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5. Sports Medicine MCQs

Practice Set 291 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 5801

Topic: Shoulder & Hip Sports

A 35-year-old overhead athlete presents with painless weakness in external rotation of the shoulder. Examination reveals atrophy isolated to the infraspinatus fossa. MRI demonstrates a paralabral cyst. At which of the following anatomic locations is the nerve compression most likely occurring?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Spiral groove
. Cubital tunnel

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

A paralabral cyst at the spinoglenoid notch compresses the suprascapular nerve after it has innervated the supraspinatus. This results in isolated infraspinatus atrophy and isolated weakness in external rotation without affecting the supraspinatus.

Question 5802

Topic: Shoulder & Hip Sports

A 60-year-old male with a massive, irreparable posterosuperior rotator cuff tear and intact subscapularis undergoes a latissimus dorsi tendon transfer. During harvest, the primary neurovascular pedicle must be protected. What is the major arterial supply to the latissimus dorsi muscle?

. Transverse cervical artery
. Subscapular artery
. Thoracodorsal artery
. Lateral thoracic artery
. Posterior circumflex humeral artery

Correct Answer & Explanation

. Thoracodorsal artery

Explanation

The primary blood supply to the latissimus dorsi is the thoracodorsal artery, which is a terminal branch of the subscapular artery. Protecting this pedicle and the accompanying thoracodorsal nerve is critical during mobilization for the transfer.

Question 5803

Topic: Shoulder & Hip Sports

A 42-year-old man presents with anterior shoulder pain after a fall. On examination, the examiner places the patient's palm on his contralateral shoulder and attempts to lift the hand off the shoulder while the patient resists. Which specific portion of the rotator cuff is best isolated by this test?

. Superior subscapularis
. Inferior subscapularis
. Supraspinatus
. Infraspinatus
. Teres minor

Correct Answer & Explanation

. Superior subscapularis

Explanation

This describes the 'Bear Hug' test, which has been shown to be highly sensitive and specific for identifying tears of the superior portion of the subscapularis. The lift-off test is generally more specific for evaluating the inferior portion of the subscapularis.

Question 5804

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes a biological process known as 'ligamentization.' At which post-operative time frame is the graft mechanically at its weakest due to active remodeling and necrosis?

. 1-2 weeks
. 6-12 weeks
. 4-6 months
. 9-12 months
. 18-24 months

Correct Answer & Explanation

. 6-12 weeks

Explanation

The ligamentization process includes phases of necrosis, revascularization, cellular repopulation, and remodeling. The graft is mechanically at its weakest during the revascularization and early remodeling phase, which typically peaks between 6 and 12 weeks post-operatively. This is a critical period where aggressive rehabilitation can stretch or fail the graft.

Question 5805

Topic: Knee Sports

A 45-year-old male sustains a posterior root tear of the medial meniscus.

Biomechanically, if this injury is left untreated, it alters knee contact pressures and kinematics most similarly to which of the following conditions?

. An ACL deficient knee
. A complete medial meniscectomy
. A longitudinal bucket-handle tear
. A radial tear of the anterior horn
. An isolated medial collateral ligament (MCL) rupture

Correct Answer & Explanation

. A complete medial meniscectomy

Explanation

The meniscal roots are essential for anchoring the meniscus and converting axial loads into circumferential 'hoop' stresses. A complete radial tear at the posterior root completely disrupts this ability to contain hoop stresses, causing the meniscus to extrude. Biomechanical studies have shown that the contact pressures in a knee with a medial meniscus root tear are nearly identical to those of a knee that has undergone a complete medial meniscectomy.

Question 5806

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft

. Postoperatively, she reports a localized area of numbness on the anterior/anterolateral aspect of her proximal leg. Injury to which nerve during graft harvest is responsible for this finding?

. Lateral femoral cutaneous nerve
. Infrapatellar branch of the saphenous nerve
. Sural nerve
. Medial femoral cutaneous nerve
. Deep fibular nerve

Correct Answer & Explanation

. Infrapatellar branch of the saphenous nerve

Explanation

The infrapatellar branch of the saphenous nerve crosses the proximal anterior tibia from medial to lateral. It is highly susceptible to iatrogenic injury during the anterior longitudinal incision used for harvesting a central third bone-patellar tendon-bone autograft. Injury results in numbness over the anterior and lateral aspect of the knee and proximal leg.

Question 5807

Topic: 5. Sports Medicine

A 17-year-old female soccer player sustains a non-contact pivoting injury to her knee, diagnosed as an anterior cruciate ligament (ACL) tear.

Which of the following is considered the most significant modifiable risk factor for ACL tears in female athletes?

. Intercondylar notch width
. Neuromuscular control and landing mechanics
. Hormonal fluctuations during the menstrual cycle
. Generalized ligamentous laxity
. Q-angle

Correct Answer & Explanation

. Neuromuscular control and landing mechanics

Explanation

Poor neuromuscular control, specifically valgus collapse and stiff-legged landing mechanics, is the most significant modifiable risk factor for non-contact ACL injuries. Injury prevention programs specifically target these biomechanical deficits.

Question 5808

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of the anteromedial (AM) and posterolateral (PL) bundles. During which knee position is the PL bundle most tight?

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

Correct Answer & Explanation

. Full extension

Explanation

The posterolateral (PL) bundle of the ACL is tightest in full extension and primarily controls rotatory stability. The anteromedial (AM) bundle is tightest in flexion and primarily controls anterior translation.

Question 5809

Topic: Shoulder & Hip Sports

A 22-year-old male athlete sustains an anterior shoulder dislocation. An MRI reveals an avulsion of the anterior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL) from the glenoid rim. What is the eponym for this specific lesion?

. Hill-Sachs lesion
. ALPSA lesion
. SLAP lesion
. Bankart lesion
. HAGL lesion

Correct Answer & Explanation

. Bankart lesion

Explanation

A Bankart lesion is defined as an avulsion of the anterior-inferior labrum and the attached inferior glenohumeral ligament complex from the anterior glenoid rim. It is the most common "essential lesion" in traumatic anterior shoulder instability.

Question 5810

Topic: Shoulder & Hip Sports

According to modern quantitative perfusion studies, which vascular structure provides the predominant blood supply to the humeral head, and via which anatomical pathway does it enter?

. Anterior circumflex humeral artery via the bicipital groove
. Posterior circumflex humeral artery via the posterior and inferior capsule
. Profunda brachii artery via the spiral groove
. Suprascapular artery via the superior rotator cuff insertion
. Thoracoacromial artery via the clavipectoral fascia

Correct Answer & Explanation

. Posterior circumflex humeral artery via the posterior and inferior capsule

Explanation

Recent studies (e.g., Hettrich et al.) demonstrated that the posterior circumflex humeral artery provides approximately 64% of the blood supply to the humeral head, entering via the posterior capsule, overriding the historical emphasis on the arcuate branch of the anterior circumflex.

Question 5811

Topic: Shoulder & Hip Sports

During a deltopectoral approach for open reduction and internal fixation of a proximal humerus fracture, the surgeon encounters the 'three sisters'. These structures consist of two venae comitantes and which of the following arteries?

. Thoracoacromial artery
. Posterior circumflex humeral artery
. Anterior circumflex humeral artery
. Acromial branch of the suprascapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Anterior circumflex humeral artery

Explanation

The 'three sisters' refer to the anterior circumflex humeral artery and its two accompanying veins. They are consistently found running transversely across the inferior border of the subscapularis muscle and often require ligation to mobilize the subscapularis.

Question 5812

Topic: Shoulder & Hip Sports

In a displaced surgical neck fracture of the humerus, the proximal shaft is typically displaced anteromedially. Which muscle is the primary deforming force responsible for this specific displacement?

. Deltoid
. Latissimus dorsi
. Pectoralis major
. Subscapularis
. Biceps brachii

Correct Answer & Explanation

. Pectoralis major

Explanation

In surgical neck fractures, the pectoralis major acts as the primary deforming force on the humeral shaft, pulling it medially and anteriorly. Meanwhile, the proximal fragment remains neutral or abducted due to the balanced pull of the rotator cuff muscles.

Question 5813

Topic: Shoulder & Hip Sports

An 80-year-old female presents with an anterior shoulder dislocation and an expanding axillary hematoma. A traction injury to the axillary artery is suspected. The axillary artery is formally divided into three distinct anatomical parts by which of the following structures?

. Pectoralis major
. Pectoralis minor
. Teres major
. Subscapularis
. Clavicle

Correct Answer & Explanation

. Pectoralis minor

Explanation

The axillary artery is anatomically divided into three segments based on its relationship to the pectoralis minor muscle. The first part is medial, the second part lies posterior, and the third part lies lateral to the pectoralis minor.

Question 5814

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to his knee. He reports immediate pain, swelling, and a 'pop.' On examination, there is a positive Lachman test and pivot shift test. Which of the following associated injuries is most commonly missed on initial MRI or requires arthroscopic evaluation for definitive diagnosis?

. Medial collateral ligament tear
. Lateral meniscus tear
. Articular cartilage injury
. Posterior cruciate ligament tear
. Posterolateral corner injury

Correct Answer & Explanation

. Articular cartilage injury

Explanation

While MCL tears and meniscal tears (especially lateral) are common with ACL injuries, significant articular cartilage injuries (osteochondral fractures or chondral delamination) are frequently associated with acute ACL ruptures due to the valgus-external rotation or internal rotation impaction mechanisms. These can be difficult to fully appreciate on initial MRI and may only be definitively diagnosed during arthroscopy, often contributing to long-term issues if not addressed. PCL and PLC injuries are distinct and usually evident.

Question 5815

Topic: Knee Sports

Which of the following ligaments is the primary static stabilizer preventing anterior translation of the tibia on the femur?

. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Anterior cruciate ligament
. Meniscofemoral ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The Anterior Cruciate Ligament (ACL) is the primary static stabilizer preventing anterior translation of the tibia on the femur. The Posterior Cruciate Ligament (PCL) prevents posterior translation. The Medial Collateral Ligament (MCL) resists valgus stress, and the Lateral Collateral Ligament (LCL) resists varus stress. The meniscofemoral ligament (Humphry and Wrisberg ligaments) are secondary stabilizers and attachments to the menisci.

Question 5816

Topic: Shoulder & Hip Sports

Which of the following is the most sensitive test for subacromial impingement syndrome?

. Cross-body adduction test
. Speed's test
. Hawkins-Kennedy test
. Empty Can test
. Drop arm test

Correct Answer & Explanation

. Hawkins-Kennedy test

Explanation

The Hawkins-Kennedy test is considered one of the most sensitive tests for subacromial impingement syndrome. It involves internally rotating the arm with the shoulder flexed to 90 degrees and the elbow flexed to 90 degrees, which causes the supraspinatus tendon to impinge under the coracoacromial arch. The Empty Can test and Drop Arm test are more specific for rotator cuff tears, particularly the supraspinatus. Speed's test is for biceps pathology. Cross-body adduction test is for AC joint pathology.

Question 5817

Topic: Shoulder & Hip Sports

Which muscle is primarily responsible for the initiation of shoulder abduction in the first 15-30 degrees?

. Deltoid
. Pectoralis major
. Latissimus dorsi
. Supraspinatus
. Teres major

Correct Answer & Explanation

. Supraspinatus

Explanation

The supraspinatus muscle is primarily responsible for initiating shoulder abduction (first 15-30 degrees) before the deltoid muscle takes over for the remainder of the range. The deltoid is a powerful abductor but is less efficient at initiation. Pectoralis major and latissimus dorsi are adductors and internal rotators. Teres major is an adductor and internal rotator.

Question 5818

Topic: Knee Sports

A 28-year-old professional athlete sustains an acute knee injury while pivoting during a basketball game, hearing a "pop." He experiences immediate pain and swelling. On examination, a positive Lachman test and pivot shift test are present. Radiographs are normal. What is the MOST likely diagnosis?

. Meniscal tear
. Patellar dislocation
. Medial collateral ligament (MCL) sprain
. Anterior cruciate ligament (ACL) rupture
. Posterior cruciate ligament (PCL) rupture

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) rupture

Explanation

The classic triad of an acute knee injury involving a 'pop,' immediate swelling (hemarthrosis), and positive Lachman and pivot shift tests is highly indicative of an Anterior Cruciate Ligament (ACL) rupture. Meniscal tears cause mechanical symptoms but less immediate swelling unless associated with ACL. Patellar dislocation is usually obvious with patellar displacement. MCL sprains typically present with valgus instability. PCL ruptures manifest with a positive posterior drawer test and sag sign.

Question 5819

Topic: Knee Sports

A 25-year-old female presents with recurrent anterior knee pain, particularly with stair climbing and prolonged sitting. Physical examination reveals tenderness along the medial patellar facet and a positive patellar apprehension test. What is the MOST likely diagnosis?

. Meniscal tear
. ACL tear
. Patellar tendonitis
. Patellofemoral pain syndrome
. Osteochondritis dissecans

Correct Answer & Explanation

. Patellofemoral pain syndrome

Explanation

Recurrent anterior knee pain, exacerbated by stair climbing, prolonged sitting ('theater sign'), and tenderness along the patellar facets, particularly with a positive patellar apprehension test (indicating patellar instability), is classic for patellofemoral pain syndrome, or patellar instability if the apprehension is severe. Meniscal and ACL tears present differently with mechanical or instability symptoms. Patellar tendonitis is pain at the inferior patellar pole. Osteochondritis dissecans is less common and localized bone/cartilage lesion.

Question 5820

Topic: Shoulder & Hip Sports

Which rotator cuff muscle is primarily responsible for internal rotation of the shoulder?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Subscapularis

Explanation

The subscapularis muscle is the primary internal rotator of the shoulder and is one of the four rotator cuff muscles. The supraspinatus is responsible for abduction. The infraspinatus and teres minor are external rotators. The deltoid is a major abductor and flexor/extensor, but not a rotator cuff muscle.

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