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5. Sports Medicine MCQs

Practice Set 263 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 5241

Topic: Shoulder & Hip Sports

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

. Arthroscopic Bankart repair with superior capsular shift
. Arthroscopic remplissage alone
. Coracoid transfer (Latarjet procedure)
. Open capsulolabral repair
. Putti-Platt procedure

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

Critical glenoid bone loss (>20-25%) in a young, high-demand athlete is an absolute indication for a bony augmentation procedure, such as the Latarjet procedure. Soft tissue repairs alone have an unacceptably high failure rate in this setting.

Question 5242

Topic: Shoulder & Hip Sports

A 29-year-old professional tennis player reports progressive weakness in his serving arm. Examination demonstrates normal supraspinatus strength but 3/5 strength in external rotation with the arm at the side. Atrophy is noted only in the infraspinatus fossa. Where is the most likely location of nerve compression?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Triangular interval
. Cervical neural foramen (C5)

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 5243

Topic: Shoulder & Hip Sports

A 21-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. MRI arthrogram shows undersurface fraying of the posterior supraspinatus and anterior infraspinatus tendons, along with posterosuperior labral fraying. What is the primary pathoanatomic mechanism?

. Subcoracoid impingement
. Subacromial impingement
. Internal impingement
. Quadrilateral space syndrome
. Adhesive capsulitis

Correct Answer & Explanation

. Internal impingement

Explanation

Internal impingement occurs in overhead athletes when the undersurface of the posterosuperior rotator cuff abuts the posterosuperior glenoid labrum during maximum abduction and external rotation (late cocking phase).

Question 5244

Topic: Shoulder & Hip Sports

A 65-year-old man undergoes repair of a massive anterior rotator cuff tear (subscapularis) that is deemed irreparable intraoperatively. Which of the following tendon transfers is the most established option for restoring function?

. Latissimus dorsi transfer
. Lower trapezius transfer
. Pectoralis major transfer
. Biceps tenodesis
. Rhomboid major transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

Transfer of the pectoralis major (specifically the sternal head or the entire tendon routed deep to the conjoined tendon) to the lesser tuberosity is the gold standard tendon transfer for an irreparable subscapularis tear.

Question 5245

Topic: Shoulder & Hip Sports

During physical examination of a patient with suspected rotator cuff pathology, the 'Bear Hug' test and the 'Belly-Press' test are positive, but the 'Lift-Off' test is negative. Which anatomical portion of the subscapularis is most likely torn?

. Upper third
. Middle third
. Lower third
. The entire subscapularis
. The insertion on the greater tuberosity

Correct Answer & Explanation

. Lower third

Explanation

The 'Bear Hug' and 'Belly-Press' tests are highly sensitive for upper subscapularis tears. The 'Lift-Off' test requires internal rotation behind the back, which primarily isolates the lower portion of the subscapularis muscle.

Question 5246

Topic: Shoulder & Hip Sports

A 22-year-old professional rugby player presents with his fourth anterior shoulder dislocation. Advanced imaging reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Latarjet procedure
. Arthroscopic remplissage alone
. Open Bankart repair without bone grafting
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure

Explanation

In collision athletes with significant anterior glenoid bone loss (>20-25%), isolated soft-tissue repairs have an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the gold standard as it reconstructs the glenoid defect and provides a dynamic sling effect.

Question 5247

Topic: Shoulder & Hip Sports

A 28-year-old male volleyball player complains of vague posterior shoulder pain and isolated weakness in external rotation. Examination reveals normal internal rotation and abduction strength, but noticeable atrophy of the infraspinatus fossa. Which of the following is the most likely diagnosis?

. Suprascapular nerve entrapment at the suprascapular notch
. Axillary nerve injury
. Quadrilateral space syndrome
. Suprascapular nerve entrapment at the spinoglenoid notch
. Parsonage-Turner syndrome

Correct Answer & Explanation

. Suprascapular nerve entrapment at the spinoglenoid notch

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch selectively involves the branch to the infraspinatus, causing isolated external rotation weakness. Entrapment at the suprascapular notch would also involve the supraspinatus, resulting in abduction weakness.

Question 5248

Topic: Shoulder & Hip Sports

A 45-year-old manual laborer presents with an irreparable, massive, retracted posterosuperior rotator cuff tear. His subscapularis is completely intact. He demonstrates profound weakness in external rotation with a positive Hornblower's sign, but no glenohumeral arthritis. Which of the following is the most appropriate surgical option?

. Reverse total shoulder arthroplasty
. Latissimus dorsi transfer
. Lower trapezius transfer
. Superior capsule reconstruction
. Pectoralis major transfer

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

For a young patient with an irreparable posterosuperior tear and severe external rotation deficit, a tendon transfer is indicated. Lower trapezius transfer is favored because its line of pull closely mimics the native infraspinatus, making it superior to latissimus transfer for restoring external rotation.

Question 5249

Topic: 5. Sports Medicine
A 32-year-old construction worker presents with persistent shoulder pain 8 months after sustaining a Type V acromioclavicular (AC) joint separation. Nonoperative management has failed to provide relief. What is the most appropriate surgical intervention?
. Distal clavicle excision alone
. Primary AC ligament repair without augmentation
. Coracoclavicular (CC) ligament reconstruction using an autograft
. Weaver-Dunn procedure without augmentation
. Arthroscopic subacromial decompression

Correct Answer & Explanation

. Coracoclavicular (CC) ligament reconstruction using an autograft

Explanation

For symptomatic, chronic, high-grade AC joint separations (Type IV-VI or failed Type III), anatomic CC ligament reconstruction using a graft (autograft or allograft) is indicated. Primary repair or unaugmented procedures have a high failure rate in the chronic setting due to poor tissue quality.

Question 5250

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he presents with profound weakness in elbow flexion and decreased sensation over the lateral forearm. Which nerve is most likely injured?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at highest risk during a Latarjet procedure due to its proximity to the conjoint tendon, which is mobilized and retracted during the approach. It typically enters the coracobrachialis 3 to 8 cm distal to the coracoid process.

Question 5251

Topic: Shoulder & Hip Sports

A 45-year-old manual laborer presents with an irreparable, massive posterosuperior rotator cuff tear. He has an intact subscapularis but profoundly weak external rotation and a positive hornblower's sign. What is the most appropriate tendon transfer to restore external rotation?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Biceps brachii transfer
. Triceps transfer
. Coracobrachialis transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

Latissimus dorsi or lower trapezius tendon transfers are indicated for irreparable posterosuperior rotator cuff tears to restore active external rotation and elevation in younger patients with intact subscapularis function.

Question 5252

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher reports posterior shoulder pain during the late cocking phase of throwing. Exam reveals a Glenohumeral Internal Rotation Deficit (GIRD). Which of the following is the primary pathologic mechanism of internal impingement in this athlete?

. Impingement of the subscapularis on the coracoid process
. Friction between the biceps tendon and the superior labrum
. Contact between the articular-sided rotator cuff and the posterosuperior glenoid labrum
. Acromioclavicular joint osteoarthritis leading to subacromial spurring
. Dynamic subluxation of the long head of the biceps

Correct Answer & Explanation

. Contact between the articular-sided rotator cuff and the posterosuperior glenoid labrum

Explanation

Internal impingement in overhead athletes occurs when the articular surface of the supraspinatus and infraspinatus tendons abuts the posterosuperior glenoid labrum during maximum abduction and external rotation.

Question 5253

Topic: Shoulder & Hip Sports

A 35-year-old volleyball player presents with painless weakness in external rotation of the dominant shoulder. Examination shows isolated atrophy of the infraspinatus fossa with normal supraspinatus bulk. A paralabral cyst compressing a nerve is suspected. What is the most likely location of the cyst?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Guyon's canal

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

A paralabral cyst at the spinoglenoid notch selectively compresses the distal suprascapular nerve, causing isolated infraspinatus weakness and atrophy. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 5254

Topic: Shoulder & Hip Sports

A 42-year-old man presents with a locked shoulder in internal rotation following a generalized seizure. An axillary lateral radiograph reveals a posterior dislocation with a reverse Hill-Sachs lesion involving 35% of the humeral head articular surface. What is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Arthroscopic posterior labral repair
. Latarjet procedure
. McLaughlin procedure (transfer of subscapularis or lesser tuberosity)
. Total shoulder arthroplasty

Correct Answer & Explanation

. McLaughlin procedure (transfer of subscapularis or lesser tuberosity)

Explanation

For posterior dislocations with a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, a McLaughlin procedure (or modified McLaughlin transferring the lesser tuberosity) is indicated to fill the defect and prevent recurrent engagement.

Question 5255

Topic: Shoulder & Hip Sports

A 21-year-old military recruit has a history of multiple recurrent anterior shoulder dislocations. Preoperative CT imaging shows 26% anterior glenoid bone loss. Which surgical procedure is most indicated to prevent further instability?

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Latarjet procedure
. Arthroscopic remplissage alone
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical anterior glenoid bone loss (typically >20-25%) in a young, high-demand patient is a primary indication for bony augmentation, most commonly the Latarjet procedure (coracoid transfer), to restore stability.

Question 5256

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is transferred to the anterior glenoid neck. The dynamic "sling effect" that stabilizes the shoulder during abduction and external rotation is provided primarily by which anatomical structure?

. Coracoacromial ligament
. Short head of the biceps
. Pectoralis minor
. Conjoined tendon
. Subscapularis lower border

Correct Answer & Explanation

. Conjoined tendon

Explanation

The conjoined tendon provides a dynamic "sling effect" across the inferior subscapularis and anterior-inferior capsule when the arm is placed in an abducted and externally rotated position, contributing significantly to the stability conferred by the Latarjet procedure.

Question 5257

Topic: Shoulder & Hip Sports

A 24-year-old elite volleyball attacker complains of persistent posterior shoulder pain. Physical examination reveals isolated weakness in external rotation with intact forward elevation strength. At which anatomical location is the involved nerve most likely being compressed?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the terminal motor branch to the infraspinatus, causing isolated external rotation weakness. Compression at the suprascapular notch would also involve the supraspinatus, leading to elevation weakness.

Question 5258

Topic: Shoulder & Hip Sports

A 45-year-old man presents with his shoulder locked in internal rotation following a generalized seizure. Radiographs confirm a posterior shoulder dislocation. A CT scan reveals a reverse Hill-Sachs lesion involving 35% of the anterior articular surface. What is the most appropriate surgical management?

. Closed reduction and spica casting
. Arthroscopic Bankart repair
. Latarjet procedure
. Transfer of the lesser tuberosity or subscapularis into the defect
. Anatomic total shoulder arthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity or subscapularis into the defect

Explanation

For a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, transferring the lesser tuberosity or subscapularis tendon into the defect (the McLaughlin or modified McLaughlin procedure) is indicated to prevent the defect from engaging the posterior glenoid rim.

Question 5259

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. An MRI shows an anterior glenoid bone loss of 18% and a large Hill-Sachs lesion. Based on the glenoid track concept, if the Hill-Sachs lesion extends medial to the glenoid track, it is considered "off-track." Which of the following is the most appropriate surgical management for an off-track lesion in this high-demand athlete?

. Arthroscopic Bankart repair alone
. Arthroscopic Remplissage alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Open capsular shift

Correct Answer & Explanation

. Latarjet procedure

Explanation

In high-demand collision athletes with subcritical glenoid bone loss (15-20%) but an "off-track" Hill-Sachs lesion, a Latarjet procedure is often recommended. Latarjet restores the glenoid arc and stabilizes the joint through the sling effect, rendering the lesion "on-track."

Question 5260

Topic: Shoulder & Hip Sports

A 35-year-old elite volleyball player presents with vague posterior shoulder pain and weakness with external rotation. Examination reveals isolated atrophy of the infraspinatus with preserved supraspinatus bulk. Where is the most likely location of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus, causing isolated external rotation weakness and atrophy. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

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