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5. Sports Medicine MCQs

Practice Set 231 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 4601

Topic: Shoulder & Hip Sports

A patient sustains a proximal humerus fracture and later demonstrates profound weakness in shoulder abduction and diminished sensation over the lateral aspect of the deltoid. The affected nerve traverses through a space bounded by which of the following structures?

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

Correct Answer & Explanation

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

Explanation

The axillary nerve passes through the quadrangular space, bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus.

Question 4602

Topic: Shoulder & Hip Sports

A 45-year-old female presents with isolated weakness in external rotation of the shoulder. EMG reveals isolated denervation of the infraspinatus with normal supraspinatus function. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment specifically at the spinoglenoid notch results in isolated infraspinatus weakness.

Question 4603

Topic: Knee Sports

During arthroscopic anterior cruciate ligament (ACL) reconstruction, the surgeon drills the tibial tunnel. To maximally protect the popliteal artery from injury, how should the knee be positioned?

. Extension, to pull the artery anteriorly
. Flexion, to allow the artery to fall posteriorly
. Flexion, to tighten the posterior capsule
. Extension, to relax the hamstrings
. 90 degrees of flexion, to maximize patellar tendon length

Correct Answer & Explanation

. Flexion, to allow the artery to fall posteriorly

Explanation

Flexing the knee allows the popliteal artery to fall further posteriorly away from the posterior capsule. This safely increases the distance between the artery and the exiting guide pin or drill.

Question 4604

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete presents with isolated external rotation weakness of the shoulder. An MRI reveals a paralabral cyst located in the spinoglenoid notch. Which of the following physical exam findings is most expected?

. Weakness in initiating shoulder abduction
. Isolated atrophy of the infraspinatus muscle
. Sensory deficit over the lateral deltoid
. Atrophy of both the supraspinatus and infraspinatus muscles
. Positive Hornblower's sign

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus muscle

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch selectively denervates the infraspinatus muscle. Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Question 4605

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, identifying the normal anatomic footprint of the popliteus tendon on the femur is critical. Where is it located relative to the lateral collateral ligament (LCL) origin?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly deep to the LCL origin

Correct Answer & Explanation

. Distal and anterior

Explanation

On the lateral femoral epicondyle, the footprint of the popliteus tendon is located distal and anterior to the origin of the lateral collateral ligament (LCL). Respecting this anatomy ensures appropriate graft isometry.

Question 4606

Topic: 5. Sports Medicine

When establishing the anterolateral portal during ankle arthroscopy, the incision should be made just lateral to the peroneus tertius tendon. This placement primarily minimizes the risk of injury to which of the following nerves?

. Sural nerve
. Deep peroneal nerve
. Superficial peroneal nerve
. Saphenous nerve
. Lateral plantar nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The anterolateral portal is placed just lateral to the peroneus tertius tendon to avoid the intermediate dorsal cutaneous branch of the superficial peroneal nerve. Transillumination is often used to further identify and protect it.

Question 4607

Topic: Shoulder & Hip Sports

When performing a surgical dislocation of the hip for a femoroacetabular impingement procedure, preservation of the deep branch of the medial circumflex femoral artery (MCFA) is paramount to prevent avascular necrosis. In relation to the short external rotators, where is this critical vessel consistently located?

. Anterior to the obturator externus and inferior to the piriformis
. Posterior to the obturator externus tendon and anterior to the superior gemellus
. Anterior to the superior gemellus and posterior to the obturator internus
. Deep to the quadratus femoris and superficial to the obturator externus
. Superficial to the quadratus femoris and deep to the inferior gemellus

Correct Answer & Explanation

. Deep to the quadratus femoris and superficial to the obturator externus

Explanation

The deep branch of the MCFA consistently passes deep (anterior) to the quadratus femoris and superficial (posterior) to the obturator externus. Protecting the obturator externus and leaving the quadratus femoris intact (or performing a trochanteric flip) preserves this vascular supply.

Question 4608

Topic: Shoulder & Hip Sports

A 28-year-old elite pitcher presents with isolated wasting and severe weakness of the infraspinatus muscle. He has full strength in shoulder abduction, and external rotation with the arm abducted to 90 degrees is intact. Entrapment of the involved nerve is most likely occurring at which of the following anatomic locations?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve passes through the spinoglenoid notch to innervate the infraspinatus. Entrapment at this specific notch isolates the infraspinatus, completely sparing the supraspinatus which is innervated more proximally.

Question 4609

Topic: Knee Sports

In reconstructing the posterolateral corner (PLC) of the knee, the surgeon must anatomically restore the insertion of the popliteus tendon on the femur. What is its correct anatomic relationship to the fibular collateral ligament (FCL) attachment on the lateral femoral condyle?

. Anterior and inferior
. Anterior and superior
. Posterior and inferior
. Posterior and superior
. Directly medial

Correct Answer & Explanation

. Anterior and inferior

Explanation

On the lateral femoral condyle, the popliteus tendon consistently inserts anterior and inferior to the origin of the fibular collateral ligament (FCL). Re-establishing this exact footprint is critical for restoring normal PLC kinematics.

Question 4610

Topic: Shoulder & Hip Sports

A 30-year-old bodybuilder presents with poorly localized posterior shoulder pain and weakness in external rotation. MRI reveals an isolated paralabral cyst compressing the contents of the quadrilateral space. Which of the following muscles acts as the superior border of this anatomic space?

. Teres major
. Teres minor
. Long head of the triceps
. Lateral head of the triceps
. Subscapularis

Correct Answer & Explanation

. Teres minor

Explanation

The quadrilateral space is bordered by the teres minor (superiorly), teres major (inferiorly), long head of the triceps (medially), and the humeral shaft (laterally). Compression here affects the axillary nerve and posterior circumflex humeral artery.

Question 4611

Topic: 5. Sports Medicine

Comparing bone-patellar tendon-bone (BPTB) autograft to hamstring autograft for anterior cruciate ligament (ACL) reconstruction, what is a well-established difference in long-term outcomes based on current evidence?

. Higher rate of overall graft rupture in BPTB grafts
. Increased risk of contralateral ACL tear specifically linked to BPTB use
. Higher incidence of anterior knee pain and pain with kneeling with BPTB grafts
. Greater loss of terminal extension associated with hamstring grafts
. Higher rate of deep intra-articular infection with BPTB grafts

Correct Answer & Explanation

. Higher incidence of anterior knee pain and pain with kneeling with BPTB grafts

Explanation

Long-term follow-up studies consistently demonstrate that BPTB autografts are associated with a higher incidence of donor-site morbidity, particularly anterior knee pain and pain with kneeling, compared to hamstring autografts. Rates of graft rupture are either similar or slightly lower for BPTB, while hamstring grafts tend to have a slightly higher rate of minor laxity but less donor site pain.

Question 4612

Topic: 5. Sports Medicine

In a throwing athlete with a type II superior labrum anterior and posterior (SLAP) lesion, the 'peel-back' mechanism exerts maximal torsional force on the biceps anchor. This mechanism is primarily observed during which specific phase of throwing?

. Early cocking
. Late cocking
. Acceleration
. Deceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The 'peel-back' mechanism occurs during the late cocking phase of throwing. As the shoulder is placed into maximal abduction and external rotation, the biceps vector shifts posteriorly, transmitting a torsional force to the superior labrum and causing it to peel back or detach from the superior glenoid rim.

Question 4613

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction, accurate femoral tunnel positioning is crucial to avoid non-physiologic graft tension and altered patellofemoral kinematics. According to Schöttle's method, what is the correct radiographic location of the MPFL femoral insertion on a strict lateral radiograph?

. 1 mm posterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, proximal to Blumensaat's line
. 1 mm posterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, distal to Blumensaat's line
. Directly on the posterior cortex line, exactly at the intersection with Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, proximal to Blumensaat's line

Explanation

Schöttle et al. described highly reliable radiographic landmarks for the femoral insertion of the MPFL on a true lateral radiograph: 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line.

Question 4614

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with chronic groin pain exacerbated by flexion and internal rotation. Imaging reveals a significant Cam-type morphology. In femoroacetabular impingement (FAI), where does the primary cartilage damage classically initiate in the setting of an isolated Cam lesion?

. Anterosuperior acetabular cartilage and labrum
. Posteroinferior acetabular cartilage
. Superior femoral head articular cartilage
. The ligamentum teres insertion site
. Medial acetabular wall cartilage

Correct Answer & Explanation

. Anterosuperior acetabular cartilage and labrum

Explanation

Cam impingement is caused by an aspherical femoral head-neck junction that is forced into the acetabulum during flexion and internal rotation. This causes excessive shear forces that typically lead to characteristic anterosuperior labral tears and adjacent articular cartilage delamination on the acetabular side.

Question 4615

Topic: Knee Sports

Following a posterolateral corner (PLC) and ACL injury, a patient is undergoing surgical reconstruction. When drilling the fibular collateral ligament (FCL) femoral tunnel, understanding the anatomy is essential. What is the anatomic relationship of the FCL femoral footprint to the popliteus sulcus/attachment?

. Proximal and posterior to the popliteus attachment
. Proximal and anterior to the popliteus attachment
. Distal and posterior to the popliteus attachment
. Distal and anterior to the popliteus attachment
. Directly medial to the popliteus attachment

Correct Answer & Explanation

. Proximal and posterior to the popliteus attachment

Explanation

On the lateral femoral epicondyle, the fibular collateral ligament (FCL) originates an average of 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle, effectively positioning it proximal and posterior to the popliteus femoral attachment.

Question 4616

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes an isolated posterior cruciate ligament (PCL) reconstruction. The surgeon debates between a transtibial and a tibial inlay technique. Which of the following is the primary biomechanical advantage of the tibial inlay technique compared to the transtibial technique?

. Decreased graft length mismatch
. Avoidance of the 'killer turn' preventing graft abrasion
. Superior graft-tunnel incorporation at the femoral footprint
. Reduced risk of popliteal artery injury
. Earlier return to sports due to rigid cortical fixation

Correct Answer & Explanation

. Avoidance of the 'killer turn' preventing graft abrasion

Explanation

The tibial inlay technique avoids the acute angle ('killer turn') at the posterior aspect of the tibia seen in transtibial PCL reconstruction. Biomechanical studies have shown that this sharp angle in the transtibial technique can cause graft abrasion and attenuation over time, whereas the inlay technique provides a more direct pull and reduces this risk.

Question 4617

Topic: Shoulder & Hip Sports

A 45-year-old overhead worker presents with shoulder pain. MRI reveals a type II SLAP tear. After failed conservative management, surgical intervention is planned. Compared to SLAP repair, primary biceps tenodesis in this age group is associated with:

. Higher rates of postoperative stiffness
. Increased risk of recurrent superior labral tearing
. Lower rates of patient satisfaction
. Decreased reoperation rates
. Loss of shoulder external rotation

Correct Answer & Explanation

. Decreased reoperation rates

Explanation

In patients over 40 years old, isolated SLAP repair is associated with higher rates of postoperative stiffness, continued pain, and higher reoperation rates compared to biceps tenodesis. Primary biceps tenodesis yields more predictable pain relief, functional outcomes, and lower reoperation rates in this older demographic.

Question 4618

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the correct femoral footprint is critical for proper graft isometry. Radiographically, Schöttle's point representing the femoral origin of the MPFL is located:

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Bisecting the posterior femoral cortical line and Blumensaat's line

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line

Explanation

Schöttle's point is a radiographic landmark used to identify the anatomic femoral origin of the MPFL on a perfect lateral radiograph. It is located 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 4619

Topic: Knee Sports

A 19-year-old female soccer player sustains a twisting injury to her knee. Radiographs reveal an avulsion fracture of the lateral tibial plateau.

Which of the following intra-articular structures is most likely to be injured concurrently?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Posterolateral corner
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral proximal tibia at the attachment of the anterolateral ligament (ALL) and the anterolateral capsule. It is considered a pathognomonic radiographic sign for an anterior cruciate ligament (ACL) tear.

Question 4620

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan is obtained to evaluate anterior glenoid bone loss.

The 'glenoid track' concept is utilized to determine the risk of an engaging Hill-Sachs lesion. The glenoid track width is calculated as:

. 83% of the normal glenoid width minus the width of the anterior glenoid defect
. 100% of the normal glenoid width minus the width of the anterior glenoid defect
. 83% of the normal glenoid width plus the width of the Hill-Sachs lesion
. 100% of the normal glenoid width plus the depth of the Hill-Sachs lesion
. 50% of the normal glenoid width minus the depth of the anterior glenoid defect

Correct Answer & Explanation

. 83% of the normal glenoid width minus the width of the anterior glenoid defect

Explanation

The glenoid track is defined as 83% of the intact glenoid width minus the width of the anterior glenoid bone defect. If the Hill-Sachs interval (the width of the Hill-Sachs lesion plus the bone bridge to the rotator cuff footprint) is greater than the glenoid track, the lesion is 'off-track' and at risk of engaging the anterior glenoid rim during abduction and external rotation.

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