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5. Sports Medicine MCQs

Practice Set 300 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 5981

Topic: Knee Sports

A 25-year-old male presents with chronic ankle pain. MRI reveals an anterolateral osteochondral lesion of the talus (OLT) measuring 1.1 cm squared. He has failed 6 months of conservative management. What is the most appropriate primary surgical treatment?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS)
. Autologous chondrocyte implantation (ACI)
. Open internal fixation of the fragment
. Subtalar arthrodesis

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, non-cystic osteochondral lesions of the talus smaller than 1.5 cm squared, arthroscopic bone marrow stimulation (microfracture) is the first-line surgical treatment. Larger or previously failed lesions often require structural grafting like OATS.

Question 5982

Topic: 5. Sports Medicine

A 24-year-old professional athlete hyperextends his great toe on artificial turf. MRI confirms a Grade 3 turf toe injury with proximal migration of the sesamoids. Complete disruption of which structure is characteristic of this grade of injury?

. Extensor hallucis brevis
. Adductor hallucis
. Plantar plate and capsuloligamentous complex
. Abductor hallucis
. Medial collateral ligament of the MTP joint

Correct Answer & Explanation

. Extensor hallucis brevis

Explanation

Turf toe is a forced hyperextension injury of the first MTP joint. A Grade 3 injury involves a complete tear of the plantar plate and the capsuloligamentous complex, which causes the sesamoids to retract proximally.

Question 5983

Topic: 5. Sports Medicine

A 22-year-old athlete sustains a dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint of the middle finger, involving 45% of the volar articular base of the middle phalanx. The joint is highly unstable to extension block splinting. What is the most appropriate surgical management for this injury?

. Buddy taping and early active motion
. Dynamic external fixation alone
. Hemi-hamate autograft arthroplasty
. Proximal interphalangeal joint arthrodesis
. Corrective osteotomy of the proximal phalanx

Correct Answer & Explanation

. Buddy taping and early active motion

Explanation

For acute or chronic PIP joint dorsal fracture-dislocations involving >40% of the volar articular surface where the joint remains unstable, a hemi-hamate autograft is the preferred treatment. It perfectly reconstructs the cupped contour of the middle phalanx base, restoring stability and allowing for early mobilization.

Question 5984

Topic: Knee Sports

A sagittal MRI of the knee is obtained to evaluate a suspected multi-ligamentous injury.

Which of the following best describes the femoral origin and tibial insertion of the anteromedial (AM) bundle of the anterior cruciate ligament (ACL)?

. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts anteromedially on the tibial footprint
. Originates distal and anterior on the medial aspect of the lateral femoral condyle; inserts posterolaterally on the tibial footprint
. Originates on the lateral wall of the medial femoral condyle; inserts anteromedially on the tibial footprint
. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts posterolaterally on the tibial footprint
. Originates distal and posterior on the lateral wall of the medial femoral condyle; inserts centrally on the tibial footprint

Correct Answer & Explanation

. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts anteromedially on the tibial footprint

Explanation

The ACL has two distinct functional bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle originates more proximal and posterior on the medial wall of the lateral femoral condyle and inserts anteromedially on the tibial footprint. The AM bundle is tightest in flexion, whereas the PL bundle is tightest in extension.

Question 5985

Topic: Knee Sports

To anatomically reconstruct the posterolateral corner of the knee, understanding the spatial relationship on the lateral femoral epicondyle is critical. What is the relative position of the origin of the fibular collateral ligament (FCL) compared to the popliteus tendon insertion?

. FCL is anterior and inferior to the popliteus
. FCL is posterior and superior to the popliteus
. FCL is directly medial to the popliteus
. FCL is directly inferior to the popliteus
. FCL is anterior and superior to the popliteus

Correct Answer & Explanation

. FCL is anterior and inferior to the popliteus

Explanation

On the lateral aspect of the lateral femoral condyle, the origin of the fibular collateral ligament (LCL) is located proximal (superior) and posterior to the insertion footprint of the popliteus tendon. An easy way to remember this is that the popliteus is anterior and distal to the FCL origin.

Question 5986

Topic: Shoulder & Hip Sports

The coracoacromial arch is an important anatomical restraint that prevents superior translation of the humeral head and is often implicated in subacromial impingement syndrome. The coracoacromial ligament attaches to which two osseous structures?

. Coracoid process and greater tuberosity
. Coracoid process and lesser tuberosity
. Coracoid process and anterior undersurface of the acromion
. Acromion and distal clavicle
. Coracoid process and proximal clavicle

Correct Answer & Explanation

. Coracoid process and greater tuberosity

Explanation

The coracoacromial ligament forms the roof of the subacromial space. It attaches medially to the lateral border of the coracoid process and laterally to the anterior undersurface of the acromion. Thickening of this ligament or acromial osteophytes can lead to impingement of the underlying rotator cuff.

Question 5987

Topic: Shoulder & Hip Sports

When reviewing an MRI for a patient with suprascapular neuropathy, a cyst is identified at the spinoglenoid notch. Which of the following clinical findings is most likely associated with compression at this specific anatomical location?

. Isolated weakness in external rotation
. Weakness in both internal and external rotation
. Isolated weakness in arm abduction
. Weakness in arm abduction and external rotation
. Loss of sensation over the lateral deltoid

Correct Answer & Explanation

. Isolated weakness in external rotation

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. A cyst exclusively at the spinoglenoid notch causes isolated infraspinatus weakness.

Question 5988

Topic: Shoulder & Hip Sports

A 24-year-old overhead athlete presents with painless weakness of external shoulder rotation. MRI demonstrates a paralabral cyst causing compression at the spinoglenoid notch. Which of the following represents the expected clinical and anatomical findings?

. Isolated atrophy of the infraspinatus with intact sensation
. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the teres minor with numbness over the lateral deltoid
. Atrophy of the supraspinatus with preserved infraspinatus function
. Weakness of external rotation with sensory loss over the posterior scapula

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus with intact sensation

Explanation

The suprascapular nerve gives off its motor branch to the supraspinatus before passing through the spinoglenoid notch. Compression at the spinoglenoid notch therefore causes isolated infraspinatus weakness and atrophy, without sensory deficits.

Question 5989

Topic: Knee Sports

A coronal MRI of the knee is reviewed prior to posterolateral corner reconstruction.

What is the precise femoral attachment site of the fibular collateral ligament (FCL) relative to the popliteus tendon insertion?

. Proximal and posterior
. Distal and anterior
. Proximal and anterior
. Distal and posterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the fibular collateral ligament (FCL) attaches proximal and posterior to the insertion of the popliteus tendon. This relationship is critical for anatomical reconstruction of the posterolateral corner.

Question 5990

Topic: Knee Sports

A sagittal MRI of the knee highlights the meniscofemoral ligaments originating from the posterior horn of the lateral meniscus.

The ligament of Wrisberg passes in what anatomical relationship to the posterior cruciate ligament (PCL)?

. Anterior to the PCL
. Posterior to the PCL
. Superior to the ACL
. Inferior to the lateral meniscus
. Medial to the MCL

Correct Answer & Explanation

. Anterior to the PCL

Explanation

The meniscofemoral ligaments attach the posterior horn of the lateral meniscus to the medial femoral condyle. The ligament of Humphrey passes anterior to the PCL, whereas the ligament of Wrisberg passes posterior to the PCL.

Question 5991

Topic: Knee Sports

Reviewing a sagittal MRI of the knee, the normal anatomy of the posterior cruciate ligament (PCL) is best visualized. Which bundle of the PCL becomes tightest as the knee goes into deep flexion?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of two primary bundles. The larger anterolateral bundle tightens in flexion, while the smaller posteromedial bundle tightens in extension.

Question 5992

Topic: 5. Sports Medicine

A 13-year-old elite baseball pitcher complains of insidious-onset shoulder pain during the cocking phase of throwing. Radiographs reveal widening and irregularity of the proximal humeral physis.

What is the most likely diagnosis?

. Coracoid apophysitis
. Osteochondritis dissecans of the humeral head
. Proximal humeral epiphysiolysis (Little League Shoulder)
. Glenoid labrum tear

Correct Answer & Explanation

. Coracoid apophysitis

Explanation

Little League Shoulder is an overuse injury causing proximal humeral epiphysiolysis. Radiographs classically show widening, demineralization, or sclerosis of the proximal humeral physis in adolescent throwing athletes.

Question 5993

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, understanding the exact anatomic footprint on the fibular head is crucial. What is the relationship of the lateral collateral ligament (LCL) footprint to the popliteofibular ligament (PFL) footprint on the fibular head?

. The LCL footprint is medial to the PFL footprint.
. The LCL footprint is anterior and distal to the PFL footprint.
. The LCL footprint is posterior and proximal to the PFL footprint.
. The PFL footprint is anterior and distal to the LCL footprint.
. They share the exact same footprint on the fibular styloid.

Correct Answer & Explanation

. The LCL footprint is medial to the PFL footprint.

Explanation

On the fibular head, the LCL inserts anteriorly and distally relative to the popliteofibular ligament (PFL) footprint. The PFL attaches to the posterior and medial aspect of the fibular styloid.

Question 5994

Topic: 5. Sports Medicine

A 45-year-old overhead athlete presents with posterior shoulder pain and selective weakness in external rotation. Abduction strength is intact. MRI reveals a paralabral cyst. In which anatomic location is the cyst most likely compressing the suprascapular nerve, and what are its borders?

. Suprascapular notch; compressed below the transverse scapular ligament.
. Spinoglenoid notch; compressed below the spinoglenoid ligament.
. Quadrangular space; bordered by teres minor and major.
. Triangular interval; compressed below the teres major.
. Spiral groove; compressed against the posterior humerus.

Correct Answer & Explanation

. Suprascapular notch; compressed below the transverse scapular ligament.

Explanation

Isolated weakness in external rotation (infraspinatus) with preserved abduction (supraspinatus) implies compression of the suprascapular nerve at the spinoglenoid notch, which is located distal to the motor branch supplying the supraspinatus. The spinoglenoid ligament spans this notch.

Question 5995

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of the anteromedial (AM) and posterolateral (PL) bundles. During biomechanical testing, which of the following accurately describes the tensioning pattern of these bundles?

. The AM bundle is tight in extension and controls rotatory stability; the PL bundle is tight in flexion and controls anterior translation.
. The AM bundle is tight in flexion and controls anterior translation; the PL bundle is tight in extension and controls rotatory stability.
. Both bundles are equally tight throughout the entire arc of motion.
. The AM bundle restrains posterior translation while the PL bundle restrains anterior translation.
. The AM and PL bundles cross each other in extension and uncoil in flexion.

Correct Answer & Explanation

. The AM bundle is tight in extension and controls rotatory stability; the PL bundle is tight in flexion and controls anterior translation.

Explanation

The ACL has two distinct bundles named for their tibial insertion sites. The anteromedial (AM) bundle is tightest in knee flexion and provides the primary restraint to anterior tibial translation. The posterolateral (PL) bundle is tightest in extension and provides the primary restraint to rotatory loads.

Question 5996

Topic: Shoulder & Hip Sports

During a posterior approach to the shoulder (Judson approach) for the treatment of a posterior glenoid fracture, the surgeon develops the primary internervous plane. Which of the following defines the muscles and their respective innervations that form this boundary?

. Supraspinatus (Suprascapular n.) and Infraspinatus (Suprascapular n.)
. Teres minor (Axillary n.) and Teres major (Lower subscapular n.)
. Infraspinatus (Suprascapular n.) and Teres minor (Axillary n.)
. Deltoid (Axillary n.) and Triceps (Radial n.)
. Teres major (Lower subscapular n.) and Latissimus dorsi (Thoracodorsal n.)

Correct Answer & Explanation

. Supraspinatus (Suprascapular n.) and Infraspinatus (Suprascapular n.)

Explanation

The classic posterior approach to the shoulder utilizes the internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). Retracting the infraspinatus superiorly and the teres minor inferiorly provides excellent access to the posterior shoulder joint capsule while respecting distinct nerve supplies.

Question 5997

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) of the knee, careful dissection must be carried out around the lateral collateral ligament (LCL). Which vascular structure courses horizontally and immediately deep to the LCL at the level of the joint line and must be protected?

. Superior lateral genicular artery
. Inferior lateral genicular artery
. Anterior tibial recurrent artery
. Descending branch of the lateral circumflex femoral artery
. Popliteal artery

Correct Answer & Explanation

. Superior lateral genicular artery

Explanation

The inferior lateral genicular artery courses horizontally along the joint line, lying deep to the lateral collateral ligament (LCL) and superficial to the lateral meniscus. It must be carefully isolated and protected or ligated during lateral approaches to the knee, meniscus repairs, and PLC reconstructions.

Question 5998

Topic: Knee Sports

Which of the following structures is considered the primary restraint to external rotation of the tibia at 30 degrees of knee flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteofibular ligament
. Medial collateral ligament
. Oblique popliteal ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The posterolateral corner (PLC) consists primarily of the lateral collateral ligament (LCL), popliteus tendon, and popliteofibular ligament (PFL). The popliteofibular ligament and the popliteus complex serve as the primary restraint to external tibial rotation at 30 degrees of knee flexion.

Question 5999

Topic: Shoulder & Hip Sports

The subscapularis muscle is unique among the rotator cuff muscles due to its dual innervation. Which of the following nerves provides innervation to the inferior portion of the subscapularis?

. Suprascapular nerve
. Axillary nerve
. Upper subscapular nerve
. Lower subscapular nerve
. Thoracodorsal nerve

Correct Answer & Explanation

. Suprascapular nerve

Explanation

The subscapularis is innervated by both the upper and lower subscapular nerves. The upper subscapular nerve innervates the superior portion, while the lower subscapular nerve innervates the inferior portion. The lower subscapular nerve also innervates the teres major.

Question 6000

Topic: Shoulder & Hip Sports

A 25-year-old male is undergoing an open Latarjet procedure. During the approach, the surgeon must identify and protect the musculocutaneous nerve. What is the classic anatomic relationship of the musculocutaneous nerve to the coracoid process?

. It enters the coracobrachialis muscle 1 to 2 cm distal to the coracoid process.
. It enters the coracobrachialis muscle 5 to 8 cm distal to the coracoid process.
. It passes posterior to the subscapularis tendon 3 cm medial to the coracoid process.
. It courses laterally around the conjoined tendon 10 cm distal to the coracoid process.
. It pierces the short head of the biceps brachii strictly at its musculotendinous junction.

Correct Answer & Explanation

. It enters the coracobrachialis muscle 1 to 2 cm distal to the coracoid process.

Explanation

The musculocutaneous nerve typically enters the deep surface of the coracobrachialis muscle approximately 5 to 8 cm distal to the tip of the coracoid process. Retraction of the conjoined tendon medial to this point during anterior shoulder approaches places the nerve at significant risk.

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