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5. Sports Medicine MCQs

Practice Set 307 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 6121

Topic: Knee Sports

A posterior-stabilized (PS) total knee arthroplasty utilizes a cam-and-post mechanism. What is the primary biomechanical function of this design during deep knee flexion?

. To substitute for the anterior cruciate ligament (ACL) and prevent anterior tibial translation
. To substitute for the posterior cruciate ligament (PCL) and enforce posterior femoral rollback
. To provide varus-valgus constraint in the setting of collateral ligament deficiency
. To prevent hyperextension of the knee
. To increase the patellofemoral joint reaction force

Correct Answer & Explanation

. To substitute for the anterior cruciate ligament (ACL) and prevent anterior tibial translation

Explanation

In a posterior-stabilized (PS) TKA, the PCL is sacrificed. The tibial post and femoral cam engage during flexion to substitute for the PCL's function. This engagement forces the femur to roll posteriorly on the tibia (posterior femoral rollback), preventing anterior sliding of the femur, improving impingement-free flexion, and maximizing the quadriceps moment arm.

Question 6122

Topic: Shoulder & Hip Sports

A 25-year-old male undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he presents with profound weakness in elbow flexion and decreased sensation over the lateral aspect of his forearm. Which nerve is most likely injured, and what is the most common mechanism during this procedure?

. Axillary nerve; compression from the coracoid graft placement.
. Musculocutaneous nerve; excessive medial traction on the conjoined tendon.
. Suprascapular nerve; dissection around the superior labrum.
. Radial nerve; improper placement of the posterior retractors.
. Median nerve; direct laceration during the deltopectoral approach.

Correct Answer & Explanation

. Axillary nerve; compression from the coracoid graft placement.

Explanation

The musculocutaneous nerve is the most frequently injured nerve during a Latarjet procedure. It typically penetrates the coracobrachialis muscle 5 to 8 cm distal to the coracoid process. The primary mechanism of injury is excessive or prolonged medial retraction of the conjoined tendon during the approach and graft preparation. This leads to neuropraxia, presenting with biceps weakness (elbow flexion) and sensory deficits over the lateral forearm (lateral antebrachial cutaneous nerve).

Question 6123

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with vague posterior shoulder pain. Magnetic resonance imaging (MRI) reveals a paralabral cyst located strictly in the spinoglenoid notch. Which of the following physical examination findings is most specific to this pathology?

. Combined weakness in shoulder abduction and external rotation
. Isolated weakness in shoulder external rotation with arm at the side
. Isolated weakness in shoulder internal rotation
. Sensory loss over the lateral aspect of the shoulder
. Scapular winging with medial border prominence

Correct Answer & Explanation

. Combined weakness in shoulder abduction and external rotation

Explanation

A paralabral cyst in the spinoglenoid notch typically compresses the suprascapular nerve after it has innervated the supraspinatus muscle. Therefore, the patient will present with isolated denervation of the infraspinatus muscle, leading to isolated weakness in external rotation. Compression at the suprascapular notch (more proximal) would affect both the supraspinatus and infraspinatus, leading to weakness in both abduction and external rotation. The suprascapular nerve has no significant cutaneous sensory distribution over the lateral shoulder (axillary nerve territory).

Question 6124

Topic: Shoulder & Hip Sports

A 45-year-old male presents to the emergency department after a seizure. Radiographs confirm a locked posterior shoulder dislocation. A CT scan reveals an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 30% of the articular surface. The dislocation is successfully reduced, but the shoulder is highly unstable in internal rotation. What is the most appropriate surgical intervention?

. Arthroscopic posterior capsulolabral repair (posterior Bankart repair)
. Latarjet procedure
. Arthroscopic Remplissage
. Transfer of the lesser tuberosity into the defect (Modified McLaughlin procedure)
. Derotational proximal humerus osteotomy

Correct Answer & Explanation

. Arthroscopic posterior capsulolabral repair (posterior Bankart repair)

Explanation

A reverse Hill-Sachs lesion is an impaction fracture of the anteromedial humeral head resulting from a posterior shoulder dislocation. For defects comprising 20% to 40% of the articular surface, transferring the subscapularis tendon (McLaughlin procedure) or the lesser tuberosity with the attached subscapularis (Modified McLaughlin procedure) into the defect is the treatment of choice. This prevents the defect from engaging the posterior glenoid rim during internal rotation. Defects <20% may be managed non-operatively or with isolated posterior labral repair if non-engaging, while defects >40-50% generally require anatomic head reconstruction via osteochondral allograft or shoulder arthroplasty.

Question 6125

Topic: 5. Sports Medicine

A 13-year-old elite youth baseball pitcher presents with gradually worsening shoulder pain during the late cocking and early acceleration phases of pitching. Radiographs reveal widening and lateral fragmentation of the proximal humeral physis. What is the diagnosis?

. Avulsion of the medial epicondyle
. Proximal humeral epiphysiolysis
. Capitellar osteochondritis dissecans
. Superior labrum anterior to posterior (SLAP) tear
. Stress fracture of the coracoid process

Correct Answer & Explanation

. Avulsion of the medial epicondyle

Explanation

The presentation of widening, sclerosis, and fragmentation of the proximal humeral physis in a skeletally immature throwing athlete is pathognomonic for 'Little League Shoulder.' The underlying pathology is a stress fracture or epiphysiolysis of the proximal humeral physis caused by repetitive rotational and distraction shear forces during throwing. It is primarily treated with absolute rest from throwing until radiographic resolution and symptom abatement.

Question 6126

Topic: Shoulder & Hip Sports

A 24-year-old male undergoes arthroscopic stabilization for recurrent anterior shoulder instability. Intraoperatively, the surgeon notes an 'engaging' Hill-Sachs lesion and elects to perform a Remplissage procedure in addition to a Bankart repair. The Remplissage procedure specifically involves tenodesis of which of the following structures into the humeral head defect?

. Supraspinatus tendon
. Subscapularis tendon
. Infraspinatus tendon
. Teres minor tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The Remplissage procedure (French for 'to fill') is performed for anterior shoulder instability accompanied by a large, engaging Hill-Sachs lesion. It involves arthroscopically suturing the posterior capsule and the infraspinatus tendon into the Hill-Sachs defect on the posterolateral humeral head. This essentially makes the Hill-Sachs lesion extra-articular and acts as a dynamic checkrein against excessive external rotation, preventing the humeral head defect from engaging the anterior glenoid rim.

Question 6127

Topic: Shoulder & Hip Sports

A 42-year-old male presents with acute, unprovoked, agonizing pain in his right shoulder that lasted for 2 weeks before gradually subsiding. As the pain improved, he developed profound weakness in shoulder abduction and external rotation. Electromyography (EMG) shows acute denervation in the supraspinatus, infraspinatus, and deltoid. What is the most appropriate initial treatment for this condition?

. Immediate surgical decompression of the suprascapular and axillary nerves.
. Observation, physical therapy, and supportive care.
. High-dose systemic corticosteroids tapering over 6 months.
. Latissimus dorsi tendon transfer for external rotation restoration.
. Intravenous immunoglobulin (IVIG) administration.

Correct Answer & Explanation

. Immediate surgical decompression of the suprascapular and axillary nerves.

Explanation

This patient's clinical presentation is pathognomonic for Parsonage-Turner Syndrome (idiopathic brachial neuritis). The classic progression involves a prodromal phase of severe, unrelenting shoulder or arm pain lasting days to weeks, followed by patchy lower motor neuron weakness and muscle atrophy as the pain resolves. Treatment is primarily non-operative, consisting of observation, pain control (gabapentin, NSAIDs), and physical therapy to maintain range of motion. The vast majority of patients recover spontaneously, although full recovery can take 12 to 24 months.

Question 6128

Topic: Shoulder & Hip Sports

A 45-year-old volleyball player presents with painless weakness in shoulder external rotation. Abduction strength is completely normal. Physical examination reveals muscle atrophy localized exclusively to the infraspinatus fossa. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

Compression at the spinoglenoid notch selectively affects the infraspinatus branch of the suprascapular nerve, causing isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Question 6129

Topic: 5. Sports Medicine

A 60-year-old man with a massive, irreparable posterosuperior rotator cuff tear undergoes arthroscopic superior capsule reconstruction (SCR). What is the primary biomechanical objective of this specific procedure?

. To directly restore active external rotation
. To depress the humeral head and prevent superior migration
. To medialise the center of glenohumeral rotation
. To dynamically stabilize the long head of the biceps
. To replace the internal rotation function of the subscapularis

Correct Answer & Explanation

. To directly restore active external rotation

Explanation

SCR utilizes a dermal allograft or fascia lata autograft attached to the superior glenoid and greater tuberosity to recreate the superior capsular restraint. This depresses the humeral head, prevents superior migration, and improves the mechanical advantage of the deltoid.

Question 6130

Topic: Shoulder & Hip Sports

A 70-year-old female presents with an acute anterior shoulder dislocation. After successful closed reduction, she demonstrates profound inability to actively abduct her shoulder against gravity, despite adequate analgesia. What is the most likely cause of this persistent deficit in this demographic?

. Isolated axillary nerve neurapraxia
. Suprascapular nerve avulsion
. Massive rotator cuff tear
. Acute deltoid muscle avulsion
. Brachial plexus traction injury

Correct Answer & Explanation

. Isolated axillary nerve neurapraxia

Explanation

In patients over the age of 40 (and especially those over 60), anterior shoulder dislocations are highly associated with acute rotator cuff tears. While axillary nerve injuries can occur, an acute rotator cuff tear is the most common structural cause of profound post-reduction weakness.

Question 6131

Topic: Knee Sports

A 16-year-old gymnast presents with chronic elbow pain and mechanical catching. Imaging confirms a large osteochondritis dissecans (OCD) lesion of the capitellum. Which of the following is considered an indication for osteochondral autograft transfer (OATS) rather than arthroscopic microfracture?

. Patient age less than 12 years
. Lesion size measuring 8 mm in diameter
. Involvement of the uncontained lateral capitellar margin
. Completely intact articular cartilage over the subchondral cyst
. A contained central capitellar lesion

Correct Answer & Explanation

. Patient age less than 12 years

Explanation

Arthroscopic debridement and microfracture yield poor functional outcomes for large OCD lesions or those involving the uncontained lateral margin of the capitellum. OATS is specifically indicated for lesions greater than 1 cm or those with lateral margin involvement.

Question 6132

Topic: 5. Sports Medicine

A 19-year-old male rugby player sustains a traumatic anterior shoulder dislocation. Advanced imaging reveals a bony Bankart lesion. According to modern biomechanical literature, what is the critical threshold of glenoid bone loss above which isolated arthroscopic soft-tissue repair has an unacceptably high failure rate?

. 5-10 percent
. 20-25 percent
. 35-40 percent
. 45-50 percent
. 55-60 percent

Correct Answer & Explanation

. 5-10 percent

Explanation

Critical glenoid bone loss is widely accepted as 20-25% of the inferior glenoid diameter, though subcritical thresholds (13.5-15%) are now recognized in high-risk athletes. Bone loss exceeding 20% generally necessitates a bony augmentation procedure like a Latarjet.

Question 6133

Topic: Shoulder & Hip Sports

A 65-year-old female is 3 years post-anatomic total shoulder arthroplasty (TSA). She presents with increasing pain, anterior swelling, and weakness in internal rotation. Radiographs show a well-fixed implant without loosening, but ultrasound confirms a massive subscapularis failure. Which of the following is the most appropriate salvage option if primary repair is impossible?

. Latissimus dorsi transfer
. Pectoralis major transfer
. Lower trapezius transfer
. Latarjet procedure
. Teres major transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

Pectoralis major tendon transfer is the established salvage procedure for an irreparable subscapularis tear following anatomic TSA. Conversely, latissimus dorsi and lower trapezius transfers are utilized for posterosuperior cuff (supraspinatus/infraspinatus) defects.

Question 6134

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset posterior shoulder pain and profound, isolated weakness in external rotation. MRI reveals a paralabral cyst in the spinoglenoid notch. Which physical examination finding is most likely present?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the supraspinatus
. Isolated atrophy of the infraspinatus
. Weakness in both abduction and external rotation
. Scapular winging with medial border prominence

Correct Answer & Explanation

. Atrophy of both the supraspinatus and infraspinatus

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the motor branch to the infraspinatus. This results in isolated external rotation weakness and isolated infraspinatus atrophy.

Question 6135

Topic: Shoulder & Hip Sports

A 22-year-old elite tennis player complains of posterior shoulder pain during the late cocking phase of his serve. Exam shows Glenohumeral Internal Rotation Deficit (GIRD). MRI arthrogram shows a 'peel-back' SLAP lesion and partial articular-sided supraspinatus tear (PASTA). What is the primary underlying pathophysiological mechanism for this internal impingement?

. Acromioclavicular spurring
. Subcoracoid stenosis
. Contracture of the posterior inferior capsule
. Anterior capsular laxity alone
. Os acromiale

Correct Answer & Explanation

. Acromioclavicular spurring

Explanation

Internal impingement in overhead athletes is primarily driven by a contracture of the posterior inferior capsule, which causes GIRD. This contracture shifts the glenohumeral contact point posterosuperiorly during maximum external rotation, trapping the cuff against the labrum.

Question 6136

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness in external rotation. Exam reveals isolated infraspinatus atrophy with normal supraspinatus strength. MRI shows a paralabral cyst. Which specific labral tear is most commonly associated with this presentation?

. Anterior Bankart tear
. Posterior or posterosuperior labral tear
. Superior Labral Anterior Posterior (SLAP) Type II
. SLAP Type IV
. Kim lesion

Correct Answer & Explanation

. Anterior Bankart tear

Explanation

A paralabral cyst at the spinoglenoid notch compresses the suprascapular nerve after it innervates the supraspinatus, leading to isolated infraspinatus weakness. This pathology is most commonly associated with posterior or posterosuperior labral tears acting as a one-way valve.

Question 6137

Topic: 5. Sports Medicine

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical examination reveals Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side, with symmetric total arcs of motion. What is the most appropriate initial management?

. Diagnostic shoulder arthroscopy
. Posterior capsular release
. Targeted sleeper stretch physical therapy
. SLAP repair
. Subacromial corticosteroid injection

Correct Answer & Explanation

. Diagnostic shoulder arthroscopy

Explanation

Glenohumeral Internal Rotation Deficit (GIRD) in overhead athletes is typically caused by posterior capsular contracture. The initial treatment of choice is a targeted stretching program utilizing the "sleeper stretch" to address this tightness.

Question 6138

Topic: Shoulder & Hip Sports

A 24-year-old male with recurrent anterior shoulder instability undergoes preoperative evaluation. Advanced imaging demonstrates an engaging Hill-Sachs lesion with 10% anterior glenoid bone loss. Which of the following surgical strategies is most appropriate?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Iliac crest bone grafting of the glenoid
. Open capsular shift

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

For recurrent anterior shoulder instability with subcritical glenoid bone loss (< 15-20%) but a large, engaging (off-track) Hill-Sachs lesion, arthroscopic Bankart repair combined with a Remplissage procedure is indicated. This prevents the posterior defect from engaging the anterior glenoid rim.

Question 6139

Topic: Shoulder & Hip Sports

A 45-year-old manual laborer presents with chronic anterior shoulder pain and a positive O'Brien's test. MRI arthrogram reveals a Type II SLAP tear. Given his age and occupation, what is the most appropriate surgical intervention to optimize outcomes and minimize postoperative stiffness?

. Arthroscopic SLAP repair with anchors
. Biceps tenotomy without repair
. Biceps tenodesis
. Arthroscopic debridement only
. Coracoid transfer

Correct Answer & Explanation

. Arthroscopic SLAP repair with anchors

Explanation

In patients over 40 years old, especially manual laborers, biceps tenodesis is highly preferred over SLAP repair for Type II SLAP lesions. SLAP repairs in this older demographic have higher rates of persistent pain, stiffness, and revision surgery.

Question 6140

Topic: Shoulder & Hip Sports

A 32-year-old male experiences a seizure and sustains a locked posterior shoulder dislocation. A CT scan is obtained and demonstrates an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 30% of the articular surface. The joint is reduced, but remains unstable in internal rotation. What is the most appropriate surgical management?

. Observation with a sling in internal rotation
. Arthroscopic posterior labral repair only
. Open lesser tuberosity transfer into the defect
. Anatomic total shoulder arthroplasty
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Observation with a sling in internal rotation

Explanation

A reverse Hill-Sachs lesion involving 20 to 40 percent of the articular surface is typically managed with a modified McLaughlin procedure, which involves transferring the lesser tuberosity and subscapularis tendon into the defect. Defects >40% typically require arthroplasty.

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