Menu

Question 5601

Topic: 5. Sports Medicine

Which of the following is a specific component of the Instability Severity Index Score (ISIS), utilized to predict the risk of recurrent instability after an arthroscopic Bankart repair?

. Female sex
. Age under 20 years
. Number of prior dislocations
. Generalized ligamentous laxity
. Concomitant SLAP tear

Correct Answer & Explanation

. Age under 20 years


Explanation

The ISIS score includes age under 20 years, participation in competitive sports, participation in contact/forced overhead sports, anterior-posterior glenoid bone loss on AP radiograph, and a Hill-Sachs lesion visible on external rotation AP radiograph.

Question 5602

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical examination shows a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side. The primary anatomic structure responsible for this finding is:

. Contracture of the anteroinferior capsule
. Hypertrophy of the subscapularis
. Contracture of the posteroinferior capsule
. Laxity of the superior glenohumeral ligament
. Hyperlaxity of the coracohumeral ligament

Correct Answer & Explanation

. Contracture of the posteroinferior capsule


Explanation

GIRD in throwing athletes is primarily caused by contracture and thickening of the posteroinferior capsule. This occurs as a maladaptive response to repetitive eccentric loading during the deceleration phase of throwing.

Question 5603

Topic: Shoulder & Hip Sports

A 50-year-old male presents with anterior shoulder pain after a fall. He has a positive "belly-press" test. Which of the following physical examination findings would also most likely be positive in this patient?

. Jobe's test
. Bear hug test
. Hornblower's sign
. O'Brien's active compression test
. External rotation lag sign

Correct Answer & Explanation

. Bear hug test


Explanation

The belly-press test and the bear hug test are both highly specific maneuvers for evaluating the integrity of the subscapularis tendon. Hornblower's sign and the external rotation lag sign evaluate the posterosuperior rotator cuff.

Question 5604

Topic: Shoulder & Hip Sports

A 29-year-old professional volleyball player presents with painless weakness of external rotation of the shoulder. Examination reveals isolated atrophy of the infraspinatus fossa. The supraspinatus strength and muscle bulk are normal. The most likely site of nerve compression is:

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

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch presents with isolated weakness and atrophy of the infraspinatus. Compression more proximally at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 5605

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder dislocations. Imaging reveals a 25% anterior glenoid bone loss defect. Which of the following is the most appropriate surgical intervention?

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

Correct Answer & Explanation

. Latarjet procedure


Explanation

In collision athletes with critical anterior glenoid bone loss (greater than 20-25%), isolated soft tissue repairs have unacceptably high failure rates. The Latarjet procedure (coracoid transfer) is required to restore the articular arc and provide a triple blocking effect.

Question 5606

Topic: Shoulder & Hip Sports

A 48-year-old heavy laborer presents with deep anterior shoulder pain. MRI confirms an isolated Type II SLAP tear. Nonoperative management has failed after 6 months. What is the most appropriate surgical management?

. Arthroscopic SLAP repair
. Arthroscopic biceps tenodesis
. Arthroscopic biceps tenotomy
. Physical therapy focusing on internal rotation
. Subacromial decompression

Correct Answer & Explanation

. Arthroscopic biceps tenodesis


Explanation

For patients older than 40 with symptomatic Type II SLAP tears, biceps tenodesis is preferred over SLAP repair. This approach avoids the high rates of postoperative stiffness, persistent pain, and revision surgery associated with SLAP repairs in older patients.

Question 5607

Topic: Shoulder & Hip Sports

A 35-year-old elite volleyball player complains of vague posterior shoulder pain and isolated weakness in external rotation. Examination shows atrophy of the infraspinatus with a normal supraspinatus. Where is the most likely location of nerve entrapment?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Spiral groove
. Posterior cervical triangle

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch, often by a paralabral cyst, results in isolated denervation of the infraspinatus. Entrapment further proximal at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Question 5608

Topic: Shoulder & Hip Sports

A patient presents with vague posterior shoulder pain and isolated atrophy of the teres minor. An MRI demonstrates quadrilateral space syndrome. Which of the following correctly defines the borders of the quadrilateral space?

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, humeral shaft laterally
. Teres major superiorly, teres minor inferiorly, long head of triceps laterally, humeral shaft medially
. Subscapularis superiorly, teres major inferiorly, short head of biceps medially, humeral shaft laterally
. Teres minor superiorly, latissimus dorsi inferiorly, lateral head of triceps medially, humerus laterally
. Infraspinatus superiorly, teres minor inferiorly, long head of triceps medially, glenoid laterally

Correct Answer & Explanation

. Teres minor superiorly, teres major inferiorly, long head of triceps medially, humeral shaft laterally


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 humeral shaft. It transmits the axillary nerve and the posterior humeral circumflex artery.

Question 5609

Topic: 5. Sports Medicine

During arthroscopy, a surgeon identifies a complete full-thickness tear of the upper border of the subscapularis tendon. This pathology is most frequently associated with the disruption and subsequent subluxation or dislocation of which of the following structures?

. Coracoacromial ligament
. Long head of the triceps tendon
. Long head of the biceps tendon
. Short head of the biceps tendon
. Middle glenohumeral ligament

Correct Answer & Explanation

. Long head of the biceps tendon


Explanation

Complete tears of the upper border of the subscapularis frequently disrupt the medial biceps sling, which is composed of the coracohumeral and superior glenohumeral ligaments. This leads to medial subluxation or dislocation of the long head of the biceps tendon.

Question 5610

Topic: 5. Sports Medicine

Which of the following bone graft options definitively possesses osteoconductive, osteoinductive, and osteogenic properties?

. Demineralized bone matrix (DBM)
. Freeze-dried cancellous allograft
. Structural cortical autograft
. Fresh iliac crest cancellous autograft
. Calcium phosphate ceramics

Correct Answer & Explanation

. Fresh iliac crest cancellous autograft


Explanation

Fresh autogenous cancellous bone (e.g., from the iliac crest) remains the gold standard graft. It inherently provides a physical scaffold (osteoconductive), growth factors like BMPs (osteoinductive), and live osteoprogenitor cells (osteogenic).

Question 5611

Topic: 5. Sports Medicine
A 22-year-old athlete sustains a grade II medial collateral ligament (MCL) tear of the knee, which is managed conservatively. During the early proliferative phase of ligament healing (days to weeks), fibroblasts synthesize a disorganized extracellular matrix predominantly composed of which collagen type?
. Type I
. Type II
. Type III
. Type X
. Type IX

Correct Answer & Explanation

. Type III


Explanation

In the initial proliferative phase of ligament and tendon healing, the newly synthesized scar tissue is largely composed of weak, disorganized Type III collagen. Over months of remodeling, this is gradually replaced by stronger, longitudinally aligned Type I collagen.

Question 5612

Topic: Knee Sports

In understanding the biomechanics of the native anterior cruciate ligament (ACL), the anteromedial (AM) bundle is most taut in which of the following knee positions?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion


Explanation

The anteromedial (AM) bundle of the ACL is most taut in flexion (approximately 90 degrees) and is the primary restraint to anterior tibial translation in this position. The posterolateral (PL) bundle is taut in extension and provides rotatory stability.

Question 5613

Topic: 5. Sports Medicine

Which of the following bone graft materials possesses osteoconductive, osteoinductive, and osteogenic properties?

. Demineralized bone matrix
. Cancellous allograft
. Fresh autogenous cancellous bone
. Tricalcium phosphate
. Polymethylmethacrylate

Correct Answer & Explanation

. Fresh autogenous cancellous bone


Explanation

Fresh autogenous cancellous bone is considered the gold standard for bone grafting because it provides a structural scaffold (osteoconduction), growth factors (osteoinduction), and viable osteoprogenitor cells (osteogenesis).

Question 5614

Topic: 5. Sports Medicine

Which of the following bone graft substitutes is considered osteoinductive, osteoconductive, and osteogenic?

. Demineralized bone matrix
. Cortical allograft
. Calcium phosphate cement
. Cancellous autograft
. Hydroxyapatite

Correct Answer & Explanation

. Cancellous autograft


Explanation

Cancellous autograft contains surviving cells (osteogenic), a scaffolding structure (osteoconductive), and growth factors (osteoinductive). Other options lack at least one of these three essential properties.

Question 5615

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player has weakness in external rotation of the shoulder. Examination reveals isolated atrophy of the infraspinatus without supraspinatus involvement. Entrapment of the suprascapular nerve at the spinoglenoid notch is typically associated with which of the following?

. Weakness of shoulder abduction and external rotation
. Hypertrophy of the transverse scapular ligament
. A ganglion cyst arising from a posterior labral tear
. Weakness of the deltoid and teres minor
. Compression by the coracoacromial ligament

Correct Answer & Explanation

. A ganglion cyst arising from a posterior labral tear


Explanation

Entrapment at the spinoglenoid notch affects only the motor branch to the infraspinatus, leading to isolated external rotation weakness. It is most commonly caused by a ganglion cyst associated with a posterior labral tear.

Question 5616

Topic: Shoulder & Hip Sports

A 30-year-old swimmer undergoes shoulder arthroscopy for instability. The surgeon evaluates the rotator interval, an anatomical space in the anterior shoulder. Which of the following tendons forms the inferior border of the rotator interval?

. Supraspinatus
. Subscapularis
. Infraspinatus
. Teres minor
. Long head of the biceps

Correct Answer & Explanation

. Subscapularis


Explanation

The rotator interval is a triangular space bordered superiorly by the anterior margin of the supraspinatus and inferiorly by the superior margin of the subscapularis. It contains the coracohumeral ligament, superior glenohumeral ligament, and biceps tendon.

Question 5617

Topic: Shoulder & Hip Sports

During an arthroscopic procedure for adhesive capsulitis, the surgeon releases the structures within the rotator interval. Which of the following anatomic structures forms the superior border of this interval?

. Supraspinatus tendon
. Subscapularis tendon
. Coracohumeral ligament
. Superior glenohumeral ligament
. Long head of the biceps tendon

Correct Answer & Explanation

. Subscapularis tendon


Explanation

The rotator interval is a triangular anatomic space in the anterosuperior shoulder. It is bordered 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.

Question 5618

Topic: Knee Sports

During knee flexion, what is the normal biomechanical tension pattern of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL)?

. Both bundles become tight
. Both bundles become lax
. AM bundle tightens and PL bundle becomes lax
. AM bundle becomes lax and PL bundle tightens
. AM bundle tightens in early flexion then becomes lax

Correct Answer & Explanation

. AM bundle tightens and PL bundle becomes lax


Explanation

The ACL is composed of two distinct bundles. During knee flexion, the anteromedial (AM) bundle tightens while the posterolateral (PL) bundle becomes lax, whereas in extension the PL bundle is tight.

Question 5619

Topic: Knee Sports

The ligaments of Humphry and Wrisberg are accessory meniscofemoral ligaments. The ligament of Wrisberg is characterized anatomically as running from the:

. Posterior horn of the medial meniscus passing anterior to the PCL
. Posterior horn of the lateral meniscus passing anterior to the PCL
. Posterior horn of the lateral meniscus passing posterior to the PCL
. Anterior horn of the medial meniscus passing posterior to the ACL
. Anterior horn of the lateral meniscus passing anterior to the ACL

Correct Answer & Explanation

. Posterior horn of the lateral meniscus passing posterior to the PCL


Explanation

The meniscofemoral ligaments originate from the posterior horn of the lateral meniscus and insert onto the medial femoral condyle. Humphry passes Anterior to the PCL, while Wrisberg passes Posterior to the PCL (mnemonic: 'Humphry is High/Ahead, Wrisberg is in the Wake/Behind').

Question 5620

Topic: Shoulder & Hip Sports

During the Latarjet procedure for recurrent anterior shoulder instability, the musculocutaneous nerve is at risk. It typically pierces the coracobrachialis muscle at what average distance distal to the tip of the coracoid process?

. 1-3 cm
. 5-8 cm
. 10-12 cm
. 15-18 cm
. 20-22 cm

Correct Answer & Explanation

. 5-8 cm


Explanation

The musculocutaneous nerve typically enters the coracobrachialis muscle approximately 5-8 cm distal to the coracoid process. Care must be taken during anterior shoulder approaches and coracoid osteotomy down to this level.