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5. Sports Medicine MCQs

Practice Set 285 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 5681

Topic: Shoulder & Hip Sports

A patient describes a sensation of the shoulder 'slipping out' when reaching across the body to perform a task like fastening a seatbelt. This mechanism is suggestive of which type of instability?

. Anterior instability
. Posterior instability
. Inferior instability
. Multidirectional instability
. Rotator cuff impingement

Correct Answer & Explanation

. Posterior instability

Explanation

Reaching across the body (horizontal adduction and internal rotation) is a classic position for posterior subluxation or dislocation. Anterior instability typically occurs with abduction and external rotation. Inferior instability is less position-specific but involves inferior translation. Multidirectional instability would involve multiple directions. Rotator cuff impingement causes pain with certain movements but not a 'slipping out' sensation.

Question 5682

Topic: Shoulder & Hip Sports

In assessing a patient for multidirectional instability (MDI), which of the following signs would be most indicative?

. A positive Apprehension Test with external rotation
. A positive Jerk Test with horizontal adduction
. A positive Sulcus Sign with inferior traction
. All of the above combined with generalized ligamentous laxity
. Isolated pain with resisted internal rotation

Correct Answer & Explanation

. All of the above combined with generalized ligamentous laxity

Explanation

Multidirectional instability (MDI) implies instability in at least two, but typically three, directions (anterior, posterior, and inferior). Therefore, a patient with MDI would likely exhibit positive findings on tests for anterior instability (Apprehension Test), posterior instability (Jerk Test), and inferior instability (Sulcus Sign). Generalized ligamentous laxity (e.g., Beighton score) often predisposes to MDI. Isolated pain with resisted internal rotation suggests rotator cuff pathology.

Question 5683

Topic: Shoulder & Hip Sports

A patient presents with a superior labral anterior-posterior (SLAP) lesion. Which physical exam maneuver is MOST likely to elicit pain?

. Neer Impingement Test
. Hawkins-Kennedy Impingement Test
. Speed's Test
. Empty Can Test
. Cross-Body Adduction Test

Correct Answer & Explanation

. Speed's Test

Explanation

Speed's Test (or Biceps Load Test II) is specifically designed to test for SLAP lesions, assessing pain with resisted shoulder flexion while the elbow is extended and forearm supinated. Neer and Hawkins-Kennedy are for impingement, Empty Can for supraspinatus, and Cross-Body Adduction for AC joint pathology. While impingement tests can sometimes be positive with SLAP, Speed's test is more specific for biceps/labral irritation.

Question 5684

Topic: Shoulder & Hip Sports

What is the primary purpose of obtaining an axillary view radiograph in a patient with a suspected shoulder dislocation?

. To assess for a Hill-Sachs lesion
. To visualize a bony Bankart lesion
. To differentiate between anterior and posterior dislocations
. To evaluate for rotator cuff tears
. To measure the critical shoulder angle

Correct Answer & Explanation

. To differentiate between anterior and posterior dislocations

Explanation

The axillary view (or Velpeau view if unable to abduct) is crucial for differentiating between anterior and posterior dislocations, as it provides a true lateral view of the glenohumeral joint and shows the relationship of the humeral head to the glenoid. An AP view alone can sometimes be misleading, especially with posterior dislocations. While it can also show bony Bankart lesions, its primary utility is differentiation of dislocation type. Hill-Sachs can be seen on AP or West Point axillary. It does not directly evaluate rotator cuff tears or measure the critical shoulder angle (which is for impingement/arthritis risk).

Question 5685

Topic: Shoulder & Hip Sports

When performing the Load and Shift test, what does excessive posterior translation of the humeral head indicate?

. Anterior capsular laxity
. Posterior capsular laxity
. Inferior glenohumeral ligament incompetence
. Superior labral tear
. Rotator cuff tear

Correct Answer & Explanation

. Posterior capsular laxity

Explanation

The Load and Shift test assesses glenohumeral translation in anterior and posterior directions. Excessive posterior translation indicates posterior capsular laxity, a hallmark of posterior glenohumeral instability. Anterior capsular laxity would manifest as excessive anterior translation. Inferior glenohumeral ligament incompetence would contribute to inferior instability. Labral or rotator cuff tears are structural injuries, not directly measured by generalized capsular laxity translation tests.

Question 5686

Topic: Shoulder & Hip Sports

In a patient presenting with an acute shoulder dislocation, a palpable clunk or grind during gentle rotation of the arm post-reduction could indicate:

. Successful reduction and stability
. Recurrent dislocation
. Intra-articular loose body or labral injury
. Axillary nerve recovery
. Musculocutaneous nerve injury

Correct Answer & Explanation

. Intra-articular loose body or labral injury

Explanation

A palpable clunk or grind post-reduction, especially with specific movements, can indicate an intra-articular loose body (e.g., osteochondral fragment, bony Bankart fragment) or a labral tear (e.g., Bankart lesion). It suggests continued pathology within the joint despite reduction. Successful reduction implies smooth, pain-free motion. Recurrence would be a complete dislocation. Nerve recovery/injury is unrelated to mechanical clunking.

Question 5687

Topic: Shoulder & Hip Sports

When examining a patient with recurrent anterior shoulder instability, what is the significance of a 'Bankart lesion'?

. It describes an impaction fracture of the posterior-superior humeral head
. It refers to an avulsion of the anterior-inferior labrum and glenohumeral ligaments from the glenoid rim
. It is a fracture of the greater tuberosity of the humerus
. It indicates a tear of the supraspinatus tendon
. It represents a defect in the articular cartilage of the humeral head

Correct Answer & Explanation

. It refers to an avulsion of the anterior-inferior labrum and glenohumeral ligaments from the glenoid rim

Explanation

A Bankart lesion is a specific injury to the anterior-inferior glenoid labrum and the attached inferior glenohumeral ligament, caused by the humeral head forcefully impacting the glenoid rim during an anterior dislocation. It is a critical lesion contributing to recurrent anterior instability. Option A describes a Hill-Sachs lesion. Options C, D, and E describe other distinct injuries.

Question 5688

Topic: Shoulder & Hip Sports

A 45-year-old male sustains a fall onto his abducted arm. Radiographs confirm an anterior shoulder dislocation. Which associated fracture is most likely due to impaction of the posterior-superior humeral head against the anterior glenoid rim?

. Reverse Hill-Sachs lesion
. Bony Bankart lesion
. Greater tuberosity fracture
. Surgical neck fracture
. Clavicle fracture

Correct Answer & Explanation

. Bony Bankart lesion

Explanation

A Bony Bankart lesion is an avulsion fracture of the anterior-inferior glenoid rim, occurring when the humeral head dislocates anteriorly and impacts the glenoid. A Reverse Hill-Sachs lesion is associated with posterior dislocations. Greater tuberosity and surgical neck fractures are also associated but are different mechanisms. Clavicle fractures are less directly associated with the dislocation mechanism itself.

Question 5689

Topic: Shoulder & Hip Sports

What is the primary significance of a 'Hill-Sachs lesion' in the context of shoulder dislocation?

. It indicates posterior glenohumeral instability.
. It is an avulsion fracture of the greater tuberosity.
. It is an impaction fracture on the posterior-superior aspect of the humeral head, typically associated with anterior dislocation.
. It signifies an irreparable rotator cuff tear.
. It represents a tear of the superior glenoid labrum.

Correct Answer & Explanation

. It is an impaction fracture on the posterior-superior aspect of the humeral head, typically associated with anterior dislocation.

Explanation

A Hill-Sachs lesion is an impaction fracture on the posterior-superior aspect of the humeral head, caused when the humeral head impacts against the anterior glenoid rim during an anterior dislocation. It is a key indicator of prior anterior dislocation and contributes to recurrent instability. Reverse Hill-Sachs is for posterior. Greater tuberosity is a separate fracture. Rotator cuff tears and labral tears are distinct injuries.

Question 5690

Topic: Shoulder & Hip Sports

When assessing for posterior instability with the patient supine, which test involves applying an axial load while horizontally adducting and internally rotating the arm?

. Apprehension Test
. Relocation Test
. Sulcus Sign
. Jerk Test
. Lift-Off Test

Correct Answer & Explanation

. Jerk Test

Explanation

The Jerk Test (also known as the Posterior Clunk Test or Load and Shift with specific movements) is performed with the patient supine, arm abducted to 90 degrees, and internally rotated. An axial load is applied through the humerus, and the arm is then moved into horizontal adduction. A sudden 'jerk' or clunk as the humeral head subluxates posteriorly indicates a positive test for posterior instability. Apprehension and Relocation tests are for anterior. Sulcus Sign is for inferior. Lift-Off Test is for subscapularis.

Question 5691

Topic: Shoulder & Hip Sports

A patient with a suspected first-time shoulder dislocation is unable to move their arm. Which finding on a pre-reduction X-ray would be a contraindication to closed reduction in the emergency department?

. Large Hill-Sachs lesion
. Bony Bankart lesion
. Fracture of the surgical neck of the humerus
. Greater tuberosity avulsion fracture
. Minor calcification in the rotator cuff tendons

Correct Answer & Explanation

. Fracture of the surgical neck of the humerus

Explanation

A displaced fracture of the surgical neck of the humerus is generally a contraindication to closed reduction in the emergency department, as reduction maneuvers could further displace the fracture or cause neurovascular injury. Such cases often require orthopedic consultation for potential open reduction or different reduction strategies. Hill-Sachs, bony Bankart, and greater tuberosity fractures, while associated, are not absolute contraindications to closed reduction unless they are very large or complex. Minor calcification is irrelevant for acute dislocation management.

Question 5692

Topic: Shoulder & Hip Sports

The 'Drop Arm Test' is positive in a patient with a dislocated shoulder. What associated injury does this MOST likely indicate?

. Axillary nerve palsy
. Complete rotator cuff tear
. Anterior labral avulsion
. Biceps tendon rupture
. Acromioclavicular joint separation

Correct Answer & Explanation

. Complete rotator cuff tear

Explanation

The Drop Arm Test assesses the integrity of the rotator cuff, particularly the supraspinatus. A positive test, where the patient cannot smoothly lower their arm from abduction or the arm 'drops,' suggests a complete rotator cuff tear. While axillary nerve palsy can also cause abduction weakness, the specific 'dropping' often points to the rotator cuff. Labral avulsion, biceps rupture, and AC joint separation have different specific tests.

Question 5693

Topic: Shoulder & Hip Sports

When evaluating a patient for shoulder instability, what is the purpose of assessing the 'apprehension' rather than just pain?

. Apprehension is a more reliable indicator of rotator cuff pathology.
. Apprehension is subjective and less useful than objective pain.
. Apprehension specifically indicates a fear of impending dislocation, suggestive of true instability.
. Pain is always indicative of instability, while apprehension is not.
. Apprehension indicates a biceps tendon injury.

Correct Answer & Explanation

. Apprehension specifically indicates a fear of impending dislocation, suggestive of true instability.

Explanation

In the context of the Apprehension Test, 'apprehension' refers to the patient's subjective feeling of the shoulder 'going out' or impending dislocation, often accompanied by muscle guarding. This is a more specific indicator of true glenohumeral instability (especially anterior) than pain alone, as pain can arise from various shoulder pathologies. A positive apprehension indicates that the position reproduces the sensation of instability, which is distinct from mere pain.

Question 5694

Topic: Shoulder & Hip Sports

A 19-year-old male presents with recurrent anterior shoulder dislocations. On examination, he is found to have a positive 'Kim Test.' What does this test evaluate?

. Anterior labral tear
. Posterior-inferior labral avulsion
. Superior labral tear
. Rotator cuff integrity
. Acromioclavicular joint pathology

Correct Answer & Explanation

. Posterior-inferior labral avulsion

Explanation

The Kim Test is a specific maneuver used to detect a posterior-inferior labral avulsion, which is associated with posterior shoulder instability. It involves the examiner holding the patient's elbow and applying an axial load while elevating the arm to 90 degrees and applying a posteroinferior force to the humeral head. A positive test elicits posterior pain and a clunk. Anterior labral tears (Bankart) are assessed with other tests (e.g., Apprehension/Relocation). SLAP lesions (superior labral) are assessed with tests like Speed's or O'Brien's.

Question 5695

Topic: Shoulder & Hip Sports

A patient with a dislocated shoulder has a suspected Axillary nerve injury. Which muscle should you test to assess its motor function?

. Supraspinatus
. Infraspinatus
. Deltoid
. Biceps brachii
. Subscapularis

Correct Answer & Explanation

. Deltoid

Explanation

The axillary nerve innervates the deltoid and teres minor muscles. Therefore, testing the deltoid (e.g., resisted shoulder abduction) is the primary way to assess the motor function of the axillary nerve. Supraspinatus and Infraspinatus are innervated by the suprascapular nerve. Biceps brachii by the musculocutaneous nerve. Subscapularis by the upper and lower subscapular nerves.

Question 5696

Topic: Shoulder & Hip Sports

A patient presents with a chronic, unreduced posterior shoulder dislocation. Which associated complication is MOST likely to lead to poor long-term outcomes even after successful reduction?

. Axillary nerve neuropraxia
. A small Bankart lesion
. Significant reverse Hill-Sachs lesion (impaction fracture)
. Generalized ligamentous laxity
. Concomitant greater tuberosity fracture

Correct Answer & Explanation

. Significant reverse Hill-Sachs lesion (impaction fracture)

Explanation

Chronic posterior dislocations often lead to a large reverse Hill-Sachs lesion (an impaction fracture on the anterior-medial humeral head). If this defect involves a significant portion of the humeral head articular surface (e.g., >25-40%), it can prevent stable reduction and lead to persistent pain, arthritis, and recurrent instability, even after surgical intervention, significantly impacting long-term outcomes. Axillary nerve neuropraxia often recovers. Small Bankart lesions are associated with anterior instability. Generalized laxity is a predisposing factor but not a direct complication of chronic dislocation. Greater tuberosity fractures are associated with anterior dislocations and are typically managed acutely.

Question 5697

Topic: Shoulder & Hip Sports

In the acute assessment of a dislocated shoulder, what is the MOST reliable way to differentiate between an anterior and posterior dislocation on a single, well-centered AP radiograph, if other views are unavailable?

. The 'light bulb sign' for posterior dislocation
. The presence of a Hill-Sachs lesion for anterior dislocation
. The degree of external rotation of the humeral head for anterior dislocation
. The 'rim sign' for posterior dislocation
. The 'trough line sign' for posterior dislocation

Correct Answer & Explanation

. The 'light bulb sign' for posterior dislocation

Explanation

While several signs can suggest a posterior dislocation on an AP view, the 'light bulb sign' is considered the most reliable. This refers to the appearance of the humeral head as uniformly rounded and internally rotated, obscuring the normal profile of the humeral head (the 'handshake sign' or half-moon sign). Hill-Sachs and Bankart lesions are associated with anterior dislocations. The rim sign (widening of the glenohumeral interval) and trough line sign are also for posterior, but the 'light bulb sign' is a common and distinctive feature on AP. Degree of external rotation is usually lost in posterior, but 'light bulb' describes the specific head shape due to fixed internal rotation.

Question 5698

Topic: Shoulder & Hip Sports

Which test is used to assess the integrity of the subscapularis tendon in a patient with a suspected rotator cuff injury accompanying a dislocation?

. Empty Can Test
. External Rotation Lag Sign
. Internal Rotation Lag Sign (or Lift-Off Test)
. Belly Press Test
. Both C and D

Correct Answer & Explanation

. Both C and D

Explanation

Both the Internal Rotation Lag Sign (which is essentially the Lift-Off Test performed with resistance) and the Belly Press Test are used to assess the subscapularis tendon. The Lift-Off Test is performed with the hand behind the back, asking the patient to lift it off their back against resistance. The Belly Press Test involves the patient pressing their hand into their belly with internal rotation force. Empty Can Test is for supraspinatus. External Rotation Lag Sign is for infraspinatus and teres minor.

Question 5699

Topic: Shoulder & Hip Sports

When evaluating the stability of a reduced shoulder, what is the 'Recurrence Rate' primarily influenced by?

. Patient's age at first dislocation
. Mechanism of injury
. Presence of a Hill-Sachs lesion
. Type of initial reduction maneuver
. All of the above

Correct Answer & Explanation

. Patient's age at first dislocation

Explanation

The patient's age at the time of the first dislocation is the single most significant risk factor for recurrent instability. Younger patients (e.g., teenagers and those in their early 20s) have significantly higher recurrence rates (up to 90%) compared to older patients, largely due to higher activity levels and stronger collagen which makes soft tissue healing less robust compared to bone in younger patients, leading to persistent laxity. While other factors contribute, age at first dislocation is paramount. Presence of a Hill-Sachs lesion increases the risk too, but age at first dislocation is the primary driver of recurrence rates.

Question 5700

Topic: Shoulder & Hip Sports

A patient with a dislocated shoulder is suspected of having an associated Bankart lesion. Which imaging study is BEST for visualizing this injury?

. Plain radiographs (AP, lateral, axillary views)
. CT scan without contrast
. MRI without contrast
. MR arthrogram
. Ultrasound

Correct Answer & Explanation

. MR arthrogram

Explanation

A Bankart lesion is a soft tissue injury (labral avulsion). While a bony Bankart lesion (with a bone fragment) can be seen on plain radiographs or CT, a pure soft tissue Bankart lesion is best visualized with an MR arthrogram. The intra-articular contrast distends the joint capsule and outlines the labrum and glenohumeral ligaments, making tears and avulsions much more apparent than on a standard MRI or CT. Ultrasound has limited utility for labral assessment.

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