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5. Sports Medicine MCQs

Practice Set 305 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 6081

Topic: Shoulder & Hip Sports

A 31-year-old elite volleyball player presents with insidious onset of right shoulder weakness. Physical examination reveals profound atrophy isolated to the infraspinatus fossa, with normal bulk of the supraspinatus. External rotation strength is significantly decreased, while abduction strength is preserved. What is the most likely anatomical location of the nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Triangular space

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates the supraspinatus before wrapping around the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch (often by a paralabral cyst associated with a posterior labral tear in overhead athletes) leads to isolated infraspinatus weakness and atrophy.

Question 6082

Topic: Shoulder & Hip Sports

A 55-year-old heavy laborer presents with a massive, retracted, and irreparable posterosuperior rotator cuff tear. He has significant weakness in external rotation and elevation. A latissimus dorsi tendon transfer is planned. Which of the following is an absolute contraindication to this procedure?

. Intact subscapularis tendon
. Intact teres minor tendon
. Hamada Grade 1 radiographic changes
. Subscapularis tear with an absent coracoacromial ligament
. Age over 50 years

Correct Answer & Explanation

. Intact subscapularis tendon

Explanation

For a latissimus dorsi transfer to be successful, there must be a functioning subscapularis and an intact anterior deltoid to maintain force couples. An unrepairable subscapularis tear, especially combined with an absent coracoacromial ligament, leads to anterosuperior humeral escape and is an absolute contraindication for this transfer.

Question 6083

Topic: Shoulder & Hip Sports

A 21-year-old male undergoes diagnostic arthroscopy for recurrent anterior shoulder instability. The surgeon visualizes an anterior labral tear. The labrum is displaced medially and inferiorly on the glenoid neck, but the anterior scapular periosteum remains intact, forming a sleeve. What is the eponym for this specific lesion?

. Bankart lesion
. Perthes lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Bankart lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior labrum is torn and displaced medially and inferiorly along the glenoid neck, but the anterior scapular periosteum remains intact. A Bankart lesion involves a frank disruption of the periosteum.

Question 6084

Topic: Shoulder & Hip Sports

A 32-year-old male presents with vague posterior shoulder pain and numbness over the lateral deltoid after a blunt trauma to the posterior shoulder. An MRI reveals isolated atrophy of the teres minor muscle. Entrapment of the neurovascular bundle in the quadrilateral space is suspected. Which of the following structures forms the superior border of this space?

. Teres major
. Long head of the triceps
. Teres minor
. Humeral shaft
. Latissimus dorsi

Correct Answer & Explanation

. Teres major

Explanation

The quadrilateral space boundaries are: Superiorly: Teres minor (and inferior margin of the subscapularis anteriorly). Inferiorly: Teres major. Medially: Long head of the triceps. Laterally: Surgical neck of the humerus. The axillary nerve and posterior circumflex humeral artery pass through this space.

Question 6085

Topic: Shoulder & Hip Sports

A 24-year-old elite volleyball player complains of vague posterior shoulder pain and progressive weakness. On exam, she has full active forward elevation and normal internal rotation, but significant isolated weakness in external rotation. An MRI is obtained. What is the most likely pathological finding and its anatomical location?

. Paralabral cyst at the spinoglenoid notch associated with a posterior labral tear
. Paralabral cyst at the suprascapular notch associated with a SLAP lesion
. Lipoma in the quadrilateral space compressing the axillary nerve
. Ganglion cyst at the spiral groove compressing the radial nerve
. Hypertrophy of the coracoacromial ligament causing outlet impingement

Correct Answer & Explanation

. Paralabral cyst at the spinoglenoid notch associated with a posterior labral tear

Explanation

Isolated weakness of external rotation (infraspinatus) without supraspinatus involvement points to suprascapular nerve compression distal to the suprascapular notch, specifically at the spinoglenoid notch. This is classically caused by a paralabral cyst associated with a posterior or superior labral tear in overhead athletes.

Question 6086

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. He has a 25-degree loss of internal rotation compared to his contralateral arm. Pathology in internal impingement syndrome typically involves contact between which two structures?

. The anterior-inferior labrum and the subscapularis
. The articular surface of the supraspinatus/infraspinatus and the posterior-superior glenoid labrum
. The bursal surface of the supraspinatus and the coracoacromial arch
. The subscapularis and the coracoid process
. The biceps tendon and the superior margin of the lesser tuberosity

Correct Answer & Explanation

. The anterior-inferior labrum and the subscapularis

Explanation

Internal impingement occurs in the late cocking phase of throwing (maximum abduction and external rotation). It involves the abnormal contact (impingement) of the articular side of the rotator cuff (typically supraspinatus and anterior infraspinatus) against the posterior-superior glenoid labrum.

Question 6087

Topic: Shoulder & Hip Sports

In the patient described above with glenohumeral internal rotation deficit (GIRD), what is the primary pathoanatomic cause, and what is the initial recommended treatment?

. Contracture of the anterior-inferior capsule; anterior capsular release
. Retroversion of the humeral head; derotational osteotomy
. Contracture of the posterior-inferior capsule; sleeper stretches
. Hypertrophy of the teres major; botulinum toxin injection
. Acromial spurring; subacromial decompression

Correct Answer & Explanation

. Contracture of the anterior-inferior capsule; anterior capsular release

Explanation

GIRD is defined as a loss of >20 degrees of internal rotation. It is caused by contracture and thickening of the posterior-inferior joint capsule (often an adaptive response to repetitive microtrauma from throwing). Initial treatment is physical therapy utilizing 'sleeper stretches' and cross-body adduction stretches to target the posterior capsule.

Question 6088

Topic: Shoulder & Hip Sports

A 65-year-old male with a massive rotator cuff tear undergoes arthroscopic rotator cuff repair. A degenerative, symptomatic long head of the biceps tendon is noted, and the surgeon decides to perform a biceps tenotomy instead of a tenodesis. Compared to tenodesis, which of the following is true regarding biceps tenotomy?

. It is associated with a significantly higher rate of long-term shoulder stiffness
. It has a higher incidence of cosmetic 'Popeye' deformity and bicep muscle cramping
. It yields significantly inferior clinical outcomes in terms of forward elevation strength
. It carries a higher risk of postoperative infection
. It requires a longer postoperative immobilization period

Correct Answer & Explanation

. It is associated with a significantly higher rate of long-term shoulder stiffness

Explanation

Biceps tenotomy is technically simpler, faster, and requires less postoperative restriction than tenodesis. However, it carries a higher risk of a cosmetic 'Popeye' deformity (distal migration of the muscle belly) and subjective fatigue/cramping of the biceps muscle compared to tenodesis. Neither procedure has been shown to have a clinically significant difference in overall functional shoulder scores or strength in older, lower-demand patients.

Question 6089

Topic: Shoulder & Hip Sports

A 55-year-old laborer complains of deep shoulder pain and clicking. MRI reveals an isolated Type II SLAP lesion. He has failed 6 months of conservative management. Based on recent literature, what is the most reliable surgical intervention for this patient to achieve pain relief and return to work?

. Arthroscopic repair of the superior labrum with suture anchors
. Arthroscopic debridement of the superior labrum without repair
. Biceps tenodesis
. Biceps tenotomy and subacromial decompression
. Open anterior capsulolabral reconstruction (Bankart repair)

Correct Answer & Explanation

. Arthroscopic repair of the superior labrum with suture anchors

Explanation

In older patients (>40-45 years), arthroscopic repair of SLAP lesions has a high rate of failure, persistent pain, and postoperative stiffness. Biceps tenodesis has been shown to provide more reliable pain relief and functional improvement with lower complication rates for Type II SLAP tears in this age group.

Question 6090

Topic: Shoulder & Hip Sports

A 42-year-old male presents to the emergency department locked in internal rotation after a severe seizure. Anteroposterior radiographs show a 'lightbulb' appearance of the humeral head. A CT scan reveals a reverse Hill-Sachs lesion involving 35% of the articular surface. Which of the following is the most appropriate surgical management?

. Closed reduction and spica casting
. Open reduction and subscapularis transfer (McLaughlin procedure)
. Open reduction and lesser tuberosity transfer (Modified McLaughlin procedure)
. Anatomic total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Closed reduction and spica casting

Explanation

For reverse Hill-Sachs defects between 25% and 40%, reconstruction of the articular defect is required. The modified McLaughlin procedure transfers the lesser tuberosity with the attached subscapularis into the defect, which yields more robust bone-to-bone healing compared to the soft-tissue transfer of the classic McLaughlin procedure.

Question 6091

Topic: Knee Sports

A 29-year-old male sustains a 'floating knee' injury (ipsilateral femur and tibia fractures) in a motor vehicle collision. Which of the following associated local injuries has the highest incidence of initially being missed in this patient?

. Popliteal artery occlusion
. Cruciate and collateral ligament tears
. Meniscal root avulsions
. Common peroneal nerve palsy

Correct Answer & Explanation

. Popliteal artery occlusion

Explanation

Ligamentous injuries to the knee (especially ACL and collateral ligaments) are present in up to 50% of floating knee injuries but are frequently missed during initial evaluation due to the overriding long bone instability.

Question 6092

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, the 'glenoid track' concept is utilized to determine the risk of an engaging Hill-Sachs lesion. The normal width of the glenoid track is calculated as what percentage of the native inferior glenoid diameter (assuming no anterior bone loss)?

. 60%
. 73%
. 83%
. 95%
. 100%

Correct Answer & Explanation

. 60%

Explanation

The glenoid track concept describes the contact zone between the glenoid and the humeral head during abduction and external rotation. The native glenoid track represents 83% of the width of the inferior glenoid. If there is anterior glenoid bone loss, the width of the track is calculated as 83% minus the width of the anterior bone defect. A Hill-Sachs lesion that extends medially beyond this track is termed 'off-track' and has a high risk of engagement.

Question 6093

Topic: Knee Sports

Six months following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, a patient complains of a progressive loss of terminal knee extension accompanied by an audible clunk at the end of range of motion. MRI reveals a nodular mass in the anterior intercondylar notch. Histological examination of this mass would most likely show:

. Disorganized hyaline cartilage
. Fibrovascular scar tissue
. Giant cell tumor of tendon sheath
. Synovial chondromatosis
. Gouty tophi with giant cell reaction

Correct Answer & Explanation

. Disorganized hyaline cartilage

Explanation

The scenario describes 'Cyclops syndrome', a form of localized anterior arthrofibrosis that mechanically blocks terminal knee extension after ACL reconstruction. The 'cyclops lesion' itself is composed primarily of fibrovascular scar tissue, which proliferates in the anterior notch.

Question 6094

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes evaluation for recurrent anterior shoulder instability. Advanced imaging and 3D reconstruction reveal an anterior inferior labral tear and a Hill-Sachs lesion that actively engages the anterior glenoid rim when the arm is placed in abduction and external rotation. The glenoid bone loss is calculated at 12%. Which of the following surgical procedures is most appropriate?

. Arthroscopic Bankart repair alone
. Open Latarjet procedure
. Arthroscopic Bankart repair with Remplissage
. Open inferior capsular shift without labral repair
. Iliac crest bone grafting of the anterior glenoid

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

For recurrent anterior shoulder instability with an 'engaging' (or off-track) Hill-Sachs lesion but subcritical glenoid bone loss (typically <20-25%), adding a Remplissage (tenodesis of the infraspinatus tendon into the Hill-Sachs defect) to an arthroscopic Bankart repair is the standard of care. This prevents the humeral head defect from engaging the glenoid rim. A Latarjet or structural grafting is generally reserved for critical glenoid bone loss (>20-25%).

Question 6095

Topic: 5. Sports Medicine

A 35-year-old recreational basketball player suffers an acute, closed Achilles tendon rupture. He is evaluating treatment options and asks about the risk of re-rupture. Based on recent high-quality randomized controlled trials, which of the following statements comparing nonoperative and operative management is most accurate?

. Operative treatment provides statistically superior plantar flexion strength at 2-year follow-up.
. Nonoperative treatment, regardless of protocol, has a significantly higher re-rupture rate.
. Nonoperative treatment using an early functional rehabilitation protocol results in equivalent re-rupture rates compared to surgery.
. Operative treatment significantly reduces the overall risk of deep vein thrombosis.
. Nonoperative treatment consistently yields a faster return to competitive sports.

Correct Answer & Explanation

. Operative treatment provides statistically superior plantar flexion strength at 2-year follow-up.

Explanation

Multiple modern, high-quality randomized controlled trials (such as Willits et al., JBJS 2010) have demonstrated that when an early functional rehabilitation protocol (involving early weight-bearing and active range of motion) is employed, the re-rupture rates between nonoperative and operative treatment of acute Achilles tendon ruptures are statistically equivalent. Operative treatment, however, carries a higher risk of soft-tissue complications.

Question 6096

Topic: 5. Sports Medicine

During the incorporation process of a bone-patellar tendon-bone (BPTB) autograft used for ACL reconstruction, what is the weakest point of the construct at 6 to 8 weeks postoperatively?

. The tibial bone plug fixation
. The femoral bone plug fixation
. The mid-substance of the graft
. The intra-articular graft-bone interface
. The extra-articular insertion

Correct Answer & Explanation

. The tibial bone plug fixation

Explanation

The autograft undergoes a process of 'ligamentization' which involves early necrosis, followed by revascularization and cellular repopulation. At 6 to 8 weeks postoperatively, the graft is undergoing extensive remodeling, and its mid-substance becomes the weakest link, rather than the initial fixation sites (bone plugs) which usually incorporate by 6 weeks.

Question 6097

Topic: Shoulder & Hip Sports

In the management of anterior shoulder instability with a concurrent osseous defect on the posterolateral humeral head (Hill-Sachs lesion), whether the lesion is "engaging" is best conceptualized and predicted using which of the following biomechanical paradigms?

. Glenoid track concept
. Peel-back mechanism
. Circle concept of instability
. Rotator interval volume
. Posterior cord tension

Correct Answer & Explanation

. Glenoid track concept

Explanation

The Glenoid Track concept, described by Itoi et al., states that if a Hill-Sachs lesion remains within the 'track' of the glenoid during external rotation and abduction, it is 'on-track' and will not engage the anterior glenoid rim. If it extends medially outside this track, it is 'off-track' and is considered an engaging lesion, often necessitating a Remplissage or structural graft.

Question 6098

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses fluoroscopy to determine the anatomic femoral attachment site. According to Schöttle's method, where should the femoral tunnel be placed on a true lateral radiograph?
. Anterior to the posterior cortical line and superior to Blumensaat's line
. Posterior to the posterior cortical line and inferior to Blumensaat's line
. 1 mm anterior to the posterior cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. Just distal to the adductor tubercle and anterior to the medial epicondyle
. In the center of the trochlear groove

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line

Explanation

Schöttle's point is a radiographic landmark on a true lateral radiograph of the knee used to identify the anatomic femoral origin of the MPFL. It is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior extension of Blumensaat's line.

Question 6099

Topic: 5. Sports Medicine
A 24-year-old overhead throwing athlete presents with deep shoulder pain and clicking. MRI arthrogram shows a detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid. The labral tissue itself is not torn in a bucket-handle fashion, and the biceps tendon is intact but detached at its anchor. According to the Snyder classification, what type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

The Snyder classification of SLAP (Superior Labrum Anterior to Posterior) tears: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the labrum that extends into the biceps tendon.

Question 6100

Topic: Knee Sports

During biomechanical testing of the knee's posterolateral corner (PLC), sequential sectioning of the structures is performed. Which of the following describes the primary restraint to varus angulation at 30 degrees of knee flexion?

. Popliteofibular ligament
. Popliteus tendon
. Iliotibial band
. Fibular collateral ligament (FCL)
. Lateral capsule

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The fibular collateral ligament (FCL), also known as the lateral collateral ligament (LCL), is the primary restraint to varus opening of the knee, particularly at 30 degrees of knee flexion. The popliteus tendon and popliteofibular ligament primarily act as the primary restraints to external tibial rotation. Understanding these specific biomechanical contributions is critical for diagnosing and reconstructing PLC injuries.

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