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5. Sports Medicine MCQs

Practice Set 243 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 4841

Topic: 5. Sports Medicine

A 24-year-old collegiate athlete presents with severe pain at the base of his great toe after being tackled while his foot was planted and dorsiflexed. Examination reveals exquisite tenderness over the plantar aspect of the first MTP joint, with gross instability on Lachman testing. Fluoroscopy demonstrates proximal migration of the sesamoids compared to the contralateral side. What is the most appropriate management?

. Immediate return to play with a carbon-fiber shoe insert
. Corticosteroid injection into the first MTP joint and rigid taping
. Closed reduction and a short leg spica cast for 6 weeks
. Surgical repair of the plantar plate and sesamoid complex
. Excision of the medial sesamoid

Correct Answer & Explanation

. Surgical repair of the plantar plate and sesamoid complex

Explanation

The patient has sustained a severe Turf Toe injury, corresponding to a Grade 3 injury (complete disruption of the plantar plate complex). Proximal migration of the sesamoids is pathognomonic for a complete tear. Given his high athletic demands, gross instability, and proximal sesamoid migration, surgical repair of the plantar plate is indicated to restore joint stability and push-off strength.

Question 4842

Topic: 5. Sports Medicine
A 21-year-old football player sustains a severe hyperextension injury to his first metatarsophalangeal (MTP) joint. Examination demonstrates gross instability of the joint with dorsal subluxation of the proximal phalanx. Weight-bearing radiographs reveal significant proximal migration of the sesamoid apparatus compared to the uninjured foot. What is the most appropriate management for this injury?
. Stiff-soled shoe with immediate weight-bearing as tolerated
. Taping the toe in plantarflexion and immediate return to play
. Closed reduction and a spica cast for 6 weeks
. Surgical repair of the plantar plate and flexor hallucis brevis complex
. Primary arthrodesis of the first MTP joint

Correct Answer & Explanation

. Surgical repair of the plantar plate and flexor hallucis brevis complex

Explanation

This is a Grade III turf toe injury, which involves a complete tear of the plantar plate and flexor hallucis brevis (FHB) complex, leading to gross instability and proximal retraction of the sesamoids. While Grade I and II injuries are managed non-operatively (stiff shoe, taping, rest), surgical repair of the plantar plate and FHB complex is indicated for Grade III injuries with significant instability, widely separated intra-articular fractures, or significant proximal migration of the sesamoids to restore push-off strength and prevent chronic deformity.

Question 4843

Topic: 5. Sports Medicine
A 22-year-old professional running back sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint during a game. Clinical examination reveals marked ecchymosis, swelling, a palpable gap, and localized plantar tenderness. MRI confirms a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate definitive management for this injury in an elite athlete?
. Immobilization in a short leg cast for 4 weeks followed by taping
. Stiff-soled shoe with a Morton's extension and weight-bearing as tolerated
. Intra-articular corticosteroid injection and immediate return to play
. Surgical repair of the plantar capsuloligamentous complex
. Primary arthrodesis of the first MTP joint

Correct Answer & Explanation

. Surgical repair of the plantar capsuloligamentous complex

Explanation

A Grade III turf toe injury involves a complete tear of the plantar capsuloligamentous complex (plantar plate) of the first MTP joint, often resulting in proximal migration of the sesamoids and gross instability. While Grade I and II injuries are managed nonoperatively, Grade III injuries in elite professional athletes generally require primary surgical repair. Surgery aims to restore the anatomical alignment of the sesamoids, rebuild the push-off strength of the great toe, and prevent long-term complications such as chronic instability or progressive hallux rigidus.

Question 4844

Topic: 5. Sports Medicine

A 28-year-old female presents with chronic deep ankle pain following a severe ankle sprain 2 years ago. MRI reveals a 1.2 cm x 1.0 cm osteochondral lesion on the medial talar dome. The overlying cartilage is intact but there is subchondral cystic change. She has failed 6 months of conservative treatment. What is the most appropriate first-line surgical intervention?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS) procedure
. Autologous chondrocyte implantation (ACI)
. Fresh osteochondral allograft
. Total ankle arthroplasty

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary osteochondral lesions of the talus (OLT) that are small to medium-sized (< 1.5 cm diameter or < 150 mm^2 area), arthroscopic bone marrow stimulation (e.g., microfracture) is considered the first-line surgical treatment. It provides excellent clinical outcomes for lesions of this size and preserves future surgical options. Structural grafts (OATS) or cellular techniques (ACI) are generally reserved for larger lesions, massive cystic bone loss, or failed primary bone marrow stimulation.

Question 4845

Topic: Knee Sports

A 28-year-old female runner presents with persistent deep anterior ankle pain 8 months after a severe inversion injury. An MRI demonstrates a 1.2 cm by 1.0 cm osteochondral lesion on the medial aspect of the talar dome. The overlying articular cartilage appears intact on imaging, but conservative treatment including immobilization and physical therapy has failed. What is the standard first-line surgical management?

. Arthroscopic bone marrow stimulation (microfracture)
. Open osteochondral autograft transfer system (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Open reduction and internal fixation of the osteochondral fragment
. Distal tibial osteotomy to offload the medial compartment

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, symptomatic osteochondral lesions of the talus (OLT) that are small to medium-sized (less than 1.5 cm in diameter or 1.5 cm^2 in area) and have failed conservative management, the gold standard first-line surgical treatment is arthroscopic debridement and bone marrow stimulation (microfracture or drilling). This technique promotes the formation of fibrocartilage. OATS and MACI are typically reserved for larger lesions (> 1.5 cm^2), cystic lesions, or lesions that have failed primary microfracture.

Question 4846

Topic: 5. Sports Medicine

A 28-year-old professional football player hyperextends his great toe on artificial turf. He has severe pain, swelling, and ecchymosis at the first MTP joint. MRI reveals a complete rupture of the plantar plate and flexor hallucis brevis from the base of the proximal phalanx, with proximal retraction of the sesamoids. What is the recommended treatment?

. Stiff-soled shoe insert and return to play as tolerated
. Short leg walking cast for 4 weeks
. First MTP joint arthrodesis
. Surgical repair of the plantar plate and soft tissues
. Excision of the sesamoids

Correct Answer & Explanation

. Surgical repair of the plantar plate and soft tissues

Explanation

A complete rupture of the plantar plate with proximal retraction of the sesamoids constitutes a Grade 3 turf toe injury. In high-level athletes, non-operative management of a Grade 3 injury often results in chronic pain, push-off weakness, and a cock-up deformity. Surgical repair of the plantar plate and capsuloligamentous structures is indicated to restore anatomy and function.

Question 4847

Topic: 5. Sports Medicine

A 45-year-old active male sustains an acute Achilles tendon rupture while playing tennis. He opts for non-operative management. Which of the following is the most significant advantage of utilizing a functional rehabilitation protocol with early dynamic weight-bearing compared to traditional rigid immobilization?

. Decreased risk of deep vein thrombosis
. Re-rupture rate equivalent to operative repair
. Increased plantarflexion strength at 1 year
. Decreased risk of sural nerve injury
. Accelerated return to professional sports

Correct Answer & Explanation

. Re-rupture rate equivalent to operative repair

Explanation

Non-operative management with early functional rehabilitation for acute Achilles tendon ruptures has been shown in recent high-quality randomized controlled trials to have a re-rupture rate comparable to that of operative repair, while eliminating surgical complications such as wound breakdown and infection. Historically, non-operative management was thought to have a much higher re-rupture rate, but the incorporation of early dynamic weight-bearing protocols has altered this paradigm.

Question 4848

Topic: 5. Sports Medicine

A 24-year-old professional football player sustains a severe hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI demonstrates a complete tear of the plantar plate with proximal retraction of the sesamoids. He has profound weakness with resisted hallux plantarflexion. What is the most appropriate management?

. Taping, stiff-soled shoe, and immediate return to play
. Boot immobilization for 2 weeks followed by physical therapy
. Corticosteroid injection into the MTP joint
. Surgical repair of the plantar plate and capsuloligamentous complex
. First MTP joint arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

This describes a Grade 3 turf toe injury, characterized by complete disruption of the plantar capsuloligamentous complex. In an elite athlete, conservative management of a Grade 3 injury with significant instability and proximal retraction of the sesamoids leads to chronic pain and decreased push-off strength. Surgical repair of the plantar complex is indicated to restore anatomy, ensure joint stability, and maximize the likelihood of returning to pre-injury performance levels.

Question 4849

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute complete Achilles tendon rupture. He opts for nonoperative management with a functional rehabilitation protocol. Compared to operative management, which of the following is true regarding nonoperative treatment with early functional rehabilitation?

. Significantly higher rerupture rate
. Higher rate of deep infection
. Greater loss of plantarflexion strength at 2 years
. Similar rerupture rate and lower overall complication rate
. Higher rate of sural nerve injury

Correct Answer & Explanation

. Similar rerupture rate and lower overall complication rate

Explanation

Recent high-level evidence (Level I randomized controlled trials) has demonstrated that nonoperative management of acute Achilles tendon ruptures utilizing an early functional rehabilitation protocol (early weight-bearing in a functional orthosis) results in a similar rerupture rate compared to operative management. Furthermore, nonoperative management completely avoids surgical complications such as infection, wound breakdown, and iatrogenic sural nerve injury, leading to a lower overall complication rate.

Question 4850

Topic: 5. Sports Medicine
A 22-year-old wide receiver sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint. He presents with severe pain, swelling, and marked instability with a positive Lachman test of the joint. Radiographs show proximal migration of the sesamoids. What is the most appropriate management?
. Stiff-soled shoe and immediate return to play
. Surgical repair of the plantar plate
. Taping the toe in extension and non-weight-bearing for 2 weeks
. Corticosteroid injection into the first MTP joint
. Excision of the sesamoids

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

This is a Grade III turf toe injury involving a complete tear of the plantar plate complex, resulting in frank instability and proximal migration of the sesamoids. Grade III injuries in high-level athletes with significant instability often require surgical repair of the plantar plate to restore push-off strength.

Question 4851

Topic: Shoulder & Hip Sports

A 68-year-old man presents with chronic right shoulder pain and an inability to actively elevate his arm above 40 degrees. Passive elevation is preserved to 160 degrees. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus with advanced fatty infiltration (Goutallier stage 4), while the subscapularis and teres minor are intact. What is the most reliable surgical option to restore active forward elevation in this patient?

. Latissimus dorsi tendon transfer
. Arthroscopic superior capsular reconstruction (SCR)
. Lower trapezius tendon transfer
. Reverse total shoulder arthroplasty (rTSA)
. Arthroscopic debridement and subacromial decompression

Correct Answer & Explanation

. Reverse total shoulder arthroplasty (rTSA)

Explanation

The patient presents with pseudoparalysis of elevation secondary to a massive, irreparable posterosuperior rotator cuff tear. In elderly patients with pseudoparalysis and advanced fatty infiltration, reverse total shoulder arthroplasty (rTSA) provides the most reliable restoration of active elevation by medializing the center of rotation and maximizing the deltoid moment arm. Tendon transfers and SCR are generally less reliable for reversing true pseudoparalysis.

Question 4852

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete complains of poorly localized posterior shoulder pain and paresthesias over the lateral deltoid. MRI of the shoulder reveals isolated atrophy and fatty infiltration of the teres minor muscle. Which of the following anatomic structures form the borders of the space where the affected nerve is likely compressed?

. Teres minor, teres major, long head of triceps, and surgical neck of the humerus
. Teres minor, teres major, long head of triceps, and medial border of the scapula
. Supraspinatus, infraspinatus, subscapularis, and coracoid process
. Subscapularis, teres major, latissimus dorsi, and long head of biceps
. Teres major, latissimus dorsi, medial head of triceps, and humeral shaft

Correct Answer & Explanation

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

Explanation

The clinical presentation and MRI findings (isolated teres minor atrophy) are classic for Quadrilateral Space Syndrome. This syndrome involves compression of the axillary nerve and posterior humeral circumflex artery. The anatomical boundaries of the quadrilateral space are the teres minor (superiorly), teres major (inferiorly), long head of the triceps (medially), and the surgical neck of the humerus (laterally). Compression in this space typically leads to lateral deltoid paresthesias and selective denervation of the teres minor and/or deltoid.

Question 4853

Topic: Shoulder & Hip Sports

A 24-year-old elite volleyball player complains of vague posterior shoulder pain and weakness with overhead serving. Physical examination reveals atrophy of the infraspinatus but normal bulk of the supraspinatus. There is notable weakness in external rotation but normal abduction. An MRI shows a paralabral cyst. In which of the following anatomic locations is the cyst most likely compressing the involved nerve?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus and infraspinatus. It passes through the suprascapular notch (where compression affects both muscles) and then winds around the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch, often by a paralabral cyst associated with a posterior labral tear, results in isolated infraspinatus atrophy and weakness in external rotation, while the supraspinatus remains spared.

Question 4854

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with chronic, intractable posterior shoulder pain and profound weakness in external rotation. He has a positive Hornblower's sign and a positive dropping sign. MRI demonstrates a massive, retracted, and irreparably atrophic tear of the infraspinatus and teres minor, with an intact subscapularis. Which of the following tendon transfers is most appropriate to restore external rotation in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Pectoralis minor transfer
. Biceps tendon rerouting

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

This patient has an isolated loss of active external rotation due to irreparable tears of the infraspinatus and teres minor. The lower trapezius transfer is highly effective for restoring external rotation in this setting because the line of pull of the lower trapezius closely replicates the vector of the infraspinatus. While the latissimus dorsi transfer is used for massive posterosuperior tears, its vector is less ideal for isolated external rotation compared to the lower trapezius. Pectoralis major transfers are used for irreparable subscapularis tears.

Question 4855

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of right shoulder pain and weakness. Examination reveals isolated atrophy of the infraspinatus muscle with normal bulk of the supraspinatus. MRI demonstrates a paralabral cyst. At which anatomic location is the nerve compression most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular space
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. Compression at the suprascapular notch affects both muscles. Compression at the spinoglenoid notch, often due to a paralabral cyst associated with a posterior SLAP tear in overhead athletes, affects only the distal infraspinatus branch, leading to isolated infraspinatus atrophy and weakness in external rotation.

Question 4856

Topic: Shoulder & Hip Sports

A 42-year-old man presents with a history of sudden, severe, unremitting right shoulder pain lasting for 2 weeks that woke him from sleep. The pain has now largely resolved, but he has noticed profound weakness in shoulder abduction and external rotation. There is no history of trauma. EMG at 4 weeks reveals acute denervation changes in the supraspinatus and deltoid. What is the most likely diagnosis and appropriate initial management?

. Cervical radiculopathy; anterior cervical discectomy and fusion
. Parsonage-Turner syndrome; physical therapy and observation
. Acute rotator cuff tear; arthroscopic rotator cuff repair
. Quadrilateral space syndrome; surgical decompression
. Suprascapular nerve entrapment; cyst excision

Correct Answer & Explanation

. Parsonage-Turner syndrome; physical therapy and observation

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) typically presents with acute, severe shoulder pain that lasts for 1-3 weeks. As the pain subsides, profound weakness and muscle atrophy (commonly affecting the deltoid, supraspinatus, and infraspinatus) become evident. It is typically a self-limiting condition, and the initial management consists of pain control, physical therapy, and observation.

Question 4857

Topic: Shoulder & Hip Sports

A 24-year-old elite volleyball attacker complains of vague posterior shoulder pain and painless weakness over the past 6 months. Physical examination reveals notable atrophy of the infraspinatus fossa but normal bulk of the supraspinatus. She has full strength in shoulder abduction but 3/5 strength in external rotation with the arm at the side. An MRI is obtained, demonstrating a paralabral cyst. Where is the cyst most likely located and which nerve is affected?

. Suprascapular notch; suprascapular nerve
. Spinoglenoid notch; suprascapular nerve
. Quadrilateral space; axillary nerve
. Suprascapular notch; axillary nerve
. Spinoglenoid notch; spinal accessory nerve

Correct Answer & Explanation

. Spinoglenoid notch; suprascapular nerve

Explanation

Isolated infraspinatus weakness and atrophy strongly suggest entrapment of the suprascapular nerve at the spinoglenoid notch. In athletes, particularly overhead throwers and volleyball players, this is often due to a paralabral cyst associated with a posterosuperior labral tear. Entrapment at the suprascapular notch, which is more proximal, would typically denervate both the supraspinatus and infraspinatus muscles.

Question 4858

Topic: Shoulder & Hip Sports

A 26-year-old professional baseball pitcher undergoes shoulder arthroscopy for a Type II SLAP tear. During dynamic intraoperative testing, the surgeon observes a 'peel-back' mechanism of the superior labrum when the arm is placed in the late-cocking position (abduction and external rotation). This biomechanical phenomenon most directly leads to which of the following secondary shoulder pathologies in overhead athletes?

. Internal impingement resulting in articular-sided posterosuperior rotator cuff tears
. Subcoracoid impingement resulting in subscapularis tears
. Adhesive capsulitis due to capsular contracture
. Classic subacromial impingement leading to bursal-sided rotator cuff tears
. Anterior shoulder instability resulting from Bankart lesion extension

Correct Answer & Explanation

. Internal impingement resulting in articular-sided posterosuperior rotator cuff tears

Explanation

In the overhead throwing athlete, placing the arm in abduction and maximal external rotation (the late cocking phase) shifts the biceps vector posteriorly, creating a 'peel-back' torsional force on the superior labrum. A Type II SLAP tear allows increased posterosuperior translation of the humeral head and increased external rotation. This kinematics shift leads to internal impingement, where the articular surface of the posterosuperior rotator cuff (supraspinatus and infraspinatus) abuts the posterosuperior glenoid labrum, frequently leading to articular-sided 'kissing' lesions of the rotator cuff.

Question 4859

Topic: Shoulder & Hip Sports

A 28-year-old professional tennis player presents with posterior shoulder pain and selective weakness in external rotation. An MRI of the shoulder reveals a multi-lobulated paralabral cyst located strictly within the spinoglenoid notch. Based on this isolated compression, which of the following clinical findings would most likely be observed on physical examination?

. Atrophy of both the supraspinatus and infraspinatus muscles
. Isolated atrophy of the supraspinatus muscle
. Isolated atrophy of the infraspinatus muscle
. Atrophy of the teres minor muscle
. Atrophy of the posterior deltoid muscle

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus muscle

Explanation

The suprascapular nerve supplies motor innervation to the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Compression of the nerve at the spinoglenoid notch (often caused by a paralabral cyst associated with a posterior labral tear) results in isolated denervation, weakness, and subsequent atrophy of the infraspinatus muscle. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 4860

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher presents with deep shoulder pain and decreased throwing velocity. He has a positive O'Brien test and dynamic labral shear test. MRI arthrogram shows a type II SLAP tear. Following 3 months of failed physical therapy, what is the most appropriate surgical treatment?

. Biceps tenodesis
. Arthroscopic SLAP repair
. Biceps tenotomy
. Debridement of the superior labrum
. Open capsular shift

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In a young, high-demand overhead athlete (such as a collegiate pitcher) with a symptomatic type II SLAP tear that has failed conservative management, arthroscopic SLAP repair is the preferred surgical treatment. Restoring the anatomy of the superior labrum and the tension of the biceps anchor is critical for the 'peel-back' mechanism and maintaining normal shoulder kinematics required for high-velocity overhead throwing. Biceps tenodesis is increasingly favored in older, non-overhead athletes due to a lower risk of postoperative stiffness, but it alters throwing mechanics in elite pitchers.

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