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5. Sports Medicine MCQs

Practice Set 152 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 3021

Topic: Shoulder & Hip Sports

A 40-year-old man falls while skiing and sustains an isolated full-thickness tear of the subscapularis tendon. Which of the following physical examination findings has the highest sensitivity for identifying a lesion specifically involving the upper portion of the subscapularis tendon footprint?

. Positive Jobe's (empty can) test
. Positive Hornblower's sign
. Positive Belly-press test
. Positive Bear-hug test
. Positive Lift-off test

Correct Answer & Explanation

. Positive Bear-hug test

Explanation

The bear-hug test has been shown in multiple biomechanical and clinical studies (such as Barth et al.) to be the most sensitive test for evaluating tears of the upper footprint of the subscapularis tendon. The lift-off test is highly specific but evaluates primarily the lower portion of the subscapularis. The belly-press test evaluates the middle/upper portions but is generally less sensitive than the bear-hug test for isolated upper tears. Hornblower's is for the teres minor, and Jobe's is for the supraspinatus.

Question 3022

Topic: 5. Sports Medicine

Which biomechanical mechanism is primarily responsible for the development of a Type II SLAP (Superior Labrum Anterior to Posterior) tear in an elite overhead throwing athlete?

. Direct impact to the anterior shoulder in an abducted position
. Excessive translation of the humeral head during the follow-through phase
. The peel-back mechanism during late cocking and early acceleration phases
. Eccentric overload of the biceps tendon during deceleration
. Subacromial impingement during the wind-up phase

Correct Answer & Explanation

. The peel-back mechanism during late cocking and early acceleration phases

Explanation

In overhead throwers, the most widely accepted mechanism for a Type II SLAP tear is the 'peel-back' mechanism. During the late cocking and early acceleration phases, the shoulder is in maximum abduction and external rotation. This shifts the vector of the biceps tendon, creating a severe torsional force that 'peels back' the posterosuperior labrum from the glenoid.

Question 3023

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, the surgeon aims to recreate the three primary static stabilizing structures. Which of the following correctly identifies these three structures?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris tendon, popliteus tendon, and lateral collateral ligament
. Iliotibial band, popliteofibular ligament, and fabellofibular ligament
. Arcuate ligament, popliteus tendon, and fibular collateral ligament
. Fibular collateral ligament, lateral meniscus, and popliteofibular ligament

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The three major static stabilizers of the posterolateral corner (PLC) of the knee are the fibular collateral ligament (also known as the lateral collateral ligament), the popliteus tendon, and the popliteofibular ligament. Anatomical PLC reconstructions (such as the LaPrade technique) specifically reconstruct these three distinct structures.

Question 3024

Topic: 5. Sports Medicine

A 65-year-old male with a symptomatic SLAP tear and an intact rotator cuff is undergoing arthroscopy. The surgeon opts for a biceps procedure. Which of the following is a recognized distinct disadvantage of performing a biceps tenotomy compared to a biceps tenodesis?

. Higher risk of postoperative shoulder stiffness
. Significantly longer postoperative rehabilitation period
. Increased incidence of Popeye deformity and biceps cramping pain
. Higher incidence of persistent anterior shoulder pain
. Requirement for implant placement and related hardware complications

Correct Answer & Explanation

. Increased incidence of Popeye deformity and biceps cramping pain

Explanation

Biceps tenotomy is simpler, avoids hardware, and allows for faster rehabilitation. However, its primary disadvantages compared to tenodesis are a higher incidence of cosmetic 'Popeye' muscle deformity and a higher rate of localized cramping or fatigue pain in the biceps muscle belly due to the loss of length-tension relationship.

Question 3025

Topic: Knee Sports

During a physical examination of a patient with a suspected multiligamentous knee injury, the Dial test is performed. The patient exhibits 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. What is the most likely diagnosis?

. Isolated Posterior Cruciate Ligament (PCL) injury
. Isolated Posterolateral Corner (PLC) injury
. Combined PCL and PLC injury
. Isolated Anterior Cruciate Ligament (ACL) tear
. Combined ACL and Medial Collateral Ligament (MCL) tear

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The Dial test evaluates external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of knee flexion, but NOT at 90 degrees, indicates an isolated Posterolateral Corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, it suggests a combined injury to both the PLC and the Posterior Cruciate Ligament (PCL).

Question 3026

Topic: Shoulder & Hip Sports

A 22-year-old male athlete undergoes arthroscopic stabilization for recurrent anterior shoulder instability. The surgeon identifies a bony Bankart lesion involving 25% of the anterior glenoid width. What is the most appropriate management of this bony defect?

. Arthroscopic soft-tissue Bankart repair incorporating the capsule over the defect
. Open Latarjet procedure (coracoid transfer)
. Remplissage procedure (infraspinatus tenodesis)
. Arthroscopic superior labrum anterior and posterior (SLAP) repair
. Non-operative management with prolonged immobilization

Correct Answer & Explanation

. Open Latarjet procedure (coracoid transfer)

Explanation

In the setting of recurrent anterior shoulder instability, a critical anterior glenoid bone loss of greater than 20-25% results in an unacceptably high failure rate for isolated arthroscopic soft-tissue repair. The most appropriate management to restore anterior stability is a bony augmentation procedure, most commonly the Latarjet procedure.

Question 3027

Topic: Shoulder & Hip Sports
A 22-year-old baseball pitcher presents with deep shoulder pain during the late cocking phase of throwing. MRI arthrogram reveals a Type II SLAP (Superior Labrum Anterior to Posterior) tear. What is the defining anatomical characteristic 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 superior glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum with detachment of the biceps anchor
. An anteroinferior labral tear extending continuously to the superior labrum

Correct Answer & Explanation

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

Explanation

Snyder's classification for SLAP lesions: Type I is degenerative fraying with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor from the glenoid rim. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

Question 3028

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), recreating the anterolateral (AL) bundle is crucial. At what degree of knee flexion is the AL bundle of the native PCL most taut?

. 0 degrees (Full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger and is most taut in flexion (typically reaching maximum tension around 90 degrees), whereas the PM bundle is most taut in extension.

Question 3029

Topic: 5. Sports Medicine

A 22-year-old overhead athlete is diagnosed with a superior labrum anterior to posterior (SLAP) tear. Which of the following physical exam tests is most specific for identifying a SLAP lesion?

. Neer impingement sign
. O'Brien's active compression test
. Speed's test
. Yergason's test
. Apprehension test

Correct Answer & Explanation

. O'Brien's active compression test

Explanation

O'Brien's active compression test is classically described for identifying SLAP lesions when deep pain is elicited with the arm forward flexed, adducted, and internally rotated (thumb down), and the pain is relieved when the test is repeated with the arm externally rotated (thumb up). Speed's and Yergason's tests evaluate the long head of the biceps.

Question 3030

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BPTB) autografts to hamstring autografts for anterior cruciate ligament (ACL) reconstruction, BPTB grafts are most commonly associated with a higher incidence of which of the following postoperative complications?

. Postoperative deep joint infection.
. Graft rupture within the first two years.
. Anterior knee pain and kneeling pain.
. Isokinetic hamstring weakness.
. Femoral tunnel widening.

Correct Answer & Explanation

. Anterior knee pain and kneeling pain.

Explanation

BPTB autografts are historically considered the 'gold standard' for bone-to-bone healing and graft strength. However, the most consistent disadvantage when compared to hamstring autografts is a significantly higher incidence of donor site morbidity, particularly anterior knee pain and pain with kneeling.

Question 3031

Topic: Shoulder & Hip Sports

An elite baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a significant Glenohumeral Internal Rotation Deficit (GIRD). This condition is primarily driven by contracture of which of the following capsular structures?

. Anterior-inferior capsule
. Superior glenohumeral ligament
. Coracohumeral ligament
. Posterior-inferior capsule
. Middle glenohumeral ligament

Correct Answer & Explanation

. Posterior-inferior capsule

Explanation

Glenohumeral Internal Rotation Deficit (GIRD) in overhead athletes is primarily caused by an adaptive contracture and thickening of the posterior-inferior capsule. This contracture alters the glenohumeral kinematics, shifting the center of rotation posterosuperiorly during abduction and external rotation, leading to internal impingement (SLAP tears and PASTA lesions).

Question 3032

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon aims to accurately restore the native footprints of the anteromedial (AM) and posterolateral (PL) bundles on the femur. With the knee in full extension, which of the following accurately describes their relative positions on the medial wall of the lateral femoral condyle?

. The AM bundle is proximal and posterior; the PL bundle is distal and anterior.
. The AM bundle is distal and anterior; the PL bundle is proximal and posterior.
. The AM bundle is superior and anterior; the PL bundle is inferior and posterior.
. The AM bundle is distal and posterior; the PL bundle is proximal and anterior.
. Both bundles share an identical origin footprint with no distinct spatial separation.

Correct Answer & Explanation

. The AM bundle is proximal and posterior; the PL bundle is distal and anterior.

Explanation

On the medial wall of the lateral femoral condyle, with the knee in extension, the anteromedial (AM) bundle originates proximal and posterior to the posterolateral (PL) bundle. The PL bundle originates distal and anterior. During knee flexion, their relative orientation changes as the bundles cross one another.

Question 3033

Topic: Shoulder & Hip Sports

The 'glenoid track' concept is crucial in the preoperative evaluation of anterior shoulder instability. A Hill-Sachs lesion is deemed 'off-track' (or engaging) if its medial margin lies where in relation to the glenoid track?

. Lateral to the medial margin of the glenoid track
. Medial to the medial margin of the glenoid track
. Within the central 50% of the glenoid articular surface
. Directly on the superior aspect of the glenoid rim
. Posterior to the bare area of the humeral head

Correct Answer & Explanation

. Medial to the medial margin of the glenoid track

Explanation

The glenoid track is calculated as 83% of the native glenoid width (minus any anterior bone loss). A Hill-Sachs lesion is considered 'off-track' if its medial margin extends medial to the medial boundary of the glenoid track. This indicates the lesion is large or medial enough to drop over and engage the anterior glenoid rim during abduction and external rotation, typically necessitating a Latarjet or remplissage.

Question 3034

Topic: Knee Sports

During the physical examination of a patient with a suspected multiligament knee injury, the 'dial test' is performed. Which of the following findings is diagnostic of an isolated posterolateral corner (PLC) injury?

. Increased external rotation of >10 degrees at 30 degrees of flexion, but normal at 90 degrees
. Increased external rotation of >10 degrees at 90 degrees of flexion, but normal at 30 degrees
. Increased external rotation of >10 degrees at both 30 and 90 degrees of flexion
. Increased internal rotation at 30 degrees of flexion
. Increased internal rotation at both 30 and 90 degrees of flexion

Correct Answer & Explanation

. Increased external rotation of >10 degrees at 30 degrees of flexion, but normal at 90 degrees

Explanation

The dial test evaluates external rotation of the tibia relative to the femur. An isolated injury to the posterolateral corner (PLC) is indicated by increased external rotation (>10 degrees compared to the uninjured contralateral side) at 30 degrees of knee flexion, but not at 90 degrees. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury of both the PLC and the posterior cruciate ligament (PCL).

Question 3035

Topic: 5. Sports Medicine

Following a Zone II flexor tendon repair in the hand, an early active mobilization protocol is initiated. Compared to a strict passive mobilization protocol, what is the primary biomechanical advantage of early active motion?

. Increased tendon excursion, leading to reduced peritendinous adhesions
. Decreased work of flexion due to reduced intra-synovial edema
. Elimination of the risk of tendon rupture during the first 3 weeks
. Accelerated remodeling of the epitenon layer exclusively
. Preferential healing of the Flexor Digitorum Superficialis over the Profundus

Correct Answer & Explanation

. Increased tendon excursion, leading to reduced peritendinous adhesions

Explanation

Early active mobilization protocols generate greater differential tendon excursion between the FDS, FDP, and the surrounding sheath compared to passive protocols. This increased excursion is critical for preventing restrictive peritendinous adhesions and improving final digit range of motion. However, it does carry a higher risk of rupture if the repair is not robust enough (typically requiring a 4-strand or greater core suture technique) or if the patient is non-compliant.

Question 3036

Topic: Shoulder & Hip Sports

Internal impingement of the shoulder, commonly seen in overhead throwing athletes during the late cocking phase, involves pathologic contact between the:

. Articular surface of the supraspinatus/infraspinatus tendon and the posterosuperior glenoid labrum
. Bursal surface of the supraspinatus tendon and the coracoacromial ligament
. Subscapularis tendon and the tip of the coracoid process
. Long head of the biceps tendon and the superior border of the subscapularis
. Articular surface of the subscapularis tendon and the anteroinferior glenoid labrum

Correct Answer & Explanation

. Articular surface of the supraspinatus/infraspinatus tendon and the posterosuperior glenoid labrum

Explanation

Internal impingement occurs during maximal abduction and external rotation (the late cocking phase of throwing). In this position, the undersurface (articular surface) of the posterior rotator cuff (supraspinatus and anterior infraspinatus) becomes pinched between the greater tuberosity of the humerus and the posterosuperior rim of the glenoid/labrum, leading to articular-sided cuff tears and labral fraying.

Question 3037

Topic: Knee Sports

During physical examination of a knee with a suspected anterior cruciate ligament (ACL) injury, the pivot-shift test is performed. This test primarily isolates and evaluates which specific structural component of the ACL?

. Anteromedial bundle
. Posterolateral bundle
. Intermediate bundle
. Posteromedial bundle
. Anterolateral bundle

Correct Answer & Explanation

. Anteromedial bundle

Explanation

The ACL has two main bundles: the anteromedial (AM) and the posterolateral (PL). The AM bundle tightens in flexion and provides the primary restraint to anterior tibial translation (tested by the Lachman and anterior drawer tests). The PL bundle tightens in extension and provides the primary restraint to rotatory instability, which is clinically evaluated using the pivot-shift test.

Question 3038

Topic: 5. Sports Medicine

In elite overhead throwing athletes, such as baseball pitchers, Type II Superior Labrum Anterior to Posterior (SLAP) tears are a common source of shoulder pain. Which of the following biomechanical mechanisms is most widely accepted as the primary cause of these SLAP lesions during the late cocking phase of throwing?

. Traction mechanism
. Peel-back mechanism
. Internal impingement
. Direct compression
. Shear mechanism

Correct Answer & Explanation

. Peel-back mechanism

Explanation

During the late cocking phase of throwing, the shoulder is in maximal abduction and external rotation. This position causes the biceps vector to shift posteriorly, placing a torsional force on the superior labrum that twists and 'peels back' the posterosuperior labrum from the glenoid rim. This is known as the peel-back mechanism.

Question 3039

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher presents with posterior shoulder pain during the late cocking and early acceleration phases of throwing. MRI arthrogram reveals a partial articular-sided supraspinatus tendon tear and superior labral fraying. The pathophysiology of this internal impingement is characterized by pathologic abutment between which of the following structures?

. The greater tuberosity and the coracoacromial ligament
. The lesser tuberosity and the coracoid process
. The articular surface of the rotator cuff and the posterosuperior glenoid labrum
. The subscapularis tendon and the anteroinferior glenoid rim
. The long head of the biceps tendon and the transverse humeral ligament

Correct Answer & Explanation

. The articular surface of the rotator cuff and the posterosuperior glenoid labrum

Explanation

Internal impingement (posterosuperior impingement) typically affects overhead athletes. During the extreme abduction and external rotation of the late cocking phase of throwing, the articular-sided junction of the supraspinatus and infraspinatus tendons abuts against the posterosuperior glenoid rim and labrum. This repetitive contact leads to articular-sided 'kissing' lesions of the rotator cuff and posterosuperior labral fraying.

Question 3040

Topic: 5. Sports Medicine

A 9-year-old girl (Tanner stage I) sustains a complete anterior cruciate ligament (ACL) tear while playing soccer. Non-operative management fails due to recurrent instability. To minimize the risk of physeal arrest, which of the following surgical techniques is most appropriate?

. Transphyseal reconstruction using a quadrupled hamstring autograft
. Transphyseal reconstruction using a bone-patellar tendon-bone autograft
. An extra-articular and intra-articular physeal-sparing reconstruction using the iliotibial band
. All-inside reconstruction with a synthetic graft
. Primary repair of the ACL with internal brace augmentation

Correct Answer & Explanation

. An extra-articular and intra-articular physeal-sparing reconstruction using the iliotibial band

Explanation

In a skeletally immature patient with significant remaining growth (Tanner stage 1 or 2, open physes), standard transphyseal ACL drilling carries a high risk of growth arrest or angular deformity. The recommended surgical approach for recurrent instability in this demographic is a completely physeal-sparing technique, such as the Micheli-Kocher method, which utilizes a strip of the iliotibial band routed extra-articularly and intra-articularly over the top of the lateral femoral condyle.

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