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 6281
Topic: Knee Sports
A 25-year-old athlete sustains a twisting injury to the knee. Physical examination demonstrates a positive Dial test with more than 10 degrees of increased external rotation at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. What does this indicate?
Increased external rotation isolated to 30 degrees of flexion with a normal assessment at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.
Question 6282
Topic: Shoulder & Hip Sports
A 28-year-old overhead athlete presents with posterior shoulder pain and profound weakness in external rotation. Forward elevation strength is normal. Examination reveals isolated atrophy of the infraspinatus. An MRI shows a paralabral cyst. Where is the most likely location of the nerve compression?
Correct Answer & Explanation
. Suprascapular notch
Explanation
Isolated weakness and atrophy of the infraspinatus points to compression of the suprascapular nerve at the spinoglenoid notch. Compression at the suprascapular notch would typically involve denervation of both the supraspinatus and infraspinatus muscles.
Question 6283
Topic: Knee Sports
During anterior cruciate ligament (ACL) reconstruction, understanding the anatomy of the native bundles is crucial. Which of the following accurately describes the primary function of the anteromedial (AM) bundle of the ACL?
Correct Answer & Explanation
. Primary restraint to anterior tibial translation at 90 degrees of flexion
Explanation
The anteromedial (AM) bundle of the ACL is the primary restraint to anterior tibial translation when the knee is flexed to 90 degrees. The posterolateral (PL) bundle is tight in extension and provides primary rotatory stability.
Question 6284
Topic: Shoulder & Hip Sports
A 22-year-old collegiate baseball pitcher presents with a symptomatic Type II SLAP tear that has failed conservative management. Which surgical intervention is most appropriate?
Correct Answer & Explanation
. Biceps tenodesis
Explanation
In young, active overhead throwing athletes, the preferred surgical treatment for a Type II SLAP tear is arthroscopic repair. Biceps tenodesis alters the anatomy and is generally reserved for older patients or those with recurrent tears.
Question 6285
Topic: Shoulder & Hip Sports
A 22-year-old male rugby player presents with his fourth anterior shoulder dislocation. A pre-operative CT scan demonstrates 25% anterior glenoid bone loss. Which of the following surgical interventions provides the most biomechanically sound and durable stabilization for this patient?
Correct Answer & Explanation
. Arthroscopic Bankart repair with suture anchors
Explanation
The Latarjet procedure involves transferring the coracoid process with the attached conjoined tendon to the anterior glenoid neck. It is indicated in patients with recurrent anterior shoulder instability who have critical glenoid bone loss (typically >20-25%). It provides a triple blocking effect: bone block, sling effect of the conjoined tendon, and capsular repair.
Question 6286
Topic: Shoulder & Hip Sports
A 35-year-old male presents to the ER following a first-time generalized tonic-clonic seizure. He complains of right shoulder pain and his arm is locked in adduction and internal rotation. Passive external rotation is severely restricted. An AP radiograph shows a 'lightbulb' sign
. What is the most common associated bony defect seen with this specific injury pattern?
Correct Answer & Explanation
. Greater tuberosity fracture
Explanation
The patient has a posterior shoulder dislocation, classically associated with seizures, electrocution, or high-energy trauma. The 'lightbulb' sign is typical on AP radiographs due to internal rotation of the humerus. The most common associated bony defect is a reverse Hill-Sachs lesion, which is an impaction fracture of the anteromedial aspect of the humeral head against the posterior glenoid rim.
Question 6287
Topic: Shoulder & Hip Sports
A 40-year-old male presents with weakness in his right shoulder that began 3 weeks ago. He initially experienced excruciating, acute shoulder pain that woke him from sleep and lasted for several days before subsiding. He denies any trauma but notes a viral respiratory infection a month prior. On exam, he has prominent scapular winging and profound weakness in forward elevation. EMG shows denervation in the supraspinatus, infraspinatus, and serratus anterior. What is the most appropriate management?
Correct Answer & Explanation
. Corticosteroid injection into the subacromial space
Explanation
This clinical presentation is classic for Parsonage-Turner Syndrome (idiopathic brachial neuritis). It typically begins with acute, severe shoulder pain that gradually subsides, followed by profound weakness/paralysis of shoulder girdle muscles (commonly involving the long thoracic or suprascapular nerves). The condition is self-limiting in the vast majority of cases. The treatment is primarily supportive with observation, pain management, and physical therapy to maintain ROM.
Question 6288
Topic: Shoulder & Hip Sports
A 45-year-old recreational tennis player presents with chronic anterior shoulder pain. The pain is strongly reproduced by passive forward flexion, internal rotation, and adduction. MRI of the shoulder reveals subcoracoid stenosis and localized edema in the subscapularis tendon insertion. Based on these findings, he is diagnosed with coracoid impingement syndrome. On an axial MRI slice, what anatomical distance between the tip of the coracoid and the lesser tuberosity is classically considered diagnostic for this condition?
Correct Answer & Explanation
. < 15 mm
Explanation
Coracoid impingement occurs when the subscapularis tendon is compressed between the coracoid process and the lesser tuberosity. While the normal coracohumeral distance on an axial MRI or CT scan is typically 8 to 11 mm, a narrowed distance of less than 6 mm (in internal rotation) is considered highly suggestive and diagnostic of coracoid impingement.
Question 6289
Topic: Shoulder & Hip Sports
A 40-year-old female presents to the emergency department after a generalized tonic-clonic seizure. She has a locked, internally rotated shoulder.
CT imaging reveals a locked posterior shoulder dislocation with a reverse Hill-Sachs lesion involving 35% of the humeral head articular surface. Which surgical procedure is most appropriate?
Correct Answer & Explanation
. Arthroscopic posterior Bankart repair
Explanation
The patient has a posterior shoulder dislocation with a medium-sized reverse Hill-Sachs (anteromedial humeral head) defect. The management algorithm depends on the defect size: <20% can often be managed non-operatively or with simple subscapularis transfer (McLaughlin procedure); 20% to 40% defects are best treated with a modified McLaughlin procedure (transfer of the lesser tuberosity with the attached subscapularis tendon into the defect) to provide structural bone fill and dynamic stabilization; >40-50% defects typically require structural allograft or arthroplasty (hemiarthroplasty or TSA depending on glenoid condition and patient age).
Question 6290
Topic: Shoulder & Hip Sports
A 28-year-old elite volleyball player presents with painless weakness in external rotation of his right shoulder. His abduction strength and forward elevation are symmetric to the contralateral side. Physical examination reveals isolated atrophy of the infraspinatus muscle belly.
Where is the most likely location of nerve compression?
Correct Answer & Explanation
. Suprascapular notch
Explanation
The patient presents with isolated infraspinatus atrophy and weakness in external rotation, with preserved supraspinatus function (normal abduction). This presentation is characteristic of suprascapular nerve compression at the spinoglenoid notch. Compression at the more proximal suprascapular notch (beneath the transverse scapular ligament) would typically affect both the supraspinatus and infraspinatus, leading to weakness in both abduction and external rotation. A paralabral cyst (often associated with posterior SLAP tears in overhead athletes) is a common cause of compression at the spinoglenoid notch.
Question 6291
Topic: Shoulder & Hip Sports
A 60-year-old female sustains a two-part surgical neck fracture of the proximal humerus. Examination reveals decreased sensation over the lateral aspect of the deltoid. Which of the following muscles is also most likely to exhibit weakness due to this specific neurologic injury?
Correct Answer & Explanation
. Infraspinatus
Explanation
The patient has an axillary nerve injury, which is a common complication of proximal humerus fractures. The axillary nerve innervates both the deltoid and the teres minor muscles.
Question 6292
Topic: 5. Sports Medicine
A 30-year-old male suffers a seizure and sustains a locked posterior shoulder dislocation.
CT scan shows an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 30% of the articular surface. What is the most appropriate surgical management?
Correct Answer & Explanation
. Closed reduction and spica cast immobilization
Explanation
For reverse Hill-Sachs defects between 20% and 40%, transfer of the lesser tuberosity and subscapularis tendon into the defect (Neer modification of the McLaughlin procedure) is indicated. Defects >40% typically require allograft reconstruction or arthroplasty.
Question 6293
Topic: 5. Sports Medicine
A 55-year-old manual laborer presents with a massive, irreparable posterosuperior rotator cuff tear. His subscapularis is intact, and he has no glenohumeral arthritis. He undergoes an arthroscopic superior capsular reconstruction (SCR). The primary biomechanical purpose of the dermal allograft is to prevent which of the following?
Correct Answer & Explanation
. Anterior subluxation of the humeral head
Explanation
Superior capsular reconstruction (SCR) is designed to restore the static restraint to superior translation of the humeral head, stabilizing the fulcrum for the remaining intact muscles (deltoid) to elevate the arm.
Question 6294
Topic: Shoulder & Hip Sports
A 29-year-old elite volleyball player presents with insidious onset of right shoulder weakness. Clinical examination reveals isolated profound atrophy of the infraspinatus with completely preserved supraspinatus bulk. An MRI is most likely to reveal a paralabral cyst compressing the nerve at which anatomical location?
Correct Answer & Explanation
. Suprascapular notch
Explanation
Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus.
Question 6295
Topic: Shoulder & Hip Sports
A 24-year-old active male presents with recurrent anterior shoulder instability. A 3D CT scan demonstrates 12% anterior glenoid bone loss. An MRI reveals an off-track Hill-Sachs lesion. What is the most appropriate surgical management?
Correct Answer & Explanation
. Arthroscopic Bankart repair alone
Explanation
In patients with subcritical glenoid bone loss (<15-20%) and an off-track (engaging) Hill-Sachs lesion, arthroscopic Bankart repair combined with remplissage is indicated. This fills the humeral defect with the infraspinatus tendon, preventing engagement during abduction and external rotation.
Question 6296
Topic: Shoulder & Hip Sports
A 45-year-old male presents with a locked posterior shoulder dislocation following a seizure. CT imaging shows an anteromedial humeral head impression fracture (reverse Hill-Sachs lesion) involving 30% of the articular surface. The glenoid is intact. What is the most appropriate surgical treatment?
Correct Answer & Explanation
. Closed reduction and spica cast immobilization
Explanation
For a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, the modified McLaughlin procedure is indicated. It involves transferring the lesser tuberosity and attached subscapularis into the anteromedial humeral defect to restore stability.
Question 6297
Topic: Shoulder & Hip Sports
A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness. MRI reveals a paralabral cyst located strictly at the spinoglenoid notch. Which of the following clinical deficits is most likely present?
Correct Answer & Explanation
. Weakness in both shoulder abduction and external rotation
Explanation
A cyst at the spinoglenoid notch compresses the suprascapular nerve after it has already innervated the supraspinatus. This leads to isolated denervation of the infraspinatus, resulting in weakness in external rotation only.
Question 6298
Topic: Shoulder & Hip Sports
A 55-year-old manual laborer presents with persistent anterior shoulder pain. MRI confirms an isolated Type II SLAP tear. Given the patient's age and occupation, what is the most reliable surgical intervention to provide pain relief and functional recovery?
Correct Answer & Explanation
. Arthroscopic SLAP repair with suture anchors
Explanation
In patients over 40-50 years of age, especially laborers, biceps tenodesis is highly preferred over SLAP repair. SLAP repairs in older patients have a high failure rate and frequently lead to postoperative stiffness.
Question 6299
Topic: Shoulder & Hip Sports
A 25-year-old athlete undergoes arthroscopic stabilization for recurrent anterior shoulder instability. MRI reveals an engaging Hill-Sachs lesion and 10% anterior glenoid bone loss. What is the primary biomechanical rationale for performing an arthroscopic remplissage alongside a Bankart repair?
Correct Answer & Explanation
. To restore the glenoid articular arc
Explanation
Remplissage involves tenodesis of the infraspinatus into the Hill-Sachs defect. This prevents the defect from engaging the anterior glenoid rim by effectively converting it into an extra-articular lesion.
Question 6300
Topic: Shoulder & Hip Sports
A 28-year-old elite volleyball player presents with painless weakness in external rotation. Physical examination reveals isolated atrophy of the infraspinatus with a normal supraspinatus. MRI demonstrates a paralabral cyst. Where is the cyst most likely located to cause these specific findings?
Correct Answer & Explanation
. Suprascapular notch
Explanation
Compression of the suprascapular nerve at the spinoglenoid notch affects only the motor branch to the infraspinatus, causing isolated external rotation weakness. Proximal compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.