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 3201
Topic: Shoulder & Hip Sports
A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. MRI reveals a paralabral cyst. Compression of the involved nerve at the spinoglenoid notch will selectively denervate which of the following muscles?
Correct Answer & Explanation
. Infraspinatus
Explanation
The suprascapular nerve innervates the supraspinatus prior to passing through the spinoglenoid notch. Therefore, a cyst at the spinoglenoid notch causes isolated denervation of the infraspinatus muscle.
Question 3202
Topic: Knee Sports
A patient is undergoing reconstruction of the posterolateral corner (PLC) of the knee. Which of the following structures constitutes the primary static stabilizer to external tibial rotation at 30 degrees of knee flexion?
Correct Answer & Explanation
. Popliteofibular ligament (PFL)
Explanation
The popliteofibular ligament (PFL) is a critical component of the PLC and acts as the primary static stabilizer against external rotation of the tibia. The LCL is the primary restraint to varus stress.
Question 3203
Topic: 5. Sports Medicine
To avoid iatrogenic injury during placement of the anterolateral portal for ankle arthroscopy, the surgeon must be aware of the path of the superficial peroneal nerve. On average, where does this nerve pierce the deep crural fascia to become subcutaneous?
Correct Answer & Explanation
. 10 to 12 cm proximal to the lateral malleolus
Explanation
The superficial peroneal nerve typically pierces the deep crural fascia to become subcutaneous approximately 10 to 12 cm proximal to the tip of the lateral malleolus. It crosses anteriorly and is at risk during anterolateral ankle portal placement.
Question 3204
Topic: Shoulder & Hip Sports
A surgeon is executing a posterior approach to the shoulder. The superficial dissection interval is between the deltoid and the teres minor. The deep internervous plane separates which two muscles?
Correct Answer & Explanation
. Infraspinatus and Teres Minor
Explanation
The deep internervous plane in the posterior approach to the shoulder is between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve).
Question 3205
Topic: Shoulder & Hip Sports
A 30-year-old baseball pitcher presents with vague posterior shoulder pain and deltoid weakness. MRI reveals isolated atrophy of the teres minor. Which of the following anatomic boundaries defines the quadrilateral space through which the affected nerve passes?
Correct Answer & Explanation
. Teres minor superiorly, teres major inferiorly, long head of triceps medially, surgical neck of humerus laterally
Explanation
Quadrilateral space syndrome involves compression of the axillary nerve, causing denervation to the teres minor and deltoid. The space is bounded by the teres minor (superior), teres major (inferior), long head of the triceps (medial), and the surgical neck of the humerus (lateral).
Question 3206
Topic: Knee Sports
A patient undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee. The surgeon reconstructs the popliteofibular ligament, which originates from the popliteus musculotendinous junction and inserts onto the fibular styloid. What is its primary biomechanical role?
Correct Answer & Explanation
. Resists primary external rotation of the tibia
Explanation
The popliteofibular ligament is a key static stabilizer of the posterolateral corner of the knee. Its primary biomechanical function, along with the lateral collateral ligament and popliteus tendon, is resisting external rotation of the tibia.
Question 3207
Topic: Shoulder & Hip Sports
A 45-year-old patient presents postoperatively with profound isolated weakness in shoulder external rotation following a massive rotator cuff repair. Electromyography reveals denervation of the infraspinatus with normal supraspinatus function. At what anatomical site is the suprascapular nerve most likely entrapped?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch causes isolated infraspinatus weakness, whereas suprascapular notch entrapment affects both muscles.
Question 3208
Topic: 5. Sports Medicine
A 28-year-old overhead athlete presents with vague posterior shoulder pain and deltoid weakness. MRI reveals isolated atrophy of the teres minor. Compression in the quadrilateral space is suspected. What are the correct anatomical boundaries of this space?
Correct Answer & Explanation
. Teres minor (superior), Teres major (inferior), Long head of triceps (medial), Humeral shaft (lateral)
Explanation
The quadrilateral space is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the humeral shaft. It contains the axillary nerve and the posterior circumflex humeral artery.
Question 3209
Topic: Shoulder & Hip Sports
A patient has isolated weakness in external rotation of the shoulder but demonstrates normal active abduction. An MRI reveals a paralabral cyst. In which anatomical location is the cyst most likely compressing the affected nerve?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
The suprascapular nerve innervates the supraspinatus (abduction) before passing through the spinoglenoid notch to innervate the infraspinatus (external rotation). Compression at the spinoglenoid notch selectively impairs the infraspinatus while sparing the supraspinatus.
Question 3210
Topic: Knee Sports
A surgeon is reconstructing the posterolateral corner of the knee. The fibular collateral ligament (FCL) and the popliteus tendon (PT) both insert on the lateral femoral epicondyle. What is the spatial relationship of the FCL footprint relative to the PT footprint on the femur?
Correct Answer & Explanation
. Proximal and posterior
Explanation
On the lateral femoral condyle, the origin of the fibular collateral ligament (FCL) is located proximal and posterior to the origin of the popliteus tendon.
Question 3211
Topic: 5. Sports Medicine
A 28-year-old overhead throwing athlete presents with posterior shoulder pain and teres minor atrophy on MRI. Entrapment of the axillary nerve in the quadrilateral space is suspected. What are the boundaries of this anatomical space?
Correct Answer & Explanation
. Teres minor (superior), teres major (inferior), long head of triceps (medial), humeral shaft (lateral)
Explanation
The quadrilateral space is bounded superiorly by the teres minor, inferiorly by the teres major, laterally by the humeral shaft, and medially by the long head of the triceps. It contains the axillary nerve and the posterior circumflex humeral artery.
Question 3212
Topic: Knee Sports
A surgeon is reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability. Anatomically, the femoral origin of the native MPFL is located in a saddle-like depression between which two osseous landmarks?
Correct Answer & Explanation
. Adductor tubercle and medial epicondyle
Explanation
The femoral origin of the MPFL lies in a saddle-shaped depression located between the medial epicondyle (distally) and the adductor tubercle (proximally). Finding this isometric point is critical for avoiding abnormal graft tension during knee flexion.
Question 3213
Topic: Shoulder & Hip Sports
A 32-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. MRI reveals a paralabral cyst compressing a nerve at the spinoglenoid notch. Which physical examination finding corresponds to this specific level of entrapment?
Correct Answer & Explanation
. Isolated atrophy of the infraspinatus
Explanation
The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch selectively denervates the infraspinatus, causing isolated external rotation weakness without abduction deficit.
Question 3214
Topic: Knee Sports
The posterolateral corner (PLC) of the knee provides primary restraint to varus stress and posterolateral rotation. Which of the following structures is considered one of the three major static stabilizers of the PLC?
Correct Answer & Explanation
. Popliteofibular ligament
Explanation
The three primary static stabilizers of the posterolateral corner of the knee are the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. The biceps femoris and iliotibial band provide dynamic, rather than static, stability.
Question 3215
Topic: 5. Sports Medicine
What fibers of the anterior cruciate ligament tighten with extension of the knee?
Correct Answer & Explanation
. Posterolateral
Explanation
The anterior cruciate ligament consists of two functional bundles: anteromedial and posterolateral. During extension of the knee, the posterolateral bundle becomes taut. In flexion, the anteromedial bundle is tight and the posterolateral bundle relaxes. Traditionally, anterior cruciate ligament reconstruction primarily recreates the anteromedial bundle. Recently, techniques for double bundle reconstruction have been described to recreate the normal anatomic relationship of the two bundles. Girgis FG, Marshall JL, Monajem AS: The cruciate ligaments of the knee joint: Anatomical, functional and experimental analysis. Clin Orthop Relat Res 1975;106:216-231. Cha PS, Brucker PU, West RV, et al: Arthroscopic double-bundle anterior cruciate ligament reconstruction: An anatomic approach. Arthroscopy 2005;21:1275.
Question 3216
Topic: Knee Sports
Figure 51 shows an arthroscopic view of the patellofemoral joint from an inferolateral portal. The arrow points to which of the following structures?
Correct Answer & Explanation
. Plica
Explanation
Synovial folds or plicae are the result of incomplete or partial resorption of the synovial membranes during fetal development of the knee. The arthroscopic view shows a medial patellar plica, which has been noted in 5% to 55% of all individuals but becomes symptomatic in only a small number of patients. Symptoms may include crepitus, pain, snapping, and swelling and often respond to nonsurgical management. Clarke HD, Scott WN, Insall JN: Anatomic aberrations, in Insall JN, Scott WN (eds): Surgery of the Knee, ed 4. Philadelphia, PA, Churchill Livingstone, 2006, vol 1, pp 67-85.
Question 3217
Topic: 5. Sports Medicine
A 45-year-old overhead athlete presents with deep posterior shoulder pain and weakness in external rotation. Abduction strength is symmetric. MRI reveals a paralabral cyst. The cyst is most likely located in which of the following anatomic locations?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
Isolated infraspinatus weakness (diminished external rotation) with normal supraspinatus function (intact abduction) suggests distal suprascapular nerve compression at the spinoglenoid notch. A cyst at the suprascapular notch would typically affect both muscles.
Question 3218
Topic: 5. Sports Medicine
A 24-year-old athlete sustains a posterolateral corner (PLC) knee injury. Surgical reconstruction involves repairing the structure that inserts onto the fibular head and is the primary restraint to varus opening at 30 degrees of knee flexion. What is this structure?
Correct Answer & Explanation
. Lateral collateral ligament (LCL)
Explanation
The Lateral Collateral Ligament (LCL) inserts on the fibular head and is the primary restraint to varus stress at 30 degrees of knee flexion. The popliteofibular ligament and popliteus tendon primarily control external tibial rotation.
Question 3219
Topic: Knee Sports
A surgeon is performing a posterolateral corner reconstruction of the knee and must drill tunnels for the anatomic femoral attachments of the fibular collateral ligament (FCL) and the popliteus tendon. What is the typical anatomic relationship of the popliteus femoral footprint relative to the FCL footprint?
Correct Answer & Explanation
. Distal and anterior
Explanation
The popliteus tendon inserts on the femur at the anterior aspect of the popliteal sulcus. This footprint is located just distal and anterior (typically 18.5 mm) to the femoral attachment of the fibular collateral ligament.
Question 3220
Topic: 5. Sports Medicine
A 28-year-old overhead athlete presents with isolated weakness in shoulder external rotation. Abduction is full and painless. Magnetic resonance imaging reveals a paralabral cyst. Compression of the nerve at which of the following locations is most likely responsible for this specific physical examination finding?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
A cyst at the spinoglenoid notch compresses the terminal branch of the suprascapular nerve, resulting in isolated infraspinatus weakness (external rotation). Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.
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