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5. Sports Medicine MCQs

Practice Set 195 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 3881

Topic: Shoulder & Hip Sports

When performing an arthroscopic stabilization for recurrent anterior shoulder instability, which of the following is the primary indication for adding a 'Remplissage' procedure to a Bankart repair?

. Anterior glenoid bone loss greater than 25%
. Presence of a massive, retracted rotator cuff tear
. Subcritical glenoid bone loss with an engaging, off-track Hill-Sachs lesion
. A reverse Hill-Sachs lesion
. A concomitant Type II SLAP tear

Correct Answer & Explanation

. Anterior glenoid bone loss greater than 25%

Explanation

Remplissage involves tenodesis of the infraspinatus and posterior capsule into a Hill-Sachs defect. It is indicated for off-track, engaging Hill-Sachs lesions in the setting of subcritical (<15-20%) anterior glenoid bone loss.

Question 3882

Topic: Shoulder & Hip Sports

Which of the following anatomic structures are the primary components found within the rotator interval?

. Superior glenohumeral ligament, coracohumeral ligament, long head of the biceps tendon
. Middle glenohumeral ligament, inferior glenohumeral ligament, long head of the biceps tendon
. Coracoacromial ligament, supraspinatus tendon, subscapularis tendon
. Supraspinatus tendon, infraspinatus tendon, teres minor tendon
. Short head of the biceps, coracobrachialis, pectoralis minor

Correct Answer & Explanation

. Superior glenohumeral ligament, coracohumeral ligament, long head of the biceps tendon

Explanation

The rotator interval is a triangular space between the supraspinatus and subscapularis. It contains the superior glenohumeral ligament (SGHL), the coracohumeral ligament (CHL), and the long head of the biceps tendon.

Question 3883

Topic: Shoulder & Hip Sports

A lower trapezius tendon transfer is performed for a patient with an irreparable posterosuperior rotator cuff tear. The line of pull of the transferred lower trapezius tendon most closely mimics which native rotator cuff muscle to restore what specific motion?

. Supraspinatus; active abduction
. Subscapularis; active internal rotation
. Teres major; active adduction
. Infraspinatus; active external rotation
. Teres minor; active extension

Correct Answer & Explanation

. Supraspinatus; active abduction

Explanation

The lower trapezius transfer vector closely mimics the infraspinatus muscle. It is highly effective at restoring active external rotation in patients with irreparable posterosuperior cuff tears.

Question 3884

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D computed tomography (CT) scan reveals 26% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic anterior labral repair with anchor fixation
. Arthroscopic capsular plication
. Open coracoid transfer to the anterior glenoid (Latarjet)
. Arthroscopic remplissage alone
. Open inferior capsular shift

Correct Answer & Explanation

. Arthroscopic anterior labral repair with anchor fixation

Explanation

Anterior glenoid bone loss greater than 20-25% in a contact athlete is an indication for a bony augmentation procedure, most commonly the Latarjet procedure. Soft tissue Bankart repairs have an unacceptably high failure rate in this setting.

Question 3885

Topic: Shoulder & Hip Sports

A 68-year-old male with a massive, retracted rotator cuff tear is being evaluated for surgical repair. Preoperative MRI shows Goutallier stage 4 fatty infiltration of the supraspinatus and infraspinatus. What does this finding indicate regarding the prognosis of a primary repair?

. It is a normal age-related finding and does not affect healing
. It indicates muscular hypertrophy compensating for the tear
. It predicts a higher likelihood of structural failure after repair
. It signifies that a single-row repair is biomechanically superior to double-row
. It confirms an intact suprascapular nerve

Correct Answer & Explanation

. It is a normal age-related finding and does not affect healing

Explanation

Goutallier stage 3 or 4 fatty infiltration (more fat than muscle) is an irreversible change that strongly correlates with poor functional outcomes and high re-tear rates following primary rotator cuff repair.

Question 3886

Topic: Shoulder & Hip Sports

A 35-year-old male weightlifter complains of vague posterior shoulder pain and weakness with external rotation. MRI reveals a paralabral cyst located strictly at the spinoglenoid notch. Which physical exam finding is most likely present?

. Weakness in both abduction and external rotation
. Isolated weakness in external rotation with the arm at the side
. Positive lift-off test
. Positive belly-press test
. Weakness in internal rotation

Correct Answer & Explanation

. Weakness in both abduction and external rotation

Explanation

A cyst at the spinoglenoid notch compresses the distal suprascapular nerve, resulting in isolated denervation and weakness of the infraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 3887

Topic: Shoulder & Hip Sports

During the Latarjet procedure, the coracoid process is transferred to the anterior glenoid. The primary stabilizing mechanism of this procedure in abduction and external rotation is attributed to:

. The bone block increasing the anteroposterior diameter of the glenoid
. The sling effect of the conjoint tendon on the lower subscapularis and capsule
. The repair of the coracoacromial ligament to the capsule
. The shortening of the musculocutaneous nerve
. The tightening of the middle glenohumeral ligament

Correct Answer & Explanation

. The bone block increasing the anteroposterior diameter of the glenoid

Explanation

While the Latarjet provides a triple blocking effect, the most significant biomechanical contribution in abduction and external rotation is the dynamic sling effect of the conjoint tendon over the inferior subscapularis.

Question 3888

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete is diagnosed with recurrent shoulder instability. Advanced imaging demonstrates an 'off-track' Hill-Sachs lesion and 12% anterior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Humeral head osteochondral allografting
. Open anterior capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

An 'off-track' Hill-Sachs lesion will engage the anterior glenoid rim during external rotation. When combined with subcritical glenoid bone loss (less than 20%), an arthroscopic Bankart repair combined with Remplissage is indicated to prevent engagement.

Question 3889

Topic: Shoulder & Hip Sports

A patient with a massive rotator cuff tear is examined in the clinic. The examiner supports the patient's arm in 90 degrees of abduction in the scapular plane with the elbow flexed to 90 degrees, and asks the patient to externally rotate against resistance. The patient is unable to do so, and the hand drops forward. Which muscle is predominantly deficient?

. Supraspinatus
. Subscapularis
. Teres major
. Teres minor
. Pectoralis major

Correct Answer & Explanation

. Supraspinatus

Explanation

This describes Hornblower's sign, which is highly sensitive and specific for an irreparable tear or severe fatty degeneration of the teres minor.

Question 3890

Topic: Shoulder & Hip Sports

Which of the following findings accurately differentiates an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion from a classic Bankart lesion on MRI?

. The labrum is detached completely with an associated bony fragment
. The anterior labrum is displaced medially and remains attached to the intact scapular periosteum
. The superior labrum is stripped from anterior to posterior
. There is extravasation of contrast into the axillary pouch
. The inferior glenohumeral ligament is avulsed from the humeral neck

Correct Answer & Explanation

. The labrum is detached completely with an associated bony fragment

Explanation

An ALPSA lesion involves an avulsion of the anterior labroligamentous complex where the periosteum remains intact, allowing the labrum to roll medially and scar down on the glenoid neck. It has a higher recurrence rate if not properly mobilized during repair.

Question 3891

Topic: Shoulder & Hip Sports

A 60-year-old man sustains an acute traumatic fall. He presents with profound weakness in internal rotation and a positive lift-off test. If this specific rotator cuff tendon is completely torn and left untreated, which secondary pathology is most likely to develop?

. Acromioclavicular joint osteoarthritis
. Medial subluxation or dislocation of the long head of the biceps tendon
. Atrophy of the deltoid muscle
. Adhesive capsulitis
. Teres minor fatty infiltration

Correct Answer & Explanation

. Acromioclavicular joint osteoarthritis

Explanation

The subscapularis tendon and the coracohumeral ligament are critical stabilizers of the long head of the biceps tendon. An untreated complete subscapularis tear frequently leads to medial subluxation or dislocation of the biceps tendon.

Question 3892

Topic: Shoulder & Hip Sports

A 55-year-old male is evaluated for chronic shoulder pain. Anteroposterior (AP) radiographs reveal an acromiohumeral interval (AHI) of 4 mm. This measurement suggests:

. A high probability of a successful primary rotator cuff repair
. An isolated subscapularis tear
. Significant superior migration of the humeral head and poor prognosis for primary cuff repair
. Multidirectional instability
. Normal glenohumeral kinematics

Correct Answer & Explanation

. A high probability of a successful primary rotator cuff repair

Explanation

A normal AHI is 7 to 14 mm. An AHI of less than 7 mm (such as 4 mm) indicates superior migration of the humeral head, often seen with massive, chronic rotator cuff tears, and correlates with high failure rates for primary repair.

Question 3893

Topic: Shoulder & Hip Sports

A 50-year-old active female is diagnosed with a Partial Articular-sided Supraspinatus Tendon Avulsion (PASTA) lesion. Arthroscopic evaluation estimates the tear involves 60% of the tendon footprint depth. What is the most widely accepted surgical management?

. Debridement alone without repair
. Subacromial decompression alone
. Completion of the tear to a full-thickness defect followed by formal repair
. Latissimus dorsi transfer
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Debridement alone without repair

Explanation

For articular-sided partial rotator cuff tears involving greater than 50% of the tendon footprint thickness, the standard of care is to complete the tear and perform a formal full-thickness repair (or an in situ repair).

Question 3894

Topic: Shoulder & Hip Sports

A 35-year-old male suffers a first-time seizure and subsequently complains of shoulder pain and severely restricted external rotation. An axillary radiograph confirms a posterior shoulder dislocation with an anteromedial humeral head defect involving 30% of the articular surface. What is the best surgical intervention?

. Closed reduction and spica casting
. Arthroscopic posterior Bankart repair
. Transfer of the lesser tuberosity or subscapularis into the defect
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Closed reduction and spica casting

Explanation

A locked posterior dislocation with a reverse Hill-Sachs defect involving 20% to 40% of the articular surface is best treated with a Modified McLaughlin procedure (transfer of the subscapularis and/or lesser tuberosity into the defect) to prevent recurrent engagement.

Question 3895

Topic: 5. Sports Medicine

When performing an arthroscopic Superior Capsular Reconstruction (SCR) for a massive irreparable rotator cuff tear, the graft is anchored to the superior glenoid medially and the greater tuberosity laterally. What primary biomechanical effect does this graft provide?

. It actively initiates shoulder abduction
. It acts as a static restraint to prevent superior migration of the humeral head
. It directly strengthens internal rotation
. It substitutes the dynamic action of the subscapularis
. It increases the acromiohumeral interval by elevating the acromion

Correct Answer & Explanation

. It actively initiates shoulder abduction

Explanation

The SCR uses a dermal allograft or fascia lata to statically replace the superior capsule. This depresses the humeral head, preventing superior migration and improving the fulcrum for the intact deltoid to elevate the arm.

Question 3896

Topic: Shoulder & Hip Sports

A 45-year-old construction worker undergoes an arthroscopic double-row rotator cuff repair. Postoperatively, the patient acknowledges smoking 1 pack of cigarettes per day. How does nicotine primarily compromise rotator cuff tendon-to-bone healing?

. It causes up-regulation of osteoblasts at the footprint
. It directly lyses suture material
. It induces peripheral vasoconstriction and reduces tissue microvascularity
. It increases the proliferation of tenocytes
. It accelerates early collagen cross-linking

Correct Answer & Explanation

. It causes up-regulation of osteoblasts at the footprint

Explanation

Nicotine is a potent vasoconstrictor that significantly impairs microvascular perfusion at the repair site. This leads to local tissue hypoxia, impaired fibroblast function, and a markedly increased rate of non-healing and re-tearing.

Question 3897

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain, a sulcus sign of 2 cm, and apprehension in multiple positions. She has failed 6 months of dedicated physical therapy emphasizing periscapular strengthening. What is the surgical treatment of choice for her condition?

. Arthroscopic SLAP repair
. Latarjet procedure
. Arthroscopic or open capsular plication and inferior capsular shift
. Humeral head resurfacing
. Coracoid transfer to the posterior glenoid

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

This patient has multidirectional instability (MDI). When prolonged conservative management fails, the surgical standard of care is a capsular shift (open or arthroscopic capsular plication) to reduce the redundant capsular volume.

Question 3898

Topic: Shoulder & Hip Sports

A 25-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. He demonstrates increased external rotation and decreased internal rotation (GIRD) compared to the contralateral shoulder. MRI reveals a partial articular-sided tear of the infraspinatus and a posterosuperior labral fraying. What is the most likely diagnosis?

. Subcoracoid impingement
. Internal impingement
. Primary adhesive capsulitis
. Parsonage-Turner syndrome
. Classic external subacromial impingement

Correct Answer & Explanation

. Subcoracoid impingement

Explanation

Internal impingement occurs in overhead athletes during maximum abduction and external rotation. The greater tuberosity abuts the posterosuperior glenoid, causing undersurface 'kissing lesions' of the supraspinatus/infraspinatus and posterosuperior labrum.

Question 3899

Topic: Shoulder & Hip Sports

A massive rotator cuff tear is generally defined by which of the following criteria?

. Tear size greater than 2 cm
. Involvement of any part of the subscapularis
. A tear involving two or more entire tendons or a diameter greater than 5 cm
. Retraction strictly medial to the glenoid face
. Fatty infiltration grade 2 or higher

Correct Answer & Explanation

. Tear size greater than 2 cm

Explanation

The classic definition of a massive rotator cuff tear, originally described by Cofield, is a tear with a diameter greater than 5 cm. Alternatively, Gerber defines it as the complete detachment of two or more rotator cuff tendons.

Question 3900

Topic: Shoulder & Hip Sports

A 65-year-old man presents with an inability to actively raise his right arm above 40 degrees, despite having 150 degrees of passive forward elevation. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus with Goutallier grade 4 fatty infiltration. His subscapularis and deltoid are intact. What is the most appropriate surgical treatment?

. Arthroscopic primary repair
. Arthroscopic debridement and partial repair
. Latissimus dorsi tendon transfer
. Superior capsular reconstruction
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic primary repair

Explanation

In a patient with true pseudoparalysis and severe fatty infiltration (Goutallier grade 4) of a massive rotator cuff tear, a reverse total shoulder arthroplasty provides the most reliable return of active elevation.

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