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5. Sports Medicine MCQs

Practice Set 247 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 4921

Topic: Shoulder & Hip Sports

A 30-year-old elite volleyball player develops progressive, isolated weakness of shoulder external rotation with no sensory deficits. Abduction strength is graded 5/5 and is symmetric to the contralateral shoulder. Given this specific clinical presentation, an entrapment neuropathy is suspected. Where is the most likely location of the nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus (shoulder abduction) and the infraspinatus (shoulder external rotation). Entrapment at the suprascapular notch affects BOTH muscles. Entrapment at the spinoglenoid notch (commonly due to a paralabral cyst associated with a posterior SLAP tear in overhead athletes) occurs distal to the motor branch to the supraspinatus, resulting in isolated infraspinatus atrophy and isolated external rotation weakness.

Question 4922

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner of the knee, the surgeon must identify the popliteofibular ligament. Which of the following accurately describes the anatomy of the popliteofibular ligament?

. It originates from the fibular styloid and inserts on the lateral femoral epicondyle.
. It originates from the anterior aspect of the fibular head and inserts on the popliteus muscle belly.
. It originates from the popliteus tendon and inserts on the posteromedial aspect of the fibular head.
. It originates from the lateral meniscus and inserts on the popliteus tendon.
. It originates from the popliteus tendon and inserts on the posteromedial tibia.

Correct Answer & Explanation

. It originates from the popliteus tendon and inserts on the posteromedial aspect of the fibular head.

Explanation

The popliteofibular ligament is a critical static stabilizer of the posterolateral corner of the knee. It originates from the musculotendinous junction of the popliteus and inserts on the posteromedial aspect of the fibular head. Its primary function is to resist excessive external rotation of the tibia and provide varus stability.

Question 4923

Topic: Shoulder & Hip Sports

During arthroscopic shoulder surgery, the rotator interval is evaluated. Which of the following correctly identifies the anatomical borders and contents of the rotator interval?

. Superiorly bounded by supraspinatus, inferiorly bounded by infraspinatus; contains long head of biceps.
. Superiorly bounded by subscapularis, inferiorly bounded by supraspinatus; contains middle glenohumeral ligament.
. Medially bounded by the coracoid process, laterally bounded by the bicipital groove; contains the short head of the biceps.
. Superiorly bounded by the coracoacromial ligament, inferiorly bounded by the supraspinatus; contains the subacromial bursa.
. Superiorly bounded by supraspinatus, inferiorly bounded by subscapularis; contains long head of biceps and coracohumeral ligament.

Correct Answer & Explanation

. Superiorly bounded by supraspinatus, inferiorly bounded by subscapularis; contains long head of biceps and coracohumeral ligament.

Explanation

The rotator interval is a triangular anatomic space in the anterosuperior shoulder. It is bounded superiorly by the anterior margin of the supraspinatus tendon, inferiorly by the superior margin of the subscapularis tendon, and medially by the base of the coracoid process. Its vital contents include the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 4924

Topic: Knee Sports

A 24-year-old football player sustains a contact injury to his knee, resulting in a varus and hyperextension moment. He complains of lateral knee pain and instability. Physical examination reveals a positive dial test at 30 degrees of flexion, which normalizes at 90 degrees. Which of the following structures is the primary static restraint to external rotation at 30 degrees of knee flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteofibular ligament
. Iliotibial band
. Lateral collateral ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

A positive dial test at 30 degrees of knee flexion that normalizes at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). The primary restraints to external tibial rotation at 30 degrees of knee flexion are the popliteus complex (including the popliteofibular ligament) and the lateral collateral ligament (LCL). However, biomechanical studies demonstrate that the popliteofibular ligament is specifically the most critical static restraint to external rotation in this position.

Question 4925

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, the surgeon isolates the fibular collateral ligament (FCL) to prepare for anatomic graft placement. Which of the following best describes the precise anatomic footprint of the FCL on the lateral femoral condyle relative to the popliteus tendon insertion?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral condyle, the footprint of the fibular collateral ligament (FCL) is located proximal and posterior to the attachment of the popliteus tendon. Recognizing this specific anatomic relationship is essential for accurate tunnel placement during anatomic posterolateral corner reconstructions.

Question 4926

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with vague posterolateral shoulder pain and isolated weakness in external rotation. Shoulder abduction strength is normal.

An MRI reveals a paralabral cyst. Based on the clinical findings of isolated infraspinatus weakness with normal supraspinatus function, at which of the following anatomic locations is the nerve compression most likely occurring?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve passes through the suprascapular notch, where it gives off motor branches to the supraspinatus, and then continues through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch (often due to a posterior labral tear and subsequent paralabral cyst) results in isolated infraspinatus denervation and external rotation weakness, sparing the supraspinatus.

Question 4927

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes an anatomic reconstruction of the posterolateral corner (PLC) of the knee. The footprints of the fibular collateral ligament (FCL) and the popliteus tendon on the lateral femoral condyle must be accurately identified. What is the normal anatomic relationship of the FCL footprint relative to the popliteus tendon footprint?

. Distal and anterior
. Proximal and anterior
. Proximal and posterior
. Distal and posterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral condyle, the popliteus tendon attaches at the anterior aspect of the popliteal sulcus. The fibular collateral ligament (FCL) attachment is located proximal and posterior to the popliteus tendon attachment. The average distance between the two insertions is 18.5 mm.

Question 4928

Topic: Shoulder & Hip Sports

During an arthroscopic evaluation of a shoulder, the surgeon visualizes the rotator interval. Which of the following options correctly identifies the anatomic borders and contents of the rotator interval?

. Infraspinatus superiorly, teres minor inferiorly; containing the posterior circumflex humeral artery.
. Supraspinatus superiorly, subscapularis inferiorly; containing the middle glenohumeral ligament and axillary nerve.
. Subscapularis superiorly, pectoralis major inferiorly; containing the short head of the biceps.
. Supraspinatus superiorly, subscapularis inferiorly; containing the long head of the biceps and coracohumeral ligament.
. Coracoacromial ligament superiorly, supraspinatus inferiorly; containing the subacromial bursa.

Correct Answer & Explanation

. Supraspinatus superiorly, subscapularis inferiorly; containing the long head of the biceps and coracohumeral ligament.

Explanation

The rotator interval is a triangular space bounded superiorly by the anterior margin of the supraspinatus tendon and inferiorly by the superior margin of the subscapularis tendon. Its contents include the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 4929

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst causing nerve compression in the quadrangular space. The space through which this compressed nerve passes is anatomically bordered by which of the following structures?

. Teres minor, teres major, long head of triceps, humerus
. Teres minor, teres major, long head of triceps, medial head of triceps
. Teres major, latissimus dorsi, long head of triceps, humerus
. Infraspinatus, teres minor, long head of triceps, humerus
. Supraspinatus, infraspinatus, teres minor, humerus

Correct Answer & Explanation

. Teres minor, teres major, long head of triceps, humerus

Explanation

The quadrangular space is bordered superiorly by the teres minor (or subscapularis when viewed anteriorly), inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus. It transmits the axillary nerve and the posterior humeral circumflex artery. Compression here leads to axillary nerve neuropathy, commonly presenting with teres minor and deltoid denervation changes.

Question 4930

Topic: Knee Sports

A 22-year-old collegiate football player undergoes reconstruction of a multi-ligament knee injury. MRI confirms complete rupture of the primary static stabilizers of the posterolateral corner (PLC). The surgeon identifies the popliteofibular ligament for anatomical reconstruction. What are the correct origin and insertion sites of the native popliteofibular ligament?

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial down-slope of the fibular styloid.
. Originates from the lateral femoral epicondyle and inserts on the fibular head.
. Originates from the popliteus muscle belly and inserts on the lateral tibial plateau.
. Originates from the posterior horn of the lateral meniscus and inserts on the fibular head.
. Originates from the fabella and inserts on the fibular head.

Correct Answer & Explanation

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial down-slope of the fibular styloid.

Explanation

The major static stabilizers of the posterolateral corner are the fibular collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament (PFL). The PFL originates from the musculotendinous junction of the popliteus and runs distally to insert on the posteromedial aspect (down-slope) of the fibular styloid. It acts as a crucial restraint to posterior translation, varus opening, and external rotation.

Question 4931

Topic: Shoulder & Hip Sports

A surgeon is performing a posterior approach to the shoulder to address a locked posterior glenohumeral fracture-dislocation. To safely access the posterior joint capsule and avoid denervating the dynamic stabilizers of the shoulder, an internervous plane is developed. Which of the following describes the correct internervous plane and its respective muscle innervations?

. Between Supraspinatus (suprascapular n.) and Infraspinatus (suprascapular n.)
. Between Infraspinatus (suprascapular n.) and Teres Minor (axillary n.)
. Between Teres Minor (axillary n.) and Teres Major (lower subscapular n.)
. Between Teres Major (lower subscapular n.) and Latissimus Dorsi (thoracodorsal n.)
. Between Deltoid (axillary n.) and Triceps (radial n.)

Correct Answer & Explanation

. Between Infraspinatus (suprascapular n.) and Teres Minor (axillary n.)

Explanation

The classic posterior approach to the shoulder exploits the true internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). Retracting the infraspinatus superiorly and the teres minor inferiorly safely exposes the posterior joint capsule while protecting the critical neurovascular supply to the rotator cuff musculature.

Question 4932

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete presents with insidious onset of poorly localized posterior shoulder pain and paresthesias over the lateral aspect of the deltoid. Examination reveals isolated atrophy of the teres minor. The structure responsible for the patient's symptoms passes 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, long head of triceps, and anatomical neck of humerus
. Teres major, latissimus dorsi, long head of triceps, and shaft of humerus
. Subscapularis, coracobrachialis, short head of biceps, and humerus
. Supraspinatus, infraspinatus, subscapularis, and glenoid

Correct Answer & Explanation

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

Explanation

The patient has Quadrilateral Space Syndrome, characterized by compression of the axillary nerve and posterior circumflex humeral artery. 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. Compression typically presents with posterior shoulder pain, paresthesias over the lateral deltoid, and selective atrophy of the teres minor (and occasionally the deltoid).

Question 4933

Topic: Shoulder & Hip Sports

A 32-year-old elite volleyball player complains of right shoulder pain and weakness. An MRI demonstrates a large paralabral cyst causing isolated compression at the spinoglenoid notch. Physical examination is most likely to demonstrate weakness in which of the following motions, and normal strength in which?

. Weakness in external rotation; normal abduction
. Weakness in abduction; normal external rotation
. Weakness in internal rotation; normal abduction
. Weakness in external rotation and abduction
. Weakness in forward flexion; normal internal rotation

Correct Answer & Explanation

. Weakness in external rotation; normal abduction

Explanation

The suprascapular nerve first passes through the suprascapular notch (innervating the supraspinatus) and then continues distally through the spinoglenoid notch to innervate the infraspinatus. A paralabral cyst at the spinoglenoid notch will compress only the distal portion of the nerve, resulting in isolated denervation of the infraspinatus (weakness in external rotation). Supraspinatus function (abduction) remains completely intact as its motor branches arise proximal to the cyst.

Question 4934

Topic: Knee Sports
A surgeon is utilizing Schöttle's point on a true lateral fluoroscopic view of the knee to determine the precise femoral attachment for a medial patellofemoral ligament (MPFL) reconstruction graft. According to Schöttle's radiographic landmarks, the correct femoral attachment is located:
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. 5 mm posterior to the posterior cortex line, on Blumensaat's line
. 10 mm anterior to the posterior cortex line, distal to Blumensaat's line
. 2 mm posterior to the posterior cortex line, 5 mm proximal to the joint line
. Distal to the medial epicondyle and anterior to the adductor tubercle

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 Blumensaat's line

Explanation

Schöttle's point establishes the strict radiographic location of the femoral footprint of the MPFL. On a perfect lateral radiograph, it is found 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior perpendicular line originating from the posterior-most point of the medial femoral condyle, and just proximal to Blumensaat's line. Placing the graft here ensures near-isometric behavior during knee flexion.

Question 4935

Topic: Knee Sports

A 24-year-old rugby player sustains a severe contact injury to his knee, resulting in a grade 3 posterolateral corner (PLC) tear. The surgeon plans an anatomical reconstruction. Which of the following correctly describes the normal anatomical relationship of the fibular collateral ligament (FCL) and the popliteus tendon (PT) at their femoral insertions on the lateral epicondyle?

. The FCL inserts proximal and posterior to the PT
. The FCL inserts distal and anterior to the PT
. The FCL inserts proximal and anterior to the PT
. The FCL inserts distal and posterior to the PT
. The FCL and PT share a conjoined origin on the lateral epicondyle

Correct Answer & Explanation

. The FCL inserts proximal and posterior to the PT

Explanation

According to the anatomical studies by LaPrade et al., on the lateral femoral condyle, the origin of the fibular collateral ligament (FCL) is situated 18.5 mm proximal and posterior to the origin of the popliteus tendon (PT). The popliteus inserts in the anterior portion of the popliteal sulcus. Understanding this spatial relationship is critical for accurate tunnel placement during anatomical posterolateral corner reconstructions.

Question 4936

Topic: Knee Sports

A 25-year-old professional football player requires an anatomic posterolateral corner (PLC) reconstruction of the knee. During the preparation of the femoral tunnel for the popliteus tendon, the surgeon must be aware of its anatomic relationship to the origin of the lateral collateral ligament (LCL). What is the classic anatomic position of the popliteus insertion relative to the LCL femoral attachment?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Distal and anterior

Explanation

On the lateral femoral condyle, the insertion of the popliteus tendon is consistently located in the popliteus sulcus, which is anterior and distal (inferior) to the origin of the lateral collateral ligament (LCL). Recognizing this relationship is critical for accurate tunnel placement during posterolateral corner reconstruction.

Question 4937

Topic: Shoulder & Hip Sports

A 35-year-old male undergoes a Latarjet procedure for recurrent anterior shoulder instability. Postoperatively, he has weakness in elbow flexion and decreased sensation over the lateral forearm. Which of the following anatomic structures was most likely injured during the conjoint tendon retraction?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve penetrates the coracobrachialis muscle typically 5-8 cm distal to the coracoid process, though variations exist. Retraction of the conjoint tendon during the Latarjet procedure places this nerve at high risk of neuropraxia or structural injury. It provides motor innervation to the biceps brachii and brachialis (elbow flexion) and continues as the lateral antebrachial cutaneous nerve, providing sensation to the lateral forearm.

Question 4938

Topic: Knee Sports

A 22-year-old football player sustains a direct blow to the anteromedial aspect of his knee, resulting in a posterolateral corner (PLC) injury. During surgical reconstruction of the PLC, the surgeon dissects near the fibular head. Where is the common peroneal nerve most vulnerable to iatrogenic injury in this region?

. As it passes superficial to the lateral collateral ligament
. As it courses deep to the popliteus tendon
. As it wraps around the fibular neck, deep to the peroneus longus fascia
. Within the substance of the biceps femoris muscle belly
. Posterior to the lateral head of the gastrocnemius

Correct Answer & Explanation

. As it wraps around the fibular neck, deep to the peroneus longus fascia

Explanation

The common peroneal nerve descends obliquely along the lateral side of the popliteal fossa to the head of the fibula. It lies posterior to the biceps femoris tendon, then winds around the lateral surface of the fibular neck, deep to the peroneus longus muscle. This subfascial course around the fibular neck makes it highly vulnerable to injury during procedures addressing the posterolateral corner or proximal fibula.

Question 4939

Topic: Shoulder & Hip Sports

A 45-year-old tennis player complains of vague posterior shoulder pain and weakness in external rotation. An MRI reveals a multilobulated paralabral cyst at the spinoglenoid notch. Which of the following muscles is most likely to exhibit isolated atrophy on physical examination or imaging?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Infraspinatus

Explanation

The suprascapular nerve passes through the suprascapular notch (where compression affects both the supraspinatus and infraspinatus) and continues laterally and inferiorly through the spinoglenoid notch to innervate the infraspinatus. A cyst located specifically at the spinoglenoid notch compresses the nerve distal to the motor branches supplying the supraspinatus, resulting in isolated denervation, weakness, and atrophy of the infraspinatus muscle.

Question 4940

Topic: Knee Sports

A 28-year-old soccer player undergoes surgical reconstruction of the posterior cruciate ligament (PCL) after a dashboard injury. The surgeon plans a double-bundle reconstruction to restore the native biomechanics of the PCL. During graft tensioning, at which degree of knee flexion should the anterolateral (AL) bundle and posteromedial (PM) bundle be tensioned, respectively?

. AL bundle at 90 degrees; PM bundle at 0 degrees
. AL bundle at 0 degrees; PM bundle at 90 degrees
. AL bundle at 30 degrees; PM bundle at 90 degrees
. AL bundle at 90 degrees; PM bundle at 90 degrees
. AL bundle at 0 degrees; PM bundle at 30 degrees

Correct Answer & Explanation

. AL bundle at 90 degrees; PM bundle at 0 degrees

Explanation

The PCL is composed of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. Biomechanically, the AL bundle is the larger, primary restraint and is tightest in knee flexion (around 90 degrees). The PM bundle is smaller and is tightest in knee extension (0 degrees). Therefore, in a double-bundle PCL reconstruction, the AL bundle is typically tensioned in roughly 90 degrees of flexion, while the PM bundle is tensioned in full extension.

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