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5. Sports Medicine MCQs

Practice Set 234 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 4661

Topic: 5. Sports Medicine

A 24-year-old minor league pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a 25-degree loss of internal rotation at 90 degrees of abduction compared to the contralateral side, while external rotation is increased by 10 degrees. What is the most appropriate initial management?

. Arthroscopic posterior capsular release
. Arthroscopic superior labrum anterior and posterior (SLAP) repair
. Physical therapy focusing on posterior capsular stretching (sleeper stretches)
. Anterior capsulolabral reconstruction
. Open capsular shift

Correct Answer & Explanation

. Physical therapy focusing on posterior capsular stretching (sleeper stretches)

Explanation

This patient exhibits Glenohumeral Internal Rotation Deficit (GIRD), which is commonly seen in overhead throwing athletes. It is characterized by posterior capsular contracture and a loss of internal rotation. A true GIRD is defined as an internal rotation deficit of >20 degrees compared to the contralateral shoulder with a loss of total arc of motion. The initial management for symptomatic GIRD is a targeted physical therapy program focusing on stretching the posterior capsule, utilizing sleeper stretches and cross-body adduction stretches. Operative management is rarely indicated unless prolonged non-operative management fails.

Question 4662

Topic: Knee Sports

A 21-year-old football player sustains a direct blow to the anteromedial aspect of his knee. Physical examination shows 15 degrees of increased external rotation at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of knee flexion compared to the uninjured side.

Which structure is most likely injured?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Isolated Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Combined PCL and PLC

Correct Answer & Explanation

. Isolated Posterolateral corner (PLC)

Explanation

The clinical exam describes the dial test. A positive dial test is defined as >10 degrees of increased external rotation compared to the contralateral knee. If the test is positive at 30 degrees of flexion but symmetric (negative) at 90 degrees, it indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 4663

Topic: Shoulder & Hip Sports

A 22-year-old hockey player complains of insidious onset groin pain exacerbated by hip flexion and internal rotation. Anteroposterior radiographs of the pelvis reveal a lateral center-edge angle (LCEA) of 45 degrees and a positive crossover sign. What is the most likely diagnosis?

. Cam-type femoroacetabular impingement
. Pincer-type femoroacetabular impingement
. Femoral neck stress fracture
. Developmental dysplasia of the hip
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Pincer-type femoroacetabular impingement

Explanation

Pincer-type femoroacetabular impingement (FAI) is caused by focal or global overcoverage of the femoral head by the acetabulum. Radiographic findings diagnostic of pincer FAI include a lateral center-edge angle >39 degrees, acetabular retroversion (indicated by a crossover sign or ischial spine sign), or coxa profunda/protrusio acetabuli. Cam impingement is defined by a lack of femoral head-neck offset, often quantified by an alpha angle >55 degrees.

Question 4664

Topic: Knee Sports

During a double-bundle anterior cruciate ligament (ACL) reconstruction, precise knowledge of bundle anatomy and biomechanics is required. Which of the following statements regarding the anteromedial (AM) and posterolateral (PL) bundles of the ACL is correct?

. The AM bundle is tight in extension and primarily controls rotatory stability.
. The PL bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and primarily controls anterior translation.
. The PL bundle is tight in flexion and primarily controls rotatory stability.
. Both bundles are equally tight throughout the entire range of motion.

Correct Answer & Explanation

. The AM bundle is tight in flexion and primarily controls anterior translation.

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation. The PL bundle tightens in extension and is the primary restraint to rotatory loads (e.g., positive pivot shift). During isolated single-bundle reconstruction, surgeons generally target the center of the footprint or slightly toward the AM bundle position to optimize AP stability.

Question 4665

Topic: Knee Sports

A 16-year-old dancer undergoes surgical reconstruction of the medial patellofemoral ligament (MPFL) for recurrent lateral patellar instability. To avoid non-anatomic graft placement, which can result in patellofemoral arthrosis or graft failure, where should the femoral footprint of the MPFL be anatomically positioned?

. Proximal to the adductor tubercle and anterior to the medial epicondyle
. Distal to the adductor tubercle and proximal and posterior to the medial epicondyle
. Anterior to the medial collateral ligament origin and distal to the medial epicondyle
. Proximal to the adductor tubercle and posterior to the medial epicondyle
. Distal to the medial epicondyle and anterior to the adductor tubercle

Correct Answer & Explanation

. Distal to the adductor tubercle and proximal and posterior to the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL resides in a saddle-like depression located distal to the adductor tubercle, proximal and posterior to the medial epicondyle, and superficial to the superficial MCL origin. Radiographically, Schottle's point describes this optimal femoral attachment: 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior point of Blumensaat's line.

Question 4666

Topic: 5. Sports Medicine

A 24-year-old male presents with loss of knee flexion 6 months after an endoscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Radiographs and an MRI are evaluated.

Which of the following technical errors during graft placement most likely caused this specific complication?

. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Tibial tunnel placed too posteriorly
. Graft tensioned at 90 degrees of knee flexion

Correct Answer & Explanation

. Femoral tunnel placed too anteriorly

Explanation

An anteriorly placed femoral tunnel creates an ACL graft that is inappropriately tight in flexion and loose in extension, leading to a loss of flexion. Conversely, a tibial tunnel placed too anteriorly leads to graft impingement against the intercondylar notch in extension, leading to a loss of extension.

Question 4667

Topic: Shoulder & Hip Sports

A 19-year-old female collegiate swimmer presents with bilateral shoulder pain and a feeling of joint 'looseness'. Physical examination reveals a positive sulcus sign that does not reduce with external rotation, and apprehension with both anterior and posterior translation. She has failed 6 months of supervised physical therapy. If surgical intervention is planned, what is the most appropriate procedure?

. Arthroscopic Bankart repair
. Arthroscopic posterior labral repair
. Open Latarjet procedure
. Arthroscopic capsular plication
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Arthroscopic capsular plication

Explanation

The patient has multidirectional instability (MDI) failing conservative management, which is the gold standard initial treatment. Surgical management typically involves reducing capsular volume. Arthroscopic capsular plication (or open inferior capsular shift) is the procedure of choice. Thermal capsulorrhaphy is historical and has high failure and complication rates. Bankart or posterior repairs alone do not address the global capsular redundancy unless a specific labral tear is identified. A sulcus sign that does not reduce with external rotation indicates an incompetent rotator interval.

Question 4668

Topic: 5. Sports Medicine

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain during the late cocking and early acceleration phases of throwing. Physical exam reveals a 25-degree loss of internal rotation compared to the contralateral side, with normal total arc of motion. He has localized tenderness at the posterior joint line. Which of the following is the most appropriate initial management?

. Arthroscopic posterior capsular release
. Arthroscopic SLAP repair
. Sleeper stretch program emphasizing the posteroinferior capsule
. Open anterior capsulolabral reconstruction
. Corticosteroid injection into the subacromial space

Correct Answer & Explanation

. Sleeper stretch program emphasizing the posteroinferior capsule

Explanation

The patient has Glenohumeral Internal Rotation Deficit (GIRD) symptomatic of a tight posteroinferior capsule. In the throwing athlete, GIRD is defined as a loss of internal rotation >20 degrees compared to the non-throwing shoulder, often with a preserved total arc of motion due to compensatory increased external rotation. The initial treatment is a dedicated physical therapy program utilizing 'sleeper stretches' to stretch the posteroinferior capsule. Surgery is only considered if prolonged nonoperative management fails.

Question 4669

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with an insidious onset of right shoulder weakness and vague posterior shoulder pain. Physical examination demonstrates isolated weakness in external rotation. Internal rotation and forward elevation are 5/5. There is noticeable atrophy of the infraspinatus fossa, while the supraspinatus fossa appears normal. MRI reveals a paralabral cyst. Where is the cyst most likely located?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The clinical presentation of isolated infraspinatus atrophy and external rotation weakness indicates compression of the suprascapular nerve at the spinoglenoid notch, distal to the innervation of the supraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles, leading to weakness in both abduction and external rotation. Paralabral cysts at the spinoglenoid notch are often associated with posterior superior labral tears.

Question 4670

Topic: Knee Sports

A 17-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. To ensure isometry of the graft, the femoral attachment must be placed precisely. In terms of anatomic landmarks on the medial femur, where is the origin of the MPFL located?

. Distal to the adductor tubercle and anterior to the medial epicondyle
. At the center of the posterior aspect of the medial femoral condyle
. Proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. At the direct center of the medial epicondyle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic origin of the MPFL is located in a saddle-shaped groove between the medial epicondyle and the adductor tubercle. On a true lateral radiograph, Schottle's point defines this radiographic location: 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior portion of Blumensaat's line.

Question 4671

Topic: Knee Sports

A 19-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using an anteromedial portal technique for femoral tunnel drilling. To avoid a critically short femoral tunnel and prevent posterior cortical blowout, at what approximate knee flexion angle should the femoral tunnel be drilled?

. 70 degrees
. 90 degrees
. 100 degrees
. 120 degrees
. 135 degrees

Correct Answer & Explanation

. 120 degrees

Explanation

When drilling the femoral tunnel through an anteromedial (AM) portal during ACL reconstruction, the knee must be hyperflexed (typically 120 degrees or more). This maneuver changes the trajectory of the drill in relation to the femur, ensuring a longer femoral tunnel and minimizing the risk of posterior cortical blowout. Drilling at 90 degrees or less via the AM portal typically results in a short tunnel and a high risk of violating the posterior femoral cortex.

Question 4672

Topic: 5. Sports Medicine

A 25-year-old professional baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a loss of internal rotation of 25 degrees compared to the contralateral side, with normal total arc of motion. What is the most appropriate initial management for this patient's condition?

. Arthroscopic SLAP repair
. Arthroscopic posterior capsule release
. Anterior capsule plication
. Sleeper stretch program and posterior capsular stretching
. Biceps tenodesis

Correct Answer & Explanation

. Sleeper stretch program and posterior capsular stretching

Explanation

The patient is presenting with Glenohumeral Internal Rotation Deficit (GIRD), common in overhead throwing athletes due to contracture of the posteroinferior capsule. The hallmark is a loss of internal rotation with a corresponding gain in external rotation, maintaining a normal total arc of motion. The initial and most effective treatment is a conservative physical therapy regimen focusing on stretching the posterior capsule, specifically utilizing the 'sleeper stretch'.

Question 4673

Topic: Knee Sports

A 20-year-old female presents with recurrent lateral patellar instability and has failed conservative management. A medial patellofemoral ligament (MPFL) reconstruction is planned. Which of the following best describes the anatomical origin of the MPFL on the femur?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Proximal and posterior to the medial epicondyle, and distal to the adductor tubercle
. Distal and anterior to the adductor tubercle
. Directly on the medial epicondyle

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle, and distal to the adductor tubercle

Explanation

The femoral footprint of the MPFL is situated in a 'saddle' area that is proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Radiographically, this is described by Schรถttle's point: 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior intersecting line of the femoral condyle, and proximal to Blumensaat's line.

Question 4674

Topic: Shoulder & Hip Sports

A 28-year-old hockey player undergoes hip arthroscopy for a symptomatic CAM lesion (femoroacetabular impingement). Following the osteochondroplasty of the femoral head-neck junction, what complication is significantly increased if the resection depth exceeds 30% of the femoral neck diameter?

. Avascular necrosis of the femoral head
. Anterior hip dislocation
. Femoral neck fracture
. Sciatic nerve palsy
. Heterotopic ossification

Correct Answer & Explanation

. Femoral neck fracture

Explanation

During osteochondroplasty for a CAM lesion, resection of the anterolateral femoral head-neck junction is performed. Biomechanical studies have demonstrated that resecting greater than 30% of the femoral neck diameter significantly alters the load-bearing capacity of the proximal femur, drastically increasing the risk of a post-operative femoral neck fracture.

Question 4675

Topic: 5. Sports Medicine

A 32-year-old recreational athlete sustains an acute Achilles tendon rupture. Based on recent Level I evidence comparing operative repair to nonoperative management with an early functional rehabilitation protocol, what is the expected outcome?

. Significantly higher re-rupture rate with nonoperative management
. Significantly higher deep infection rate with nonoperative management
. Similar re-rupture rates, but higher overall complication rates in the operative group
. Operative management results in significantly greater plantar flexion strength at 2 years
. Nonoperative management requires 6 weeks of strict non-weight bearing casting

Correct Answer & Explanation

. Similar re-rupture rates, but higher overall complication rates in the operative group

Explanation

Recent high-level evidence (such as the Willits et al. trial and subsequent meta-analyses) has demonstrated that when nonoperative management is paired with an early functional rehabilitation protocol (early weight-bearing and ROM in a functional brace), the re-rupture rates are equivalent to operative repair. However, operative management carries a higher risk of complications, particularly superficial and deep infections, and sural nerve injury.

Question 4676

Topic: Knee Sports

A 45-year-old woman experiences a 'pop' in the back of her knee while squatting. MRI reveals a complete radial tear of the posterior horn of the medial meniscus at its root attachment. If left untreated, the alteration in knee joint biomechanics most closely mimics which of the following conditions?

. Complete anterior cruciate ligament deficiency
. Total medial meniscectomy
. Grade III medial collateral ligament sprain
. Posterolateral corner deficiency
. Total lateral meniscectomy

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior horn medial meniscal root tear disrupts the circumferential hoop stresses of the meniscus. Biomechanical studies have shown that a root tear leads to meniscal extrusion and alters contact areas and peak contact pressures in the medial compartment to a degree that is functionally equivalent to a total medial meniscectomy. This leads to rapid progression of osteoarthritis if not repaired.

Question 4677

Topic: 5. Sports Medicine

A 14-year-old male presents with vague medial knee pain. Radiographs and MRI demonstrate an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physis is wide open, and the MRI shows intact overlying cartilage with no fluid behind the lesion.

What is the most appropriate initial treatment?

. Microfracture of the lesion
. Arthroscopic drilling of the lesion
. Osteochondral autograft transfer
. Restricted weight-bearing and activity modification
. Internal fixation with bioabsorbable screws

Correct Answer & Explanation

. Restricted weight-bearing and activity modification

Explanation

Juvenile osteochondritis dissecans (OCD) in a patient with open physes and a stable lesion (intact cartilage, no fluid behind the fragment on MRI) has a high healing potential with conservative management. The initial treatment of choice is nonoperative, focusing on activity modification, restricted weight-bearing, and immobilization if symptomatic.

Question 4678

Topic: Shoulder & Hip Sports

A 65-year-old man presents with chronic, profound shoulder weakness. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus tendons with Goutallier stage 4 fatty infiltration.

During attempted arthroscopic mobilization and lateral traction of these chronically retracted tendons, which neurologic structure is at greatest risk of stretch injury?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Suprascapular nerve

Explanation

The suprascapular nerve innervates the supraspinatus and infraspinatus muscles. It is relatively fixed at the suprascapular notch and the spinoglenoid notch. In the setting of a massive, chronically retracted rotator cuff tear, the muscle belly shortens. Aggressive lateral traction during mobilization or repair places significant tension on the suprascapular nerve, increasing the risk of a traction neuropraxia.

Question 4679

Topic: Knee Sports

A 24-year-old male is 3 months post-operative from an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He complains of a painful clunk and inability to fully extend the knee. An MRI shows a nodular mass anterior to the ACL graft. What is the most likely diagnosis and appropriate next step in management?

. Septic arthritis; urgent joint aspiration and lavage.
. Graft impingement; revision ACL reconstruction with a more posterior femoral tunnel.
. Cyclops lesion; arthroscopic excision of the nodule.
. Arthrofibrosis; aggressive manipulation under anesthesia.
. Infrapatellar fat pad syndrome; corticosteroid injection.

Correct Answer & Explanation

. Cyclops lesion; arthroscopic excision of the nodule.

Explanation

A cyclops lesion is a localized form of anterior arthrofibrosis that occurs after ACL reconstruction. It typically presents with a loss of terminal extension and a painful clunk at terminal extension as the fibrotic nodule gets trapped between the femur and tibia. MRI classically demonstrates a soft-tissue nodule anterior to the tibial insertion of the ACL graft. The definitive treatment is arthroscopic excision, which generally restores full extension and resolves symptoms.

Question 4680

Topic: Knee Sports

A 28-year-old soccer player sustains a twisting knee injury. On physical examination, the Dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Posterior cruciate ligament and lateral collateral ligament.
. Lateral collateral ligament, popliteus, and popliteofibular ligament.
. Posterior cruciate ligament alone.
. Posterior cruciate ligament, lateral collateral ligament, and popliteus.
. Anterior cruciate ligament and medial collateral ligament.

Correct Answer & Explanation

. Lateral collateral ligament, popliteus, and popliteofibular ligament.

Explanation

The Dial test evaluates external rotation of the tibia relative to the femur and is used to assess the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase of more than 10 degrees of external rotation compared to the normal side at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the PLC (which includes the lateral collateral ligament, popliteus tendon, and popliteofibular ligament). If the test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

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