5. Sports Medicine MCQs

A 28-year-old professional volleyball player complains of vague posterior shoulder pain and weakness with overhead serving. Physical examination reveals isolated weakness in external rotation with the arm at the side and noticeable atrophy of the infraspinatus. Supraspinatus strength is normal. An MRI reveals a paralabral cyst. Where is the cyst most likely located?

A 22-year-old rugby player with recurrent anterior shoulder instability is scheduled for an open Latarjet procedure (coracoid transfer) after a CT scan demonstrates 28% anterior glenoid bone loss. During the osteotomy of the coracoid and its subsequent transfer through the split in the subscapularis tendon, which of the following nerves is at greatest risk of iatrogenic injury?

A 50-year-old man presents with profound weakness in external rotation and elevation of his right shoulder following a massive, irreparable posterosuperior rotator cuff tear. Examination reveals a positive Hornblower's sign and intact subscapularis function. There is no evidence of glenohumeral arthritis. Which of the following tendon transfers is biomechanically most appropriate to restore external rotation in this patient?

A 28-year-old elite volleyball player complains of vague posterior shoulder pain and weakness in external rotation. Clinical examination reveals isolated atrophy of the infraspinatus muscle, while supraspinatus strength and bulk are normal. An MRI confirms the presence of a paralabral cyst. At which of the following anatomic locations is the nerve compression most likely occurring?

A 62-year-old man presents to the clinic 4 weeks after an anterior shoulder dislocation that was successfully reduced in the emergency department. He reports persistent weakness in the shoulder, specifically when trying to lift his arm away from his body and externally rotate. Plain radiographs show concentric reduction with no fractures. What is the most appropriate next step in management?

A 55-year-old man falls while skiing, forcibly externally rotating his right arm. He exhibits increased passive external rotation and tests positive on the belly-press test. MRI confirms an isolated, full-thickness tear of the subscapularis tendon with medial retraction. During arthroscopic repair, which anatomic landmark is most reliable for identifying the superior border of the retracted subscapularis tendon?

A 75-year-old active woman sustains a 4-part proximal humerus fracture. Because of the risk of avascular necrosis and severe comminution, she undergoes a shoulder hemiarthroplasty. What is the most critical prognostic factor determining the long-term functional outcome of active forward elevation in this patient?

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A pre-operative 3D CT scan of his shoulder reveals anterior glenoid bone loss. Historically, at which of the following percentages of inferior glenoid bone loss is an arthroscopic soft-tissue Bankart repair alone considered to have an unacceptably high failure rate, thus definitively indicating the need for a bony augmentation procedure (e.g., Latarjet)?

A 60-year-old man with a massive, retracted, chronic posterosuperior rotator cuff tear develops weakness not only in abduction and external rotation but also demonstrates electromyographic (EMG) evidence of denervation of the supraspinatus and infraspinatus. Traction on which of the following structures is most likely responsible for the suprascapular nerve injury in this specific setting?

A 60-year-old male is evaluated for a massive, retracted rotator cuff tear. Preoperative MRI is obtained to assess the viability of a primary repair. According to the Goutallier classification of fatty infiltration, which stage is defined specifically by the presence of an equal amount of fat and muscle tissue within the muscle belly?

A 28-year-old elite volleyball player presents with vague posterior shoulder pain and progressive weakness in external rotation. Examination reveals atrophy isolated to the infraspinatus fossa. MRI demonstrates a paralabral cyst in the spinoglenoid notch. Based on the site of nerve compression, which of the following findings on physical examination would also be expected?

A 28-year-old elite volleyball player presents with insidious onset of right shoulder pain and weakness, predominantly with external rotation. Examination reveals isolated atrophy of the infraspinatus muscle. The supraspinatus muscle bulk and strength are normal. Where is the most likely location of the nerve entrapment?

According to the Snyder classification of Superior Labrum Anterior to Posterior (SLAP) lesions, a Type II tear is characterized by:

A 45-year-old male construction worker presents with deep, aching shoulder pain and a positive O'Brien test. An MRI arthrogram reveals a type II SLAP tear. Nonoperative management has failed. Based on recent literature, what is the most appropriate surgical intervention to minimize postoperative stiffness and allow a predictable return to work?

A 28-year-old elite volleyball player presents with vague posterior shoulder pain and progressive weakness with serving. Physical examination reveals marked atrophy of both the supraspinatus and infraspinatus muscles. At what anatomical location is the neurological compression most likely occurring?

A 22-year-old collegiate rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability associated with 28% anterior glenoid bone loss. The procedure involves transferring the coracoid process to the anterior glenoid neck. Which muscular structure is transferred along with the coracoid to provide a dynamic 'sling' effect across the anteroinferior capsule?

A 29-year-old elite volleyball attacker reports vague posterior shoulder pain and progressive weakness. Physical examination reveals isolated weakness in external rotation and profound atrophy of the infraspinatus fossa. Abduction strength and supraspinatus bulk are entirely normal. An MRI confirms a paralabral cyst compressing a peripheral nerve. At what specific anatomic location is the nerve compression occurring?

A 45-year-old manual laborer presents with chronic shoulder pain, profound weakness in external rotation, and a positive hornblower's sign. MRI demonstrates a massive, retracted, and irreparable tear of the supraspinatus and infraspinatus with Goutallier stage 4 fatty infiltration. The subscapularis is intact, and there is no glenohumeral arthritis. Which of the following is the most appropriate tendon transfer to restore active external rotation?

A 21-year-old collegiate rugby player is undergoing a Latarjet procedure for recurrent anterior shoulder instability. The coracoid process is osteotomized and transferred to the anterior glenoid neck. Which of the following structures creates the 'sling effect' that provides dynamic stability in this procedure?

A 29-year-old elite volleyball player presents with insidious onset of posterior right shoulder pain and weakness. On physical examination, there is noticeable atrophy of the infraspinatus muscle fossa, but the bulk of the supraspinatus is normal. She demonstrates significant weakness in external rotation, while her abduction strength is fully preserved. Which of the following is the most likely anatomic location of the nerve compression?