5. Sports Medicine MCQs

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain during the late cocking and early acceleration phases of throwing. Examination reveals a 25-degree Glenohumeral Internal Rotation Deficit (GIRD) compared to the non-throwing shoulder, and positive apprehension. MRI arthrography demonstrates a posterosuperior labral tear and a partial articular-sided supraspinatus tendon avulsion (PASTA) lesion. Which of the following pathophysiologic mechanisms is most directly responsible for this specific cascade of pathology?

A 42-year-old recreational tennis player has persistent, severe anterior shoulder pain. Nonoperative management, including physical therapy and injections, has failed. MRI arthrogram reveals a Type II SLAP tear. Diagnostic arthroscopy confirms a detached superior labrum and an unstable biceps anchor. Based on current orthopedic literature, what is the best management strategy for this patient?

A 14-year-old elite gymnast presents with lateral elbow pain and catching that worsens during weight-bearing activities. Radiographs demonstrate a radiolucent defect in the capitellum. An MRI is obtained. Which of the following MRI findings is an absolute indication for surgical intervention rather than nonoperative management?

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. He has had four anterior dislocations over the past season. A 3D-CT scan reveals 25% anterior glenoid bone loss, and MRI shows an engaging Hill-Sachs lesion. What is the most appropriate surgical management?

A 27-year-old professional volleyball player presents with an insidious onset of right shoulder pain and weakness. Physical examination reveals isolated atrophy of the infraspinatus with profound weakness in external rotation, while abduction strength is completely normal. MRI of the shoulder is most likely to show a paralabral cyst in which of the following locations, and what labral pathology is typically associated with this finding?

A 22-year-old collegiate baseball pitcher presents with vague anterior shoulder pain and a 'dead arm' sensation during the late cocking phase of throwing. MRI arthrogram reveals a type II SLAP (superior labrum anterior and posterior) lesion. He has failed a 4-month course of physical therapy focusing on periscapular stabilization and posterior capsular stretching. What is the most appropriate surgical management to optimize his return to elite throwing?

A 21-year-old collegiate baseball pitcher presents with chronic right shoulder pain that occurs primarily during the late cocking and early acceleration phases of throwing. He has failed a 4-month course of physical therapy. Physical exam reveals a positive O'Brien's active compression test and a positive dynamic labral shear test. MRI arthrogram demonstrates a Type II SLAP (Superior Labrum Anterior to Posterior) tear. What is the most appropriate surgical treatment for this athlete?

A 40-year-old man presents with sudden, severe, non-traumatic right shoulder pain that awakened him from sleep. The severe pain persisted for 2 weeks and has now begun to rapidly subside; however, he has noticed profound weakness in overhead activities. Examination reveals significant atrophy of the supraspinatus and infraspinatus. Passive shoulder range of motion is full and painless. MRI of the shoulder and cervical spine are unremarkable. What is the most likely diagnosis?

A 55-year-old man presents with chronic anterior shoulder pain and weakness. On physical examination, he demonstrates increased passive external rotation compared to the contralateral side. He tests positive for both the lift-off and belly-press tests. An MRI demonstrates a complete, retracted tear of the subscapularis tendon. Which of the following structures is most likely to be concomitantly injured or destabilized in this patient?

A 28-year-old male professional volleyball player presents with progressive right shoulder weakness and vague posterior shoulder pain. Examination reveals visible atrophy of the infraspinatus fossa but normal bulk of the supraspinatus. He has isolated weakness in external rotation with the arm at his side. Forward elevation and abduction strength are normal. An MRI of the shoulder is most likely to show a paralabral cyst in which of the following locations?

A 25-year-old professional athlete undergoes an osteochondral autograft transfer for a focal chondral defect of the medial femoral condyle. When reviewing the histologic zones of normal articular cartilage, the deepest layer (adjacent to the subchondral bone) is primarily characterized by which of the following structural orientations and functions?

A 25-year-old athlete undergoes an osteochondral autograft transfer. Regarding the ultrastructure of normal articular cartilage, which zone is characterized by the highest water content, lowest proteoglycan concentration, and collagen fibers oriented parallel to the joint surface?

A 22-year-old female athlete tears her anterior cruciate ligament (ACL) and undergoes reconstruction using a bone-patellar tendon-bone (BPTB) autograft. The surgeon discusses the biological remodeling process of the graft, known as 'ligamentization'. At which postoperative time point is the structural graft mechanically at its weakest, owing primarily to the phase of revascularization and cellular repopulation?

A 25-year-old collegiate soccer player undergoes an osteochondral autograft transfer system (OATS) procedure for a full-thickness chondral defect. The structural integrity of the newly implanted graft depends on the intrinsic architecture of hyaline cartilage. To resist compressive loads, normal articular cartilage relies heavily on its deepest structural layer before reaching the calcified zone. Which of the following best describes the collagen type and fiber orientation in this specific zone?

A 35-year-old marathon runner is undergoing an osteochondral autograft transfer system (OATS) procedure for a full-thickness chondral defect. The normal articular cartilage surrounding the defect is evaluated histologically. Which zone of the articular cartilage has the highest concentration of water, the lowest concentration of proteoglycans, and collagen fibers oriented parallel to the joint surface?

A 45-year-old male presents with persistent anterior shoulder pain, particularly with overhead activities and internal rotation against resistance. On examination, he has tenderness over the bicipital groove and a positive Speed's test. During arthroscopy, the surgeon notes fraying of the superior labrum extending into the biceps anchor. Which structure forms the inferior border of the rotator cuff interval?

A surgeon is performing an arthroscopic repair of a lateral meniscal tear. To ensure proper fixation and stability, the surgeon must understand the meniscal attachments. Which ligament attaches the posterior horn of the lateral meniscus to the medial femoral condyle, potentially hindering its mobility?

A patient presents with shoulder weakness, specifically difficulty with abduction and external rotation. MRI reveals denervation changes in the supraspinatus and infraspinatus muscles. Which anatomical structure is most commonly implicated in compression of the nerve supplying these muscles?

A surgeon is performing an anterior cruciate ligament (ACL) reconstruction. When preparing the tibial tunnel, it is critical to avoid impingement of the graft. Which anatomical structure marks the anteromedial border of the intercondylar notch on the tibia and serves as a key landmark for tibial tunnel placement?

A surgeon is performing an anatomical anterior cruciate ligament (ACL) reconstruction. Accurate placement of the femoral tunnel is crucial. Which specific anatomical landmark on the lateral femoral condyle represents the most isometric and stable attachment point for the native ACL?