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5. Sports Medicine MCQs

Practice Set 123 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 2441

Topic: 5. Sports Medicine

In the setting of a massive, irreparable posterosuperior rotator cuff tear in a young, active laborer without significant glenohumeral arthritis or pseudoparalysis, a lower trapezius tendon transfer (often augmented with an Achilles allograft) may be performed. This specific transfer primarily aims to restore which of the following shoulder biomechanical functions?

. Forward elevation
. Internal rotation
. External rotation with the arm in abduction
. Adduction strength
. Scapular retraction

Correct Answer & Explanation

. External rotation with the arm in abduction

Explanation

The lower trapezius tendon transfer is performed to recreate the vector of the infraspinatus. Because the line of pull of the lower trapezius closely matches that of the infraspinatus, it is highly effective at restoring active external rotation, particularly with the arm abducted to 90 degrees. It has largely replaced the latissimus dorsi transfer for massive tears primarily involving severe loss of external rotation.

Question 2442

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Which muscle or tendon must be split to pass the coracoid graft to the anterior glenoid neck?

. Conjoint tendon
. Pectoralis minor
. Subscapularis
. Infraspinatus
. Pectoralis major

Correct Answer & Explanation

. Subscapularis

Explanation

During the Latarjet procedure, the coracoid process with the attached conjoint tendon is passed through a horizontal split in the subscapularis muscle to reach the anterior glenoid rim. This creates a dynamic sling effect that contributes to stability.

Question 2443

Topic: Shoulder & Hip Sports

In an anatomic total shoulder arthroplasty, the phenomenon of 'rocking horse' loosening of the glenoid component is most commonly caused by which of the following?

. Superior migration of the humeral head due to rotator cuff deficiency
. Failure to restore native humeral retroversion
. Use of a metal-backed glenoid component
. Unrecognized axillary nerve palsy
. Over-reaming of the anterior glenoid vault

Correct Answer & Explanation

. Superior migration of the humeral head due to rotator cuff deficiency

Explanation

Eccentric loading of the glenoid component, most commonly due to superior migration of the humeral head in the setting of rotator cuff deficiency, creates a rocking horse effect that leads to premature aseptic glenoid loosening.

Question 2444

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has profound weakness in elbow flexion and decreased sensation over the lateral aspect of his forearm. Which nerve was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis 5-8 cm distal to the coracoid process but can have a higher entry point. It is at significant risk during coracoid osteotomy, mobilization, and retraction during the Latarjet procedure. Injury results in biceps/brachialis weakness (diminished elbow flexion) and numbness in the lateral antebrachial cutaneous nerve distribution.

Question 2445

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination shows a 25-degree loss of internal rotation compared to the contralateral side. Which of the following pathologic mechanisms is primarily responsible for internal impingement in this athlete?

. Contact between the coracoid process and the subscapularis tendon
. Contact between the articular surface of the rotator cuff and the posterosuperior glenoid labrum
. Anterior capsular contracture displacing the humeral head posteriorly
. Acromioclavicular joint osteophyte abrading the supraspinatus
. Tightness of the pectoralis minor tendon causing scapular dyskinesia

Correct Answer & Explanation

. Contact between the articular surface of the rotator cuff and the posterosuperior glenoid labrum

Explanation

Internal impingement in overhead throwing athletes occurs during extreme abduction and external rotation (late cocking phase). This position causes the articular (undersurface) side of the posterosuperior rotator cuff (supraspinatus/infraspinatus) to impinge against the posterosuperior glenoid and labrum. GIRD (glenohumeral internal rotation deficit) from posterior capsular contracture frequently contributes.

Question 2446

Topic: Shoulder & Hip Sports

When evaluating recurrent anterior shoulder instability, a 3D CT scan is often obtained to quantify glenoid bone loss using the 'best-fit circle' method. What is the classic critical threshold of glenoid bone loss above which isolated soft tissue stabilization (Bankart repair) has unacceptably high failure rates?

. 5-10%
. 15-18%
. 20-25%
. 35-40%
. 45-50%

Correct Answer & Explanation

. 20-25%

Explanation

The traditional 'critical' threshold for glenoid bone loss is 20-25%. Although recent literature suggests 'subcritical' bone loss (13.5-20%) can also lead to poorer outcomes, 20-25% remains the classic board answer threshold indicating the definitive need for a bony augmentation procedure (e.g., Latarjet).

Question 2447

Topic: 5. Sports Medicine

A 60-year-old male undergoes an anatomic TSA for osteoarthritis. The surgeon utilizes a lesser tuberosity osteotomy (LTO) for joint access. At 8 weeks postoperatively, the patient reports increased pain and an inability to actively internally rotate against resistance. Which physical exam finding is most indicative of failure of the LTO and subscapularis repair?

. Positive Hornblower's sign
. Positive belly-press test with the elbow dropping posteriorly
. Increased external rotation lag in 90 degrees of abduction
. Positive Jobe's (empty can) test
. Positive Speed's test with bicipital groove tenderness

Correct Answer & Explanation

. Positive belly-press test with the elbow dropping posteriorly

Explanation

The belly-press test evaluates the integrity of the subscapularis. A positive test indicates subscapularis weakness or failure (such as an LTO nonunion or tendon rupture). It is characterized by the patient dropping their elbow posteriorly and flexing the wrist to press on the abdomen, thereby substituting wrist flexion and shoulder extension for internal rotation. Hornblower's sign tests the teres minor.

Question 2448

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with a massive, irreparable posterosuperior rotator cuff tear (supraspinatus and infraspinatus). He has an intact subscapularis, a severe external rotation lag, but pseudoparalysis is absent. Which tendon transfer is most appropriate to restore active external rotation and forward elevation in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Trapezius transfer to the lesser tuberosity
. Biceps rerouting and tenodesis
. Levator scapulae transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

The latissimus dorsi transfer (and increasingly the lower trapezius transfer) is indicated for young, active patients with massive, irreparable posterosuperior rotator cuff tears (involving the supraspinatus and infraspinatus). It aims to restore active external rotation and forward elevation. Key prerequisites include an intact subscapularis, intact deltoid, minimal glenohumeral arthritis, and the absence of true pseudoparalysis. Pectoralis major transfers are reserved for irreparable subscapularis tears.

Question 2449

Topic: 5. Sports Medicine

A 45-year-old male with an irreparable supraspinatus tear undergoes a Superior Capsular Reconstruction (SCR) utilizing a thick dermal allograft. What is the primary biomechanical function of the graft in this procedure?

. To re-center the humeral head by providing a static restraint against superior translation
. To actively participate in glenohumeral abduction via dynamic graft tensioning
. To replace the subscapularis function and balance transverse force couples
. To stimulate biologic regeneration of the native supraspinatus muscle belly
. To prevent posterior translation of the humeral head during terminal internal rotation

Correct Answer & Explanation

. To re-center the humeral head by providing a static restraint against superior translation

Explanation

The primary biomechanical rationale for Superior Capsular Reconstruction (SCR) is to use a robust graft (like dermal allograft or fascia lata) to span the gap from the superior glenoid to the greater tuberosity. The graft acts as a static spacer and tether (a "trampoline" effect) to physically restrain superior migration of the humeral head, thereby restoring the stable fulcrum necessary for the deltoid to initiate and maintain active elevation.

Question 2450

Topic: Shoulder & Hip Sports

A 70-year-old male presents with deep shoulder pain 6 years after an anatomic TSA. Radiographs demonstrate superior migration of the humeral head and a "rocking horse" loosening pattern of the polyethylene glenoid component. This specific mechanism of glenoid loosening is most commonly associated with which underlying pathology?

. Eccentric cyclic loading secondary to massive rotator cuff failure
. Indolent deep periprosthetic infection with Cutibacterium acnes
. Excessive retroversion of the humeral stem during index surgery
. Aggressive over-reaming of the anterior glenoid rim
. Unrecognized axillary nerve palsy leading to deltoid fatigue

Correct Answer & Explanation

. Eccentric cyclic loading secondary to massive rotator cuff failure

Explanation

The "rocking horse" phenomenon describes the eccentric loading of the glenoid component that leads to catastrophic early loosening. This most frequently occurs in anatomic TSA when the rotator cuff (specifically the supraspinatus) fails, causing the humeral head to migrate superiorly. The superiorly migrated head applies eccentric, unbalanced cyclic forces to the superior edge of the glenoid, levering it out of the cement mantle.

Question 2451

Topic: 5. Sports Medicine

A 42-year-old recreational athlete sustains an acute Achilles tendon rupture. He discusses treatment options with his surgeon, who offers nonoperative management coupled with a functional rehabilitation protocol. Compared to operative repair, what does current level 1 evidence conclude regarding this nonoperative functional approach?

. It results in a significantly higher rate of re-rupture but similar functional outcomes
. It results in an equivalent re-rupture rate and equivalent functional outcomes
. It results in a lower rate of re-rupture and superior functional outcomes
. It carries a higher risk of sural nerve injury
. It provides significantly better plantarflexion strength at 1 year post-injury

Correct Answer & Explanation

. It results in an equivalent re-rupture rate and equivalent functional outcomes

Explanation

Recent high-quality randomized controlled trials and meta-analyses show that when dynamic functional rehabilitation (early weight-bearing and early ROM in an orthosis) is employed, nonoperative management has an equivalent re-rupture rate and equivalent functional outcome compared to operative management, while entirely avoiding surgical complications such as infection.

Question 2452

Topic: 5. Sports Medicine

During anterior ankle arthroscopy, the anterolateral portal is established. Which nerve is at greatest risk of iatrogenic injury during the placement of this specific portal?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The anterolateral portal is placed just lateral to the peroneus tertius tendon. The intermediate dorsal cutaneous branch of the superficial peroneal nerve (SPN) crosses the joint very close to this area and is at high risk of injury. The anteromedial portal risks the saphenous nerve. The anterocentral portal risks the deep peroneal nerve and dorsalis pedis artery.

Question 2453

Topic: 5. Sports Medicine
A 20-year-old collegiate wide receiver sustains an acute hyper-dorsiflexion injury to his first metatarsophalangeal (MTP) joint. MRI confirms a Grade III 'Turf Toe' injury with complete rupture of the plantar plate from the base of the proximal phalanx, associated with proximal migration of the sesamoids. What is the most appropriate definitive management?
. Taping the toe in plantarflexion and immediate return to play
. Stiff carbon fiber shoe insert and weight-bearing as tolerated
. Corticosteroid injection into the MTP joint
. Surgical repair of the plantar plate and capsuloligamentous complex
. First MTP arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

Grade III Turf Toe injuries involve a complete tear of the plantar plate and capsuloligamentous complex. In high-level athletes, especially when accompanied by frank instability or proximal migration of the sesamoids (indicating loss of the flexor hallucis brevis mechanical advantage), surgical repair is indicated to restore push-off strength and joint stability. Grades I and II are generally managed nonoperatively.

Question 2454

Topic: 5. Sports Medicine
A professional football player presents with severe pain and swelling at the plantar aspect of the first metatarsophalangeal (MTP) joint after hyperextending his toe on artificial turf. MRI confirms a complete rupture of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?
. Stiff-soled shoe and immediate weight-bearing
. Taping the toe in dorsiflexion
. Corticosteroid injection into the first MTP joint
. Surgical repair of the plantar plate
. First MTP arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

A complete rupture of the plantar plate with proximal retraction of the sesamoids (Grade III turf toe) typically requires surgical repair, especially in a competitive athlete, to restore the push-off strength and stability of the first MTP joint.

Question 2455

Topic: 5. Sports Medicine

A 22-year-old collegiate basketball player presents with a Zone 2 fracture of the proximal fifth metatarsal (Jones fracture). Operative intervention with intramedullary screw fixation is chosen to facilitate an early return to play. Which of the following screw characteristics is associated with the lowest risk of clinical failure and refracture?

. A small-diameter screw to preserve endosteal blood supply
. A cannulated design to ensure precise guidewire placement over a curved path
. The largest diameter solid screw that can be accommodated by the medullary canal
. A bioabsorbable screw to prevent long-term stress shielding
. A fully threaded screw with a pitch of less than 1.5 mm

Correct Answer & Explanation

. The largest diameter solid screw that can be accommodated by the medullary canal

Explanation

In the intramedullary fixation of Jones fractures, biomechanical and clinical studies indicate that a solid, largest-diameter screw that fits the medullary canal provides the highest pull-out and bending strength. Cannulated screws are weaker in bending and more prone to breakage. The strong fixation minimizes micromotion, preventing delayed union and refracture in high-level athletes.

Question 2456

Topic: 5. Sports Medicine

Recent high-quality, randomized controlled trials comparing operative repair versus non-operative management with early functional rehabilitation for acute Achilles tendon ruptures have consistently demonstrated which of the following outcomes?

. A significantly higher re-rupture rate in the non-operative group, regardless of the rehabilitation protocol used
. Superior long-term plantarflexion power and peak torque in the non-operative group
. No statistically significant difference in re-rupture rates, with higher soft-tissue complication rates in the operative group
. Faster return to elite sports in the non-operative group
. Higher rates of deep vein thrombosis in the operative group due to prolonged casting

Correct Answer & Explanation

. No statistically significant difference in re-rupture rates, with higher soft-tissue complication rates in the operative group

Explanation

Landmark RCTs (e.g., Willits et al.) have established that when an early functional rehabilitation protocol is utilized, there is no statistically significant difference in the re-rupture rate between operative and non-operative management of acute Achilles tendon ruptures. However, operative management is associated with a significantly higher risk of complications, particularly superficial and deep wound infections.

Question 2457

Topic: 5. Sports Medicine

A professional running back sustains an acute hyperextension injury to his first metatarsophalangeal (MTP) joint. Clinical examination reveals gross instability of the MTP joint on Lachman testing. MRI confirms a complete tear of the plantar plate from the metatarsal neck with proximal retraction of the sesamoids. What is the most appropriate management?

. Taping and immediate return to play with a stiff carbon-fiber plate
. Immobilization in a walking boot for 2 weeks followed by physical therapy
. Surgical repair of the plantar plate and capsuloligamentous complex
. Excision of the tibial sesamoid
. Primary arthrodesis of the first MTP joint

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

This describes a Grade 3 Turf Toe injury (complete disruption of the plantar plate/capsuloligamentous complex). Given the gross instability, proximal retraction of the sesamoids, and the patient's status as a professional athlete requiring push-off strength, surgical repair of the plantar plate is indicated to restore MTP joint stability. Grades 1 and 2 are typically managed non-operatively.

Question 2458

Topic: 5. Sports Medicine

A 42-year-old recreational athlete suffers an acute, closed midsubstance Achilles tendon rupture. Based on current high-level evidence, which of the following is true regarding outcomes when functional rehabilitation (early weight-bearing and mobilization) is employed in non-operative management compared to operative management?

. Rerupture rates are significantly higher with non-operative management.
. Deep infection rates are comparable between the two groups.
. Return to sport is significantly faster with operative management.
. Rerupture rates are similar, with a lower overall complication profile for non-operative management.
. Plantar flexion strength is significantly greater at 2 years with operative management.

Correct Answer & Explanation

. Rerupture rates are similar, with a lower overall complication profile for non-operative management.

Explanation

Multiple randomized controlled trials have demonstrated that when acute Achilles tendon ruptures are treated non-operatively using a functional rehabilitation protocol (early weight-bearing and early ROM), the rerupture rate is equivalent to operative management. Non-operative management avoids surgical complications, such as deep infection and wound healing issues, giving it a lower overall complication profile.

Question 2459

Topic: 5. Sports Medicine

A 22-year-old football player sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint. Clinical examination reveals ecchymosis, moderate swelling, and unrestricted but painful active range of motion. MRI shows a partial tear of the plantar plate with intact articular cartilage. What is the most appropriate initial management for this Grade 2 Turf Toe injury?

. Immediate open repair of the plantar plate
. Primary arthrodesis of the first MTP joint
. Walking boot for 1 to 4 weeks followed by progressive return to play with taping
. Taping, stiff-soled shoe, and immediate return to play as tolerated
. Corticosteroid injection and immediate return to play

Correct Answer & Explanation

. Walking boot for 1 to 4 weeks followed by progressive return to play with taping

Explanation

A Grade 2 turf toe injury represents a partial tear of the plantar plate complex. Standard management involves protection and immobilization (often in a walking boot) for 1 to 4 weeks to allow for initial healing, followed by progressive weight-bearing and return to play with a stiff-soled shoe or taping. Grade 1 injuries can often return immediately with taping, while Grade 3 (complete tear) may require operative intervention in elite athletes.

Question 2460

Topic: 5. Sports Medicine

A professional football player sustains a severe hyperdorsiflexion injury to the first metatarsophalangeal joint. MRI demonstrates a complete disruption of the plantar plate with proximal retraction of the sesamoids. What is the recommended treatment for this Grade 3 turf toe injury?

. Stiff-soled shoe and early weight-bearing
. Non-weight bearing cast for 6 weeks
. Closed reduction and percutaneous pinning
. Primary surgical repair of the plantar plate
. Excision of the sesamoids

Correct Answer & Explanation

. Primary surgical repair of the plantar plate

Explanation

A Grade 3 turf toe involves a complete tear of the plantar plate complex with proximal retraction of the sesamoids. In competitive athletes, primary surgical repair is indicated to restore joint stability and push-off strength.

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