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5. Sports Medicine MCQs

Practice Set 313 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 6241

Topic: Shoulder & Hip Sports

A 28-year-old elite overhead athlete presents with painless weakness in the dominant shoulder. Physical examination reveals isolated severe atrophy of the infraspinatus muscle, but completely preserved muscle bulk and strength of the supraspinatus. Where is the most likely anatomical site of nerve compression?

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

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. It passes through the suprascapular notch (where compression affects both muscles) and then winds around the spinoglenoid notch to supply the infraspinatus. Compression at the spinoglenoid notch (often due to a paralabral cyst) causes isolated infraspinatus weakness and atrophy.

Question 6242

Topic: Shoulder & Hip Sports

A 24-year-old male with recurrent anterior shoulder instability is evaluated preoperatively with 3D CT. The concept of the 'glenoid track' is used to evaluate the interplay between glenoid bone loss and a Hill-Sachs lesion. Which of the following correctly defines an 'off-track' Hill-Sachs lesion?

. The medial margin of the Hill-Sachs lesion is lateral to the medial margin of the glenoid track.
. The medial margin of the Hill-Sachs lesion is medial to the medial margin of the glenoid track.
. The lateral margin of the Hill-Sachs lesion is medial to the medial margin of the glenoid track.
. The width of the Hill-Sachs lesion is less than 83% of the native glenoid width.
. The lesion involves solely articular cartilage without engaging the anterior glenoid rim.

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion is lateral to the medial margin of the glenoid track.

Explanation

The glenoid track is calculated as 83% of the intact glenoid width minus any anterior bone loss. If the medial margin of the Hill-Sachs lesion extends further medially than the medial margin of the glenoid track, it will fall 'off-track' and engage the anterior glenoid rim upon external rotation and abduction. This requires addressing the humeral side (e.g., remplissage) or increasing the glenoid track (e.g., Latarjet).

Question 6243

Topic: 5. Sports Medicine

A superior capsular reconstruction (SCR) using a thick dermal allograft is performed for a patient with a massive, irreparable posterosuperior rotator cuff tear. Biomechanically, what is the primary structural role of the graft in this procedure?

. It acts as an active dynamic stabilizer to initiate shoulder abduction.
. It depresses the humeral head by recreating the superior static fulcrum.
. It provides an osteoinductive scaffold for supraspinatus tendon regeneration.
. It prevents anterior subluxation by tightening the rotator interval.
. It acts as a tenodesis site for the long head of the biceps.

Correct Answer & Explanation

. It acts as an active dynamic stabilizer to initiate shoulder abduction.

Explanation

The primary biomechanical role of the graft in a Superior Capsular Reconstruction (SCR) is to act as a static restraint against superior humeral head migration. By recreating the superior capsular roof (fulcrum), it restores the native force couples, allowing the remaining rotator cuff and deltoid to effectively elevate the arm without early superior impingement.

Question 6244

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a locked posterior shoulder dislocation sustained during a seizure. Imaging reveals a reverse Hill-Sachs (impaction) defect involving 35% of the anterior articular surface of the humeral head. Assuming an intact glenohumeral joint otherwise, which of the following is the most appropriate surgical management?

. Closed reduction and prolonged immobilization in internal rotation.
. Arthroscopic posterior Bankart repair alone.
. Transfer of the lesser tuberosity and subscapularis into the defect (Modified McLaughlin).
. Coracoid transfer to the posterior glenoid (Reverse Latarjet).
. Immediate total shoulder arthroplasty.

Correct Answer & Explanation

. Closed reduction and prolonged immobilization in internal rotation.

Explanation

For reverse Hill-Sachs defects involving 20% to 40% of the humeral head articular surface in posterior shoulder dislocations, structural filling of the defect is required to prevent recurrent instability. The modified McLaughlin procedure (transferring the lesser tuberosity with the attached subscapularis into the defect) or allograft reconstruction are the treatments of choice.

Question 6245

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, careful retraction of the conjoint tendon is essential. Over-retraction medially places which of the following nerves at the greatest risk of iatrogenic injury?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Median nerve
. Radial nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

The musculocutaneous nerve typically enters the coracobrachialis 5 to 8 cm distal to the tip of the coracoid process. Aggressive medial retraction of the conjoint tendon during the Latarjet procedure places a stretch on this nerve, making it the most vulnerable to neuropraxia or structural injury in this specific step.

Question 6246

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete presents with posterior shoulder pain and weakness in external rotation. Forward elevation and internal rotation strength are normal. MRI reveals a paralabral cyst in the spinoglenoid notch. Which physical examination finding is most likely to be exclusively present?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the supraspinatus
. Isolated atrophy of the infraspinatus
. Weakness in shoulder abduction above 90 degrees
. Decreased sensation over the lateral deltoid

Correct Answer & Explanation

. Atrophy of both the supraspinatus and infraspinatus

Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve distal to the motor branches that supply the supraspinatus. This results in isolated denervation and subsequent atrophy/weakness of the infraspinatus muscle. A cyst at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6247

Topic: Shoulder & Hip Sports

A 35-year-old male presents with a locked posterior shoulder dislocation following a seizure. CT imaging shows a reverse Hill-Sachs lesion (anteromedial humeral head defect) involving approximately 35% of the articular surface. The joint is unstable after closed reduction. What is the most appropriate surgical management?

. Arthroscopic posterior Bankart repair alone
. Remplissage procedure with infraspinatus tenodesis
. Transfer of the lesser tuberosity into the defect (Neer modification of McLaughlin)
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Arthroscopic posterior Bankart repair alone

Explanation

For reverse Hill-Sachs defects involving 20% to 40% of the articular surface, filling the defect is required to restore stability. The McLaughlin procedure (transfer of the subscapularis tendon) or the Neer modification (transfer of the lesser tuberosity with the subscapularis) into the anterior defect is the treatment of choice. Defects >40% typically require arthroplasty.

Question 6248

Topic: 5. Sports Medicine

A 22-year-old elite collegiate baseball pitcher presents with deep shoulder pain and decreased throwing velocity. MRI arthrogram shows a peel-back of the superior labrum with detachment of the biceps anchor (Type II SLAP tear). Conservative treatment has failed. What is the most appropriate surgical approach?

. Biceps tenodesis alone
. Biceps tenotomy
. Arthroscopic SLAP repair
. Diagnostic arthroscopy and debridement only
. Coracoid transfer

Correct Answer & Explanation

. Biceps tenodesis alone

Explanation

In a young, high-demand overhead throwing athlete, an arthroscopic SLAP repair is the preferred treatment to restore normal mechanics. Biceps tenodesis is typically favored in older, non-throwing patients.

Question 6249

Topic: Shoulder & Hip Sports

A 40-year-old man falls onto an outstretched hand and presents with anterior shoulder pain. He has a positive bear hug test and belly press test. The external rotation lag sign is negative. MRI confirms an isolated tear of the subscapularis tendon. Which of the following associated findings is most likely present?

. Dislocation of the long head of the biceps tendon
. Retraction of the supraspinatus tendon
. Fracture of the greater tuberosity
. Atrophy of the teres minor
. Labral tear at the 6 o'clock position

Correct Answer & Explanation

. Dislocation of the long head of the biceps tendon

Explanation

The subscapularis tendon provides the medial restraint for the long head of the biceps tendon. Isolated subscapularis tears often lead to medial subluxation or dislocation of the biceps tendon.

Question 6250

Topic: Shoulder & Hip Sports

A 42-year-old male suffers a seizure and subsequently complains of shoulder pain and inability to externally rotate his arm. An axillary lateral radiograph reveals a posterior shoulder dislocation with an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. What is the most appropriate management?

. Closed reduction and sling immobilization in internal rotation
. Arthroscopic Bankart repair
. McLaughlin procedure or modification (transfer of lesser tuberosity/subscapularis)
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Closed reduction and sling immobilization in internal rotation

Explanation

For a locked posterior dislocation with a reverse Hill-Sachs defect between 25-40%, a McLaughlin procedure or modified McLaughlin is indicated to fill the defect and prevent recurrent engagement.

Question 6251

Topic: Shoulder & Hip Sports

A 30-year-old elite volleyball player complains of vague posterior shoulder pain and weakness in external rotation. Examination shows isolated atrophy of the infraspinatus fossa. MRI shows a paralabral cyst at the spinoglenoid notch. Which finding is most likely to be present on physical examination?

. Weakness in shoulder abduction
. Isolated weakness in external rotation with arm at the side
. Sensory deficit over the lateral deltoid
. Positive Hornblower's sign
. Positive Bear hug test

Correct Answer & Explanation

. Weakness in shoulder abduction

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the motor branch to the infraspinatus, causing isolated weakness in external rotation. The supraspinatus (abduction) is spared.

Question 6252

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a locked posterior shoulder dislocation during a seizure. A CT scan reveals an anterior articular impaction fracture (reverse Hill-Sachs lesion) involving 30% of the humeral head articular surface. What is the most appropriate surgical management?

. Closed reduction and spica cast immobilization
. Open reduction and Latarjet procedure
. Modified McLaughlin procedure
. Reverse total shoulder arthroplasty
. Arthroscopic posterior Bankart repair

Correct Answer & Explanation

. Closed reduction and spica cast immobilization

Explanation

For reverse Hill-Sachs lesions involving 20% to 40% of the articular surface, transferring the lesser tuberosity with the subscapularis tendon into the defect (Modified McLaughlin procedure) provides excellent stability.

Question 6253

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of shoulder pain and isolated weakness in external rotation. An MRI demonstrates a paralabral cyst in the spinoglenoid notch compressing a nerve. This cyst is most commonly associated with which of the following intra-articular pathologies?

. Anterior Bankart lesion
. Superior SLAP tear extending anteriorly
. Posterior labral tear
. ALPSA lesion
. HAGL lesion

Correct Answer & Explanation

. Anterior Bankart lesion

Explanation

Spinoglenoid notch cysts strongly correlate with posterior or posterosuperior labral tears. A one-way valve effect forces joint fluid into the cyst, which compresses the distal branches of the suprascapular nerve supplying the infraspinatus.

Question 6254

Topic: Knee Sports

Regarding the biomechanics of the native anterior cruciate ligament (ACL), the posterolateral (PL) bundle reaches its maximum tension at which of the following knee positions?

. 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 ACL is composed of two main bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees. The PL bundle is tightest in full extension and plays a primary role in rotational stability.

Question 6255

Topic: Knee Sports
The anterior cruciate ligament (ACL) possesses a poor intrinsic healing capacity compared to the medial collateral ligament (MCL). This is primarily attributed to the intra-articular environment, specifically due to the upregulation of which molecule that dissolves the provisional fibrin clot?
. Plasmin
. Thrombin
. Fibrinogen
. Factor XIII
. Matrix Metalloproteinase-13

Correct Answer & Explanation

. Plasmin

Explanation

Synovial fluid contains high levels of plasminogen and plasminogen activators (like uPA), which convert plasminogen into plasmin. Plasmin prematurely degrades the fibrin clot necessary for a scaffold during the initial inflammatory phase of ligament healing.

Question 6256

Topic: Knee Sports

Following a meniscus tear, the potential for healing is greatest in the peripheral third. This is primarily due to blood supply derived from which of the following structures?

. Middle genicular artery
. Perimeniscal capillary plexus
. Popliteal artery direct branches
. Cruciate ligament anastomoses
. Synovial fluid diffusion

Correct Answer & Explanation

. Middle genicular artery

Explanation

The peripheral 10-30% of the meniscus (red-red zone) is vascularized by the perimeniscal capillary plexus. This plexus arises from the medial and lateral superior and inferior genicular arteries.

Question 6257

Topic: 5. Sports Medicine

A marathon runner relies heavily on muscle fibers adapted for endurance to complete a race. Compared to Type IIb muscle fibers, the predominant muscle fibers utilized by this athlete during prolonged running are characterized by:

. High glycolytic capacity and low capillary density
. High myosin ATPase activity and fast contraction
. Low myoglobin content and rapid fatigue
. High oxidative capacity and high mitochondrial density
. Large cross-sectional area and low lipid stores

Correct Answer & Explanation

. High glycolytic capacity and low capillary density

Explanation

Endurance athletes primarily utilize Type I (slow-twitch) muscle fibers. These fibers are adapted for aerobic metabolism, characterized by high oxidative capacity, high mitochondrial density, rich capillary supply, and high myoglobin content (giving them a red appearance). They fatigue slowly. Type IIb fibers are fast-twitch, rely on anaerobic glycolysis, fatigue rapidly, and are used for short, explosive bursts.

Question 6258

Topic: Shoulder & Hip Sports

When evaluating an MRI of the shoulder for rotator cuff pathology, a hyperintense signal is noted within the substance of the supraspinatus tendon on short TE sequences (T1, PD) that resolves on long TE sequences (T2). The tendon in this region is oriented at approximately 55 degrees relative to the static magnetic field. This phenomenon is best described as:

. A full-thickness tendon tear
. Acute hemorrhagic tendinosis
. Magic angle phenomenon
. Susceptibility artifact from microscopic metallic debris
. Chemical shift artifact

Correct Answer & Explanation

. A full-thickness tendon tear

Explanation

The magic angle phenomenon is a well-described MRI artifact that occurs in highly ordered collagenous tissues, such as tendons and ligaments, when their fibers are oriented at exactly 54.7 degrees to the main magnetic field (B0). This orientation prolongs T2 relaxation time, leading to artificially increased signal intensity on short echo time (TE) sequences (T1, PD, GRE). The signal typically normalizes on T2-weighted sequences.

Question 6259

Topic: 5. Sports Medicine

Following an ACL reconstruction using a hamstring autograft, the graft must incorporate into the bone tunnels. Which of the following zones characterizes the normal direct insertion (enthesis) of a ligament or tendon to bone?

. Tendon, uncalcified fibrocartilage, calcified fibrocartilage, bone
. Tendon, loose areolar tissue, bone
. Tendon, Sharpey's fibers, periosteum, bone
. Tendon, hyaline cartilage, bone
. Tendon, calcified fibrocartilage, hyaline cartilage, bone

Correct Answer & Explanation

. Tendon, uncalcified fibrocartilage, calcified fibrocartilage, bone

Explanation

A direct enthesis transitions through four distinct zones: tendon/ligament, uncalcified fibrocartilage, calcified fibrocartilage, and bone. This gradual transition helps minimize stress concentrations at the insertion site.

Question 6260

Topic: 5. Sports Medicine

A surgeon uses a freeze-dried cortical allograft for a massive structural defect. Which of the following properties does this graft possess?

. Osteoinductive only
. Osteoconductive only
. Osteogenic only
. Osteoconductive and osteoinductive
. Osteoconductive, osteoinductive, and osteogenic

Correct Answer & Explanation

. Osteoinductive only

Explanation

Structural cortical allografts are primarily osteoconductive, providing a scaffold for host bone ingrowth. The processing required to make them immunologically safe and structurally sound (like freeze-drying) destroys osteogenic cells and highly diminishes osteoinductive proteins.

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