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5. Sports Medicine MCQs

Practice Set 146 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 2901

Topic: Shoulder & Hip Sports

A 35-year-old male competitive swimmer presents with chronic posterior shoulder pain, worse during the late cocking and early acceleration phases of his stroke. On examination, he has tenderness in the posterior joint line and a positive 'relocation test' for posterior pain. MRI shows a posterior labral tear and some posterior capsular laxity. What is the MOST likely underlying pathology?

. Anterior glenohumeral instability
. Subacromial impingement
. Internal impingement (postero-superior impingement)
. Biceps tendinopathy
. Adhesive capsulitis

Correct Answer & Explanation

. Internal impingement (postero-superior impingement)

Explanation

The symptoms of posterior shoulder pain in an overhead athlete, particularly during late cocking and early acceleration, tenderness in the posterior joint line, and a positive posterior relocation test (relieving posterior pain), are classic for internal impingement (also known as postero-superior impingement). This condition involves impingement of the undersurface of the rotator cuff (supraspinatus/infraspinatus) and posterior labrum against the postero-superior glenoid rim in the abducted, externally rotated, and extended position, common in throwing athletes. Anterior instability, subacromial impingement, and biceps tendinopathy typically present with different pain patterns and examination findings. Adhesive capsulitis presents with global stiffness.

Question 2902

Topic: Shoulder & Hip Sports

A 58-year-old female presents with a chronic posterior shoulder dislocation that was missed for 3 months. She has limited active external rotation and abduction. Radiographs confirm posterior dislocation with a significant anterior impression fracture of the humeral head (reverse Hill-Sachs lesion). What is the MOST appropriate surgical intervention?

. Closed reduction and immobilization
. Latarjet procedure
. Disimpaction and allograft reconstruction of the humeral head defect (e.g., McLaughlin procedure)
. Reverse total shoulder arthroplasty
. Arthroscopic posterior labral repair

Correct Answer & Explanation

. Disimpaction and allograft reconstruction of the humeral head defect (e.g., McLaughlin procedure)

Explanation

Chronic posterior dislocations, especially with a significant reverse Hill-Sachs lesion (anterior humeral head impression fracture), are often irreducible by closed means and require specific surgical approaches. The choice depends on the size of the humeral head defect. For defects involving 25-50% of the articular surface, disimpaction of the humeral head and filling the defect with allograft (e.g., McLaughlin procedure or modified Neer procedure) is a common technique to restore the humeral head contour and improve stability. If the defect is very large (>50%), or if significant glenohumeral arthritis is present, shoulder arthroplasty (hemi or total, or even reverse) may be considered. Closed reduction is unlikely to be successful after 3 months. Latarjet is for anterior instability with glenoid bone loss. Arthroscopic repair is for labral tears without significant bony defects.

Question 2903

Topic: Shoulder & Hip Sports

A 60-year-old female presents with a painful shoulder and a history of progressive difficulty with external rotation. She denies trauma. On examination, active external rotation is significantly weaker than passive external rotation. She has no instability and full passive range of motion. MRI shows a massive tear of the supraspinatus and infraspinatus, but the subscapularis is intact. What is the MOST appropriate surgical option?

. Subacromial decompression alone
. Rotator cuff repair of the supraspinatus and infraspinatus
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty
. Glenohumeral arthrodesis

Correct Answer & Explanation

. Latissimus dorsi tendon transfer

Explanation

This patient has a massive, but potentially reparable, postero-superior rotator cuff tear (supraspinatus and infraspinatus) with an intact subscapularis. Her symptoms indicate functional deficits from this tear. Latissimus dorsi tendon transfer is a recognized surgical option for symptomatic, irreparable postero-superior rotator cuff tears with an intact subscapularis, aiming to restore active external rotation and elevation. Subacromial decompression alone does not address the torn cuff. Repair of a massive tear, while ideal, may not be possible, and the question implies a challenging scenario with 'progressive difficulty'. Reverse total shoulder arthroplasty is typically for rotator cuff tear arthropathy where the cuff is irreparable and severe arthritis is present, or if significant superior migration is already present. Arthrodesis is a salvage procedure.

Question 2904

Topic: Shoulder & Hip Sports
A 30-year-old male presents with chronic anterior shoulder pain, clicking, and a sensation of 'catching' with overhead activities. He is a keen tennis player. On examination, O'Brien's test (active compression test) is positive, and he has pain with resisted supination of the forearm while the elbow is flexed (Speed's test). MRI confirms a superior labrum anterior posterior (SLAP) tear. What type of SLAP lesion is MOST likely given his symptoms?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

The symptoms of chronic pain, clicking, catching with overhead activities, positive O'Brien's, and Speed's test are highly suggestive of a SLAP tear. Type II SLAP lesions are the most common type and involve detachment of the superior labrum and the biceps anchor from the glenoid, making the biceps unstable. Type I is fraying/degeneration of the superior labrum. Type III involves a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV involves a bucket-handle tear of the superior labrum extending into the biceps tendon. Type V is a Type II SLAP tear extending into an anterior Bankart lesion.

Question 2905

Topic: Shoulder & Hip Sports

A 20-year-old competitive swimmer presents with chronic shoulder pain, particularly during the pull-through phase of his stroke. He has a positive Jobe's test and Empty Can test. Which muscle/tendon unit is MOST likely involved?

. Subscapularis
. Teres minor
. Infraspinatus
. Supraspinatus
. Long head of biceps

Correct Answer & Explanation

. Supraspinatus

Explanation

The Jobe's test (Empty Can test) specifically assesses the integrity and strength of the supraspinatus muscle-tendon unit. A positive test indicates weakness or pain originating from the supraspinatus, which is a common cause of shoulder pain and impingement, especially in overhead athletes. Subscapularis is tested with Lift-off or Belly-press. Teres minor and infraspinatus are tested with resisted external rotation. Long head of biceps is assessed with Speed's or Yergason's test.

Question 2906

Topic: Shoulder & Hip Sports

A 62-year-old male with a history of recurrent anterior shoulder dislocations now presents with chronic pain and instability. Radiographs reveal significant glenoid bone loss (estimated at 30%) and a large engaging Hill-Sachs lesion. Which of the following procedures is MOST appropriate to address his instability?

. Arthroscopic Bankart repair
. Open Bankart repair with capsular plication
. Latarjet procedure
. Remplissage procedure
. SLAP repair

Correct Answer & Explanation

. Latarjet procedure

Explanation

For recurrent anterior shoulder instability with significant glenoid bone loss (typically >20-25%), the Latarjet procedure is the procedure of choice. It involves transferring the coracoid process with the attached conjoint tendon to the anterior glenoid, providing a bone block effect, a sling effect from the conjoint tendon, and re-tensioning of the anterior capsule. Arthroscopic Bankart repair is typically ineffective with significant bone loss. Open Bankart repair might be considered for isolated soft tissue lesions but not extensive bone loss. Remplissage addresses an engaging Hill-Sachs lesion but not the glenoid bone loss. SLAP repair is for superior labral pathology.

Question 2907

Topic: Shoulder & Hip Sports

A 50-year-old female undergoes arthroscopic rotator cuff repair. During the procedure, the posterior portal is placed too medially. Post-operatively, she develops weakness in abduction and external rotation, along with atrophy of the supraspinatus and infraspinatus muscles. Sensation is intact. What nerve is MOST likely injured?

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

Correct Answer & Explanation

. Suprascapular nerve

Explanation

The suprascapular nerve is vulnerable during arthroscopic shoulder surgery, particularly during posterior portal placement if it's placed too medially and inferiorly, or during extensive debridement in the suprascapular or spinoglenoid notch. Injury to the suprascapular nerve results in weakness and atrophy of the supraspinatus (abduction) and infraspinatus (external rotation) muscles, typically without sensory deficits, as the nerve is primarily motor. Axillary nerve injury affects the deltoid and teres minor, with sensory loss in the regimental badge area. Musculocutaneous affects biceps. Long thoracic affects serratus anterior. Radial nerve affects wrist/finger extensors.

Question 2908

Topic: Shoulder & Hip Sports

A 30-year-old construction worker presents with chronic pain and weakness in his right shoulder, specifically with heavy lifting and forceful internal rotation. He describes an audible 'pop' during a lifting incident 6 months ago. On examination, he has tenderness over the anterior aspect of the shoulder, and weakness with resisted internal rotation (positive 'belly press' and 'lift-off' tests). What structure is MOST likely injured?

. Supraspinatus tendon
. Infraspinatus tendon
. Teres minor tendon
. Subscapularis tendon
. Long head of biceps tendon

Correct Answer & Explanation

. Subscapularis tendon

Explanation

The symptoms of anterior shoulder pain, weakness with resisted internal rotation, and positive 'belly press' and 'lift-off' tests are highly suggestive of a subscapularis tendon tear. The subscapularis is the largest and most powerful rotator cuff muscle, primarily responsible for internal rotation and anterior stability. Supraspinatus is tested with abduction (Jobe's test). Infraspinatus and Teres minor are tested with external rotation. Long head of biceps tendinopathy causes pain in the bicipital groove and with resisted elbow flexion/forearm supination.

Question 2909

Topic: Shoulder & Hip Sports

A 40-year-old male presents with shoulder pain, clicking, and a 'dead arm' sensation after a forceful throw. He has a positive apprehension test and pain during the late cocking phase of throwing. MRI reveals a Bankart lesion and a significant Hill-Sachs lesion. Which of the following is the MOST appropriate surgical intervention?

. Arthroscopic capsular plication
. Open Bankart repair with capsular shift
. Latarjet procedure
. Remplissage procedure alone
. SLAP repair

Correct Answer & Explanation

. Open Bankart repair with capsular shift

Explanation

The patient has a traumatic anterior shoulder instability with a Bankart lesion (anterior labral tear) and a significant Hill-Sachs lesion (compression fracture of the posterior humeral head). For traumatic anterior instability with a Bankart lesion, an open Bankart repair with capsular shift (if capsular laxity is also present) is a common and effective surgical intervention. Arthroscopic Bankart repair is typically preferred for isolated Bankart lesions without significant bone loss. The Latarjet procedure is usually reserved for cases with significant glenoid bone loss (>20-25%) or failed previous stabilization. Remplissage alone is for engaging Hill-Sachs lesions without significant glenoid bone loss or instability. SLAP repair is for superior labral tears.

Question 2910

Topic: Shoulder & Hip Sports

A 31-year-old elite volleyball player complains of vague posterior shoulder pain and isolated weakness in external rotation. MRI reveals a paralabral cyst in the spinoglenoid notch. Which of the following exam findings is most expected?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the infraspinatus
. Positive lift-off test
. Loss of active forward elevation
. Winging of the medial scapula

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus

Explanation

A cyst at the spinoglenoid notch specifically compresses the distal branches of the suprascapular nerve, resulting in isolated denervation and atrophy of the infraspinatus muscle. The supraspinatus is spared because its nerve supply branches off proximal to the notch.

Question 2911

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with isolated atrophy and weakness of the infraspinatus. An MRI reveals a paralabral cyst located in the spinoglenoid notch. This finding is most highly associated with which of the following concomitant intra-articular pathologies?

. Anterior Bankart lesion
. Posterior superior labral (SLAP) tear
. Anterior superior labral (SLAP) tear
. ALPSA lesion
. Humeral avulsion of the glenohumeral ligament (HAGL)

Correct Answer & Explanation

. Posterior superior labral (SLAP) tear

Explanation

Paralabral cysts at the spinoglenoid notch are strongly associated with posterior superior labral (SLAP) tears, which create a one-way valve allowing joint fluid to accumulate. Compression at the spinoglenoid notch selectively affects the suprascapular nerve branches to the infraspinatus, sparing the supraspinatus.

Question 2912

Topic: 5. Sports Medicine

A 32-year-old male weightlifter feels a tearing sensation in his anterior axilla while performing a heavy bench press. He has an obvious loss of the anterior axillary fold contour and weakness in internal rotation. MRI reveals a pectoralis major rupture located entirely within the musculotendinous junction. What is the most appropriate management?

. Direct end-to-end suture repair
. Repair to the humeral shaft using suture anchors
. Tendon allograft reconstruction
. Nonoperative management with progressive mobilization
. Strict immobilization in external rotation for 6 weeks

Correct Answer & Explanation

. Nonoperative management with progressive mobilization

Explanation

Pectoralis major ruptures at the musculotendinous junction or within the muscle belly itself are generally treated nonoperatively because the muscle tissue holds sutures poorly. Operative repair is primarily indicated for avulsions of the tendon from its insertion on the humeral shaft in active patients.

Question 2913

Topic: Shoulder & Hip Sports

A 25-year-old elite overhead thrower presents with chronic posterior shoulder pain during the late cocking phase of throwing. Examination reveals a significant Glenohumeral Internal Rotation Deficit (GIRD) and a positive posterior impingement test. Diagnostic arthroscopy is most likely to reveal which of the following?

. Anterior labral tear with middle glenohumeral ligament rupture
. Fraying of the posterosuperior labrum and articular-sided rotator cuff
. Subacromial bursitis with profound coracoacromial ligament thickening
. Degenerative tearing of the subscapularis and biceps pulley
. Os acromiale with mechanical subacromial impingement

Correct Answer & Explanation

. Fraying of the posterosuperior labrum and articular-sided rotator cuff

Explanation

Internal impingement in overhead athletes occurs when the posterosuperior rotator cuff is pinched between the greater tuberosity and the posterosuperior glenoid labrum during extreme abduction and external rotation. This repetitive trauma predictably leads to articular-sided cuff fraying and posterosuperior labral pathology.

Question 2914

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of deep shoulder pain during the late cocking phase of throwing. MRI arthrogram shows a Type II SLAP tear. After failing 6 months of targeted physical therapy, what is the most appropriate surgical intervention?

. Arthroscopic SLAP repair
. Open subpectoral biceps tenodesis
. Arthroscopic biceps tenotomy
. Coracoid transfer (Latarjet procedure)
. Arthroscopic subacromial decompression

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In a young overhead athlete with a Type II SLAP tear failing conservative treatment, arthroscopic SLAP repair is the preferred surgical option to maintain the biceps anchor and normal shoulder kinematics. Biceps tenodesis is typically reserved for older patients, laborers, or revision settings.

Question 2915

Topic: 5. Sports Medicine

An 18-year-old football player is tackled onto his lateral shoulder and presents with severe sternoclavicular pain, shortness of breath, and hoarseness. The medial clavicle is not palpable. What is the most appropriate next step in management?

. Immediate closed reduction in the emergency department
. CT angiography of the chest
. MRI of the sternoclavicular joint
. Application of a figure-of-eight brace
. Diagnostic shoulder arthroscopy

Correct Answer & Explanation

. CT angiography of the chest

Explanation

Posterior sternoclavicular dislocations can compress mediastinal structures, causing life-threatening respiratory distress or vascular compromise. CT angiography of the chest is critical to evaluate the position of the medial clavicle relative to the great vessels before a cardiothoracic-backed reduction is attempted.

Question 2916

Topic: Shoulder & Hip Sports

A 45-year-old male sustains a traumatic right shoulder injury. He exhibits increased passive external rotation, a positive lift-off test, and a positive belly-press test. MRI confirms an isolated full-thickness tear of the subscapularis tendon. Which associated pathology must be carefully evaluated and addressed during surgical repair?

. SLAP tear
. Long head of the biceps tendon subluxation or dislocation
. Teres minor atrophy
. Acromioclavicular joint separation
. Suprascapular nerve entrapment

Correct Answer & Explanation

. Long head of the biceps tendon subluxation or dislocation

Explanation

The subscapularis tendon contributes to the medial wall of the bicipital groove and the transverse humeral ligament. A full-thickness tear of the subscapularis is highly associated with medial subluxation or dislocation of the long head of the biceps tendon.

Question 2917

Topic: 5. Sports Medicine
A 25-year-old collegiate football player sustains a knee injury after a direct blow to the lateral aspect of his knee, with his foot planted. He reports immediate pain and instability. On examination, there is a positive Lachman test, pivot shift, and a grade III medial collateral ligament (MCL) laxity. Which of the following is the most appropriate initial management approach?
. Immediate surgical reconstruction of all injured ligaments.
. Non-operative management focused on MCL healing, followed by ACL reconstruction if symptoms persist.
. Diagnostic arthroscopy immediately to assess the extent of injury.
. Long leg cast immobilization for 6 weeks.
. MRI of the knee followed by early rehabilitation and progressive weight-bearing.

Correct Answer & Explanation

. Non-operative management focused on MCL healing, followed by ACL reconstruction if symptoms persist.

Explanation

This patient presents with a combined ACL rupture (positive Lachman, pivot shift) and a Grade III MCL tear. While ACL reconstruction is often indicated in active individuals, MCL tears, especially Grade III, generally heal well with non-operative management. The standard approach for combined ACL and MCL injuries is to initially treat the MCL non-operatively, allowing it to heal, typically with bracing and protected weight-bearing. Once the MCL has healed (usually 6-8 weeks), the ACL can then be addressed surgically if the patient remains symptomatic or desires to return to high-level activities. Immediate reconstruction of all ligaments can lead to increased stiffness and poorer outcomes for the MCL. Diagnostic arthroscopy is not an initial management step. Long leg casting is typically avoided due to stiffness. MRI is important for confirmation but does not replace the initial management strategy.

Question 2918

Topic: Shoulder & Hip Sports

A 30-year-old female presents to the emergency department with a history of recurrent anterior shoulder dislocations. She is considering surgical stabilization. Which physical examination finding would most strongly suggest the presence of a Bankart lesion and indicate the need for surgery?

. Apprehension test positive with external rotation and abduction.
. Sulcus sign positive with inferior traction.
. O'Brien's test positive with pain on internal rotation.
. Pain on resisted abduction.
. Weakness of external rotation.

Correct Answer & Explanation

. Apprehension test positive with external rotation and abduction.

Explanation

A positive apprehension test (eliciting apprehension or pain when the arm is abducted and externally rotated) is the classic clinical sign for anterior glenohumeral instability and strongly suggests a Bankart lesion or other anterior labral pathology. The apprehension test assesses the anterior stability of the shoulder. A sulcus sign indicates inferior instability/multidirectional instability. O'Brien's test is for SLAP lesions (superior labral tears). Pain on resisted abduction could be impingement or rotator cuff pathology. Weakness of external rotation suggests rotator cuff pathology. While other findings may be present, the apprehension test is the most direct indicator of anterior instability leading to recurrent dislocations.

Question 2919

Topic: Knee Sports

A 25-year-old male presents with a painful, swollen knee following a twisting injury while playing soccer. There is a large effusion, and he has limited range of motion. Aspiration of the knee joint yields frank blood. Which of the following injuries is most likely?

. Meniscus tear.
. Medial collateral ligament (MCL) sprain.
. Anterior cruciate ligament (ACL) tear.
. Prepatellar bursitis.
. Patellar tendinitis.

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) tear.

Explanation

Hemarthrosis (frank blood in the joint) after acute knee trauma, especially a twisting injury, is highly indicative of a significant intra-articular injury with rich blood supply. The most common cause is an Anterior Cruciate Ligament (ACL) tear, which involves disruption of the highly vascular ACL. Other causes include osteochondral fractures, peripheral meniscal tears (less common to cause frank hemarthrosis on their own), and patellar dislocations. Isolated meniscus tears or MCL sprains, prepatellar bursitis, and patellar tendinitis typically do not cause frank hemarthrosis. An MCL sprain is extra-articular.

Question 2920

Topic: Shoulder & Hip Sports

A 40-year-old male sustains an anterior glenohumeral dislocation. After successful closed reduction, what is the most important radiographic view to obtain to assess for associated injuries?

. AP shoulder view.
. Y-scapular view.
. Axillary view.
. Stryker notch view.
. Outlet view.

Correct Answer & Explanation

. Axillary view.

Explanation

After closed reduction of an anterior glenohumeral dislocation, the axillary view is the most important radiographic view. It is crucial for confirming concentric reduction and for detecting associated injuries such as a Hill-Sachs lesion (compression fracture of the posterior humeral head), bony Bankart lesion (fracture of the anteroinferior glenoid rim), or greater tuberosity fracture. While AP and Y-scapular views are important for initial diagnosis and pre-reduction assessment, they may not adequately visualize these specific associated injuries post-reduction. The Stryker notch view is specifically for Hill-Sachs lesions, and the outlet view is for impingement, but the axillary view provides a comprehensive post-reduction assessment.

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