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 361
Topic: Shoulder & Hip Sports
Which of the following combinations of structures accurately defines the contents of the rotator interval of the shoulder?
Correct Answer & Explanation
. Supraspinatus tendon, infraspinatus tendon, and coracohumeral ligament
Explanation
The rotator interval is the triangular anatomical space between the supraspinatus and subscapularis tendons. It contains the long head of the biceps tendon, the superior glenohumeral ligament (SGHL), and the coracohumeral ligament (CHL).
Question 362
Topic: Knee Sports
The posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia relative to the femur. At what degree of knee flexion does it provide the maximum percentage of this restraining force?
Correct Answer & Explanation
. 0 degrees
Explanation
The PCL provides up to 95% of the total restraining force to posterior translation of the tibia. Its effectiveness as a primary restraint is greatest at 90 degrees of knee flexion.
Question 363
Topic: Knee Sports
The medial patellofemoral ligament (MPFL) is recognized as the primary soft tissue restraint against lateral patellar translation. At what angle of knee flexion does it provide the greatest percentage of this restraining force?
Correct Answer & Explanation
. 0 to 30 degrees
Explanation
The MPFL provides 50-60% of the restraining force against lateral patellar displacement, functioning primarily from 0 to 30 degrees of flexion before the patella fully engages the bony stability of the trochlear groove.
Question 364
Topic: Knee Sports
The primary blood supply to the anterior cruciate ligament (ACL) is derived from which of the following vascular structures?
Correct Answer & Explanation
. Lateral inferior genicular artery
Explanation
Both the anterior and posterior cruciate ligaments receive their primary blood supply from the middle genicular artery. This artery branches from the popliteal artery and pierces the posterior capsule to supply the intracapsular structures.
Question 365
Topic: Shoulder & Hip Sports
In the setting of a massive rotator cuff tear involving the supraspinatus and infraspinatus, which intact anatomical structure limits superior translation (escape) of the humeral head?
Correct Answer & Explanation
. Coracoacromial ligament
Explanation
The coracoacromial ligament forms the critical "roof" of the coracoacromial arch over the humeral head. In massive rotator cuff tears, it provides a crucial static restraint against superior humeral head escape and should generally be preserved during surgery.
Question 366
Topic: Knee Sports
A 22-year-old female sustains a non-contact pivoting injury to her knee, reporting a loud pop.
Assuming an acute anterior cruciate ligament (ACL) rupture occurred, which associated meniscal injury is most commonly encountered in this acute setting?
Correct Answer & Explanation
. Longitudinal tear of the lateral meniscus
Explanation
In the setting of acute ACL ruptures, lateral meniscus tears (especially posterior horn longitudinal tears) are significantly more common due to the characteristic pivoting and subluxation mechanism. Conversely, medial meniscus tears are more frequently associated with chronic ACL-deficient knees.
Question 367
Topic: Shoulder & Hip Sports
Following two previous shoulder stabilization procedures for recurrent dislocations, a 45-year-old man complains of pain and limited motion. Examination reveals increased passive external rotation and an inability to lift the back of the hand away from his back. Which of the following muscles is injured:
Correct Answer & Explanation
. Subscapularis
Explanation
The patient has an incompetent subscapularis muscle. An inability to lift the back of the hand away from the back (a positive Liftoff test) has been described by Gerber and colleagues and is a reliable method of evaluating subscapularis integrity. Patients with subscapularis tears often demonstrate an increase in passive external rotation and weakness in internal rotation.
Question 368
Topic: Shoulder & Hip Sports
Which of the following structures is involved in the "essential lesion" of a stiff shoulder?
Correct Answer & Explanation
. Coracohumeral ligament
Explanation
The long head of the biceps tendon defines the region of the rotator interval, which is the area between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. This region usually is contracted in individuals who lack external rotation of the adducted shoulder. Coracohumeral ligament contracture is an important component of adhesive capsulitis.
Question 369
Topic: Shoulder & Hip Sports
Which of the following muscles is most responsible for deceleration of the arm during pitching:
Correct Answer & Explanation
. Deltoid
Explanation
During the deceleration phase, the excess kinetic energy that was not transferred to the ball is dissipated by controlled deceleration of the upper extremity. The rotator cuff (primarily teres minor) is the principle decelerator and is susceptible to tensile failure from eccentric loading.
Question 370
Topic: Shoulder & Hip Sports
Which of the following conditions most often accompanies a dislocation of the longhead of the biceps tendon?
Correct Answer & Explanation
. Anterior instability
Explanation
Although isolated ruptures of the biceps tendon have been described, most cases involving biceps tendon pathology are accompanied by rotator cuff injury. When computerized tomography arthrograms are performed on patients who have clinical criteria for isolated ruptures of the long head of the biceps, the incidence of isolated lesions decreases to 6%. Although primary bicipital tendinitis was recognized as a frequent cause of anterior shoulder pain in the 1950s, it is currently a diagnosis of exculsion that is made far less frequently.
Question 371
Topic: Knee Sports
Which of the following statements is true concerning the bands of the anterior cruciate ligament:
Correct Answer & Explanation
. The anterolateral band is tightest in flexion.
Explanation
The anterior cruciate ligament is composed of at least two functional bands. The larger anteromedial band is tightest in flexion and loosest in extension. The smaller posterolateral band is tightest in extension and loosest in flexion. Conventional anterior cruciate ligament reconstruction replaces only the anteromedial band.
Question 372
Topic: Knee Sports
A 10-year-old female gymnast twists her knee on her dismount from the balance beam. She hears a pop and has immediate swelling. She is unable to continue with activity. Physical examination reveals a positive Lachman test and positive pivot shift. She has no joint line tenderness. Radiographs are normal. After an initial period of ice and range of motion exercises, recommended treatment should include:
Correct Answer & Explanation
. Direct repair of the anterior cruciate ligament
Explanation
Anterior cruciate ligament injuries in children represent a vexing clinical problem. Standard anterior cruciate ligament reconstructions would involve drilling across an open physis, which may cause a growth disturbance. Results of direct repair or extra-articular reconstruction have been no better in children than in adults. The most reasonable initial treatment is rehabilitation. If despite adequate rehabilitation, the child continues to have instability, it is recommended that the child discontinues the activities that result in instability until skeletal maturity when a standard reconstruction can be performed, or when the child undergoes a physeal sparing reconstruction (i.e., Bergfeld's "tomato stake" reconstruction).
Question 373
Topic: Knee Sports
The most common location of osteochondritis dissecans in the knee is the:
Correct Answer & Explanation
. Lateral aspect of the medial femoral condyle
Explanation
Osteochondritis dissecans affects adolescents, and the knee joint is the most commonly affected joint. The most common location in the knee is the lateral aspect of the medial femoral condyle at the intercondylar notch. Treatment varies with the stability of the lesion from observation to operative reduction and fixation.
Question 374
Topic: 5. Sports Medicine
A 15-year-old female volleyball player twisted her knee while planting her foot. She states she felt her knee give out. She had immediate swelling and was unable to continue participation. She denies hearing a pop. Physical examination reveals a large effusion with a range of motion from full extension to 80° flexion. She has marked tenderness along the medial retinaculum of her knee. She has no joint line tenderness. There is no pathologic laxity involving the collateral or cruciate ligaments. The most likely diagnosis is:
Correct Answer & Explanation
. Patellar subluxation
Explanation
Patellar subluxation is a common injury in athletes. It generally presents with a large effusion. Patients usually have a limited arc of motion but can usually obtain full extension. In addition to medial retinacular tenderness, patients will have apprehension to attempts at lateral displacement of the patella. Treatment is initially nonoperative, emphasizing quadriceps strengthening. Operative treatment is reserved for patients with continued instability despite appropriate rehabilitation.
Question 375
Topic: Shoulder & Hip Sports
A 55-year-old man presents with anterior shoulder pain and increased passive external rotation after a heavy fall. Examination reveals a positive belly-press test and an inability to maintain internal rotation against resistance. Which structure is most likely injured?
Correct Answer & Explanation
. Subscapularis
Explanation
The subscapularis is the primary internal rotator of the shoulder. A positive belly-press test and an abnormal increase in passive external rotation strongly indicate a subscapularis tendon rupture.
Question 376
Topic: 5. Sports Medicine
During shoulder arthroscopy for a suspected SLAP lesion, the surgeon notes peeling back of the superior labrum when the arm is placed in abduction and external rotation. This "peel-back" mechanism is most commonly associated with which type of SLAP tear?
Correct Answer & Explanation
. Type II
Explanation
The "peel-back" mechanism is the classic pathomechanical sign of a Type II SLAP tear. In this lesion, the superior labrum and biceps anchor are detached from the superior glenoid tubercle.
Question 377
Topic: Shoulder & Hip Sports
A 32-year-old elite volleyball player presents with isolated weakness in external rotation of the shoulder. Examination reveals atrophy of the infraspinatus fossa, but supraspinatus strength and bulk are perfectly normal. Where is the most likely site of nerve entrapment?
Correct Answer & Explanation
. Spinoglenoid notch
Explanation
Entrapment of the suprascapular nerve at the spinoglenoid notch selectively denervates only the infraspinatus muscle, causing isolated external rotation weakness. Proximal entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus.
Question 378
Topic: Shoulder & Hip Sports
A 22-year-old rugby player with recurrent anterior shoulder instability is found to have 25% anterior glenoid bone loss. An open Latarjet procedure is planned. During the surgical approach to the anterior glenoid, which muscle's tendon is classically split horizontally?
Correct Answer & Explanation
. Subscapularis
Explanation
During the Latarjet procedure, the subscapularis tendon and muscle belly are split longitudinally (horizontally relative to the fibers) at the junction of the upper two-thirds and lower one-third. This provides optimal access to the anterior glenoid neck.
Question 379
Topic: Shoulder & Hip Sports
A 22-year-old professional baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination reveals a 20-degree loss of internal rotation compared to the contralateral side. What is the most likely pathophysiology of his condition?
Correct Answer & Explanation
. Posterosuperior glenoid impingement of the undersurface of the rotator cuff
Explanation
This describes internal impingement, common in overhead athletes. It involves the undersurface of the supraspinatus and infraspinatus impinging against the posterosuperior glenoid and labrum during extreme abduction and external rotation.
Question 380
Topic: Shoulder & Hip Sports
A 30-year-old weightlifter presents with vague posterior shoulder pain and paresthesias over the lateral deltoid. MRI demonstrates isolated fatty infiltration and atrophy of the teres minor muscle. The affected nerve is compressed in a space defined by which of the following boundaries?
Correct Answer & Explanation
. Teres minor (superior), teres major (inferior), long head of triceps (medial), humeral shaft (lateral)
Explanation
Quadrilateral space syndrome involves compression of the axillary nerve and posterior humeral circumflex artery. The boundaries are the teres minor (superior), teres major (inferior), long head of triceps (medial), and surgical neck of the humerus (lateral).
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