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5. Sports Medicine MCQs

Practice Set 306 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 6101

Topic: Shoulder & Hip Sports

In a patient with recurrent anterior shoulder instability, advanced 3D imaging reveals 25% anterior glenoid bone loss. Which of the following is the most appropriate definitive surgical intervention?

. Arthroscopic Bankart repair
. Arthroscopic Remplissage
. Latarjet procedure (coracoid transfer)
. Open inferior capsular shift
. Putti-Platt procedure

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

In the setting of significant anterior glenoid bone loss (typically greater than 20-25%), an isolated soft tissue repair has an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet, is indicated to restore joint stability and the articular arc.

Question 6102

Topic: Shoulder & Hip Sports

A 65-year-old female presents with a 3-part proximal humerus fracture.

An axillary nerve injury is suspected. Which of the following muscles is primarily evaluated to assess the motor function of this nerve?

. Teres major
. Teres minor
. Subscapularis
. Infraspinatus
. Supraspinatus

Correct Answer & Explanation

. Teres major

Explanation

The axillary nerve innervates the deltoid and teres minor muscles. Teres major is innervated by the lower subscapular nerve, subscapularis by upper and lower subscapular nerves, and infra/supraspinatus by the suprascapular nerve.

Question 6103

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of shoulder pain and weakness.

Examination reveals weakness in external rotation but normal strength in abduction. Entrapment of the suprascapular nerve is suspected. At what anatomical site is the compression most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular space
. Spiral groove

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates the supraspinatus (shoulder abduction) and infraspinatus (external rotation). Compression at the spinoglenoid notch, often due to a paralabral cyst from a posterior labral tear, affects only the branch to the infraspinatus, sparing the supraspinatus. Compression at the suprascapular notch would affect both.

Question 6104

Topic: Shoulder & Hip Sports

A 24-year-old athlete sustains recurrent anterior shoulder dislocations. An MRI reveals a Hill-Sachs lesion. Advanced imaging and 3D modeling demonstrate that the lesion 'engages' the anterior glenoid rim when the arm is in abduction and external rotation. According to the glenoid track concept, how is this lesion classified?

. Off-track lesion
. On-track lesion
. Bipolar track lesion
. Non-engaging lesion
. Reverse Hill-Sachs lesion

Correct Answer & Explanation

. Off-track lesion

Explanation

In the glenoid track concept, if a Hill-Sachs lesion extends medially beyond the glenoid track, it will drop over the anterior rim of the glenoid during abduction and external rotation (engaging). This is termed an 'off-track' lesion and typically requires a remplissage procedure or bone block in addition to a Bankart repair.

Question 6105

Topic: Shoulder & Hip Sports

During arthroscopic evaluation of the shoulder, a Type II SLAP tear is identified. The 'peel-back' mechanism is tested to assess the dynamic instability of the biceps anchor. This mechanism is maximally provoked in which shoulder position?

. Abduction and external rotation
. Adduction and internal rotation
. Forward flexion and internal rotation
. Extension and internal rotation
. Abduction and internal rotation

Correct Answer & Explanation

. Abduction and external rotation

Explanation

The 'peel-back' mechanism occurs when the arm is placed in abduction and external rotation (ABER position). In this position, the vector of the biceps tendon shifts posteriorly and medially, creating a torsional force that 'peels back' the superior labrum off the glenoid rim.

Question 6106

Topic: Shoulder & Hip Sports

A 40-year-old male presents with sudden, severe, unprovoked pain in his right shoulder that awoke him from sleep. The pain lasted for four days and required opioids. As the pain subsided, he noticed profound weakness in shoulder abduction and external rotation. He denies any trauma. MRI of the shoulder is unremarkable. EMG obtained 4 weeks later demonstrates denervation potentials in the supraspinatus and infraspinatus muscles. What is the most likely diagnosis?

. Massive rotator cuff tear
. Quadrilateral space syndrome
. Parsonage-Turner syndrome
. Cervical radiculopathy
. Suprascapular nerve entrapment at the spinoglenoid notch

Correct Answer & Explanation

. Massive rotator cuff tear

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) classically presents with an acute onset of severe, unremitting shoulder or arm pain followed days to weeks later by patchy muscle weakness and atrophy as the pain resolves. It often affects the suprascapular nerve, long thoracic nerve, or anterior interosseous nerve. The lack of trauma, unremarkable MRI, and classic sequence of severe pain followed by flaccid paresis point away from mechanical tears or structural entrapments. Entrapment at the spinoglenoid notch would typically spare the supraspinatus.

Question 6107

Topic: Shoulder & Hip Sports

A 38-year-old male suffers a high-energy dashboard injury resulting in a posterior dislocation of the shoulder. He is noted to have an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Latarjet procedure
. Lesser tuberosity transfer (McLaughlin procedure)
. Humeral head resurfacing
. Anatomic total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

For reverse Hill-Sachs lesions involving 20% to 40% of the humeral head, transfer of the lesser tuberosity and subscapularis into the defect (McLaughlin or modified McLaughlin procedure) is the standard of care.

Question 6108

Topic: 5. Sports Medicine



A 38-year-old recreational athlete sustains an acute, closed Achilles tendon rupture. He opts for nonoperative management. According to recent high-level evidence, which rehabilitation protocol yields a re-rupture rate most comparable to operative treatment?

. Strict immobilization in a short-leg cast in equinus for 8 weeks
. Strict immobilization in a long-leg cast for 4 weeks followed by a short-leg cast for 4 weeks
. Immediate full weight-bearing without a brace to promote tendon remodeling
. Functional rehabilitation with early protected weight-bearing and active plantarflexion in a brace
. Surgical repair is the only method to achieve an acceptable re-rupture rate; nonoperative treatment universally fails

Correct Answer & Explanation

. Strict immobilization in a short-leg cast in equinus for 8 weeks

Explanation

Recent high-level randomized controlled trials have demonstrated that functional rehabilitation protocols (early protected weight-bearing and range of motion in a functional orthosis) for nonoperative management of acute Achilles tendon ruptures result in re-rupture rates comparable to surgical repair, while avoiding surgical complications like wound breakdown or nerve injury.

Question 6109

Topic: 5. Sports Medicine

A 22-year-old collegiate football lineman presents with severe pain at the base of the great toe after being tackled with his foot planted in extreme dorsiflexion. MRI confirms a complete tear of the plantar plate complex with proximal retraction of the sesamoids. What is the most appropriate management for this athlete?

. Stiff-soled shoe and immediate weight-bearing as tolerated
. Short leg cast for 6 weeks followed by progressive ROM
. Corticosteroid injection and return to play with taping
. Surgical repair of the plantar plate and capsuloligamentous complex
. Primary arthrodesis of the first metatarsophalangeal joint

Correct Answer & Explanation

. Stiff-soled shoe and immediate weight-bearing as tolerated

Explanation

Grade 3 turf toe injuries involving a complete plantar plate tear with sesamoid retraction in elite athletes generally require surgical repair. This restores the push-off strength and normal biomechanics of the first MTP joint.

Question 6110

Topic: 5. Sports Medicine

A professional American football lineman sustains a severe hyperextension injury to his great toe. Clinical exam shows marked swelling, ecchymosis, and a gross lack of resistance to passive MTP dorsiflexion. MRI confirms a complete rupture of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?

. Stiff-soled shoe and taping for 6-8 weeks
. Rigid carbon fiber orthosis and immediate return to play
. Surgical repair of the plantar plate and soft tissues
. Local corticosteroid injection followed by physical therapy
. Excision of the fractured or retracted sesamoids

Correct Answer & Explanation

. Stiff-soled shoe and taping for 6-8 weeks

Explanation

This is a Grade 3 'turf toe' injury characterized by a complete tear of the plantar plate complex and proximal migration of the sesamoids. Surgical repair is indicated in elite athletes to restore the push-off strength and prevent chronic instability.

Question 6111

Topic: Knee Sports

In the evaluation of a painful TKA, a patient is found to have paradoxical anterior translation of the femur on the tibia during knee flexion. Which of the following scenarios is most likely responsible for this kinematic abnormality?

. A cruciate-retaining (CR) femoral component with an incompetent posterior cruciate ligament (PCL)
. A posterior-stabilized (PS) femoral component with an incompetent PCL
. A constrained condylar knee (CCK) insert
. An excessively thick asymmetric polyethylene insert
. An ultracongruent insert with an intact PCL

Correct Answer & Explanation

. A cruciate-retaining (CR) femoral component with an incompetent posterior cruciate ligament (PCL)

Explanation

Paradoxical anterior translation of the femur during flexion typically occurs in a CR knee if the PCL is deficient or excessively loose, leading to altered kinematics and poor flexion.

Question 6112

Topic: 5. Sports Medicine

A 72-year-old female sustains an acute patellar tendon rupture 3 months following a primary TKA. Primary repair is attempted but fails at 6 weeks postoperatively. What is the most reliable salvage reconstruction technique for this complication?

. Direct primary repair with cerclage wire augmentation
. Gastrocnemius rotational flap
. Patellectomy and V-Y quadricepsplasty
. Extensor mechanism allograft reconstruction
. Synthetic mesh augmentation without allograft

Correct Answer & Explanation

. Direct primary repair with cerclage wire augmentation

Explanation

Extensor mechanism allograft reconstruction, typically utilizing a full Achilles tendon or tibial tubercle-patellar tendon-bone allograft, provides the most reliable salvage reconstruction for chronic or failed patellar tendon ruptures post-TKA. Direct repairs have an unacceptably high failure rate.

Question 6113

Topic: Knee Sports

Following the initial bone cuts in a cruciate-retaining total knee arthroplasty, the surgeon assesses the gaps with spacer blocks. The knee is tight in flexion and symmetric in extension. Which of the following is the most appropriate next step to balance the knee?

. Recut the distal femur to remove more bone
. Downsize the femoral component and augment the posterior aspect
. Decrease the posterior slope of the tibial cut
. Release the posterior cruciate ligament (PCL)
. Increase the size of the polyethylene insert

Correct Answer & Explanation

. Recut the distal femur to remove more bone

Explanation

A knee that is tight in flexion but balanced in extension indicates an isolated tight flexion gap. In a CR knee, an excessively tight PCL can tether the flexion gap. Appropriate interventions include releasing or recessing the PCL, downsizing the femoral component, or increasing the posterior tibial slope.

Question 6114

Topic: 5. Sports Medicine

A 68-year-old female sustains a complete patellar tendon rupture 4 years after a primary total knee arthroplasty. The components are well-fixed and appropriately positioned. What is the most reliable surgical option to restore active extension?

. Primary end-to-end repair with non-absorbable suture
. Primary repair augmented with semitendinosus autograft
. Extensor mechanism allograft reconstruction
. Revision to a hinged knee prosthesis
. Patellectomy and advancement of the quadriceps tendon

Correct Answer & Explanation

. Primary end-to-end repair with non-absorbable suture

Explanation

Complete patellar tendon ruptures in the setting of a TKA have very poor outcomes with primary repair. Extensor mechanism allograft reconstruction (involving the tibial tubercle, patellar tendon, patella, and quadriceps tendon) or synthetic mesh reconstruction are the most reliable salvage options.

Question 6115

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which statement accurately describes the tensioning pattern of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, and the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. Both bundles are tight in flexion and lax in extension.
. Both bundles are tight in extension and lax in flexion.
. The tension of both bundles remains constant throughout the entire range of motion.

Correct Answer & Explanation

. The anteromedial bundle is tight in extension, and the posterolateral bundle is tight in flexion.

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is primarily tight in flexion and controls anterior translation. The PL bundle is primarily tight in extension and provides rotational stability. Mnemonic: AM is tight in flexion, PL is tight in extension.

Question 6116

Topic: Shoulder & Hip Sports

A 40-year-old female presents to the clinic 2 weeks after receiving a viral vaccination. She describes a sudden onset of excruciating right shoulder pain that lasted for a week, which has now subsided and been replaced by profound weakness in external rotation and abduction. What is the most likely diagnosis?

. C5 cervical radiculopathy
. Parsonage-Turner syndrome (Acute Brachial Neuritis)
. Acute massive rotator cuff tear
. Adhesive capsulitis
. Suprascapular nerve entrapment at the spinoglenoid notch

Correct Answer & Explanation

. C5 cervical radiculopathy

Explanation

The classic presentation of Parsonage-Turner syndrome (idiopathic acute brachial neuritis) is sudden, severe, unilateral shoulder or arm pain followed days to weeks later by patchy weakness and atrophy of the affected musculature (often supraspinatus, infraspinatus, serratus anterior, or deltoid). It frequently follows a viral illness, vaccination, or stressful event. Pain improving while weakness worsens is the hallmark.

Question 6117

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles that function synergistically during the knee arc of motion. During knee flexion, which bundle is the primary restraint to anterior tibial translation?

. Posterolateral bundle
. Anteromedial bundle
. Anterolateral bundle
. Posteromedial bundle
. Ligament of Humphrey

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The ACL consists of the Anteromedial (AM) and Posterolateral (PL) bundles. The AM bundle is tight in flexion and serves as the primary restraint to anterior tibial translation at higher degrees of knee flexion. The PL bundle is tight in extension and is the primary restraint to rotatory instability (pivot shift) as the knee approaches full extension.

Question 6118

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft, placement of the femoral tunnel too far anteriorly will result in which kinematic abnormality?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will restrict internal rotation at all angles
. The graft will cause obligatory posterior subluxation of the tibia
. The graft will be universally loose throughout the range of motion

Correct Answer & Explanation

. The graft will be tight in extension and loose in flexion

Explanation

Placing the femoral tunnel too anteriorly (ventral) is a common technical error in ACL reconstruction. It increases the distance between the tibial and femoral attachment sites during flexion, resulting in a graft that is tight in flexion and loose in extension, ultimately limiting knee flexion.

Question 6119

Topic: Knee Sports

Which of the following nerve injuries is most classically associated with a high-energy posterolateral dislocation of the knee?

. Tibial nerve
. Common peroneal nerve
. Saphenous nerve
. Deep femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Tibial nerve

Explanation

Posterolateral corner injuries or knee dislocations place the common peroneal nerve at immense risk for traction injury due to its tethered anatomical course around the fibular neck. Patients typically present with a foot drop and lateral leg numbness.

Question 6120

Topic: Knee Sports

In native knee kinematics, femoral rollback during deep flexion is essential to improve the moment arm of the extensor mechanism and prevent posterior impingement. This rollback is primarily driven by the tension in which of the following structures?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

As the knee flexes, the tension in the posterior cruciate ligament (PCL) forces the femur to roll and translate posteriorly on the tibial plateau. This femoral rollback allows for increased flexion before the posterior femur impinges on the posterior tibia.

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