement causes the graft to impinge against the roof of the intercondylar notch (Blumensaat's line) during terminal extension, leading to repetitive microtrauma, fraying of the graft, and subsequent reactive fibrous tissue proliferation.

Question 2276

Topic: Knee Sports

A 19-year-old female dancer presents with recurrent lateral patellar instability. An MRI of her knee reveals a Tibial Tubercle to Trochlear Groove (TT-TG) distance of 23 mm, a Caton-Deschamps index of 1.0, and a Dejour Type A trochlear dysplasia. She has failed conservative management. Which of the following surgical procedures is most appropriate to minimize her risk of recurrence?

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction
. MPFL reconstruction combined with a medializing tibial tubercle osteotomy (TTO)
. MPFL reconstruction combined with a distalizing tibial tubercle osteotomy (TTO)
. Lateral retinacular release and medial plication
. Isolated trochleoplasty

Correct Answer & Explanation

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction

Explanation

The patient has recurrent patellar instability with an abnormally high TT-TG distance. A normal TT-TG distance is generally < 15 mm. A distance of > 20 mm is considered pathologic and is an absolute indication for a medializing tibial tubercle osteotomy (TTO) to centralize the extensor mechanism. Performing an isolated MPFL reconstruction in the setting of a TT-TG > 20 mm subjects the graft to excessive lateralizing forces, resulting in an unacceptably high rate of graft failure. Because her Caton-Deschamps index is 1.0 (normal patellar height), a distalizing TTO is not indicated.

Question 2277

Topic: Knee Sports
A 55-year-old female feels a sudden 'pop' in the posterior aspect of her knee while descending stairs. She complains of intense posteromedial knee pain. An MRI reveals >3 mm of medial meniscal extrusion on the coronal sequence and a 'ghost sign' on the sagittal sequence. This specific meniscal injury pattern is most strongly associated with the subsequent development of which of the following conditions if left untreated?
. Anterior cruciate ligament insufficiency
. Subchondral insufficiency fracture of the knee (SIFK) / spontaneous osteonecrosis (SONK)
. Pigmented villonodular synovitis (PVNS)
. Patellofemoral osteoarthritis
. Popliteal artery entrapment

Correct Answer & Explanation

. Subchondral insufficiency fracture of the knee (SIFK) / spontaneous osteonecrosis (SONK)

Explanation

The clinical presentation and MRI findings (extrusion > 3 mm, 'ghost sign') are pathognomonic for a medial meniscus posterior root tear. The posterior root anchor is essential for converting axial loads into hoop stresses. Disruption of the root biomechanically mimics a total meniscectomy, leading to drastically increased focal contact pressures in the medial compartment. If left untreated, this rapid loss of load distribution is highly associated with the development of a subchondral insufficiency fracture of the knee (SIFK), classically referred to as spontaneous osteonecrosis of the knee (SONK), and rapid progression of osteoarthritis.

Question 2278

Topic: 5. Sports Medicine

A 55-year-old male with end-stage renal disease presents with acute anterior knee pain and an inability to perform a straight leg raise after a slip and fall. Lateral radiographs of the knee demonstrate a patella baja (low-riding patella) with an Insall-Salvati ratio of 0.6. Which of the following is the most likely diagnosis?

. Patellar tendon rupture
. Quadriceps tendon rupture
. Tibial tubercle avulsion fracture
. Transverse patella fracture
. Osgood-Schlatter disease exacerbation

Correct Answer & Explanation

. Patellar tendon rupture

Explanation

An inability to perform a straight leg raise indicates disruption of the extensor mechanism. A low-riding patella (patella baja), evidenced by an Insall-Salvati ratio < 0.8, points to a quadriceps tendon rupture, as the intact patellar tendon tethers the patella distally. A patellar tendon rupture would result in a high-riding patella (patella alta).

Question 2279

Topic: Knee Sports

A 30-year-old male is evaluated for knee instability following a wrestling injury. A Dial test is performed in the prone position. There is 20 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which structure(s) are primarily injured?

. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Combined PCL and PLC
. Anterior cruciate ligament (ACL) and PLC
. Combined ACL and PCL

Correct Answer & Explanation

. Isolated posterior cruciate ligament (PCL)

Explanation

The Dial test evaluates posterolateral rotatory instability. Increased external rotation (>10 degrees compared to the normal knee) at 30 degrees of flexion, but normal at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If increased external rotation is present at both 30 and 90 degrees, it indicates a combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 2280

Topic: Knee Sports

A 28-year-old male requires open reduction and internal fixation of a large, displaced tibial-sided avulsion fracture of the posterior cruciate ligament (PCL). A traditional posteromedial approach to the knee is planned. The deep surgical dissection passes between the medial head of the gastrocnemius and which other muscle to expose the posterior capsule?

. Popliteus
. Soleus
. Semimembranosus
. Biceps femoris
. Gracilis

Correct Answer & Explanation

. Popliteus

Explanation

The posteromedial approach to the knee (often attributed to Burks and Schaffer) relies on the internervous/intermuscular plane between the medial head of the gastrocnemius (tibial nerve) and the semimembranosus (sciatic nerve). Retracting the gastrocnemius laterally protects the midline neurovascular structures.

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