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5. Sports Medicine MCQs

Practice Set 196 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 3901

Topic: 5. Sports Medicine

A 22-year-old collegiate athlete presents with recurrent anterior shoulder dislocations. Imaging demonstrates a bipolar bone loss scenario. Which of the following defines an "engaging" Hill-Sachs lesion?

. A defect that is wider than it is deep
. A defect parallel to the glenoid face
. A defect whose long axis is parallel to the anterior glenoid rim when the shoulder is in abduction and external rotation
. A defect associated with exactly 10% glenoid bone loss
. A defect exclusively located at the superior pole of the humeral head

Correct Answer & Explanation

. A defect that is wider than it is deep

Explanation

An engaging Hill-Sachs lesion drops over the anterior glenoid rim. Its long axis aligns parallel to the anterior glenoid rim when the arm is placed in a functional position of abduction and external rotation.

Question 3902

Topic: Shoulder & Hip Sports

A 55-year-old woman undergoes arthroscopic repair of a full-thickness supraspinatus tear. Which of the following best describes the normal progression of rotator cuff tendon healing to bone?

. Immediate regeneration of the native 4-zone enthesis within 6 weeks
. Formation of a fibrovascular scar followed by a fibrocartilage transition zone and Sharpey fibers
. Primary membranous ossification replacing the tendon end
. Formation of woven bone followed by endochondral ossification
. Extensive scar tissue formation composed exclusively of Type II collagen indefinitely

Correct Answer & Explanation

. Immediate regeneration of the native 4-zone enthesis within 6 weeks

Explanation

Rotator cuff healing typically occurs via initial fibrovascular scar formation. This gradually remodels to form a fibrocartilaginous transition zone integrating with the bone via Sharpey fibers, though it rarely fully recreates the native enthesis.

Question 3903

Topic: Shoulder & Hip Sports

A 20-year-old male athlete has failed a previous arthroscopic Bankart repair and presents with recurrent anterior instability. A 3D CT scan reveals 25% anterior glenoid bone loss. What is the most appropriate definitive management?

. Revision arthroscopic Bankart repair
. Open Bankart repair and capsular shift
. Remplissage
. Latarjet procedure
. Latissimus dorsi transfer

Correct Answer & Explanation

. Revision arthroscopic Bankart repair

Explanation

In the setting of failed soft-tissue stabilization and critical anterior glenoid bone loss (>20-25%), a coracoid transfer (Latarjet procedure) is indicated to restore anterior glenoid bone stock and provide a dynamic sling effect.

Question 3904

Topic: 5. Sports Medicine

Which physical examination finding is most specific for diagnosing a complete subscapularis tendon rupture?

. Positive Neer impingement sign
. Positive Hornblower's sign
. Increased passive external rotation compared to the contralateral side
. Positive Jobe's test
. Positive O'Brien test

Correct Answer & Explanation

. Positive Neer impingement sign

Explanation

Increased passive external rotation compared to the normal contralateral shoulder, along with positive lift-off or belly-press tests, is a highly specific physical examination finding for a subscapularis tendon rupture.

Question 3905

Topic: Shoulder & Hip Sports

A 45-year-old male weightlifter presents with acute weakness in internal rotation after feeling a "pop" in his shoulder. MRI confirms an acute, isolated, full-thickness subscapularis tear retracted to the glenoid rim. What is the most appropriate management?

. Physical therapy for 6 months
. Pectoralis major transfer
. Latissimus dorsi transfer
. Arthroscopic or open primary repair
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Physical therapy for 6 months

Explanation

Acute traumatic full-thickness subscapularis tears in active patients should undergo early surgical repair. Rapid muscle atrophy and fatty infiltration occur much earlier in the subscapularis compared to the supraspinatus.

Question 3906

Topic: Shoulder & Hip Sports

A 68-year-old woman presents with chronic shoulder pain and imaging showing a massive, irreparable posterosuperior rotator cuff tear. She has an intact subscapularis and no pseudoparalysis. Which tendon transfer is most appropriate to restore external rotation?

. Pectoralis major transfer
. Lower trapezius transfer
. Pectoralis minor transfer
. Coracobrachialis transfer
. Subscapularis transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

The lower trapezius transfer is indicated for irreparable posterosuperior rotator cuff tears. It has a synergistic line of pull that excellently restores external rotation and centers the humeral head.

Question 3907

Topic: Shoulder & Hip Sports

A 32-year-old baseball pitcher presents with posterior shoulder pain. MRI reveals a large paralabral cyst in the spinoglenoid notch. Which isolated physical exam finding is most likely to be present?

. Weakness in isolated external rotation with the arm at the side
. Weakness in internal rotation
. Positive lift-off test
. Positive anterior apprehension test
. Pseudoparalysis of forward elevation

Correct Answer & Explanation

. Weakness in isolated external rotation with the arm at the side

Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve after it has innervated the supraspinatus. This leads to isolated infraspinatus denervation and isolated external rotation weakness.

Question 3908

Topic: Shoulder & Hip Sports

During arthroscopic rotator cuff repair, a double-row transosseous-equivalent (suture bridge) technique is utilized. Which of the following best describes the primary biomechanical advantage of this construct?

. It relies solely on the pullout strength of the medial anchors
. It increases the pressurized contact area between the tendon and the bone footprint
. It completely relies on Type I collagen synthesis for primary stability
. It prevents subscapularis impingement against the coracoid
. It eliminates the risk of recurrent tears by rigid fixation

Correct Answer & Explanation

. It relies solely on the pullout strength of the medial anchors

Explanation

The transosseous-equivalent (suture bridge) technique maximizes the pressurized contact area between the rotator cuff tendon and its anatomic footprint. This optimizes the biological environment for healing.

Question 3909

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a massive rotator cuff tear involving the subscapularis and supraspinatus. If the subscapularis is deemed chronically irreparable and atrophic, which tendon transfer is indicated?

. Latissimus dorsi transfer
. Pectoralis major transfer
. Lower trapezius transfer
. Rhomboid major transfer
. Levator scapulae transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

A pectoralis major transfer (typically routed subcoracoid or subclavicular) is the most utilized tendon transfer for an irreparable subscapularis tear. It restores dynamic anterior stability and internal rotation function.

Question 3910

Topic: Shoulder & Hip Sports

What is considered a critical contraindication to performing a latissimus dorsi tendon transfer for an irreparable posterosuperior rotator cuff tear?

. Patient age greater than 50
. Goutallier grade 2 fatty infiltration of the infraspinatus
. Concomitant irreparable subscapularis tear
. Mild acromioclavicular joint osteoarthritis
. Intact teres minor

Correct Answer & Explanation

. Patient age greater than 50

Explanation

A latissimus dorsi transfer relies heavily on an intact or repairable subscapularis to maintain a balanced transverse force couple. An irreparable subscapularis tear is a strict contraindication to this procedure.

Question 3911

Topic: Shoulder & Hip Sports

The "remplissage" procedure is often performed as an adjunct to an arthroscopic Bankart repair. Which of the following correctly describes the technical execution of this procedure?

. Transferring the coracoid to the anterior glenoid
. Tenodesis of the infraspinatus tendon and posterior capsule into the Hill-Sachs defect
. Tying the anterior labrum directly to the subscapularis
. Advancing the subscapularis tendon over the lesser tuberosity
. Shifting the inferior capsule to the superior glenoid

Correct Answer & Explanation

. Transferring the coracoid to the anterior glenoid

Explanation

The remplissage procedure involves suturing the infraspinatus tendon and posterior capsule into an engaging Hill-Sachs defect. This converts it to an extra-articular lesion, preventing it from engaging the anterior glenoid rim.

Question 3912

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with his fourth anterior shoulder dislocation. A 3D CT scan reveals 26% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Open Bankart repair with inferior capsular shift
. Arthroscopic Bankart repair with Remplissage
. Coracoid transfer (Latarjet procedure)
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

The Latarjet procedure is indicated for recurrent anterior shoulder instability in the presence of critical glenoid bone loss (typically >20-25%). Soft tissue stabilization alone in this setting has an unacceptably high failure rate.

Question 3913

Topic: Shoulder & Hip Sports

A 28-year-old man has recurrent anterior shoulder instability. Diagnostic arthroscopy reveals an engaging Hill-Sachs lesion and <10% glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair alone
. Open Latarjet procedure
. Arthroscopic Bankart repair with Remplissage
. Humeral head osteochondral allograft
. Capsular plication alone

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

An engaging Hill-Sachs lesion in the setting of subcritical glenoid bone loss is best treated with a Bankart repair and Remplissage (infraspinatus tenodesis into the defect) to prevent engagement and recurrent dislocation.

Question 3914

Topic: Shoulder & Hip Sports

A 30-year-old elite volleyball player presents with painless weakness in external rotation of the dominant shoulder. Physical exam reveals isolated atrophy of the infraspinatus fossa. MRI shows a paralabral cyst in the spinoglenoid notch. What is the most likely associated intra-articular pathology?

. Anterior Bankart lesion
. Posterior SLAP tear
. Subscapularis tear
. Anterior labral periosteal sleeve avulsion (ALPSA)
. Humeral avulsion of the glenohumeral ligament (HAGL)

Correct Answer & Explanation

. Anterior Bankart lesion

Explanation

Cysts at the spinoglenoid notch are highly associated with posterior or posterosuperior SLAP tears. They selectively compress the suprascapular nerve branch to the infraspinatus, causing isolated external rotation weakness and atrophy.

Question 3915

Topic: Shoulder & Hip Sports

The biomechanical 'suspension bridge' concept of the rotator cuff relies on force couples to maintain the humeral head centered on the glenoid. Which two muscles form the primary force couple in the transverse plane?

. Supraspinatus and Deltoid
. Supraspinatus and Infraspinatus
. Subscapularis and Teres major
. Subscapularis and Infraspinatus/Teres minor
. Pectoralis major and Latissimus dorsi

Correct Answer & Explanation

. Supraspinatus and Deltoid

Explanation

The transverse plane force couple of the shoulder is formed by the subscapularis anteriorly and the infraspinatus and teres minor posteriorly. This couple is crucial for dynamic glenohumeral stability.

Question 3916

Topic: Shoulder & Hip Sports

An 18-year-old female gymnast complains of bilateral shoulder pain and a sensation of 'slipping'. On exam, she has a positive sulcus sign and apprehension in multiple positions. Beighton score is 6/9. What is the most appropriate initial management?

. Supervised physical therapy focusing on periscapular stabilizers
. Arthroscopic capsular plication
. Open inferior capsular shift
. Thermal capsulorrhaphy
. Latarjet procedure

Correct Answer & Explanation

. Supervised physical therapy focusing on periscapular stabilizers

Explanation

Multidirectional instability (MDI) typically presents in young, hyperlax patients. The first-line treatment is always an extended course of dedicated physical therapy focusing on rotator cuff and periscapular strengthening.

Question 3917

Topic: 5. Sports Medicine

A 24-year-old throwing athlete is diagnosed with a Type II SLAP tear via MRI arthrogram. Diagnostic arthroscopy confirms a 'peel-back' lesion of the superior labrum. When placing suture anchors for repair, where is the optimal location to restore biomechanics and prevent internal impingement?

. Anterior to the biceps anchor
. Directly beneath the biceps anchor at 12 o'clock
. Posterior to the biceps anchor on the superior glenoid
. At the mid-anterior glenoid (3 o'clock)
. At the inferior glenoid (6 o'clock)

Correct Answer & Explanation

. Anterior to the biceps anchor

Explanation

For Type II SLAP tears involving a peel-back mechanism, repairing the labrum slightly posterior to the biceps anchor is critical to neutralize the posterior peel-back forces generated during the late cocking phase of throwing.

Question 3918

Topic: Shoulder & Hip Sports

A 31-year-old man suffers a traumatic anterior shoulder dislocation. MRI reveals a 'J-sign' involving the inferior glenohumeral ligament (IGHL) complex. This indicates a Humeral Avulsion of the Glenohumeral Ligament (HAGL) lesion. Which of the following is true regarding this condition?

. It typically causes anterior instability without a concomitant Bankart lesion
. It is best treated with an isolated Remplissage procedure
. It represents a tear of the superior glenohumeral ligament
. It frequently causes isolated posterior instability
. It is the most common cause of multidirectional instability

Correct Answer & Explanation

. It typically causes anterior instability without a concomitant Bankart lesion

Explanation

A HAGL lesion involves avulsion of the IGHL from its humeral attachment, leading to anterior instability. It is an important cause of recurrent instability that occurs without a traditional anterior labral (Bankart) tear.

Question 3919

Topic: Shoulder & Hip Sports

A patient presents with anterior shoulder pain exacerbated by internal rotation and forward elevation. MRI demonstrates a narrowed coracohumeral interval (<6 mm). Subcoracoid impingement syndrome is suspected. This condition is most strongly associated with pathology of which structure?

. Supraspinatus tendon
. Infraspinatus tendon
. Teres minor tendon
. Subscapularis tendon
. Long head of the triceps

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

Subcoracoid impingement involves compression of the tissues between the coracoid process and the lesser tuberosity, which most directly affects and damages the subscapularis tendon.

Question 3920

Topic: Shoulder & Hip Sports

The Latarjet procedure provides stability through a 'triple effect'. Which structure provides the dynamic 'sling effect' when the arm is abducted and externally rotated?

. Conjoined tendon (short head of biceps and coracobrachialis)
. Pectoralis minor tendon
. Coracoacromial ligament
. Long head of the biceps tendon
. Inferior glenohumeral ligament

Correct Answer & Explanation

. Conjoined tendon (short head of biceps and coracobrachialis)

Explanation

The Latarjet procedure transfers the coracoid and its attached conjoined tendon. In abduction and external rotation, the conjoined tendon acts as a dynamic sling across the anterior-inferior capsule, providing critical stability.

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