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5. Sports Medicine MCQs

Practice Set 230 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 4581

Topic: Shoulder & Hip Sports

A 31-year-old elite volleyball player is diagnosed with a paralabral cyst causing a compression neuropathy at the spinoglenoid notch. Which of the following clinical and anatomical findings is most specifically associated with nerve entrapment at this location?

. Weakness in both shoulder abduction and external rotation
. Isolated weakness in external rotation with atrophy of the infraspinatus
. Denervation of the teres minor and deltoid muscles
. Sensory loss over the superior aspect of the shoulder joint
. The compressing structure lies superior to the transverse scapular ligament

Correct Answer & Explanation

. Weakness in both shoulder abduction and external rotation

Explanation

The suprascapular nerve innervates the supraspinatus muscle and then continues distally, passing through the spinoglenoid notch (under the spinoglenoid ligament) to innervate the infraspinatus. Entrapment at the spinoglenoid notch (commonly due to a posterior paralabral cyst) results in isolated denervation of the infraspinatus. This presents clinically as weakness in external rotation and isolated infraspinatus atrophy. Entrapment further proximal, at the suprascapular notch, would affect both the supraspinatus and infraspinatus.

Question 4582

Topic: Shoulder & Hip Sports

A 31-year-old professional tennis player complains of chronic, aching posterior shoulder pain and significant weakness in external rotation. On physical examination, forward elevation and abduction strength are fully preserved (5/5). There is noticeable atrophy of the infraspinatus fossa, while the supraspinatus fossa appears completely normal. MRI reveals a multiloculated paralabral cyst. In which of the following anatomic locations is the cyst most likely compressing the affected nerve?

. Suprascapular notch
. Spinoglenoid notch
. Quadrangular space
. Triangular space
. Triangular interval

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve provides motor innervation to both the supraspinatus and infraspinatus muscles. It first passes through the suprascapular notch (under the superior transverse scapular ligament) to innervate the supraspinatus, and then courses through the spinoglenoid notch to reach and innervate the infraspinatus. Compression at the suprascapular notch causes weakness in both shoulder abduction (supraspinatus) and external rotation (infraspinatus). Compression at the spinoglenoid notch results in isolated infraspinatus weakness and atrophy, with fully preserved abduction, which perfectly matches this patient's clinical presentation.

Question 4583

Topic: Knee Sports

A 24-year-old football player sustains a multi-ligament knee injury. MRI demonstrates complete disruption of the posterolateral corner structures. For anatomical reconstruction, the surgeon identifies the femoral footprints of the lateral collateral ligament (LCL) and the popliteus tendon. What is the anatomic location of the LCL origin relative to the popliteus tendon insertion on the lateral femoral epicondyle?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly anterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the origin of the fibular collateral ligament (LCL) is located proximal and posterior to the popliteus tendon insertion. This is a highly tested anatomical relationship crucial for anatomic reconstruction of the posterolateral corner of the knee.

Question 4584

Topic: Knee Sports

A 22-year-old collegiate football player sustains a complex multi-ligament knee injury. Physical examination using the dial test reveals 15 degrees of increased external rotation of the tibia compared to the uninjured side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of flexion. This isolated physical examination finding is most indicative of an injury to which of the following structures?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the contralateral normal knee) exclusively at 30 degrees of knee flexion implies an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury involving both the PLC and the PCL.

Question 4585

Topic: Knee Sports

A 24-year-old professional soccer player undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee following a multiligamentous injury. During the exposure, the femoral footprints of both the fibular collateral ligament (FCL) and the popliteus tendon are identified. What is the location of the popliteus tendon femoral footprint relative to the FCL footprint?

. Proximal and posterior
. Proximal and anterior
. Distal and anterior
. Distal and posterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

Anatomical reconstruction of the posterolateral corner requires precise knowledge of femoral footprints. The popliteus tendon footprint is located an average of 18.5 mm distal and anterior to the footprint of the fibular collateral ligament (FCL, also known as the lateral collateral ligament) on the lateral femoral condyle.

Question 4586

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness in shoulder abduction and external rotation, as well as numbness over the lateral deltoid, following a forceful posterior shoulder dislocation. An MRI reveals soft tissue entrapment in the quadrilateral space. Which of the following anatomical structures forms the superior boundary of the quadrilateral space?

. Teres major
. Teres minor
. Long head of the triceps
. Lateral head of the triceps
. Surgical neck of the humerus

Correct Answer & Explanation

. Teres major

Explanation

The quadrilateral space is bounded superiorly by the teres minor (in the posterior view; or subscapularis anteriorly), inferiorly by the teres major, medially by the long head of the triceps brachii, and laterally by the surgical neck of the humerus. It transmits the axillary nerve and the posterior circumflex humeral artery.

Question 4587

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with vague posterior shoulder pain and progressive weakness in external rotation. An MRI reveals isolated fatty infiltration and atrophy of the teres minor muscle. Compression of the nerve responsible for this clinical finding most likely occurs within an anatomic space defined by which of the following sets of boundaries?

. Teres minor, teres major, long head of triceps, and surgical neck of humerus
. Teres minor, teres major, and long head of triceps
. Teres major, latissimus dorsi, and long head of triceps
. Subscapularis, coracobrachialis, and short head of biceps
. Supraspinatus, infraspinatus, and teres minor

Correct Answer & Explanation

. Teres minor, teres major, long head of triceps, and surgical neck of humerus

Explanation

The patient has Quadrilateral Space Syndrome, characterized by compression of the axillary nerve and the posterior circumflex humeral artery. The anatomic boundaries of the quadrilateral space are the teres minor (superior), teres major (inferior), long head of the triceps (medial), and surgical neck of the humerus (lateral). Compression here typically results in isolated denervation and atrophy of the teres minor, as the deltoid branch of the axillary nerve may remain unaffected or symptomatic earlier.

Question 4588

Topic: Shoulder & Hip Sports

During a surgical dislocation of the hip to address femoroacetabular impingement (Ganz approach), the surgeon meticulously preserves the obturator externus muscle. Preservation of this muscle directly protects which of the following vital structures that provides the primary blood supply to the native femoral head?

. Ascending branch of the lateral femoral circumflex artery
. Deep branch of the medial femoral circumflex artery
. Artery of the ligamentum teres
. Inferior gluteal artery
. First perforating branch of the profunda femoris

Correct Answer & Explanation

. Ascending branch of the lateral femoral circumflex artery

Explanation

The deep branch of the medial femoral circumflex artery (MFCA) provides the primary blood supply to the femoral head. During a surgical hip dislocation (Ganz approach), the obturator externus muscle is left intact to protect the MFCA. The artery courses posterior to the obturator externus tendon and anterior to the short external rotators (superior to the quadratus femoris and inferior to the inferior gemellus). Preserving the obturator externus physically shields the vessel from traction and direct injury.

Question 4589

Topic: Knee Sports

A 25-year-old athlete sustains a multi-ligament knee injury. Physical examination reveals an asymmetric, increased external tibial rotation at both 30 degrees and 90 degrees of knee flexion compared to the contralateral side. The primary static stabilizing structures of the posterolateral corner (PLC) are ruptured. Which of the following correctly lists the three major static stabilizers of the PLC?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Lateral collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, posterior cruciate ligament, and oblique popliteal ligament
. Arcuate ligament, fabellofibular ligament, and anterolateral ligament
. Popliteofibular ligament, lateral meniscus, and coronary ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the posterolateral corner (PLC) of the knee are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. An injury to these structures results in posterolateral rotatory instability. An isolated PLC injury typically demonstrates increased external rotation on the Dial test at 30 degrees, which decreases at 90 degrees. If external rotation is increased at both 30 and 90 degrees, it suggests a combined injury of the PLC and the posterior cruciate ligament (PCL).

Question 4590

Topic: Shoulder & Hip Sports

A 22-year-old motorcyclist presents with a traumatic brachial plexus injury after landing on his shoulder. Physical examination reveals a complete loss of active shoulder abduction, external rotation, and elbow flexion. Hand and wrist functions are fully preserved, and there is no Horner syndrome. This clinical picture is most consistent with an injury to which of the following nerve roots?

. C5 and C6
. C7 only
. C8 and T1
. C5, C6, and C7
. C7, C8, and T1

Correct Answer & Explanation

. C5 and C6

Explanation

This classic presentation represents Erb's palsy, an upper trunk brachial plexus injury involving the C5 and C6 nerve roots. The deficit includes loss of function in the deltoid and supraspinatus (shoulder abduction), infraspinatus (external rotation), and biceps/brachialis (elbow flexion). The preservation of wrist and hand function (innervated by lower roots C8-T1) rules out pan-plexus or lower trunk involvement.

Question 4591

Topic: Knee Sports

A surgeon is repairing a posterolateral corner (PLC) injury of the knee. The fibular collateral ligament (FCL), popliteus tendon (PT), and popliteofibular ligament (PFL) are the primary static stabilizers of the PLC. What is the typical femoral footprint insertion site of the FCL relative to the lateral epicondyle?

. Proximal and posterior
. Distal and anterior
. Proximal and anterior
. Distal and posterior
. Directly on the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior

Explanation

Detailed anatomical studies (such as those by LaPrade et al.) have mapped the footprints of the PLC. The fibular collateral ligament (FCL) arises from the lateral femoral condyle approximately 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle. The popliteus tendon inserts on the femur 18.5 mm anterior and distal to the FCL origin. Accurate knowledge of these footprints is necessary for successful anatomic reconstruction of the PLC.

Question 4592

Topic: Shoulder & Hip Sports

A 32-year-old male recreational volleyball player complains of vague posterior right shoulder pain and progressive weakness. On physical examination, he demonstrates 5/5 strength in shoulder abduction but 3/5 strength in external rotation. MRI reveals a large paralabral cyst. Based on the physical examination findings, at which of the following anatomic locations is the nerve most likely compressed?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

The correct answer is the spinoglenoid notch. The patient presents with isolated weakness of external rotation, which points to a deficit in the infraspinatus muscle. The suprascapular nerve originates from the upper trunk of the brachial plexus and passes through the suprascapular notch, where it gives off a motor branch to the supraspinatus (responsible for shoulder abduction initiation). It then travels distally through the spinoglenoid notch to innervate the infraspinatus (responsible for external rotation). Compression at the suprascapular notch (often due to a transverse scapular ligament cyst) typically results in weakness of both abduction and external rotation. In contrast, compression at the spinoglenoid notch (often due to a paralabral cyst associated with SLAP tears) selectively denervates the infraspinatus, leading to isolated external rotation weakness. The quadrilateral space transmits the axillary nerve, and its compression would present with teres minor and deltoid deficits.

Question 4593

Topic: Knee Sports

During reconstruction of the posterolateral corner of the knee, the surgeon identifies the popliteofibular ligament. Which of the following accurately describes the origin and insertion of this structure?

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid
. Originates from the lateral epicondyle and inserts on the fibular head
. Originates from the lateral meniscus and inserts on the proximal tibia
. Originates from the popliteus tendon and inserts on the anterolateral tibia
. Originates from the Gerdy tubercle and inserts on the fibular head

Correct Answer & Explanation

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid

Explanation

The popliteofibular ligament is a critical static stabilizer of the posterolateral corner. It originates from the popliteus musculotendinous junction and inserts distally onto the posteromedial fibular styloid.

Question 4594

Topic: 5. Sports Medicine

A 28-year-old athlete sustains a multi-ligament knee injury. Examination reveals a positive dial test at 30 degrees of flexion but normal at 90 degrees. Injury to the posterolateral corner (PLC) is suspected. Which of the following structures attaches to the anteromedial aspect of the fibular styloid?

. Popliteofibular ligament
. Biceps femoris tendon
. Fibular collateral ligament (LCL)
. Fabellofibular ligament
. Arcuate ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The popliteofibular ligament attaches to the anteromedial aspect of the fibular styloid. The fibular collateral ligament (LCL) attaches laterally on the fibular head, and the biceps femoris surrounds the LCL.

Question 4595

Topic: 5. Sports Medicine

A 32-year-old overhead throwing athlete presents with poorly localized posterior shoulder pain and deltoid weakness. MRI reveals atrophy of the teres minor. Which of the following defines the borders of the space where the affected neurovascular bundle is likely compressed?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), surgical neck of humerus (lateral)
. Teres major (superior), teres minor (inferior), long head of triceps (medial), humerus (lateral)
. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humerus (medial)
. Subscapularis (superior), teres major (inferior), coracobrachialis (lateral), triceps (medial)
. Infraspinatus (superior), teres minor (inferior), lateral head of triceps (medial), humerus (lateral)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), surgical neck of humerus (lateral)

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery. The boundaries are the teres minor (superior), teres major (inferior), long head of the triceps (medial), and the surgical neck of the humerus (lateral).

Question 4596

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player has weakness in external rotation of the shoulder. Examination shows atrophy of the infraspinatus but normal bulk of the supraspinatus. Sensation is intact. Where is the most likely site of nerve compression?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Triangular interval
. Axillary fold

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (e.g., from a paralabral cyst) causes isolated infraspinatus weakness.

Question 4597

Topic: Knee Sports

The femoral attachment (footprint) of the anterior cruciate ligament (ACL) is anatomically located on the:

. Posterolateral aspect of the medial femoral condyle
. Anteromedial aspect of the lateral femoral condyle
. Anterolateral aspect of the medial femoral condyle
. Roof of the intercondylar notch
. Posteromedial aspect of the lateral femoral condyle

Correct Answer & Explanation

. Posterolateral aspect of the medial femoral condyle

Explanation

The ACL originates from the posteromedial aspect of the lateral femoral condyle. It then courses distally, medially, and anteriorly to insert on the anterior intercondylar area of the tibia.

Question 4598

Topic: Shoulder & Hip Sports

The rotator interval is a clinically important anatomical space in the shoulder. What are its superior and inferior borders?

. Supraspinatus inferiorly and subscapularis superiorly
. Infraspinatus superiorly and teres minor inferiorly
. Supraspinatus superiorly and coracohumeral ligament inferiorly
. Subscapularis superiorly and long head of biceps inferiorly
. Supraspinatus superiorly and subscapularis inferiorly

Correct Answer & Explanation

. Supraspinatus inferiorly and subscapularis superiorly

Explanation

The rotator interval is bordered superiorly by the anterior margin of the supraspinatus tendon and inferiorly by the superior margin of the subscapularis tendon. It contains the coracohumeral ligament, superior glenohumeral ligament, and the long head of the biceps tendon.

Question 4599

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, identifying the femoral footprints of the stabilizing structures is crucial. What is the anatomic relationship of the popliteus tendon (PT) insertion relative to the fibular collateral ligament (FCL) origin on the lateral femoral condyle?

. PT is proximal and posterior to FCL
. PT is distal and anterior to FCL
. PT is distal and posterior to FCL
. PT is proximal and anterior to FCL
. PT is directly anterior to FCL

Correct Answer & Explanation

. PT is proximal and posterior to FCL

Explanation

On the lateral femoral condyle, the popliteus tendon inserts an average of 18.5 mm distal and anterior to the origin of the fibular collateral ligament. This anatomical relationship is critical to recreate during posterolateral corner reconstructions.

Question 4600

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with posterior shoulder pain and deltoid weakness. MRI reveals isolated atrophy of the teres minor. Which of the following defines the superior boundary of the anatomic space where the affected nerve is compressed?

. Teres major
. Teres minor
. Long head of the triceps
. Surgical neck of the humerus
. Subscapularis

Correct Answer & Explanation

. Teres major

Explanation

The axillary nerve is compressed in the quadrilateral space. Its anatomic boundaries are the teres minor (superior), teres major (inferior), long head of the triceps (medial), and surgical neck of the humerus (lateral).

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