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 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?
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:
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?
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:
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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)?
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:
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?
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.
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