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5. Sports Medicine MCQs

Practice Set 245 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 4881

Topic: Shoulder & Hip Sports

A 29-year-old elite volleyball player presents with an 8-month history of deep, aching posterior shoulder pain and a noted decrease in serving velocity. Physical examination reveals noticeable atrophy of the infraspinatus fossa, while the supraspinatus fossa appears completely normal. She demonstrates 5/5 strength in forward elevation but 3/5 strength in external rotation with the arm resting at her side. What is the most likely anatomic location of the neural compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The clinical presentation is classic for suprascapular nerve entrapment at the spinoglenoid notch. Because the suprascapular nerve gives off its motor branches to the supraspinatus muscle proximal to the spinoglenoid notch, entrapment at this distal location results in isolated infraspinatus atrophy and weakness (manifesting as weakness in external rotation). This condition is commonly seen in overhead athletes and is frequently associated with a paralabral cyst arising from a posterior SLAP or labral tear. Entrapment at the more proximal suprascapular notch would typically affect both the supraspinatus and infraspinatus.

Question 4882

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 26% anterior glenoid bone loss. Which of the following is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair with capsulorrhaphy
. Remplissage procedure alone
. Open Latarjet procedure
. Putti-Platt procedure
. Arthroscopic labral repair with a rotator interval closure

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

Anterior glenoid bone loss greater than 20-25% is a critical threshold where arthroscopic Bankart soft-tissue repair has an unacceptably high failure rate. An open Latarjet (coracoid transfer) procedure is the treatment of choice.

Question 4883

Topic: Shoulder & Hip Sports

A 45-year-old manual laborer undergoes arthroscopic evaluation for a type II SLAP tear. He also has a full-thickness supraspinatus tear. What is the most appropriate management of the biceps labral complex in this patient demographic?

. Arthroscopic SLAP repair
. Biceps tenodesis
. Biceps tenotomy with no fixation
. Debridement of the superior labrum only
. Nonoperative management of both tears

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients older than 40 years, especially those with concomitant rotator cuff tears, biceps tenodesis yields superior functional outcomes and lower complication rates compared to SLAP repair. SLAP repair in older individuals is highly associated with postoperative stiffness.

Question 4884

Topic: Shoulder & Hip Sports

A 20-year-old rugby player has recurrent anterior shoulder instability. CT scan reveals 25% anterior glenoid bone loss. A Latarjet procedure is planned. Which nerve is at greatest risk during the coracoid transfer?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Median nerve
. Radial nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis approximately 3-8 cm distal to the coracoid process tip. It is at significant risk of traction or direct injury during coracoid osteotomy and transfer during the Latarjet procedure.

Question 4885

Topic: Shoulder & Hip Sports

A 55-year-old male presents with severe anterior shoulder pain and increased passive external rotation compared to the contralateral side. He exhibits a positive lift-off test and belly-press test. If this patient undergoes arthroscopy, what is the most likely associated pathology found in conjunction with his primary tendon injury?

. Posterior labral tear (reverse Bankart)
. Medial subluxation or dislocation of the long head of the biceps tendon
. Superior labrum anterior to posterior (SLAP) tear
. Posteroinferior capsular contracture
. Acromioclavicular joint osteoarthritis

Correct Answer & Explanation

. Medial subluxation or dislocation of the long head of the biceps tendon

Explanation

The clinical examination indicates an isolated subscapularis tear. Because the subscapularis and the coracohumeral ligament stabilize the long head of the biceps, a complete subscapularis tear frequently leads to medial subluxation or dislocation of the biceps tendon.

Question 4886

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination shows a glenohumeral internal rotation deficit (GIRD) of 25 degrees compared to the contralateral shoulder. What is the primary underlying pathophysiology driving this specific impingement pattern?

. Contracture of the posteroinferior capsule
. Subcoracoid impingement of the subscapularis
. Anteroinferior capsular laxity from repetitive microtrauma
. Primary acromial morphological abnormality
. Hypertrophy of the long head of the biceps

Correct Answer & Explanation

. Contracture of the posteroinferior capsule

Explanation

Internal impingement in overhead throwers is driven by posteroinferior capsular contracture (leading to GIRD). This contracture alters glenohumeral kinematics, shifting the humeral head posterosuperiorly during maximum external rotation and pinching the rotator cuff against the posterosuperior glenoid.

Question 4887

Topic: Shoulder & Hip Sports

A 34-year-old man presents to the emergency department after a first-time generalized tonic-clonic seizure. His shoulder is locked in internal rotation and he cannot actively or passively externally rotate. An axillary radiograph confirms a posterior glenohumeral dislocation with an anteromedial humeral head impaction fracture involving 30% of the articular surface. What is the most appropriate surgical treatment?

. Closed reduction and immobilization in internal rotation
. Arthroscopic Bankart repair
. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)

Explanation

The patient has a posterior dislocation with a significant reverse Hill-Sachs lesion (between 20-40% of the articular surface). The modified McLaughlin procedure (transfer of the lesser tuberosity/subscapularis into the defect) stabilizes the joint and prevents engagement of the defect on the posterior glenoid rim.

Question 4888

Topic: Shoulder & Hip Sports

A 26-year-old competitive volleyball player undergoes arthroscopic repair of a posterior labral tear. The surgeon places suture anchors extensively along the posteroinferior and posterosuperior glenoid rim. Postoperatively, the patient experiences isolated, profound weakness in external rotation despite a pain-free joint. What is the most likely iatrogenic cause of this complication?

. Axillary nerve injury at the inferior capsule
. Musculocutaneous nerve traction
. Over-tightening of the anterior band of the inferior glenohumeral ligament
. Suprascapular nerve entrapment at the spinoglenoid notch
. Spinal accessory nerve injury

Correct Answer & Explanation

. Suprascapular nerve entrapment at the spinoglenoid notch

Explanation

The suprascapular nerve passes through the spinoglenoid notch approximately 1 to 2 cm medial to the posterior glenoid rim. Placement of anchors or sutures too deeply or too far medially along the posterior/posterosuperior glenoid can easily entrap the nerve, causing denervation of the infraspinatus.

Question 4889

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with vague posterior shoulder pain and weakness with external rotation. Examination reveals isolated atrophy of the infraspinatus with normal supraspinatus bulk and strength. An MRI reveals a paralabral cyst. Where is the cyst most likely located to produce these exact findings?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve after it has already given off its motor branches to the supraspinatus muscle. This results in isolated infraspinatus weakness and atrophy, which is a classic finding in overhead athletes with posterior labral tears.

Question 4890

Topic: 5. Sports Medicine
During shoulder arthroscopy on a 25-year-old throwing athlete, you identify a superior labrum anterior-posterior (SLAP) lesion. The superior labrum is completely detached, and the tear extends into the substance of the long head of the biceps tendon, creating a bucket-handle tear. How is this lesion classified according to the Snyder classification?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type IV

Explanation

A Type IV SLAP tear is characterized by a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon. Treatment depends on the extent of biceps involvement and may include labral repair with or without biceps tenodesis.

Question 4891

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes diagnostic arthroscopy for recurrent anterior shoulder instability. The surgeon notes a Bankart lesion and an "engaging" Hill-Sachs lesion that drops over the anterior glenoid rim in abduction and external rotation. Assuming no significant glenoid bone loss, what adjunctive soft-tissue procedure should be performed alongside the Bankart repair?

. Arthroscopic remplissage
. Superior capsular reconstruction
. Arthroscopic SLAP repair
. Subscapularis advancement
. Rotator interval closure alone

Correct Answer & Explanation

. Arthroscopic remplissage

Explanation

An "engaging" Hill-Sachs lesion significantly increases the risk of recurrent anterior dislocation if only a Bankart repair is performed. Arthroscopic remplissage (insetting the infraspinatus tendon into the humeral defect) combined with a Bankart repair effectively converts the intra-articular defect into an extra-articular one, preventing engagement.

Question 4892

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is osteotomized and transferred to the anterior glenoid. Which nerve is at the greatest risk of injury during the mobilization and transfer of the conjoined tendon?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve penetrates the coracobrachialis muscle typically 3 to 8 cm distal to the coracoid process. It is uniquely tethered to the conjoined tendon, making it highly susceptible to stretch or transection during the Latarjet procedure.

Question 4893

Topic: Shoulder & Hip Sports

A 29-year-old volleyball player has an isolated weakness of external rotation in her dominant shoulder. Atrophy is noted over the infraspinatus fossa, while the supraspinatus muscle belly appears normal. MRI reveals a paralabral cyst. Where is the cyst most likely located?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

A cyst at the spinoglenoid notch compresses the terminal branch of the suprascapular nerve, resulting in isolated denervation of the infraspinatus. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 4894

Topic: 5. Sports Medicine

A 40-year-old man requires bone grafting for an atrophic scaphoid nonunion. The surgeon utilizes a graft source that provides osteoconduction, osteoinduction, and osteogenesis. Which of the following graft materials possesses all three of these properties?

. Demineralized bone matrix (DBM)
. Cancellous allograft
. Non-vascularized cortical allograft
. Recombinant human BMP-2
. Iliac crest bone autograft

Correct Answer & Explanation

. Iliac crest bone autograft

Explanation

Bone grafts are characterized by their biological properties. Osteoconduction provides a physical scaffold for new bone growth. Osteoinduction involves signaling molecules (like BMPs) that stimulate the differentiation of mesenchymal stem cells into osteoblasts. Osteogenesis refers to the presence of live, viable osteoprogenitor cells within the graft that can directly form new bone. Autografts (such as iliac crest bone autograft) are the only grafts that provide all three properties. Allografts lack osteogenesis because they are processed and sterilized, eliminating viable cells. DBM provides osteoconduction and osteoinduction but lacks osteogenesis. RhBMP-2 is purely osteoinductive.

Question 4895

Topic: Knee Sports

During a surgical reconstruction of the posterolateral corner of the knee, a surgeon identifies the precise fibular attachments. Which of the following correctly describes the anatomical insertion of the popliteofibular ligament?

. Anterior to the fibular styloid and medial to the biceps femoris tendon
. Posteromedial aspect of the fibular styloid, deep to the fibular collateral ligament
. Anterolateral aspect of the fibular head, superficial to the fibular collateral ligament
. Directly onto the lateral tibial tubercle (Gerdy's tubercle)
. Posterior aspect of the lateral femoral condyle

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid, deep to the fibular collateral ligament

Explanation

The popliteofibular ligament originates from the musculotendinous junction of the popliteus and inserts on the posteromedial aspect of the fibular styloid. It lies deep and posterior to the fibular collateral ligament insertion.

Question 4896

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, anatomic placement of the femoral tunnel is critical to prevent graft anisometry. According to Schöttle's radiographic point, where should the femoral footprint be located on a strict lateral radiograph?
. Anterior to the posterior cortical line and proximal to the posterior femoral condyle
. 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 level of the Blumensaat line
. Distal to the Blumensaat line and anterior to the posterior cortical line
. Directly on the medial epicondyle
. Posterior to the posterior cortical line and distal to 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, and proximal to the level of the Blumensaat line

Explanation

Schöttle's point defines the radiographic femoral footprint of the MPFL. It is located 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 4897

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete is diagnosed with a ganglion cyst causing nerve compression strictly at the spinoglenoid notch. Physical examination is most likely to reveal weakness in which of the following muscles?

. Supraspinatus only
. Infraspinatus only
. Supraspinatus and infraspinatus
. Teres minor and deltoid
. Subscapularis

Correct Answer & Explanation

. Infraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus prior to passing through the spinoglenoid notch. Compression at the spinoglenoid notch isolatedly affects the innervation to the infraspinatus, causing isolated external rotation weakness.

Question 4898

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomic femoral tunnel placement is critical. Where is the normal femoral attachment of the fibular collateral ligament (FCL)?

. Distal and anterior to the lateral epicondyle
. Proximal and posterior to the lateral epicondyle
. Directly on the lateral epicondyle
. Distal and posterior to the popliteus insertion
. Proximal and anterior to the popliteus insertion

Correct Answer & Explanation

. Proximal and posterior to the lateral epicondyle

Explanation

The fibular collateral ligament (FCL) attaches to the lateral femur proximal and posterior to the lateral epicondyle. It is also situated proximal and posterior to the femoral insertion of the popliteus tendon.

Question 4899

Topic: Knee Sports

Biomechanically, the anterior cruciate ligament (ACL) is divided into the anteromedial (AM) and posterolateral (PL) bundles. Which of the following best describes the function and tension pattern of the AM bundle?

. It is tight in extension and primarily controls rotatory stability.
. It is tight in flexion and primarily controls anterior tibial translation.
. It is tight in extension and primarily controls posterior tibial translation.
. It is tight in flexion and primarily controls varus stability.
. It is equally tense throughout the entire range of motion.

Correct Answer & Explanation

. It is tight in flexion and primarily controls anterior tibial translation.

Explanation

The AM bundle of the ACL is relatively tight in flexion and provides the primary restraint to anterior tibial translation. The PL bundle is tight in extension and is the primary restraint to rotatory loads.

Question 4900

Topic: Shoulder & Hip Sports

A surgeon is repairing a massive rotator cuff tear involving the teres minor and encounters bleeding near the quadrilateral space. What are the anatomic borders of this space?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)
. Teres major (superior), latissimus dorsi (inferior), long head of triceps (medial), humerus (lateral)
. Teres minor (superior), teres major (inferior), lateral head of triceps (medial), humerus (lateral)
. Supraspinatus (superior), infraspinatus (inferior), glenoid (medial), humerus (lateral)
. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humerus (medial)

Correct Answer & Explanation

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

Explanation

The quadrilateral space is 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. It contains the axillary nerve and posterior circumflex humeral artery.

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