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5. Sports Medicine MCQs

Practice Set 216 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 4301

Topic: Shoulder & Hip Sports

In evaluating a standard anteroposterior radiograph of the shoulder in a patient with chronic rotator cuff disease, what is the earliest radiographic sign indicative of rotator cuff tear arthropathy?

. Superior migration of the humeral head with an acromiohumeral distance less than 7 mm
. Acetabularization of the acromion
. Femoralization of the humeral head
. Inferior osteophyte formation on the glenoid
. Subchondral cysts in the greater tuberosity

Correct Answer & Explanation

. Superior migration of the humeral head with an acromiohumeral distance less than 7 mm

Explanation

The earliest radiographic manifestation of massive rotator cuff tearing and impending arthropathy is superior migration of the humeral head, defined by an acromiohumeral distance (AHD) of less than 7 mm. Acetabularization and femoralization occur in later stages (Hamada classification).

Question 4302

Topic: Shoulder & Hip Sports

A 40-year-old construction worker presents with persistent shoulder pain despite 6 months of nonoperative management. MRI reveals an articular-sided partial tear of the supraspinatus tendon involving 60% of the tendon footprint depth (PASTA lesion). What is the recommended surgical management?

. Arthroscopic debridement of the tear without repair
. Arthroscopic repair of the tendon
. Open acromioplasty and bursectomy only
. Biceps tenodesis alone
. Superior capsular reconstruction

Correct Answer & Explanation

. Arthroscopic debridement of the tear without repair

Explanation

For partial rotator cuff tears involving greater than 50% of the tendon footprint depth, surgical repair (either by completion of the tear and repair or a transtendon repair) is indicated. Debridement alone is inadequate for tears >50%.

Question 4303

Topic: Shoulder & Hip Sports

The concept of the 'glenoid track' is used to evaluate anterior shoulder instability. Which of the following statements correctly defines an 'off-track' Hill-Sachs lesion?

. The lateral margin of the lesion is lateral to the glenoid track.
. The lesion involves more than 20% of the humeral head articular surface.
. The medial margin of the lesion is medial to the glenoid track.
. The lesion is oriented vertically relative to the humeral shaft.
. The lesion remains completely contained within the glenoid track during abduction.

Correct Answer & Explanation

. The lateral margin of the lesion is lateral to the glenoid track.

Explanation

An off-track Hill-Sachs lesion occurs when its medial margin lies medial to the medial border of the glenoid track. This indicates that the lesion will engage the anterior glenoid rim during abduction and external rotation, typically necessitating a remplissage or bone block.

Question 4304

Topic: Shoulder & Hip Sports

A 58-year-old man with a massive, irreparable posterosuperior rotator cuff tear is scheduled for a latissimus dorsi tendon transfer. For this procedure to be successful in restoring active forward elevation, which of the following muscles MUST be functionally intact to provide a balanced force couple?

. Teres major
. Subscapularis
. Rhomboid major
. Levator scapulae
. Pectoralis minor

Correct Answer & Explanation

. Teres major

Explanation

A successful latissimus dorsi transfer for a massive posterosuperior cuff tear requires an intact and functioning subscapularis to maintain the anterior-posterior force couple of the shoulder, keeping the humeral head centered on the glenoid.

Question 4305

Topic: Shoulder & Hip Sports

A 22-year-old elite collegiate baseball pitcher is diagnosed with an isolated Type II SLAP tear via MRI arthrogram. He has significant glenohumeral internal rotation deficit (GIRD) on exam. What is the most appropriate initial management?

. Physical therapy focusing on internal rotation stretching and scapular stabilizers
. Arthroscopic SLAP repair with suture anchors
. Open biceps tenodesis
. Arthroscopic biceps tenotomy
. Corticosteroid injection into the subacromial space

Correct Answer & Explanation

. Physical therapy focusing on internal rotation stretching and scapular stabilizers

Explanation

First-line treatment for an isolated Type II SLAP tear in an overhead throwing athlete, especially with concomitant GIRD, is conservative management. Physical therapy emphasizing posterior capsular stretching (sleeper stretches) and scapular stabilization is highly effective and avoids the stiffness often seen post-SLAP repair.

Question 4306

Topic: Shoulder & Hip Sports

A 28-year-old male volleyball player presents with isolated, painless weakness in external rotation of his dominant shoulder. MRI reveals a paralabral ganglion cyst. At which of the following anatomic locations is the cyst most likely causing nerve compression?

. Suprascapular notch
. Quadrilateral space
. Triangular interval
. Rotator interval
. Spinoglenoid notch

Correct Answer & Explanation

. Suprascapular notch

Explanation

A cyst at the spinoglenoid notch compresses the distal suprascapular nerve, causing isolated denervation and atrophy of the infraspinatus (external rotation weakness). Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 4307

Topic: Shoulder & Hip Sports

A 52-year-old woman sustains an acute anterior shoulder dislocation. After a successful closed reduction in the emergency department, she complains of persistent pain and is completely unable to actively abduct her arm. Axillary nerve sensation is intact. What is the most likely associated injury?

. Bankart lesion
. Hill-Sachs lesion
. Rotator cuff tear
. Greater tuberosity fracture
. Coracoid fracture

Correct Answer & Explanation

. Bankart lesion

Explanation

In patients older than 40 years, there is a high incidence (ranging from 30% to 80% in older cohorts) of concomitant rotator cuff tears following acute anterior shoulder dislocations. Persistent inability to abduct after reduction should prompt immediate advanced imaging (MRI or US).

Question 4308

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder dislocations. CT scan reveals 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with capsular shift
. Open Bankart repair
. Coracoid transfer (Latarjet procedure)
. Iliac crest bone grafting
. Arthroscopic remplissage alone

Correct Answer & Explanation

. Arthroscopic Bankart repair with capsular shift

Explanation

In collision athletes with critical anterior glenoid bone loss (>20-25%), an arthroscopic or open Bankart repair has unacceptably high failure rates. A Latarjet procedure (coracoid transfer) is indicated to restore anterior stability via its triple-blocking effect.

Question 4309

Topic: Shoulder & Hip Sports

A 65-year-old man presents with chronic shoulder weakness and a massive, retracted rotator cuff tear. Which of the following preoperative MRI findings is the strongest contraindication to a primary tendon repair?

. Acromiohumeral distance of 8 mm
. Goutallier stage 3 or 4 fatty infiltration of the infraspinatus
. A tear involving the supraspinatus and upper subscapularis
. Coracohumeral interval of 6 mm
. Concomitant Type II SLAP tear

Correct Answer & Explanation

. Acromiohumeral distance of 8 mm

Explanation

High-grade (Goutallier 3 or 4) fatty infiltration and muscle atrophy indicate irreversible muscle degeneration. Attempting primary repair in these settings is associated with extremely high structural failure rates.

Question 4310

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability and bipolar bone loss, a Hill-Sachs lesion is considered 'off-track' (engaging) under which of the following conditions?

. When the intact anterior glenoid rim is less than 20% of its native width
. When the medial margin of the Hill-Sachs lesion is medial to the glenoid track
. When the lesion involves the inferior pole of the humeral head
. When it is associated with a concomitant HAGL lesion
. When the depth of the lesion exceeds 1 cm

Correct Answer & Explanation

. When the intact anterior glenoid rim is less than 20% of its native width

Explanation

The glenoid track concept determines engagement. A Hill-Sachs lesion is 'off-track' if its medial margin extends further medial than the intact glenoid track, meaning it will engage the anterior glenoid rim during abduction and external rotation.

Question 4311

Topic: Shoulder & Hip Sports

A 45-year-old laborer with an intact subscapularis presents with persistent pain and pseudoparalysis of external rotation due to a massive, irreparable posterosuperior rotator cuff tear. Which tendon transfer is most appropriate?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Rhomboid major transfer
. Serratus anterior transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

Latissimus dorsi or lower trapezius transfers are indicated to restore active external rotation and forward elevation in younger patients with massive, irreparable posterosuperior tears, provided the subscapularis and deltoid are intact.

Question 4312

Topic: Shoulder & Hip Sports

A 30-year-old weightlifter presents with posterior shoulder pain during bench presses. Examination reveals a positive jerk test. MRI confirms a posterior labral tear. What is the most appropriate initial management?

. Arthroscopic posterior stabilization
. Open posterior capsular shift
. Physical therapy focusing on periscapular and posterior deltoid strengthening
. Latarjet procedure
. Pectoralis major tendon transfer

Correct Answer & Explanation

. Arthroscopic posterior stabilization

Explanation

Initial management for posterior shoulder instability is nonoperative, focusing on comprehensive physical therapy to strengthen the dynamic posterior stabilizers (posterior cuff, periscapular muscles, and posterior deltoid).

Question 4313

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness of external rotation but normal active forward elevation. Examination reveals isolated atrophy in the infraspinatus fossa. A paralabral cyst is most likely compressing the suprascapular nerve at which anatomical location?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branches to the infraspinatus (external rotation). Compression further proximal at the suprascapular notch would also denervate the supraspinatus.

Question 4314

Topic: Shoulder & Hip Sports

A 28-year-old male with recurrent anterior instability undergoes an MRI arthrogram that shows no Bankart lesion, but reveals an avulsion of the inferior glenohumeral ligament from the humeral neck. What is this lesion termed?

. ALPSA lesion
. Perthes lesion
. HAGL lesion
. GLAD lesion
. PASTA lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

Humeral Avulsion of the Glenohumeral Ligament (HAGL) causes recurrent anterior instability. It lacks the typical labral detachment (Bankart) and requires surgical repair to the humeral neck.

Question 4315

Topic: Shoulder & Hip Sports

How does an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion classically differ from a standard Bankart lesion?

. The anterior scapular periosteum remains intact, allowing medial displacement of the labrum
. It involves an avulsion of the IGHL from the humeral side
. It involves an osteochondral defect of the glenoid face
. It predominantly affects the posterior labrum
. It requires isolated subscapularis repair without labral fixation

Correct Answer & Explanation

. The anterior scapular periosteum remains intact, allowing medial displacement of the labrum

Explanation

In an ALPSA lesion, the labroligamentous complex avulses from the glenoid rim but the scapular periosteum remains intact. This allows the torn complex to displace and heal medially on the glenoid neck.

Question 4316

Topic: 5. Sports Medicine

A 40-year-old overhead athlete presents with shoulder pain. MRI shows a partial articular-sided supraspinatus tendon avulsion (PASTA) involving 60% of the tendon footprint. If nonoperative management fails, what is the most appropriate surgical treatment?

. Arthroscopic debridement alone
. Takedown of the remaining tendon and formal repair (or in situ repair)
. Coracoacromial ligament release only
. Subacromial decompression without tendon intervention
. Latissimus dorsi transfer

Correct Answer & Explanation

. Arthroscopic debridement alone

Explanation

For partial-thickness rotator cuff tears involving greater than 50% of the tendon thickness, surgical completion and repair (or an in situ repair) is indicated due to high progression rates and continued pain with debridement alone.

Question 4317

Topic: Shoulder & Hip Sports

The arthroscopic remplissage procedure, utilized for engaging Hill-Sachs lesions, involves capsulotenodesis of which structures into the humeral defect?

. Supraspinatus and superior capsule
. Infraspinatus and posterior capsule
. Teres minor and inferior capsule
. Subscapularis and middle glenohumeral ligament
. Long head of the biceps tendon

Correct Answer & Explanation

. Supraspinatus and superior capsule

Explanation

Remplissage involves suturing the posterior capsule and the infraspinatus tendon into the Hill-Sachs defect. This converts an intra-articular engaging defect into an extra-articular non-engaging defect.

Question 4318

Topic: Shoulder & Hip Sports

During a Superior Capsular Reconstruction (SCR) for a massive irreparable rotator cuff tear, the graft is anchored to the superior glenoid medially. Where is it anchored laterally?

. Lesser tuberosity
. Greater tuberosity footprint
. Superior margin of the subscapularis
. Anterior lip of the acromion
. Coracoid process

Correct Answer & Explanation

. Lesser tuberosity

Explanation

In SCR, the dermal or fascia lata graft is secured medially to the superior glenoid and laterally to the greater tuberosity, aiming to restore the superior restraint to humeral head translation.

Question 4319

Topic: Shoulder & Hip Sports

A patient is evaluated for anterior shoulder pain. They demonstrate a positive belly-press test and increased passive external rotation. If an MRI confirms a full-thickness subscapularis tear, what associated pathology is most likely to be found?

. Posterior labral tear
. Medial subluxation/dislocation of the long head of the biceps
. Type II SLAP tear
. Spinoglenoid notch cyst
. Os acromiale

Correct Answer & Explanation

. Posterior labral tear

Explanation

The superior fibers of the subscapularis and the coracohumeral ligament create the medial sling for the biceps tendon. A tear of the subscapularis footprint frequently leads to medial subluxation or dislocation of the long head of the biceps.

Question 4320

Topic: Shoulder & Hip Sports

A 34-year-old man presents with severe shoulder pain and inability to externally rotate the arm following a generalized seizure. An axillary lateral radiograph is obtained.

Advanced imaging reveals a locked posterior shoulder dislocation with an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 30% of the articular surface. What is the most appropriate surgical management?

. Closed reduction and immobilization in internal rotation
. Arthroscopic posterior Bankart repair
. Open reduction and subscapularis tendon transfer into the defect
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Closed reduction and immobilization in internal rotation

Explanation

A reverse Hill-Sachs lesion involving 20% to 40% of the articular surface is best treated with a McLaughlin procedure or its modification (transfer of the subscapularis tendon or lesser tuberosity into the defect). Defects >40% typically require arthroplasty, while small defects <20% may be stable after reduction alone.

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