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5. Sports Medicine MCQs

Practice Set 244 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 4861

Topic: Shoulder & Hip Sports

A 68-year-old woman presents with persistent shoulder pain and pseudoparalysis. MRI reveals a massive rotator cuff tear involving the supraspinatus and infraspinatus. Which of the following MRI findings is the strongest contraindication to a primary arthroscopic repair?

. Retraction of the tendon to the glenoid rim
. Superior migration of the humeral head with an acromiohumeral interval of 6 mm
. Goutallier stage 3 or 4 fatty infiltration of the infraspinatus muscle
. Cystic changes in the greater tuberosity
. Moderate joint effusion

Correct Answer & Explanation

. Goutallier stage 3 or 4 fatty infiltration of the infraspinatus muscle

Explanation

Goutallier stage 3 or 4 fatty infiltration represents irreversible muscle degeneration. It strongly correlates with poor functional outcomes and high retear rates following rotator cuff repair, making it a major contraindication to primary arthroscopic repair.

Question 4862

Topic: 5. Sports Medicine

A 45-year-old recreational weightlifter presents with deep, anterior shoulder pain exacerbated by bench pressing. He has a positive O'Brien test and a positive Speed's test. MRI reveals a type II SLAP tear. Nonoperative management has failed. Which of the following surgical interventions provides the most reliable return to his pre-injury activity level?

. Arthroscopic SLAP repair
. Biceps tenotomy
. Biceps tenodesis
. Arthroscopic debridement of the labrum
. Coracoid transfer (Latarjet)

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients older than 35-40 years or those who are not overhead throwing athletes, biceps tenodesis provides more reliable pain relief and return to function compared to SLAP repair. SLAP repair in this demographic has a higher rate of persistent pain, stiffness, and subsequent revision surgery. Biceps tenodesis provides excellent functional outcomes without the cramping and 'Popeye' deformity risks seen with tenotomy.

Question 4863

Topic: Shoulder & Hip Sports

A 22-year-old elite collegiate baseball pitcher presents with vague posterior shoulder pain during the late cocking and early acceleration phases of throwing.

Physical examination reveals a loss of 25 degrees of internal rotation in the throwing arm compared to the contralateral side. He has a positive apprehension test that is relieved by a relocation maneuver. What is the most likely underlying pathophysiology of his pain?

. Primary anterior shoulder instability
. Contracture of the posterior band of the inferior glenohumeral ligament (IGHL)
. Coracoacromial arch impingement
. Isolated subscapularis tear
. Hypertrophy of the teres minor

Correct Answer & Explanation

. Contracture of the posterior band of the inferior glenohumeral ligament (IGHL)

Explanation

The athlete presents with Glenohumeral Internal Rotation Deficit (GIRD) and signs of internal impingement. Repetitive throwing leads to contracture of the posterior capsule and the posterior band of the inferior glenohumeral ligament (IGHL). This results in a posterosuperior shift of the glenohumeral contact point during maximum external rotation and abduction (late cocking phase), causing impingement of the undersurface of the rotator cuff and superior labrum between the greater tuberosity and the posterosuperior glenoid.

Question 4864

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player complains of vague posterior shoulder pain and weakness with external rotation. An MRI (Figure 4) demonstrates a paralabral cyst in the spinoglenoid notch. Which of the following physical examination findings is most likely present?

. Weakness of both abduction and external rotation with atrophy of the supraspinatus and infraspinatus
. Weakness of external rotation with isolated atrophy of the infraspinatus
. Weakness of internal rotation with atrophy of the subscapularis
. Weakness of shoulder elevation with atrophy of the deltoid
. Sensory deficit over the lateral aspect of the shoulder

Correct Answer & Explanation

. Weakness of external rotation with isolated atrophy of the infraspinatus

Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve distal to the motor branches supplying the supraspinatus. Consequently, it causes isolated denervation of the infraspinatus muscle, leading to isolated weakness in external rotation and infraspinatus atrophy. Entrapment at the suprascapular notch (more proximally) would affect both the supraspinatus and infraspinatus.

Question 4865

Topic: Shoulder & Hip Sports

A 60-year-old man undergoes arthroscopic rotator cuff repair. A Popeye deformity is a known potential outcome of biceps tenotomy. Compared to arthroscopic biceps tenodesis, which of the following is true regarding biceps tenotomy?

. It is associated with a higher rate of structural failure of the rotator cuff repair
. It requires a significantly longer period of postoperative immobilization
. It leads to a higher incidence of cramping pain in the biceps muscle belly
. It results in a clinically significant loss of elbow flexion strength
. It has a lower rate of patient satisfaction at 2 years postoperatively

Correct Answer & Explanation

. It leads to a higher incidence of cramping pain in the biceps muscle belly

Explanation

Biceps tenotomy and tenodesis both provide excellent pain relief for pathology of the long head of the biceps. Tenotomy is associated with a higher incidence of the 'Popeye' deformity and subjective cramping pain in the biceps muscle belly compared to tenodesis. However, there are no significant differences in functional outcome scores, overall patient satisfaction, elbow flexion, supination strength, or rotator cuff healing rates.

Question 4866

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player complains of vague, deep-seated posterior shoulder pain and weakness with overhead activities. Examination demonstrates marked atrophy of the infraspinatus fossa but normal bulk and tone of the supraspinatus. Significant weakness is noted in external rotation with the arm at the side, but abduction strength is symmetrically intact. MRI of the shoulder reveals a paralabral cyst. Based on the physical examination, where is the cyst most likely located?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The clinical presentation is classic for suprascapular nerve entrapment at the spinoglenoid notch. The suprascapular nerve provides motor innervation to the supraspinatus and then passes through the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch (proximal) would result in atrophy and weakness of both the supraspinatus and infraspinatus. Compression at the spinoglenoid notch (distal) affects only the infraspinatus, presenting as isolated external rotation weakness and isolated infraspinatus atrophy. Paralabral cysts in this location are frequently associated with posterior or SLAP labral tears.

Question 4867

Topic: Shoulder & Hip Sports

A 55-year-old construction worker presents with a symptomatic type II SLAP tear and biceps tendinopathy. He undergoes arthroscopic biceps tenodesis. Compared to biceps tenotomy, which of the following is a recognized advantage of biceps tenodesis?

. Lower risk of postoperative stiffness
. Decreased incidence of cosmetic "Popeye" deformity
. Shorter overall operative time
. Faster return to unrestricted manual labor
. Complete elimination of bicipital groove pain

Correct Answer & Explanation

. Decreased incidence of cosmetic "Popeye" deformity

Explanation

Biceps tenodesis and tenotomy are both accepted treatments for long head of the biceps pathology. Tenodesis maintains the length-tension relationship of the muscle, which theoretically preserves supination strength and significantly decreases the incidence of a cosmetic "Popeye" deformity compared to tenotomy. However, tenotomy typically requires a shorter operative time, allows a faster return to unrestricted activities, and carries a lower risk of postoperative stiffness.

Question 4868

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player complains of insidious, deep posterior shoulder pain and weakness with external rotation. Clinical examination shows isolated atrophy of the infraspinatus fossa. MRI demonstrates a paralabral cyst causing nerve compression. Based on the examination findings, where is the cyst most likely located and what is the typical associated labral pathology?

. Suprascapular notch; anterior Bankart lesion
. Spinoglenoid notch; posterosuperior labral tear
. Quadrilateral space; superior labrum anterior to posterior (SLAP) tear
. Suprascapular notch; superior labrum anterior to posterior (SLAP) tear
. Spinoglenoid notch; anterior Bankart lesion

Correct Answer & Explanation

. Spinoglenoid notch; posterosuperior labral tear

Explanation

The patient has isolated infraspinatus weakness and atrophy, which localizes the suprascapular nerve compression to the spinoglenoid notch (after the nerve has already given off its motor branches to the supraspinatus muscle at the suprascapular notch). Paralabral cysts at the spinoglenoid notch are strongly associated with posterosuperior labral tears or posterior SLAP lesions. A cyst at the suprascapular notch would typically cause weakness of both the supraspinatus and infraspinatus.

Question 4869

Topic: Shoulder & Hip Sports

A 30-year-old elite volleyball player presents with insidious onset of right shoulder pain and weakness. Physical examination reveals isolated atrophy of the infraspinatus muscle with normal bulk of the supraspinatus. Weakness is noted exclusively with external rotation. Where is the most likely location of nerve entrapment?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. Entrapment at the suprascapular notch affects both muscles, leading to weakness in abduction and external rotation. However, entrapment at the spinoglenoid notch occurs after the nerve has already given off its motor branches to the supraspinatus. This results in isolated denervation and atrophy of the infraspinatus muscle, causing weakness exclusively in external rotation. This condition is frequently seen in overhead athletes and is often associated with paralabral cysts arising from posterior labral tears.

Question 4870

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with isolated weakness in shoulder external rotation. She denies any shoulder pain. Physical examination reveals obvious atrophy of the infraspinatus, but supraspinatus strength and muscle bulk are normal. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve supplies both the supraspinatus and infraspinatus muscles. It passes first through the suprascapular notch (innervating the supraspinatus) and then continues through the spinoglenoid notch to innervate the infraspinatus. Isolated infraspinatus weakness and atrophy indicate compression at the spinoglenoid notch, frequently due to a paralabral cyst associated with superior labral tears in overhead athletes.

Question 4871

Topic: Shoulder & Hip Sports

A 38-year-old man presents with a sudden onset of excruciating right shoulder pain that began 3 weeks ago without any antecedent trauma. The severe pain has now largely subsided, but he reports profound weakness in his shoulder. Physical examination reveals noticeable atrophy of the supraspinatus and infraspinatus, with significant weakness in external rotation and forward elevation. An MRI of the cervical spine and shoulder shows no structural pathology or compressive lesions. What is the most appropriate next step in management?

. Arthroscopic rotator cuff repair
. Subacromial corticosteroid injection
. Early surgical exploration and neurolysis of the suprascapular nerve
. Observation, physical therapy, and supportive care
. Cervical epidural steroid injection

Correct Answer & Explanation

. Observation, physical therapy, and supportive care

Explanation

The clinical presentation of acute, severe shoulder pain followed by profound weakness and atrophy as the pain subsides is the classic presentation for Parsonage-Turner syndrome (idiopathic brachial neuritis or neuralgic amyotrophy). The condition is primarily self-limiting, and the mainstay of treatment is supportive care and physical therapy to maintain range of motion and strengthen the shoulder girdle.

Question 4872

Topic: Shoulder & Hip Sports

A 45-year-old recreational tennis player complains of persistent anterior shoulder pain that is exacerbated by overhead activities. An MRI arthrogram reveals an isolated type II superior labrum anterior and posterior (SLAP) tear. He has failed 6 months of comprehensive nonoperative management. In this age group, which of the following surgical interventions provides the most reliable patient-reported outcomes and the lowest revision rate?

. Arthroscopic SLAP repair with suture anchors
. Open Latarjet procedure
. Arthroscopic superior labrum debridement only
. Subpectoral biceps tenodesis
. Coracoacromial ligament release

Correct Answer & Explanation

. Subpectoral biceps tenodesis

Explanation

In patients older than 40 years, biceps tenodesis (either open subpectoral or arthroscopic) has been shown to yield more reliable pain relief, higher satisfaction, and significantly lower revision rates compared to primary arthroscopic SLAP repair. SLAP repair in this older demographic is associated with a higher risk of postoperative stiffness and persistent pain.

Question 4873

Topic: Shoulder & Hip Sports

A 60-year-old man with a massive, retracted, and irreparable posterosuperior rotator cuff tear is being evaluated for a latissimus dorsi tendon transfer. Which of the following conditions is considered an absolute contraindication to performing this procedure?

. An intact coracoacromial ligament
. Grade 4 fatty infiltration of the subscapularis
. Age greater than 55 years
. Grade 4 fatty infiltration of the infraspinatus
. Hamada Stage 1 radiographic changes

Correct Answer & Explanation

. Grade 4 fatty infiltration of the subscapularis

Explanation

Latissimus dorsi tendon transfer is indicated to restore active external rotation and forward elevation in patients with irreparable posterosuperior rotator cuff tears (supraspinatus and infraspinatus). The success of the transfer relies heavily on an intact and functioning anterior force couple to balance the transferred latissimus posteriorly and stabilize the humeral head in the glenoid. Therefore, a deficient subscapularis (e.g., irreparable tear or Grade 3/4 fatty infiltration) is a classic absolute contraindication to the procedure. Advanced glenohumeral arthritis (Hamada Stage 4 or 5) and pseudoparalysis with superior escape are also generally considered contraindications.

Question 4874

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of vague posterior shoulder pain and subjective weakness. Clinical examination reveals isolated atrophy of the infraspinatus muscle with preserved bulk of the supraspinatus. Overhead external rotation strength is decreased. An MRI is obtained. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus muscle before traversing the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch, often caused by a paralabral cyst originating from a posterior labral tear, selectively denervates the infraspinatus, leading to isolated atrophy and external rotation weakness. If compression occurred proximally at the suprascapular notch, both the supraspinatus and infraspinatus would be affected.

Question 4875

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability following 4 traumatic dislocations. A CT scan with 3D reconstruction demonstrates 28% anterior glenoid bone loss. Which of the following is the most appropriate surgical management to prevent recurrence?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair and inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Arthroscopic capsulolabral repair with superior labrum anterior-posterior (SLAP) repair
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In the setting of anterior shoulder instability, critical glenoid bone loss is generally considered to be greater than 20-25%. Soft tissue stabilization alone (e.g., arthroscopic or open Bankart repair) is contraindicated due to unacceptably high recurrence rates. A bony augmentation procedure, such as the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid), is required to restore the articular arc and provide the dynamic 'sling' effect of the conjoint tendon.

Question 4876

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with his third anterior shoulder dislocation this season. Advanced imaging shows a 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. Which of the following is the most appropriate definitive management to prevent recurrent instability and allow a return to contact sports?

. Arthroscopic Bankart repair with superior labral repair
. Arthroscopic Remplissage alone
. Open coracoid transfer (Latarjet procedure)
. Open inferior capsular shift
. Arthroscopic capsulolabral repair with thermal shrinkage

Correct Answer & Explanation

. Open coracoid transfer (Latarjet procedure)

Explanation

In a young, high-demand collision athlete with significant anterior glenoid bone loss (>20-25%), an arthroscopic Bankart repair is associated with an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is indicated to restore the glenoid arc and provide a dynamic 'sling' effect from the conjoint tendon. Remplissage can address an engaging Hill-Sachs lesion but does not treat the critical anterior glenoid bone loss.

Question 4877

Topic: Shoulder & Hip Sports

A 28-year-old male bodybuilder reports vague, deep posterior shoulder pain and weakness with external rotation. He denies any history of trauma. Physical examination reveals isolated atrophy of the infraspinatus with normal bulk of the supraspinatus. Forward elevation and internal rotation strength are normal. MRI of the shoulder is most likely to show which of the following?

. A paralabral cyst compressing the spinoglenoid notch
. A paralabral cyst compressing the suprascapular notch
. A high-grade partial tear of the upper subscapularis tendon
. Hypertrophy of the quadrilateral space borders causing axillary nerve entrapment
. An acute SLAP tear without extra-articular extension

Correct Answer & Explanation

. A paralabral cyst compressing the spinoglenoid notch

Explanation

Isolated infraspinatus atrophy with normal supraspinatus function is the classic presentation for suprascapular nerve compression at the spinoglenoid notch. In young, athletic patients, this is most commonly caused by a paralabral cyst forming as a result of a posterior labral tear. Compression at the suprascapular notch would present earlier in the nerve's course, affecting both the supraspinatus and infraspinatus muscles. Quadrilateral space syndrome involves the axillary nerve, leading to teres minor and deltoid atrophy.

Question 4878

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with an insidious onset of vague posterior shoulder pain and weakness with external rotation. Clinical examination reveals isolated atrophy of the infraspinatus with a normal bulk and strength of the supraspinatus.

The most likely site of nerve compression is the:

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve provides motor innervation to both the supraspinatus and infraspinatus muscles. Compression at the suprascapular notch affects both muscles. However, compression at the spinoglenoid notch occurs distal to the motor branch for the supraspinatus, resulting in isolated weakness and atrophy of the infraspinatus muscle. This is classically seen in overhead athletes or in association with a posterior paralabral cyst.

Question 4879

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague anterior shoulder pain during the late cocking and early acceleration phases of throwing. Examination shows a 25-degree loss of internal rotation and a 15-degree gain in external rotation in the symptomatic shoulder compared to the contralateral side. Which of the following pathological changes is most closely associated with the development of this specific glenohumeral internal rotation deficit (GIRD)?

. Contracture of the anteroinferior capsule
. Contracture of the posteroinferior capsule
. Attenuation of the coracohumeral ligament
. Shortening of the pectoralis minor
. Hypertrophy of the subscapularis tendon

Correct Answer & Explanation

. Contracture of the posteroinferior capsule

Explanation

Glenohumeral internal rotation deficit (GIRD) is classically associated with contracture and thickening of the posteroinferior capsule, commonly seen in overhead throwing athletes due to repetitive eccentric loads during the deceleration phase of throwing. This contracture shifts the glenohumeral center of rotation posterosuperiorly during the cocking phase, predisposing the athlete to SLAP tears and internal impingement. Treatment involves physical therapy focused on posterior capsule stretching (e.g., sleeper stretches).

Question 4880

Topic: Shoulder & Hip Sports

A 45-year-old manual laborer presents with chronic, severe right shoulder pain and an inability to actively elevate his arm above 40 degrees. He has a positive drop sign and a positive hornblower's sign. MRI demonstrates a massive, retracted supraspinatus and infraspinatus tear with Goutallier grade 4 fatty infiltration. The subscapularis tendon is completely intact. After failure of conservative management, what is the most appropriate surgical tendon transfer to restore active external rotation and function in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Levator scapulae transfer
. Teres major transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

A Latissimus dorsi transfer (or lower trapezius transfer) is indicated for younger patients with a massive, irreparable posterosuperior rotator cuff tear (supraspinatus and infraspinatus) who have an intact or repairable subscapularis and preserved deltoid function. The positive drop and hornblower's signs indicate profound external rotation weakness and infraspinatus/teres minor deficiency. Pectoralis major transfer is indicated for massive, irreparable subscapularis tears.

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