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5. Sports Medicine MCQs

Practice Set 20 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 381

Topic: 5. Sports Medicine

A 25-year-old overhead athlete presents with deep shoulder pain and a positive O'Brien test. An MRI is obtained.

What is the most appropriate management for an isolated Type II SLAP tear in a young, high-level throwing athlete who has failed nonoperative treatment?

. Arthroscopic SLAP repair
. Open subpectoral biceps tenodesis
. Arthroscopic biceps tenotomy
. Diagnostic arthroscopy with debridement of the superior labrum only
. Open anterior capsular shift

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In young, competitive overhead throwing athletes, arthroscopic SLAP repair is generally favored to restore the native anatomy and tension. Biceps tenodesis is highly successful but often reserved for older patients or non-throwers due to a lower complication rate.

Question 382

Topic: Shoulder & Hip Sports

In the Latarjet procedure for anterior shoulder instability, the transferred coracoid process provides stability through a 'sling effect'. Which of the following structures is responsible for this dynamic sling effect?

. Pectoralis minor
. Coracohumeral ligament
. Short head of the biceps alone
. Conjoined tendon
. Subscapularis tendon

Correct Answer & Explanation

. Conjoined tendon

Explanation

The Latarjet procedure provides dynamic stability via the 'sling effect' of the conjoined tendon (short head of biceps and coracobrachialis) acting across the anteroinferior capsule when the arm is abducted and externally rotated.

Question 383

Topic: Shoulder & Hip Sports

A 35-year-old volleyball player has persistent shoulder weakness. MRI reveals a paralabral cyst at the spinoglenoid notch compressing a nerve. Which of the following clinical findings is expected?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the infraspinatus with normal supraspinatus
. Isolated atrophy of the teres minor
. Winging of the scapula with medial translation
. Loss of internal rotation strength

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus with normal supraspinatus

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branches to the infraspinatus, leading to isolated infraspinatus atrophy. Compression at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 384

Topic: Shoulder & Hip Sports

A 50-year-old construction worker presents with weakness in internal rotation and a positive belly-press test following a lifting injury 8 months ago. MRI shows a massive, retracted, irreparable tear of the subscapularis with severe fatty infiltration. Which tendon transfer is most appropriate?

. Latissimus dorsi transfer
. Lower trapezius transfer
. Pectoralis major transfer
. Teres major transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

The pectoralis major transfer is the standard tendon transfer used to reconstruct an irreparable subscapularis tear, providing an anterior vector to restore internal rotation and dynamic anterior stability.

Question 385

Topic: Shoulder & Hip Sports

A 60-year-old man complains of profound weakness in shoulder elevation and external rotation. Imaging reveals an irreparable massive tear of the supraspinatus and infraspinatus with an intact subscapularis. There is no significant glenohumeral arthritis. Which of the following tendon transfers is best indicated?

. Latissimus dorsi transfer
. Pectoralis major transfer
. Biceps tenodesis
. Teres major transfer
. Pectoralis minor transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

A latissimus dorsi (or lower trapezius) transfer is indicated for younger, active patients with massive, irreparable posterosuperior rotator cuff tears (supraspinatus/infraspinatus) who have an intact subscapularis and lack advanced arthritis.

Question 386

Topic: Shoulder & Hip Sports

Which of the following physical examination tests is most specific for diagnosing a tear involving the upper border of the subscapularis tendon?

. Lift-off test
. Belly-press test
. Bear hug test
. O'Brien active compression test
. Jobe's empty can test

Correct Answer & Explanation

. Lift-off test

Explanation

The bear hug test is considered the most sensitive and specific test for detecting upper subscapularis tendon tears, which are often missed by the lift-off and belly-press tests that evaluate the mid and lower portions of the muscle.

Question 387

Topic: Shoulder & Hip Sports

In the evaluation of recurrent anterior glenohumeral instability, critical glenoid bone loss often dictates the need for a bony augmentation procedure (e.g., Latarjet) rather than an isolated soft-tissue Bankart repair. The universally accepted threshold for 'critical' bone loss is greater than:

. 5% to 10%
. 10% to 15%
. 20% to 25%
. 35% to 40%
. 50%

Correct Answer & Explanation

. 5% to 10%

Explanation

Bone loss greater than 20% to 25% of the inferior glenoid width is considered critical. Soft tissue repairs in this setting have an unacceptably high failure rate, making bony augmentation the standard of care.

Question 388

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher reports posterior shoulder pain during the late cocking phase of throwing. The 'internal impingement' test is positive. What is the primary pathophysiological mechanism of this condition?

. Compression of the subscapularis tendon against the coracoid process
. Contact of the undersurface of the supraspinatus and infraspinatus against the posterosuperior glenoid
. Fraying of the superior labrum from biceps traction
. Impingement of the greater tuberosity against the acromion
. Contracture of the coracohumeral ligament

Correct Answer & Explanation

. Compression of the subscapularis tendon against the coracoid process

Explanation

Internal impingement typically occurs in overhead athletes during maximal external rotation and abduction (late cocking phase). It is caused by the articular surface of the posterior rotator cuff abutting the posterosuperior glenoid and labrum.

Question 389

Topic: Shoulder & Hip Sports

A 23-year-old rugby player has recurrent anterior shoulder dislocations. Advanced imaging reveals 12% anterior glenoid bone loss and a Hill-Sachs lesion that is determined to be 'off-track'. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Iliac crest bone grafting of the humerus
. Subscapularis tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

For patients with subcritical glenoid bone loss (typically <15-20%) but an engaging or 'off-track' Hill-Sachs lesion, an arthroscopic Bankart repair combined with a remplissage (infraspinatus tenodesis) is the procedure of choice to prevent engagement.

Question 390

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with isolated weakness in shoulder external rotation. MRI reveals a paralabral cyst causing nerve compression. Where is the cyst most likely located?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus, leading to isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 391

Topic: Shoulder & Hip Sports

During a physical examination for a suspected rotator cuff tear, the examiner places the patient's palm on their contralateral shoulder and asks the patient to resist an anteriorly directed force applied to the hand. What is this test, and which specific muscle portion does it evaluate?

. Belly-press test; lower subscapularis
. Lift-off test; upper subscapularis
. Bear hug test; upper subscapularis
. Hornblower's sign; teres minor
. Gerber's test; entire subscapularis

Correct Answer & Explanation

. Belly-press test; lower subscapularis

Explanation

The Bear hug test evaluates the subscapularis and is particularly sensitive for tears of the upper portion of the subscapularis tendon. The belly-press test better isolates the lower subscapularis.

Question 392

Topic: Shoulder & Hip Sports

A 30-year-old bodybuilder feels a sudden 'pop' in his chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold contour and weakness in internal rotation. Which anatomical structure is most commonly ruptured in this scenario?

. Clavicular head of the pectoralis major at the muscle belly
. Sternal head of the pectoralis major at the humeral insertion
. Pectoralis minor at the coracoid process
. Long head of the biceps tendon
. Subscapularis at the lesser tuberosity

Correct Answer & Explanation

. Sternal head of the pectoralis major at the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur in weightlifters (e.g., bench pressing) and typically involve the sternocostal head avulsing from its insertion on the proximal humerus.

Question 393

Topic: Shoulder & Hip Sports

What is the most common cause of significant, permanent loss of external rotation following an open anterior shoulder stabilization procedure (such as a Putti-Platt or standard open Bankart)?

. Failure to repair the superior labrum
. Overtightening of the anterior capsule and subscapularis
. Iatrogenic injury to the axillary nerve
. Postoperative development of a loose body
. Improper placement of posterior portal

Correct Answer & Explanation

. Overtightening of the anterior capsule and subscapularis

Explanation

Historically, non-anatomic anterior stabilizations like the Putti-Platt intentionally shortened the subscapularis and anterior capsule, leading to an obligate loss of external rotation and subsequent posterior glenoid wear (capsulorrhaphy arthropathy).

Question 394

Topic: Shoulder & Hip Sports
A 22-year-old gymnast complains of deep, poorly localized shoulder pain during overhead routines. An MR arthrogram demonstrates a superior labral tear that propagates into the biceps anchor, causing instability of the biceps-labral complex. Based on the Snyder classification, what type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Snyder Type II SLAP lesion involves detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid, resulting in instability of the biceps-labral anchor.

Question 395

Topic: 5. Sports Medicine

A professional tennis player presents with vague shoulder aching. Physical examination demonstrates 20 degrees of internal rotation and 110 degrees of external rotation in 90 degrees of abduction. Which anatomical structure is primarily contracted, causing this Glenohumeral Internal Rotation Deficit (GIRD)?

. Anterosuperior capsule
. Coracohumeral ligament
. Posteroinferior capsule
. Middle glenohumeral ligament
. Pectoralis minor tendon

Correct Answer & Explanation

. Posteroinferior capsule

Explanation

GIRD is heavily associated with overhead throwing or serving sports. The primary structural cause is a contracture and thickening of the posteroinferior capsule, often managed successfully with sleeper stretches.

Question 396

Topic: Shoulder & Hip Sports

A 55-year-old man presents with severe shoulder pain and restricted external rotation 15 years after an open anterior shoulder stabilization (Putti-Platt procedure). Radiographs reveal severe glenohumeral osteoarthritis. What is the primary pathophysiological mechanism leading to this complication?

. Failure to address an underlying Bankart lesion
. Excessive over-tightening of the anterior capsule and subscapularis
. Iatrogenic injury to the axillary nerve
. Hardware penetration into the glenohumeral joint
. Postoperative septic arthritis

Correct Answer & Explanation

. Excessive over-tightening of the anterior capsule and subscapularis

Explanation

Capsulorrhaphy arthropathy is a known complication of non-anatomic anterior stabilization procedures like the Putti-Platt, where excessive tightening of the anterior structures leads to obligatory posterior humeral head subluxation and subsequent arthritis.

Question 397

Topic: Shoulder & Hip Sports

A 40-year-old weightlifter presents with acute weakness in internal rotation and a positive bear-hug test after a heavy bench press. MRI confirms an isolated full-thickness tear of the subscapularis tendon. What associated structural pathology is most critical to evaluate and address during surgical repair?

. Type II SLAP lesion
. Medial subluxation or dislocation of the long head of the biceps
. Suprascapular nerve entrapment
. Posterior labral tear
. Acromioclavicular joint separation

Correct Answer & Explanation

. Medial subluxation or dislocation of the long head of the biceps

Explanation

The subscapularis tendon, along with the coracohumeral ligament, forms the medial portion of the biceps pulley. A full-thickness subscapularis tear often compromises the pulley, leading to medial subluxation or dislocation of the biceps tendon.

Question 398

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Examination shows a loss of 25 degrees of internal rotation compared to the contralateral side, and pain is provoked with the shoulder abducted and externally rotated. What is the most likely diagnosis?

. Anterior capsule contracture
. Subscapularis tendinopathy
. Internal impingement with glenohumeral internal rotation deficit (GIRD)
. Quadrilateral space syndrome
. Primary subacromial impingement

Correct Answer & Explanation

. Internal impingement with glenohumeral internal rotation deficit (GIRD)

Explanation

Internal impingement occurs in overhead athletes when the posterosuperior rotator cuff impinges against the posterosuperior glenoid labrum in maximum abduction and external rotation. It is strongly associated with GIRD and posterior capsular contracture.

Question 399

Topic: Shoulder & Hip Sports

A 24-year-old athlete with recurrent anterior shoulder instability undergoes preoperative evaluation.

Imaging reveals an anterior glenoid bone loss of approximately 30%. Which of the following is the most appropriate definitive management?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic capsular plication alone
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Remplissage procedure alone

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In the setting of significant anterior glenoid bone loss (typically >20-25%), soft-tissue stabilization (Bankart repair) has a high failure rate. A bone-block augmentation, such as the Latarjet procedure, is indicated to restore glenoid tracking.

Question 400

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. MRI reveals a paralabral cyst in the spinoglenoid notch. Which muscle is primarily affected by this cyst?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Infraspinatus

Explanation

A cyst at the spinoglenoid notch specifically compresses the suprascapular nerve after it has innervated the supraspinatus, leading to isolated denervation and atrophy of the infraspinatus muscle.

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