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5. Sports Medicine MCQs

Practice Set 290 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 5781

Topic: 5. Sports Medicine

A 19-year-old football player undergoes primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. In comparing the biomechanical properties of the graft to the native ACL, which of the following statements is true regarding stiffness?

. The BPTB graft is significantly less stiff than the native ACL
. The BPTB graft has equivalent stiffness to the native ACL
. The BPTB graft is approximately 3 to 4 times stiffer than the native ACL
. A quadrupled hamstring graft is less stiff than the native ACL
. The native ACL is structurally stiffer than all available autograft choices

Correct Answer & Explanation

. The BPTB graft is approximately 3 to 4 times stiffer than the native ACL

Explanation

The native ACL has a stiffness of approximately 242 N/mm. A 10-mm BPTB graft has a stiffness of approximately 620 N/mm (some studies cite up to 3x, or ~730 N/mm depending on exact width and testing parameters), making it significantly stiffer than the native ACL. A quadrupled hamstring graft is even stiffer, typically around 800 N/mm.

Question 5782

Topic: Shoulder & Hip Sports

A 28-year-old female presents with lateral 'snapping' of the hip when walking and ascending stairs. The snap is palpable over the greater trochanter and reproduced when moving the hip from flexion to extension. A diagnosis of external snapping hip syndrome is made. If conservative management fails, surgical release of which structure is most indicated?

. Iliopsoas tendon
. Iliotibial (IT) band
. Rectus femoris
. Gluteus medius tendon
. Ligamentum teres

Correct Answer & Explanation

. Iliotibial (IT) band

Explanation

External snapping hip (coxa saltans externa) is caused by the iliotibial (IT) band or the anterior border of the gluteus maximus snapping over the greater trochanter during hip flexion and extension. Internal snapping hip is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head.

Question 5783

Topic: Knee Sports

A 15-year-old male presents with chronic knee pain. MRI reveals a stable Osteochondritis Dissecans (OCD) lesion of the knee. Which of the following anatomic locations is the classic and most common site for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Central weight-bearing surface of the lateral femoral condyle
. Posterior aspect of the lateral tibial plateau
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic 'LAME': Lateral Aspect Medial Epicondyle/Condyle). It accounts for approximately 70-80% of knee OCD lesions.

Question 5784

Topic: 5. Sports Medicine

A 40-year-old active female undergoes hip arthroscopy for labral repair. Postoperatively, she reports numbness in the perineal region and labia majora. Which of the following intraoperative factors is most highly associated with this complication?

. Use of an undersized perineal post
. Application of traction force exceeding 150 lbs
. Traction time exceeding 2 hours
. Fluid extravasation into the retroperitoneal space
. Placement of the anterolateral portal too close to the ASIS

Correct Answer & Explanation

. Traction time exceeding 2 hours

Explanation

Pudendal neuropraxia is a known complication of hip arthroscopy, typically resulting from compression against the perineal post during traction. The risk significantly increases with prolonged traction time (generally recommended to be kept under 2 hours or completely released if longer time is needed) and the use of an oversized or unpadded perineal post.

Question 5785

Topic: Shoulder & Hip Sports

A 22-year-old football player presents with recurrent anterior shoulder instability. A 3D CT scan demonstrates a bipolar bone loss pattern with a Hill-Sachs lesion. Applying the 'glenoid track' concept, an 'off-track' lesion is defined by which of the following criteria?

. The Hill-Sachs interval is less than the glenoid track width
. The Hill-Sachs interval is greater than the glenoid track width
. The articular margin bone loss is exactly 21% of the total glenoid width
. The glenoid track width exceeds the humeral head radius
. The intact anterior glenoid spans more than 85% of the native glenoid

Correct Answer & Explanation

. The Hill-Sachs interval is greater than the glenoid track width

Explanation

An 'off-track' lesion occurs when the Hill-Sachs interval (the width of the Hill-Sachs lesion plus the intact bony bridge) is greater than the glenoid track. The glenoid track is calculated as 83% of the native glenoid width minus the anterior glenoid bone loss. Off-track lesions engage during abduction and external rotation, indicating a need for procedures like a Latarjet or remplissage.

Question 5786

Topic: Shoulder & Hip Sports

A 31-year-old volleyball player presents with deep posterior shoulder pain. MRI arthrogram reveals a posterior labral tear with an associated large paralabral cyst extending into the spinoglenoid notch. Clinically, this patient is most likely to exhibit which of the following isolated motor deficits?

. Weakness in both abduction and external rotation
. Isolated weakness in internal rotation
. Isolated weakness in external rotation
. Sensory deficit over the lateral deltoid
. Weakness in forward elevation only

Correct Answer & Explanation

. Isolated weakness in external rotation

Explanation

The suprascapular nerve innervates the supraspinatus muscle before passing through the spinoglenoid notch. A cyst located strictly at the spinoglenoid notch will compress the nerve distally, causing denervation exclusively to the infraspinatus. This results in isolated weakness in external rotation, while abduction (supraspinatus) remains intact.

Question 5787

Topic: Shoulder & Hip Sports

A 30-year-old male weightlifter hears a 'pop' and experiences sudden sharp pain in his chest while bench pressing. Examination reveals a loss of the normal anterior axillary fold contour. Intraoperatively, the sternoclavicular head of the pectoralis major is found to be avulsed. What is the normal anatomic insertion of this specific head?

. Medial lip of the intertubercular groove, superficial to the clavicular head
. Lateral lip of the intertubercular groove, deep to the clavicular head
. Lesser tuberosity, superficial to the subscapularis
. Coracoid process, deep to the short head of the biceps
. Greater tuberosity, posterior to the supraspinatus

Correct Answer & Explanation

. Lateral lip of the intertubercular groove, deep to the clavicular head

Explanation

The pectoralis major inserts onto the lateral lip of the bicipital (intertubercular) groove. The tendon twists 180 degrees such that the sternoclavicular head inserts deep (posterior) and proximal to the clavicular head. It is the sternoclavicular head that is most frequently ruptured during eccentric loading (e.g., bench press).

Question 5788

Topic: Shoulder & Hip Sports

A 40-year-old male experiences a seizure and subsequently presents with a locked posterior shoulder dislocation. Imaging reveals a 30% anterior articular surface defect (reverse Hill-Sachs lesion). Which of the following surgical procedures is most appropriate to prevent recurrent engagement of this specific defect?

. Closed reduction and external rotation bracing for 6 weeks
. Transfer of the lesser tuberosity into the articular defect (Modified McLaughlin)
. Transfer of the greater tuberosity into the articular defect
. Latarjet procedure with coracoid transfer to the posterior glenoid
. Arthroscopic remplissage of the posterior defect with the infraspinatus

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the articular defect (Modified McLaughlin)

Explanation

For a locked posterior dislocation with an anteromedial humeral head defect (reverse Hill-Sachs or McLaughlin lesion) involving between 20% and 40% of the articular surface, the modified McLaughlin procedure is indicated. This involves transferring the lesser tuberosity (with its attached subscapularis) into the defect to restore stability. The classic McLaughlin involves only the subscapularis tendon.

Question 5789

Topic: Shoulder & Hip Sports

A 42-year-old man presents with acute, severe, unrelenting right shoulder pain that began 3 weeks ago without any antecedent trauma. The pain lasted for 10 days and has since significantly improved, but he now notices profound weakness when trying to elevate his arm or externally rotate it. Physical examination reveals prominent atrophy of the supraspinatus and infraspinatus fossae. MRI of the shoulder reveals no rotator cuff tears, but shows diffuse T2 hyperintensity and edema within the supraspinatus and infraspinatus muscles. What is the most likely diagnosis?

. Cervical radiculopathy (C5-C6)
. Parsonage-Turner syndrome (Neuralgic amyotrophy)
. Massive acute rotator cuff tear
. Quadrilateral space syndrome
. Suprascapular nerve entrapment at the spinoglenoid notch

Correct Answer & Explanation

. Parsonage-Turner syndrome (Neuralgic amyotrophy)

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) typically presents with an acute phase of severe shoulder girdle pain followed days to weeks later by painless weakness and muscle atrophy. The suprascapular nerve and anterior interosseous nerve are most commonly affected. MRI will show neurogenic edema (T2 hyperintensity) in the acutely denervated muscles without a structural tendon tear. Spinoglenoid notch entrapment would spare the supraspinatus.

Question 5790

Topic: 5. Sports Medicine

A 60-year-old active laborer presents with a massive, retracted, and irreparable posterosuperior rotator cuff tear. He has significant weakness in external rotation and a positive external rotation lag sign, but intact anterior elevation. He wishes to avoid arthroplasty. Which of the following tendon transfers is biomechanically superior for restoring active external rotation and closely replicates the force vector of the infraspinatus?

. Latissimus dorsi transfer
. Pectoralis major transfer
. Lower trapezius transfer
. Levator scapulae transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

The lower trapezius transfer (often augmented with an Achilles tendon allograft) has gained popularity for massive irreparable posterosuperior cuff tears. Biomechanically, the lower trapezius vector matches the line of pull of the infraspinatus much more closely than the latissimus dorsi, making it superior for restoring active external rotation and minimizing out-of-phase muscle retraining.

Question 5791

Topic: Shoulder & Hip Sports

A 27-year-old professional volleyball attacker complains of subtle posterior shoulder pain and a subjective decrease in hitting power. Physical exam reveals normal active elevation, 5/5 strength in shoulder abduction, but notable weakness (3/5) in external rotation with the arm at the side. MRI of the shoulder is ordered. Based on the physical exam findings, where is the isolated neural compression most likely located, and what is the classic associated pathologic finding?

. Suprascapular notch; benign lipoma
. Spinoglenoid notch; paralabral cyst
. Quadrilateral space; fibrous band
. Spinoglenoid notch; enlarged circumflex scapular artery
. Suprascapular notch; paralabral cyst

Correct Answer & Explanation

. Spinoglenoid notch; paralabral cyst

Explanation

The patient exhibits isolated weakness in external rotation (infraspinatus) with preserved abduction (supraspinatus). This indicates suprascapular nerve entrapment distal to the branches supplying the supraspinatus, specifically at the spinoglenoid notch. In overhead athletes, this is classically associated with a paralabral cyst extending from a posterior superior labral tear (SLAP lesion).

Question 5792

Topic: Shoulder & Hip Sports

A 29-year-old elite volleyball player presents with insidious onset of shoulder weakness. Physical examination reveals isolated atrophy of the infraspinatus fossa with normal bulk of the supraspinatus. Weakness is noted in external rotation. An MRI demonstrates a paralabral cyst. Where is the cyst most likely located, and what is the typical associated labral pathology?

. Suprascapular notch; associated with an anterior labral tear
. Suprascapular notch; associated with a superior labral anterior-to-posterior (SLAP) tear
. Spinoglenoid notch; associated with an anterior labral tear
. Spinoglenoid notch; associated with a posterior labral tear
. Quadrilateral space; associated with an inferior labral tear

Correct Answer & Explanation

. Spinoglenoid notch; associated with a posterior labral tear

Explanation

Isolated infraspinatus atrophy indicates compression of the suprascapular nerve distal to the innervation of the supraspinatus, which occurs at the spinoglenoid notch. Paralabral cysts in the spinoglenoid notch are classically associated with posterior or posterosuperior labral tears. Fluid is pumped through the labral defect into the notch, forming a cyst that compresses the suprascapular nerve.

Question 5793

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is transferred to the anterior glenoid neck. Postoperatively, the patient is unable to actively flex his elbow and reports decreased sensation over the lateral forearm. Which of the following surgical steps posed the greatest risk to the injured structure?

. Inferior capsular release at the 6 o'clock position
. Vigorous medial retraction of the conjoint tendon
. Insertion of the superior fixation screw into the glenoid
. Splitting of the subscapularis muscle belly
. Osteotomy of the coracoid process base

Correct Answer & Explanation

. Vigorous medial retraction of the conjoint tendon

Explanation

The patient has a musculocutaneous nerve injury (loss of biceps/brachialis motor function and lateral antebrachial cutaneous sensation). The musculocutaneous nerve enters the deep surface of the coracobrachialis (part of the conjoint tendon) approximately 5-8 cm distal to the coracoid tip. Vigorous medial or inferior retraction of the conjoint tendon during the Latarjet procedure places this nerve at high risk of a traction neuropraxia.

Question 5794

Topic: Shoulder & Hip Sports

A 22-year-old male with recurrent anterior shoulder dislocations undergoes arthroscopic stabilization. Imaging reveals 20% glenoid bone loss and an engaging Hill-Sachs lesion. The surgeon performs a Bankart repair and a Remplissage procedure. Which anatomic structure is tenodesed into the Hill-Sachs defect, and what clinical restriction is most commonly observed postoperatively?

. Subscapularis; restricted internal rotation
. Infraspinatus; restricted external rotation
. Supraspinatus; restricted abduction
. Teres minor; restricted internal rotation
. Long head of the biceps; restricted forward elevation

Correct Answer & Explanation

. Infraspinatus; restricted external rotation

Explanation

The Remplissage procedure involves capsulotenodesis of the posterior capsule and the infraspinatus tendon into the Hill-Sachs defect. This effectively makes the defect extra-articular and prevents it from engaging the anterior glenoid rim. Because the posterior structures are tethered, the most common postoperative restriction is a mild to moderate decrease in external rotation.

Question 5795

Topic: Shoulder & Hip Sports

A 28-year-old offensive lineman presents with vague posterior shoulder pain that worsens during blocking maneuvers. The surgeon performs a Kim test to evaluate for a posterior labral tear. Which of the following accurately describes the correct execution of the Kim test?

. Patient supine, arm in 90 degrees abduction and max external rotation, anterior translation force applied
. Patient seated, arm in 90 degrees abduction, axial load applied while elevating arm diagonally upward with a posterior/downward force
. Patient seated, arm in 90 degrees flexion and internal rotation, direct posterior force applied to the olecranon
. Patient standing, arm at side in neutral rotation, resisted internal rotation to elicit pain
. Patient supine, arm in 150 degrees of elevation, inferior traction applied to the humerus

Correct Answer & Explanation

. Patient seated, arm in 90 degrees abduction, axial load applied while elevating arm diagonally upward with a posterior/downward force

Explanation

The Kim test evaluates for a posteroinferior labral tear. With the patient seated, the examiner holds the patient's elbow and the lateral aspect of the proximal humerus. The arm is abducted to 90 degrees, and a strong axial load is applied. The arm is then elevated 45 degrees diagonally upward while the examiner simultaneously applies a downward and posterior force to the proximal humerus. A sudden onset of posterior shoulder pain implies a posteroinferior labral tear.

Question 5796

Topic: Shoulder & Hip Sports

A professional baseball pitcher presents with vague posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals an internal rotation deficit of 25 degrees compared to the non-dominant shoulder, while external rotation is increased by 10 degrees. Which of the following pathomechanical processes is most directly responsible for this glenohumeral internal rotation deficit (GIRD)?

. Anterosuperior capsular laxity
. Posteroinferior capsular contracture
. Hypertrophy of the subscapularis tendon
. Congenital glenoid retroversion
. Coracohumeral ligament contracture

Correct Answer & Explanation

. Posteroinferior capsular contracture

Explanation

Glenohumeral internal rotation deficit (GIRD) in overhead throwers is primarily driven by contracture and thickening of the posteroinferior capsule. This contracture shifts the glenohumeral contact point posterosuperiorly during the late cocking phase (abduction and maximal external rotation), leading to increased shear stress on the superior labrum (peel-back mechanism) and internal impingement of the articular-sided rotator cuff against the posterosuperior glenoid.

Question 5797

Topic: Shoulder & Hip Sports

A 32-year-old elite volleyball player presents with progressive, isolated weakness in external rotation of the shoulder. He denies any acute trauma but reports deep posterior shoulder pain. Clinical examination reveals profound atrophy of the infraspinatus fossa but normal bulk and strength of the supraspinatus. Which of the following intra-articular pathologies is most commonly associated with this specific nerve entrapment syndrome?

. Anterior Bankart lesion
. Type II SLAP tear
. Posterior labral tear
. Articular-sided partial supraspinatus tear
. Subscapularis tendon rupture

Correct Answer & Explanation

. Posterior labral tear

Explanation

Isolated infraspinatus weakness with atrophy suggests compression of the suprascapular nerve at the spinoglenoid notch (after it has already supplied motor branches to the supraspinatus). The most common cause in an overhead athlete is a paralabral ganglion cyst. These cysts are highly associated with posterior or posterosuperior labral tears, which act as a one-way valve allowing synovial fluid to form the cyst in the spinoglenoid notch.

Question 5798

Topic: Shoulder & Hip Sports

A patient presents with poorly localized shoulder pain and paresthesias over the lateral deltoid that worsen when the arm is abducted and externally rotated. An MRI reveals fibrous bands compressing structures within the quadrilateral space. Which of the following correctly defines the anatomic borders of the quadrilateral space?

. Superior: Teres major; Inferior: Teres minor; Medial: Long head of triceps; Lateral: Humeral shaft
. Superior: Teres minor; Inferior: Teres major; Medial: Long head of triceps; Lateral: Humeral shaft
. Superior: Teres minor; Inferior: Teres major; Medial: Humeral shaft; Lateral: Long head of triceps
. Superior: Infraspinatus; Inferior: Teres minor; Medial: Short head of biceps; Lateral: Humeral shaft
. Superior: Teres major; Inferior: Latissimus dorsi; Medial: Long head of triceps; Lateral: Coracobrachialis

Correct Answer & Explanation

. Superior: Teres minor; Inferior: Teres major; Medial: Long head of triceps; Lateral: Humeral shaft

Explanation

The boundaries of the quadrilateral space are the teres minor (superiorly), teres major (inferiorly), the long head of the triceps (medially), and the surgical neck of the humerus (laterally). Quadrilateral space syndrome results from compression of the axillary nerve and the posterior humeral circumflex artery within this space, often by anomalous fibrous bands.

Question 5799

Topic: Shoulder & Hip Sports

A 65-year-old sedentary male with a massive, irreparable rotator cuff tear and severe biceps tendinopathy is scheduled for surgery.

The surgeon discusses performing a biceps tenotomy versus a biceps tenodesis. According to highest-level current evidence (systematic reviews and meta-analyses), what is the primary expected difference in clinical outcome between these two procedures in this demographic?

. Tenotomy results in significantly lower objective functional scores (e.g., Constant score)
. Tenodesis significantly increases the risk of chronic regional pain syndrome
. Tenotomy has a higher rate of cosmetic 'Popeye' deformity and subjective muscle cramping
. Tenodesis provides a substantially faster return to baseline activities of daily living
. There is no difference in the rate of cosmetic deformity, but tenodesis provides superior supination strength

Correct Answer & Explanation

. Tenotomy has a higher rate of cosmetic 'Popeye' deformity and subjective muscle cramping

Explanation

Current evidence demonstrates no significant difference in objective functional shoulder scores (Constant, ASES) or objective strength between biceps tenotomy and tenodesis, particularly in older, less active patients. However, tenotomy is consistently associated with a higher incidence of cosmetic 'Popeye' deformity (up to 20-30%) and subjective biceps cramping compared to tenodesis. Tenodesis requires slightly longer operative/rehab time but lowers the risk of deformity.

Question 5800

Topic: Shoulder & Hip Sports

A 21-year-old collegiate javelin thrower presents with chronic posterior shoulder pain.

His pain is highly localized to the late cocking phase of his throwing motion. Arthroscopic evaluation reveals fraying of the posterosuperior labrum and an articular-sided, partial-thickness tear of the posterior supraspinatus and anterior infraspinatus tendons. Which of the following best describes the exact mechanism of 'internal impingement' occurring in this athlete?

. Abutment of the lesser tuberosity against the coracoid process during maximal internal rotation
. Compression of the supraspinatus tendon between the greater tuberosity and the acromion
. Pinching of the articular surface of the rotator cuff between the greater tuberosity and the posterosuperior glenoid labrum
. Entrapment of the long head of the biceps tendon within the bicipital groove
. Friction of the subscapularis tendon over a prominent lesser tuberosity

Correct Answer & Explanation

. Pinching of the articular surface of the rotator cuff between the greater tuberosity and the posterosuperior glenoid labrum

Explanation

Internal impingement is a pathologic condition seen almost exclusively in overhead athletes during the late cocking phase of throwing (extreme abduction and external rotation). In this position, the greater tuberosity rotates posteriorly and abuts against the posterosuperior glenoid labrum. This pinches the articular-sided fibers of the supraspinatus and infraspinatus tendons between the bone and the labrum, leading to 'kissing lesions': articular-sided rotator cuff tears and posterosuperior labral fraying/tearing.

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