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5. Sports Medicine MCQs

Practice Set 116 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 2301

Topic: Shoulder & Hip Sports
A 48-year-old construction worker presents with deep anterior shoulder pain. An MRI arthrogram demonstrates a Type II SLAP tear. After failing 6 months of conservative management, surgical intervention is planned. Compared to SLAP repair, primary biceps tenodesis in this demographic (workers > 40 years old) is associated with:
. Higher rates of postoperative stiffness
. Lower rates of return to previous work level
. Decreased risk of revision surgery
. Increased risk of cosmetic 'Popeye' deformity compared to tenotomy
. Equivalent functional outcomes but longer rehabilitation time

Correct Answer & Explanation

. Decreased risk of revision surgery

Explanation

In older patients, manual laborers, and those with workman's compensation claims, SLAP repair is associated with a high rate of failure, persistent pain, stiffness, and subsequent revision surgery. Current evidence strongly supports primary biceps tenodesis over SLAP repair in patients over 40 years of age, as it yields lower rates of revision surgery, more reliable pain relief, and excellent return-to-work rates while minimizing postoperative stiffness.

Question 2302

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. An MRI arthrogram reveals extravasation of contrast into the axillary pouch with a distinctive 'J-sign', demonstrating an avulsion of the inferior glenohumeral ligament from its anatomic attachment on the humerus. What is the diagnosis?

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

Correct Answer & Explanation

. HAGL lesion

Explanation

A HAGL (Humeral Avulsion of the Glenohumeral Ligament) lesion occurs when the inferior glenohumeral ligament (IGHL) avulses from its humeral insertion rather than its glenoid origin. On a coronal or oblique MRI arthrogram, the normal U-shape of the axillary recess is lost. Instead, contrast leaks out laterally and inferiorly, converting the U-shape into a characteristic 'J-sign'. Bankart, ALPSA, Perthes, and GLAD lesions all describe pathology at the glenoid attachment side.

Question 2303

Topic: 5. Sports Medicine

A 28-year-old competitive weightlifter experiences a 'pop' and severe pain in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold, and he is diagnosed with a pectoralis major tendon rupture. Which of the following accurately describes the anatomic relationship of the pectoralis major tendon insertion on the lateral lip of the bicipital groove?

. The clavicular head inserts deep and proximal to the sternal head
. The sternal head inserts deep and proximal to the clavicular head
. Both heads fuse completely to form a single homogenous insertional footprint
. The sternal head inserts superficial and distal to the clavicular head
. The clavicular head inserts directly into the coracoid process

Correct Answer & Explanation

. The sternal head inserts deep and proximal to the clavicular head

Explanation

The pectoralis major tendon consists of two primary heads: clavicular and sternal (sternocostal). As they course laterally toward their insertion on the lateral lip of the bicipital groove, the sternal head twists 180 degrees beneath the clavicular head. This unique anatomic arrangement results in the sternal head inserting deep (posterior) and proximal to the superficial, distally inserting clavicular head. Weightlifting injuries classically involve rupture of the sternal head while the clavicular head often remains intact.

Question 2304

Topic: 5. Sports Medicine

A 32-year-old competitive weightlifter sustains a pectoralis major tendon rupture while performing a heavy bench press. Which anatomical portion of the muscle-tendon unit is under the greatest tension in the lowest eccentric phase of the bench press, making it the most vulnerable to rupture?

. The clavicular head inserting proximally and anteriorly
. The sternal head inserting proximally and posteriorly
. The sternal head inserting distally and anteriorly
. The clavicular head inserting distally and posteriorly
. The abdominal head inserting distally and posteriorly

Correct Answer & Explanation

. The sternal head inserting proximally and posteriorly

Explanation

The pectoralis major tendon undergoes a 180-degree twist before its insertion on the humerus. The clavicular head inserts anteriorly and distally, while the sternal (and abdominal) head twists to insert posteriorly and proximally. During the eccentric phase of a bench press (extension and abduction), the inferior sternal fibers that insert most proximally and posteriorly are placed under maximum tension, making them most susceptible to failure.

Question 2305

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. He reports a measurable decrease in throwing velocity. MRI arthrogram is most likely to show which of the following combined pathologic findings?

. Anterior labral tear and subscapularis tendinosis
. Articular-sided partial tear of the supraspinatus/infraspinatus and posterosuperior labral fraying
. Bursal-sided partial tear of the supraspinatus and subacromial bursitis
. Inferior capsular tear and axillary nerve entrapment
. Biceps anchor avulsion and superior glenohumeral ligament tear

Correct Answer & Explanation

. Articular-sided partial tear of the supraspinatus/infraspinatus and posterosuperior labral fraying

Explanation

Internal impingement occurs in overhead athletes during the late cocking phase of throwing (maximum abduction and external rotation). In this position, the greater tuberosity impinges against the posterosuperior glenoid, trapping the posterior supraspinatus and anterior infraspinatus tendons. This causes articular-sided partial rotator cuff tears and posterosuperior labral fraying.

Question 2306

Topic: 5. Sports Medicine

A 29-year-old overhead athlete complains of poorly localized posterior shoulder pain and paresthesias in the lateral upper arm. MRI of the shoulder demonstrates isolated fatty atrophy of the teres minor. Entrapment of a neurovascular bundle is suspected. Which of the following defines the anatomical borders of the space where this entrapment is occurring?

. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humerus (medial)
. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)
. Teres minor (superior), subscapularis (inferior), long head of triceps (medial), humerus (lateral)
. Supraspinatus (superior), teres minor (inferior), short head of biceps (medial), humerus (lateral)
. Teres major (superior), latissimus dorsi (inferior), long head of triceps (medial), humerus (lateral)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)

Explanation

The patient is presenting with quadrilateral space syndrome, involving compression of the axillary nerve and posterior humeral circumflex artery. This typically leads to isolated teres minor atrophy on MRI. The borders of the quadrilateral space are the teres minor (superior), teres major (inferior), long head of the triceps (medial), and surgical neck of the humerus (lateral).

Question 2307

Topic: Shoulder & Hip Sports

In a 22-year-old collision athlete undergoing an arthroscopic anterior stabilization for recurrent shoulder instability, which of the following findings is the strongest indication to add an arthroscopic remplissage to the Bankart repair?

. An anterior glenoid bone loss of 25%
. An off-track Hill-Sachs lesion with 10% glenoid bone loss
. An associated Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion
. A concomitant type II SLAP tear
. A partial-thickness subscapularis tendon tear

Correct Answer & Explanation

. An off-track Hill-Sachs lesion with 10% glenoid bone loss

Explanation

An "off-track" Hill-Sachs lesion engages the anterior glenoid rim, significantly increasing the risk of recurrent dislocation. Performing a remplissage (infraspinatus tenodesis into the defect) converts the lesion to an "on-track" state, preventing engagement when glenoid bone loss is subcritical.

Question 2308

Topic: 5. Sports Medicine

A 24-year-old elite overhead thrower is diagnosed with a type II SLAP tear that has failed conservative management. If the surgeon elects to perform an arthroscopic SLAP repair, which of the following is the most statistically likely postoperative outcome?

. Progression to rapidly destructive rotator cuff arthropathy
. Return to pre-injury level of throwing performance in over 95% of patients
. Decreased maximum external rotation in abduction
. Iatrogenic injury to the axillary nerve
. Development of a cosmetic Popeye deformity

Correct Answer & Explanation

. Decreased maximum external rotation in abduction

Explanation

Overhead throwing athletes notoriously have poor rates of return to their pre-injury level of play after SLAP repairs (often 50-60%). The most common postoperative mechanical deficit contributing to this is a loss of maximal external rotation in the abducted position.

Question 2309

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is osteotomized and transferred to the anterior glenoid. When retracting the conjoint tendon medially to expose the subscapularis, which nerve is at the highest risk of traction injury?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Long thoracic nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve typically enters the deep surface of the coracobrachialis 5 to 8 cm distal to the coracoid process, though anatomic variations exist. During the Latarjet procedure, aggressive medial retraction of the conjoint tendon (short head of biceps and coracobrachialis) places the musculocutaneous nerve at significant risk for a traction neuropraxia.

Question 2310

Topic: Shoulder & Hip Sports

A 65-year-old male presents with severe shoulder weakness. MRI reveals a massive, retracted tear involving the supraspinatus and infraspinatus tendons with grade 3 fatty infiltration. Electromyography (EMG) indicates denervation changes in both muscles. Which anatomical site is the most likely location of secondary nerve tethering and traction injury caused directly by the medial retraction of these tendons?

. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch
. Spiral groove
. Coracoid process

Correct Answer & Explanation

. Suprascapular notch

Explanation

Massive medial retraction of the supraspinatus and infraspinatus muscles can exert a traction force on the suprascapular nerve. Because the nerve is relatively fixed at the suprascapular notch (under the transverse scapular ligament), medial retraction of the muscle belly causes the nerve to be stretched at this proximal anatomical tether point, leading to suprascapular neuropathy.

Question 2311

Topic: Shoulder & Hip Sports
In the evaluation of a 22-year-old hockey player with suspected femoroacetabular impingement (FAI), a specialized lateral radiograph of the hip (Dunn view) is obtained. Which of the following radiographic thresholds is generally accepted as diagnostic of a clinically significant Cam-type deformity?
. Center-edge angle of Wiberg > 40 degrees
. Alpha angle > 55 degrees
. Acetabular index < 0 degrees
. Tönnis angle > 15 degrees
. Crossover sign positivity

Correct Answer & Explanation

. Alpha angle > 55 degrees

Explanation

A Cam deformity represents an abnormal morphology of the proximal femur with decreased head-neck offset. The alpha angle, typically measured on a Dunn or cross-table lateral radiograph, quantifies this asphericity. An alpha angle greater than 50-55 degrees is considered diagnostic of a Cam lesion. A center-edge angle >40 degrees or a positive crossover sign suggests Pincer impingement.

Question 2312

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 25% anterior glenoid bone loss with a concomitant engaging Hill-Sachs lesion. What is the most appropriate surgical intervention to prevent recurrence?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open Latarjet procedure
. Arthroscopic superior capsular reconstruction
. Putti-Platt procedure

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

Critical anterior glenoid bone loss (generally defined as >20-25%) in a young, contact athlete with recurrent instability is best treated with a bony augmentation procedure. The open Latarjet procedure (coracoid transfer) addresses both the structural glenoid defect and provides a dynamic sling via the conjoint tendon. Arthroscopic Bankart alone has an unacceptably high failure rate in this setting. Remplissage is generally indicated for off-track engaging Hill-Sachs lesions when glenoid bone loss is subcritical (<20%).

Question 2313

Topic: Shoulder & Hip Sports

A 55-year-old patient undergoes a lower trapezius tendon transfer for an irreparable posterosuperior rotator cuff tear. To which anatomic footprint is the transferred tendon (or its allograft extension) classically attached to best restore external rotation?

. Lesser tuberosity
. Greater tuberosity (infraspinatus footprint)
. Subscapularis footprint
. Bicipital groove
. Deltoid tuberosity

Correct Answer & Explanation

. Greater tuberosity (infraspinatus footprint)

Explanation

The lower trapezius tendon transfer is increasingly utilized for irreparable posterosuperior rotator cuff tears (involving the supraspinatus and infraspinatus) in patients without advanced arthropathy. Because the line of pull of the lower trapezius mimics that of the infraspinatus, the tendon (often elongated with an Achilles allograft) is attached to the infraspinatus footprint on the greater tuberosity to restore external rotation and assist with forward elevation.

Question 2314

Topic: Shoulder & Hip Sports

A 24-year-old male athlete presents with groin pain and is evaluated for femoroacetabular impingement (FAI). Which of the following radiographic findings is most specifically characteristic of Cam-type FAI?

. Coxa profunda
. Alpha angle greater than 55 degrees
. Center-edge angle greater than 40 degrees
. Positive crossover sign
. Prominent ischial spine sign

Correct Answer & Explanation

. Alpha angle greater than 55 degrees

Explanation

Cam-type FAI is caused by an aspherical femoral head-neck junction with loss of the normal waist, leading to abutment against the acetabular rim during flexion and internal rotation. This is quantified by the alpha angle, typically measured on a Dunn or cross-table lateral radiograph. An alpha angle >55 degrees is considered diagnostic for Cam morphology. Coxa profunda, increased center-edge angle, and crossover signs are indicative of Pincer-type FAI (acetabular overcoverage).

Question 2315

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, histological examination of the healing tendon-to-bone interface at 12 weeks primarily demonstrates which of the following?
. Direct structural re-establishment of native Sharpey's fibers and uncalcified fibrocartilage
. A dense layer of primarily Type II collagen forming a direct attachment
. A mechanically inferior fibrovascular scar tissue interface consisting predominantly of Type III collagen
. Pure membranous bone formation integrating directly into the tendon fascicles
. Endochondral ossification originating from the underlying cancellous bone bed into the tendon

Correct Answer & Explanation

. A mechanically inferior fibrovascular scar tissue interface consisting predominantly of Type III collagen

Explanation

Unlike the native normal enthesis, which transitions smoothly through four zones (tendon, uncalcified fibrocartilage, calcified fibrocartilage, and bone) relying heavily on Type I collagen and Sharpey's fibers, surgically repaired rotator cuffs heal primarily by the formation of fibrovascular scar tissue. This scar tissue is mechanically inferior and consists predominantly of Type III collagen during the early and intermediate healing phases, which explains the inherent susceptibility to recurrent tears post-surgery.

Question 2316

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT evaluation shows 22% anterior glenoid bone loss and a large Hill-Sachs lesion. Applying the glenoid track concept, which of the following confirms that the Hill-Sachs lesion is 'off-track'?

. The Hill-Sachs width is less than the glenoid bone loss.
. The intact medial margin of the Hill-Sachs lesion is medial to the glenoid track.
. The intact medial margin of the Hill-Sachs lesion is lateral to the glenoid track.
. The bipolar bone loss involves only the anterior 10% of the glenoid.
. The coracoid process demonstrates congenital hypoplasia.

Correct Answer & Explanation

. The intact medial margin of the Hill-Sachs lesion is medial to the glenoid track.

Explanation

A Hill-Sachs lesion is considered 'off-track' (engaging) when its intact medial margin extends medial to the medial boundary of the glenoid track. This occurs when the combination of glenoid bone loss and the size of the humeral head defect allows the lesion to engage the anterior glenoid rim during abduction and external rotation.

Question 2317

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes hip arthroscopy for cam-type FAI. Postoperatively, he develops profound weakness in hip flexion and a small area of numbness on the anteromedial thigh. Which portal placement most likely caused this nerve injury?

. Anterolateral portal
. Mid-anterior portal
. Posterolateral portal
. Distal anterolateral accessory portal
. Proximal mid-anterior portal

Correct Answer & Explanation

. Mid-anterior portal

Explanation

The mid-anterior portal places branches of the lateral femoral cutaneous nerve at risk. Deep dissection placed too medially can endanger the femoral nerve, leading to hip flexion weakness and saphenous nerve distribution numbness.

Question 2318

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. CT scan reveals anterior glenoid bone loss of 25%. Which procedure provides the lowest recurrence rate for this patient?

. Arthroscopic Bankart repair with superior capsule reconstruction
. Open Bankart repair with capsular shift
. Arthroscopic Remplissage
. Latarjet procedure
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) in a contact athlete is best managed with a bony augmentation procedure like the Latarjet. Soft tissue repairs alone in this setting have an unacceptably high failure rate.

Question 2319

Topic: Shoulder & Hip Sports

A 55-year-old female presents with a massive, retracted, immobile tear of the supraspinatus and infraspinatus. Fatty infiltration is Goutallier stage 3. She exhibits pseudoparalysis of elevation. What is the most reliable surgical option to restore active elevation?

. Arthroscopic margin convergence repair
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty
. Superior capsular reconstruction
. Arthroscopic partial repair

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

In an older patient with a massive, irreparable rotator cuff tear, significant fatty infiltration (Goutallier 3), and pseudoparalysis, a reverse total shoulder arthroplasty provides the most reliable functional restoration.

Question 2320

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes a reverse total shoulder arthroplasty (rTSA). Preoperatively, he had an irreparable massive rotator cuff tear involving the supraspinatus, infraspinatus, and teres minor, presenting clinically with a positive hornblowers sign. Which of the following concomitant procedures is most appropriate to perform during the rTSA to optimize his postoperative function?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Trapezius transfer
. Subscapularis repair
. Biceps tenodesis

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

Patients with combined loss of active elevation and external rotation (CLEER) and a positive hornblowers sign (teres minor deficiency) benefit from a latissimus dorsi or lower trapezius transfer combined with rTSA to restore external rotation.

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