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5. Sports Medicine MCQs

Practice Set 120 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 2381

Topic: Knee Sports
A 10-year-old boy sustained an injury to the left knee. The radiographic findings shown in Figure 19 are most commonly associated with injury to which of the following structures?
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Patellar tendon
. Lateral capsule
. Pes anserinus

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

The radiograph shows a bony avulsion of the ACL attachment site on the tibial spine in this skeletally immature patient. In this age group, injury often results in failure of the bony attachment site rather than the substance of the ligament.

Question 2382

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, the 'glenoid track' concept is applied. A Hill-Sachs lesion is considered 'off-track' and at high risk for engagement if it:

. Remains engaged over the anterior glenoid rim during abduction and internal rotation
. Is entirely covered by the intact articular surface of the glenoid
. Extends medial to the medial margin of the glenoid track
. Involves less than 20% of the humeral head diameter
. Is associated with an isolated soft tissue Bankart lesion

Correct Answer & Explanation

. Extends medial to the medial margin of the glenoid track

Explanation

An 'off-track' Hill-Sachs lesion extends medial to the margin of the glenoid track. Because it is wider than the track provided by the glenoid, it will engage the anterior glenoid rim during abduction and external rotation, often necessitating a remplissage or Latarjet procedure.

Question 2383

Topic: 5. Sports Medicine

A 65-year-old woman undergoes volar locked plating for a displaced intra-articular distal radius fracture. Six months postoperatively, she suddenly loses the ability to flex her thumb interphalangeal joint. What is the most likely cause?

. Posterior interosseous nerve (PIN) entrapment
. Anterior interosseous nerve (AIN) neuropraxia
. Flexor pollicis longus (FPL) tendon rupture
. Extensor pollicis longus (EPL) tendon rupture
. Failure of the volar locking plate

Correct Answer & Explanation

. Flexor pollicis longus (FPL) tendon rupture

Explanation

Placement of a volar plate distal to the watershed line can cause prominence and attritional rupture of the flexor pollicis longus (FPL) tendon. Sudden loss of thumb IP joint flexion months after fixation strongly suggests tendon rupture rather than a nerve palsy.

Question 2384

Topic: 5. Sports Medicine

A 26-year-old male weightlifter feels a painful 'pop' in his right axilla while performing a heavy bench press. Magnetic resonance imaging confirms a complete pectoralis major tendon rupture at its humeral insertion. Which of the following accurately describes the normal anatomical arrangement of the pectoralis major tendon at its insertion?

. The clavicular head inserts posterior and proximal to the sternocostal head
. The sternocostal head inserts anterior and proximal to the clavicular head
. The clavicular head inserts anterior and distal to the sternocostal head
. The sternocostal head twists 180 degrees to insert proximal and posterior to the clavicular head
. The clavicular and sternocostal heads blend completely to form a single, untwisted laminar insertion

Correct Answer & Explanation

. The sternocostal head twists 180 degrees to insert proximal and posterior to the clavicular head

Explanation

The pectoralis major has a unique twisted insertion on the lateral lip of the bicipital groove. The clavicular head descends relatively straight to insert anteriorly and distally. The sternocostal head twists 180 degrees, passing deep to the clavicular head, to insert proximal and posterior to the clavicular head. This biomechanical arrangement places the sternocostal fibers under maximal tension when the arm is extended and externally rotated, making it the most frequently injured portion during exercises like the bench press.

Question 2385

Topic: 5. Sports Medicine

A 60-year-old male with an irreparable, massive posterosuperior rotator cuff tear and intractable pain is undergoing an arthroscopic superior capsular reconstruction (SCR) using a dermal allograft. The graft utilized in an SCR is biomechanically designed to restore normal glenohumeral kinematics primarily by preventing which of the following abnormal translations of the humeral head?

. Superior translation
. Anterior translation
. Posterior translation
. Inferior translation
. Medial translation

Correct Answer & Explanation

. Superior translation

Explanation

The superior capsule is a critical static stabilizer of the glenohumeral joint. In massive posterosuperior rotator cuff tears, the superior restraint provided by the supraspinatus and the superior capsule is lost, leading to dynamic superior migration of the humeral head. Superior Capsular Reconstruction (SCR) tethers the superior glenoid to the greater tuberosity, mechanically preventing superior translation of the humeral head and restoring the functional fulcrum for the deltoid.

Question 2386

Topic: 5. Sports Medicine

Based on recent high-quality randomized controlled trials (such as Willits et al.) comparing the management of acute Achilles tendon ruptures, which of the following statements best characterizes the comparison between operative repair and functional rehabilitation (non-operative management)?

. Operative repair results in a significantly lower rerupture rate regardless of rehabilitation protocol
. Functional rehabilitation results in a significantly higher rate of deep vein thrombosis
. There is no clinically significant difference in rerupture rates when early functional weight-bearing protocols are utilized in both groups
. Operative repair provides significantly greater long-term plantarflexion strength and return to play
. Functional rehabilitation is associated with a markedly higher risk of sural nerve injury

Correct Answer & Explanation

. There is no clinically significant difference in rerupture rates when early functional weight-bearing protocols are utilized in both groups

Explanation

Modern Level I evidence demonstrates that when a dynamic, early functional rehabilitation and weight-bearing protocol is employed, there is no statistically significant difference in the rerupture rates between non-operative and operative management of acute Achilles tendon ruptures. Furthermore, operative management carries a higher risk of soft-tissue complications, including wound infections and sural nerve injury.

Question 2387

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player with recurrent anterior shoulder instability undergoes a preoperative 3D CT scan. The 'bare spot' or 'best-fit circle' method is utilized to assess anterior glenoid bone loss. Which of the following thresholds of anterior glenoid bone loss is classically accepted as an absolute indication for a bony augmentation procedure (e.g., Latarjet) rather than an isolated arthroscopic Bankart repair?

. Greater than 5%
. Greater than 10%
. Greater than 15%
. Greater than 20-25%
. Greater than 40%

Correct Answer & Explanation

. Greater than 20-25%

Explanation

The classic threshold for critical anterior glenoid bone loss, which serves as an absolute indication for a bony augmentation procedure (such as the Latarjet procedure), is generally accepted as > 20-25%. While recent literature discusses 'subcritical' bone loss (13.5-15%) in high-demand contact athletes where bone block may be considered, > 20-25% remains the definitive, historically validated cut-off for critical bone loss where soft tissue repair alone has an unacceptably high failure rate.

Question 2388

Topic: Shoulder & Hip Sports

A 24-year-old male undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness with elbow flexion and forearm supination, as well as numbness over the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure, particularly during the coracoid osteotomy and the retraction of the conjoint tendon. Injury to this nerve results in weakness of the biceps and brachialis (elbow flexion and supination) and sensory deficits in the lateral antebrachial cutaneous nerve distribution (lateral forearm).

Question 2389

Topic: Shoulder & Hip Sports

A 60-year-old male presents with a massive, chronically retracted tear involving both the supraspinatus and infraspinatus tendons. Due to the medial retraction of these specific tendons, at which anatomical site is the suprascapular nerve most vulnerable to traction injury or tethering?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates the supraspinatus and infraspinatus. With massive, retracted tears of the supraspinatus, the nerve can be placed under significant traction and tethered at the suprascapular notch (proximal to its innervation of the supraspinatus). While retraction of the infraspinatus alone might tether the nerve at the spinoglenoid notch, medial retraction of massive tears (involving supraspinatus) primarily threatens the nerve at the suprascapular notch.

Question 2390

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. He elects for non-operative management with a modern functional rehabilitation protocol. Compared to surgical repair, high-level evidence demonstrates which of the following regarding non-operative management?

. Significantly higher rate of deep vein thrombosis
. Significantly higher re-rupture rate regardless of protocol
. Equivalent re-rupture rate but higher risk of sural nerve injury
. Equivalent re-rupture rate but a greater decrease in terminal plantarflexion strength
. Equivalent re-rupture rate with no significant difference in overall functional outcomes

Correct Answer & Explanation

. Equivalent re-rupture rate with no significant difference in overall functional outcomes

Explanation

High-level level I evidence (such as the landmark trial by Willits et al.) has demonstrated that when an early functional rehabilitation protocol is used, non-operative management of acute Achilles tendon ruptures yields equivalent re-rupture rates, strength, and functional outcomes compared to surgical repair. Furthermore, non-operative management avoids the risks of surgical complications such as deep infection and sural nerve injury.

Question 2391

Topic: 5. Sports Medicine

During a Superior Capsular Reconstruction (SCR) for an irreparable supraspinatus tear, a dermal allograft is securely attached to the superior glenoid medially and the greater tuberosity laterally. What is the primary biomechanical function of this graft in restoring shoulder kinematics?

. Directly restores active abduction by mimicking the supraspinatus muscle force
. Reverses the deltoid force vector from superior to inferior
. Depresses the humeral head to restore a stable glenohumeral fulcrum
. Tethers the humeral head anteriorly to prevent subluxation
. Increases the moment arm of the long head of the biceps tendon

Correct Answer & Explanation

. Depresses the humeral head to restore a stable glenohumeral fulcrum

Explanation

The primary biomechanical purpose of the Superior Capsular Reconstruction (SCR) is to act as a static spacer and superior tether. By preventing superior migration of the humeral head, it depresses the humeral head and restores a stable glenohumeral fulcrum. This allows the intact deltoid and remaining force couples of the rotator cuff to efficiently elevate the arm.

Question 2392

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT scan demonstrates 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. He undergoes a Latarjet procedure. During the coracoid transfer, which nerve is at greatest risk of injury if retractors are placed too vigorously on the medial aspect of the conjoint tendon?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

During the Latarjet procedure, the musculocutaneous nerve is at high risk of iatrogenic injury. It typically penetrates the coracobrachialis muscle approximately 5 to 8 cm distal to the coracoid tip but can enter much closer in anatomic variants. Vigorous medial retraction of the conjoint tendon can stretch or compress this nerve.

Question 2393

Topic: Shoulder & Hip Sports

A 28-year-old male volleyball player presents with insidious onset posterior shoulder pain and weakness in external rotation. Exam reveals atrophy of the infraspinatus with a normal appearing supraspinatus. MRI demonstrates a paralabral cyst. At which of the following anatomical locations is the cyst most likely compressing the suprascapular nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated atrophy and weakness of the infraspinatus indicate compression of the suprascapular nerve after it has innervated the supraspinatus. This occurs at the spinoglenoid notch. Compression at the more proximal suprascapular notch would cause weakness and atrophy in both the supraspinatus and infraspinatus. Paralabral cysts associated with posterior labral tears frequently track into the spinoglenoid notch.

Question 2394

Topic: 5. Sports Medicine

A 42-year-old recreational athlete sustains an acute Achilles tendon rupture. He is debating between operative repair and non-operative management. Based on the most recent high-quality randomized controlled trials utilizing early functional rehabilitation protocols, which of the following statements regarding outcomes is most accurate?

. Operative management significantly decreases the re-rupture rate compared to functional non-operative management.
. Non-operative management with a prolonged cast immobilization protocol has lower re-rupture rates than operative repair.
. There is no significant difference in re-rupture rates between operative repair and functional non-operative management.
. Operative management yields significantly superior plantarflexion strength at 2 years compared to functional non-operative management.
. Sural nerve injury is the most common complication in functional non-operative management.

Correct Answer & Explanation

. There is no significant difference in re-rupture rates between operative repair and functional non-operative management.

Explanation

Recent high-quality level I evidence (such as the Willits trial and more recent meta-analyses) demonstrates that when functional rehabilitation with early weight-bearing and range of motion is employed, there is no statistically significant difference in re-rupture rates between operative and non-operative management of acute Achilles tendon ruptures. Operative management carries higher risks of complications such as infection and nerve injury.

Question 2395

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic shoulder pain and weakness. Clinical examination demonstrates a positive external rotation lag sign and a positive Hornblower's sign. MRI reveals a massive, irreparable tear of the posterosuperior rotator cuff with significant fatty infiltration of the infraspinatus and teres minor. The subscapularis is intact. If a tendon transfer is planned, which of the following provides the most biomechanically appropriate line of pull to restore external rotation in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Levator scapulae transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

A lower trapezius transfer, often augmented with an Achilles tendon allograft, most closely replicates the anatomic vector of the infraspinatus. It is highly effective for restoring external rotation in patients with irreparable posterosuperior cuff tears and an intact subscapularis, especially when there is a pronounced external rotation deficit (positive lag and Hornblower's signs). While latissimus dorsi transfers are also used for massive posterosuperior tears, its vector is less parallel to the infraspinatus compared to the lower trapezius.

Question 2396

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals an 'inverted pear' glenoid with 28% anterior inferior bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with capsular plication
. Arthroscopic Remplissage procedure
. Latarjet procedure (coracoid transfer)
. Open inferior capsular shift
. Superior capsular reconstruction

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Anterior glenoid bone loss exceeding 20-25% ('inverted pear' glenoid) is an absolute indication for a bone block augmentation procedure, as soft tissue repairs (like an arthroscopic Bankart) have unacceptably high failure rates in this setting. The Latarjet procedure (transferring the coracoid process with the attached conjoint tendon to the anterior glenoid) provides a triple blocking effect (bone block, sling effect of the conjoint tendon, and capsular repair) and is the treatment of choice.

Question 2397

Topic: Shoulder & Hip Sports
A 24-year-old collegiate baseball pitcher presents with 'dead arm' syndrome and posterior shoulder pain during the late cocking phase of throwing. MRI reveals a Snyder Type II SLAP tear. What is the defining pathoanatomic feature of a Type II SLAP lesion?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and the long head of the biceps anchor from the glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum that extends into the biceps tendon
. Avulsion of the anterior-inferior labrum with a periosteal sleeve

Correct Answer & Explanation

. Detachment of the superior labrum and the long head of the biceps anchor from the glenoid

Explanation

According to the Snyder classification: Type I is degenerative fraying; Type II is detachment of the superior labrum and biceps anchor from the superior glenoid tubercle; Type III is a bucket-handle tear of the labrum with an intact biceps anchor; Type IV is a bucket-handle tear that extends into the long head of the biceps tendon.

Question 2398

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with vague posterior shoulder pain and isolated weakness in external rotation. Physical examination reveals noticeable atrophy of the infraspinatus fossa, while the supraspinatus fossa appears completely normal. At which anatomic location is the nerve most likely entrapped?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus muscle after passing through the suprascapular notch, and then travels through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (commonly by a paralabral cyst in overhead athletes) results in isolated infraspinatus weakness and atrophy, sparing the supraspinatus.

Question 2399

Topic: Shoulder & Hip Sports

A 26-year-old man presents with recurrent anterior shoulder instability. An MRI arthrogram reveals a HAGL lesion. What is the specific pathoanatomy defining this lesion?

. Avulsion of the middle glenohumeral ligament from the anterior glenoid rim
. Avulsion of the inferior glenohumeral ligament complex from the anatomical neck of the humerus
. A superior labral tear extending from anterior to posterior
. A bony avulsion fracture of the anterior inferior glenoid rim
. An intrasubstance tear of the upper subscapularis tendon

Correct Answer & Explanation

. Avulsion of the inferior glenohumeral ligament complex from the anatomical neck of the humerus

Explanation

HAGL stands for Humeral Avulsion of the Glenohumeral Ligament. It describes the complete detachment of the inferior glenohumeral ligament (IGHL) complex from its insertion site on the anatomical neck of the humerus. This causes a loss of the 'sling' effect of the IGHL, leading to severe anterior or anteroinferior shoulder instability. It is an important lesion to recognize, as it requires a specific surgical repair distinct from a standard Bankart repair.

Question 2400

Topic: 5. Sports Medicine

A 70-year-old female sustains a complete patellar tendon rupture 2 years after a primary TKA. She undergoes reconstruction using a full extensor mechanism allograft (tibial tubercle, patellar tendon, patella, and quadriceps tendon). To optimize outcomes and prevent a postoperative extensor lag, how should the allograft be tensioned during fixation?

. Tightly in full extension
. Tightly in 30 degrees of flexion
. Tightly in 90 degrees of flexion
. Loosely in full extension to permit early range of motion
. Tension matched to the contralateral side in 45 degrees of flexion

Correct Answer & Explanation

. Tightly in full extension

Explanation

When using an extensor mechanism allograft for a disruption post-TKA, it is imperative to tension the graft very tightly in full extension. The graft inherently stretches out postoperatively, and any laxity introduced at the time of surgery will inevitably result in a permanent and debilitating extensor lag.

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