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5. Sports Medicine MCQs

Practice Set 175 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 3481

Topic: Knee Sports

A 45-year-old construction worker falls 15 feet, sustaining a T12 burst fracture. He remains neurologically intact. Which of the following radiographic findings is the most reliable indicator of a concurrent posterior ligamentous complex (PLC) injury?

. Splaying of the spinous processes on the AP radiograph
. Anterior wedge compression of 30%
. Retropulsion of bone into the spinal canal
. Loss of vertebral body height
. Bilateral pedicle fractures

Correct Answer & Explanation

. Splaying of the spinous processes on the AP radiograph

Explanation

Splaying or widening of the interspinous distance on an AP or lateral radiograph indicates disruption of the posterior ligamentous complex (PLC). This finding upgrades the injury classification, often making it highly unstable and an indication for surgical stabilization.

Question 3482

Topic: 5. Sports Medicine

A professional football running back sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI confirms a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?

. Taping and immediate return to play
. Stiff-soled shoe and weight-bearing as tolerated
. Surgical repair of the plantar plate
. First MTP arthrodesis
. Excision of the sesamoids

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

A Grade 3 turf toe injury, characterized by a complete plantar plate tear and sesamoid retraction in a professional athlete, is generally treated with primary surgical repair to restore critical push-off strength.

Question 3483

Topic: 5. Sports Medicine

A 21-year-old elite football player suffers an acute hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI confirms a complete rupture of the plantar plate with proximal retraction of the sesamoids (Grade 3 Turf Toe). What is the recommended management?

. Stiff-soled shoe insert and immediate return to play as tolerated
. Buddy taping and corticosteroid injection
. Surgical repair of the plantar plate and capsuloligamentous complex
. Primary first MTP arthrodesis
. Proximal phalanx dorsiflexion osteotomy

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

Grade 3 turf toe injuries involve a complete tear of the plantar plate complex with sesamoid retraction. In elite athletes, surgical repair is indicated to restore push-off strength, stabilize the MTP joint, and prevent chronic deformity.

Question 3484

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. The patient is debating between operative repair and nonoperative management utilizing a modern functional rehabilitation protocol with early weight-bearing. Based on current Level 1 evidence, how do the outcomes of these two approaches compare?

. Operative repair yields significantly fewer reruptures
. Nonoperative treatment with functional rehab has equivalent rerupture rates
. Nonoperative treatment results in profound plantarflexion weakness
. Operative treatment eliminates the risk of deep vein thrombosis
. Functional rehab is contraindicated in nonoperative management

Correct Answer & Explanation

. Nonoperative treatment with functional rehab has equivalent rerupture rates

Explanation

Recent high-quality studies have demonstrated that when early functional rehabilitation protocols are utilized, the rerupture rates between nonoperative and operative management of Achilles tendon ruptures are statistically equivalent.

Question 3485

Topic: 5. Sports Medicine
A collegiate football lineman sustains a severe hyperextension injury to his 1st metatarsophalangeal (MTP) joint. MRI reveals a complete rupture of the plantar plate with proximal retraction of the sesamoids (Grade III Turf Toe). What is the recommended treatment to restore function and allow return to elite play?
. Rigid taping and immediate return to play in a stiff-soled shoe
. Intra-articular corticosteroid injection followed by passive physical therapy
. Surgical repair of the plantar plate and sesamoid complex
. Complete sesamoidectomy
. Primary 1st MTP joint arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and sesamoid complex

Explanation

A Grade III Turf Toe involves a complete tear of the plantar plate-sesamoid complex leading to gross instability. In high-level athletes, operative repair of the plantar plate is recommended to restore push-off strength and prevent chronic pain or progressive hallux rigidus.

Question 3486

Topic: 5. Sports Medicine
An elite football player sustains a forceful hyperextension injury to his first metatarsophalangeal joint. MRI reveals a Grade III turf toe injury with a complete tear of the plantar plate and marked proximal retraction of the sesamoids. What is the recommended management?
. Taping the toe and immediate return to play with a carbon-fiber insert
. Immobilization in a walking boot for 2 weeks followed by physical therapy
. Surgical repair of the plantar plate and capsuloligamentous complex
. Primary arthrodesis of the first metatarsophalangeal joint
. Excision of the fibular sesamoid to decompress the joint

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

A Grade III turf toe injury with gross instability and sesamoid retraction in a high-level athlete typically necessitates surgical repair. This restores the push-off mechanics and prevents long-term hallux rigidus.

Question 3487

Topic: 5. Sports Medicine

A professional athlete presents with severe pain at the first metatarsophalangeal (MTP) joint after hyperextending his big toe. MRI demonstrates a complete tear of the plantar plate and retraction of the sesamoids. What is the most appropriate management?

. Taping and immediate return to play
. Immobilization in a walking boot for 2 weeks
. Primary arthrodesis of the first MTP joint
. Surgical repair of the plantar plate and capsuloligamentous complex
. Excision of the sesamoids

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

This is a Grade 3 "Turf Toe" injury with a complete tear of the plantar plate and sesamoid retraction. In elite athletes, surgical repair is recommended to restore push-off strength and prevent chronic instability.

Question 3488

Topic: 5. Sports Medicine

A 25-year-old professional football player suffers a hyperextension injury to his great toe. Exam reveals profound plantar ecchymosis and a lack of active plantarflexion at the MTP joint. MRI shows a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the recommended treatment?

. Taping the toe in slight plantarflexion for 3 weeks
. Rigid carbon-fiber shoe insert
. Surgical repair of the plantar plate
. Excision of the sesamoids
. Arthrodesis of the first MTP joint

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

A Grade 3 turf toe injury (complete plantar plate tear) with proximal retraction of the sesamoids and loss of push-off strength in an elite athlete requires surgical repair to restore the windlass mechanism and MTP joint stability.

Question 3489

Topic: Shoulder & Hip Sports

A 30-year-old male sustains a medial subtalar dislocation while playing basketball. After urgent closed reduction, the post-reduction CT scan demonstrates an impaction fracture of the anterolateral talar head. This lesion is conceptually analogous to which injury in the shoulder?

. Bankart lesion
. Hill-Sachs lesion
. SLAP tear
. GLAD lesion
. ALPSA lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

In a medial subtalar dislocation, the navicular impacts the anterolateral talar head during dislocation, creating an impaction fracture. This is conceptually analogous to a Hill-Sachs lesion (humeral head impaction) seen in anterior shoulder dislocations.

Question 3490

Topic: 5. Sports Medicine

A 42-year-old recreational athlete sustains an acute Achilles tendon rupture. He elects for nonoperative management. Which of the following best describes his expected outcome compared to operative repair?

. Higher rate of deep infection
. Similar functional outcomes and re-rupture rates if an early functional rehabilitation protocol is used
. Significantly lower functional strength
. Unacceptably high re-rupture rate with functional bracing
. Higher rate of sural nerve injury

Correct Answer & Explanation

. Similar functional outcomes and re-rupture rates if an early functional rehabilitation protocol is used

Explanation

Recent literature shows that early functional rehabilitation in nonoperative management of acute Achilles tendon ruptures yields functional outcomes and re-rupture rates similar to operative repair. Operative repair carries a higher risk of wound complications and nerve injury.

Question 3491

Topic: 5. Sports Medicine

A 25-year-old professional football player suffers a severe hyperdorsiflexion injury to his great toe. MRI reveals a complete rupture of the plantar plate. Which of the following is considered a relative indication for surgical repair over non-operative management in this athlete?

. Grade 1 sprain with intact sesamoid apparatus
. Pain with passive plantarflexion
. Proximal migration of the sesamoids greater than 3 mm
. Concomitant turf toe of the second digit
. Presence of a bipartite medial sesamoid

Correct Answer & Explanation

. Proximal migration of the sesamoids greater than 3 mm

Explanation

Turf toe is a sprain of the 1st MTP plantar plate. Surgical indications for turf toe (Grade 3) include complete tears with proximal sesamoid migration (>3 mm), intra-articular loose bodies, vertical instability, or failed conservative management in a high-level athlete.

Question 3492

Topic: 5. Sports Medicine

A 24-year-old football player sustains a hyperextension injury to his first MTP joint. He has severe pain, ecchymosis, and inability to bear weight. MRI demonstrates complete disruption of the plantar plate and sesamoid complex with proximal retraction of the sesamoids. What is the most appropriate management?

. Stiff-soled shoe and taping for 2 weeks
. Non-weight-bearing cast for 6 weeks
. Corticosteroid injection and immediate return to play
. Surgical repair of the plantar plate and sesamoid complex
. First MTP arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and sesamoid complex

Explanation

This is a Grade 3 Turf Toe injury with complete rupture of the plantar plate and proximal migration of the sesamoids. Surgical repair is indicated to restore push-off strength and anatomy in a high-level athlete.

Question 3493

Topic: 5. Sports Medicine

A 38-year-old recreational athlete sustains an acute Achilles tendon rupture. He is counseled on nonoperative versus operative management. Based on recent literature, which of the following is true regarding nonoperative management utilizing an early functional rehabilitation protocol compared to traditional operative repair?

. It has a significantly higher rerupture rate.
. It results in a lower rate of deep vein thrombosis.
. It has a comparable rerupture rate to operative management.
. It carries a higher risk of sural nerve injury.
. It severely decreases long-term plantarflexion strength.

Correct Answer & Explanation

. It has a comparable rerupture rate to operative management.

Explanation

Recent high-quality studies show that nonoperative management utilizing an early functional rehabilitation protocol has a rerupture rate comparable to operative management. It also avoids surgical complications such as wound breakdown and iatrogenic nerve injury.

Question 3494

Topic: Shoulder & Hip Sports

A 42-year-old male presents with isolated weakness of the infraspinatus muscle. MRI shows a ganglion cyst compressing a nerve. At what anatomical location is the compression most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch results in isolated infraspinatus weakness, as the branch to the supraspinatus has already been given off. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 3495

Topic: 5. Sports Medicine

A 28-year-old overhead athlete is diagnosed with a Type II SLAP tear. During diagnostic arthroscopy, which of the following defines a Type II tear?

. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and 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 extending into the biceps tendon
. Fraying of the superior labrum with a partial-thickness rotator cuff tear

Correct Answer & Explanation

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

Explanation

A Type II SLAP lesion involves pathological detachment of the superior labrum and the origin of the long head of the biceps from the glenoid. It is the most common type of SLAP tear requiring surgical repair in overhead athletes.

Question 3496

Topic: Shoulder & Hip Sports

A 50-year-old man complains of inability to internally rotate his arm behind his back following a fall. Examination shows increased passive external rotation compared to the contralateral side. The lift-off and belly-press tests are positive. Which tendon is ruptured?

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

Correct Answer & Explanation

. Subscapularis

Explanation

The subscapularis is the primary internal rotator of the shoulder. A tear results in increased passive external rotation and profound weakness in active internal rotation, demonstrated by positive lift-off and belly-press tests.

Question 3497

Topic: Shoulder & Hip Sports

A 22-year-old man presents to the ER after a seizure. His arm is locked in internal rotation. An axillary radiograph reveals a posterior shoulder dislocation with a 30% reverse Hill-Sachs lesion. What is the most appropriate surgical management?

. Closed reduction and spica casting
. Arthroscopic Bankart repair
. Latarjet procedure
. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)
. Hemiarthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)

Explanation

A reverse Hill-Sachs lesion involving 20-40% of the articular surface is typically managed with a McLaughlin procedure (or modified McLaughlin). This transfers the lesser tuberosity and/or subscapularis tendon into the anterior humeral defect to prevent re-engagement.

Question 3498

Topic: Shoulder & Hip Sports

A 55-year-old female presents with severe shoulder pain. Radiographs reveal superior migration of the humeral head. Which physical exam finding would most reliably indicate a massive, irreparable posterior-superior rotator cuff tear involving the teres minor?

. Positive Neer impingement sign
. Hornblower's sign
. Positive O'Brien's test
. Positive Speed's test
. Positive lift-off test

Correct Answer & Explanation

. Hornblower's sign

Explanation

A positive Hornblower's sign (inability to maintain external rotation in 90 degrees of abduction) indicates severe weakness or absence of the teres minor. This is highly suggestive of a massive, irreparable posterior-superior rotator cuff tear.

Question 3499

Topic: Shoulder & Hip Sports

A 22-year-old football player has recurrent anterior shoulder instability. A 3D CT scan reveals 27% bone loss of the anteroinferior glenoid. What is the most appropriate surgical intervention to minimize the risk of recurrent dislocation?

. Arthroscopic capsular plication
. Arthroscopic soft-tissue Bankart repair
. Coracoid process transfer (Latarjet procedure)
. Infraspinatus remplissage
. Subscapularis advancement (Putti-Platt procedure)

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

Soft-tissue Bankart repairs have unacceptably high failure rates when glenoid bone loss exceeds 20-25%. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore the articular arc and provide a sling effect via the conjoint tendon.

Question 3500

Topic: Shoulder & Hip Sports

When evaluating massive rotator cuff tears on MRI, the Goutallier classification system is frequently used. What specific pathologic feature does this system grade to determine the prognosis of a rotator cuff repair?

. The degree of tendon retraction in the coronal plane
. The amount of fatty infiltration within the rotator cuff muscle belly
. The extent of acromioclavicular joint osteoarthritis
. The size of the tear in the sagittal plane
. The superior migration of the humeral head

Correct Answer & Explanation

. The amount of fatty infiltration within the rotator cuff muscle belly

Explanation

The Goutallier classification evaluates the severity of fatty infiltration within the rotator cuff muscle bellies, originally described on CT and adapted for MRI. High grades (greater than 50% fat) correlate with a poor prognosis for tendon healing and functional recovery following repair.

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