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5. Sports Medicine MCQs

Practice Set 335 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 6681

Topic: Shoulder & Hip Sports

For an 84-year-old lady with a history of recurrent anterior shoulder dislocations, which specific radiographic finding would indicate chronic instability and potential future surgical intervention?

. Subchondral sclerosis of the glenoid
. Flattening of the greater tuberosity
. A Hill-Sachs lesion or bony Bankart lesion
. Superior migration of the humeral head
. An intact anatomical neck

Correct Answer & Explanation

. A Hill-Sachs lesion or bony Bankart lesion

Explanation

Hill-Sachs lesions (compression fracture of the posterolateral humeral head) and bony Bankart lesions (avulsion fracture of the anterior-inferior glenoid rim) are common bony sequelae of recurrent anterior glenohumeral dislocations. Their presence indicates significant damage from prior dislocations and can contribute to recurrent instability, often necessitating surgical stabilization. Subchondral sclerosis is general OA. Flattening of GT is not specific. Superior migration is RCA. Intact anatomical neck is irrelevant.

Question 6682

Topic: Shoulder & Hip Sports

You are reviewing a follow-up X-ray for an 84-year-old with an anatomic TSA. What radiographic sign would be most concerning for glenoid component loosening?

. Development of a Hill-Sachs lesion
. Progressive lucency at the bone-cement interface of the glenoid component
. Calcification within the rotator cuff
. Increase in the acromiohumeral interval
. Scapular notching

Correct Answer & Explanation

. Progressive lucency at the bone-cement interface of the glenoid component

Explanation

Progressive lucency (a radiolucent line) greater than 1-2mm at the bone-cement or bone-implant interface around the glenoid component is the most significant radiographic sign of aseptic loosening of the glenoid component in a TSA. Hill-Sachs lesion is related to dislocation. Rotator cuff calcification is calcific tendinitis. Increased AHI suggests rotator cuff tear. Scapular notching is rTSA specific.

Question 6683

Topic: Shoulder & Hip Sports
An X-ray of an 84-year-old patient reveals a hooked or curved acromial morphology. This finding is most relevant to the pathogenesis of:
. Acromioclavicular joint osteoarthritis
. Subacromial impingement syndrome
. Rotator cuff calcific tendinitis
. Glenohumeral avascular necrosis
. Bony Bankart lesion

Correct Answer & Explanation

. Subacromial impingement syndrome

Explanation

A hooked or curved (Type II or Type III according to Bigliani's classification) acromial morphology is a well-established anatomical risk factor for subacromial impingement syndrome, as it reduces the space for the rotator cuff tendons to glide beneath the acromion. AC joint OA, calcific tendinitis, AVN, and Bankart lesions are not primarily caused by acromial morphology.

Question 6684

Topic: Shoulder & Hip Sports

Which finding on a shoulder X-ray of an 84-year-old is most indicative of early post-traumatic changes following a shoulder dislocation, rather than chronic instability?

. Large Hill-Sachs lesion
. Bony Bankart lesion
. A small glenohumeral joint effusion
. Superior migration of the humeral head
. Glenoid osteophytes

Correct Answer & Explanation

. A small glenohumeral joint effusion

Explanation

A small glenohumeral joint effusion (fluid in the joint space) can be an acute sign of trauma, including dislocation. Large Hill-Sachs and bony Bankart lesions suggest more significant or recurrent trauma. Superior migration of the humeral head indicates chronic rotator cuff deficiency. Glenoid osteophytes are a sign of chronic degenerative change.

Question 6685

Topic: Shoulder & Hip Sports

Which radiographic sign is often observed in the late stages of rotator cuff arthropathy, indicating severe joint destruction?

. Inferior glenohumeral osteophytes
. Widening of the acromioclavicular joint
. Severe superior migration of the humeral head with glenoid erosion
. Absence of a bicipital groove
. Scapular body fracture

Correct Answer & Explanation

. Severe superior migration of the humeral head with glenoid erosion

Explanation

Severe superior migration of the humeral head leading to direct articulation with the acromion, causing both acromial and glenoid erosion, is characteristic of late-stage rotator cuff arthropathy. This indicates extensive loss of the rotator cuff's stabilizing function. Inferior osteophytes are typical of primary OA. AC joint widening implies dislocation. Bicipital groove presence is normal. Scapular body fractures are traumatic.

Question 6686

Topic: 5. Sports Medicine

Which radiographic finding is most characteristic of chronic superior labrum anterior posterior (SLAP) tear on a plain shoulder X-ray in an 84-year-old, if any at all?

. Large anterior glenoid osteophyte
. Subacromial spurring
. Absence of any direct plain film findings, requiring MRI/arthroscopy for diagnosis
. Glenohumeral joint space widening
. Sclerotic changes of the greater tuberosity

Correct Answer & Explanation

. Absence of any direct plain film findings, requiring MRI/arthroscopy for diagnosis

Explanation

SLAP (Superior Labrum Anterior Posterior) tears are soft tissue injuries involving the labrum and biceps anchor. They are not directly visible on plain radiographs. Diagnosis typically requires MRI with or without arthrogram, or direct visualization during arthroscopy. Plain X-rays might show indirect signs of associated pathology (e.g., degenerative changes), but not the SLAP tear itself.

Question 6687

Topic: Shoulder & Hip Sports

You are asked about the 'Latarjet procedure'. Which specific type of shoulder instability is it primarily indicated for?

. Multidirectional instability.
. Posterior glenohumeral instability.
. Anterior glenohumeral instability with significant glenoid bone loss.
. Superior labrum anterior and posterior (SLAP) tears.
. Rotator cuff tear arthropathy.

Correct Answer & Explanation

. Anterior glenohumeral instability with significant glenoid bone loss.

Explanation

The Latarjet procedure is a bone block procedure primarily indicated for recurrent anterior glenohumeral instability, especially in cases with significant anterior glenoid bone loss (e.g., >20-25% of the inferior glenoid diameter) or in high-demand contact athletes. The transferred coracoid process acts as a bony buttress and has a sling effect on the subscapularis tendon, preventing further anterior dislocation. It is not indicated for the other conditions listed.

Question 6688

Topic: 5. Sports Medicine

An examiner asks about the 'dead arm syndrome' in a throwing athlete. What is the most likely underlying pathology?

. Cervical radiculopathy.
. Brachial plexus injury.
. Glenohumeral internal rotation deficit (GIRD).
. Microinstability or subtle anterior instability.
. Posterior labral tear.

Correct Answer & Explanation

. Microinstability or subtle anterior instability.

Explanation

The 'dead arm syndrome' in throwing athletes typically refers to a transient neurologic symptom (weakness, numbness, paresthesia) that occurs during the late cocking or early acceleration phase of throwing. It is most commonly associated with subtle anterior glenohumeral instability or microinstability, leading to nerve stretch (axillary or suprascapular) or vascular compromise during extreme abduction and external rotation. While cervical radiculopathy or brachial plexus injury could cause similar symptoms, the context of 'dead arm syndrome' in throwing athletes points to shoulder instability.

Question 6689

Topic: Shoulder & Hip Sports

When interpreting plain radiographs for a patient with shoulder pain, which view is most essential for assessing the acromial morphology and identifying a potential os acromiale?

. AP internal rotation view.
. AP external rotation view.
. Axillary lateral view.
. Scapular Y view.
. Supraspinatus outlet view.

Correct Answer & Explanation

. Supraspinatus outlet view.

Explanation

The Supraspinatus Outlet View (or 'Y' view in some contexts when evaluating the acromial undersurface projection) is specifically designed to visualize the relationship between the humeral head, glenoid, and acromion, providing an excellent profile of the acromion. It's crucial for assessing acromial morphology (e.g., curved, hooked acromion) and detecting an os acromiale, which is a common cause of impingement. The Axillary lateral view is also good for bony anatomy and glenoid version, but the outlet view is superior for acromial shape and os acromiale.

Question 6690

Topic: 5. Sports Medicine

You are discussing a patient with a posterior shoulder dislocation. After reduction, what is the most critical next step in your management, and why?

. Immediate shoulder arthroscopy to assess labral damage.
. Initiate aggressive rehabilitation to prevent stiffness.
. Obtain a CT scan to assess for associated fractures, especially a reverse Hill-Sachs lesion.
. Immobilize the arm in internal rotation for 6 weeks.
. Refer for nerve conduction studies to rule out brachial plexus injury.

Correct Answer & Explanation

. Obtain a CT scan to assess for associated fractures, especially a reverse Hill-Sachs lesion.

Explanation

After reduction of a posterior shoulder dislocation, a CT scan is crucial to assess for associated bony injuries, particularly a reverse Hill-Sachs lesion (impaction fracture on the anterior humeral head) and glenoid rim fractures. These can significantly impact prognosis and guide further management. Aggressive rehabilitation is contraindicated early on. Immobilization is typically in slight external rotation for posterior dislocations. Arthroscopy is for persistent instability, and nerve studies might be indicated if there's a clinical concern, but CT for bony lesions is a more immediate post-reduction priority.

Question 6691

Topic: 5. Sports Medicine

When discussing non-operative management for a symptomatic SLAP tear in a non-throwing athlete, what is the primary component of your initial treatment plan?

. Corticosteroid injection into the glenohumeral joint.
. Activity modification and physical therapy focusing on rotator cuff and scapular stabilization.
. Platelet-Rich Plasma (PRP) injections.
. Prolonged immobilization in a sling.
. Immediate referral for arthroscopic debridement.

Correct Answer & Explanation

. Activity modification and physical therapy focusing on rotator cuff and scapular stabilization.

Explanation

For most SLAP tears, especially in non-throwing athletes, non-operative management is the initial approach. The cornerstone of this is activity modification (avoiding aggravating activities) and a structured physical therapy program focusing on improving rotator cuff strength, scapular stabilization, and restoring glenohumeral kinematics. Injections can provide temporary symptom relief but don't address the underlying biomechanical issues. Prolonged immobilization can lead to stiffness. Surgery is reserved for failed non-operative treatment or specific types of tears (e.g., Type II in throwing athletes).

Question 6692

Topic: Shoulder & Hip Sports

You are asked about pain generators in subacromial impingement syndrome. Which structure is generally considered the primary source of pain in most cases?

. The deltoid muscle.
. The articular cartilage of the humeral head.
. The inflamed subacromial bursa and rotator cuff tendons.
. The glenoid labrum.
. The biceps tendon within the bicipital groove.

Correct Answer & Explanation

. The inflamed subacromial bursa and rotator cuff tendons.

Explanation

In subacromial impingement syndrome, the primary pain generators are the inflamed subacromial bursa and the irritated/damaged rotator cuff tendons (supraspinatus, infraspinatus, teres minor, subscapularis). These structures are compressed between the humeral head and the coracoacromial arch during overhead movements, leading to inflammation and pain. While the biceps tendon can be involved (secondary impingement), the bursa and cuff are the most common primary sources of pain.

Question 6693

Topic: Shoulder & Hip Sports

You are asked to distinguish between a Type II SLAP tear and a superior rotator cuff tear during an oral examination. What physical examination maneuver would be most helpful in differentiating these two conditions?

. Apprehension test.
. Neer impingement sign.
. Obrien's Test (Active Compression Test).
. Empty Can Test.
. External Rotation Lag Sign.

Correct Answer & Explanation

. Obrien's Test (Active Compression Test).

Explanation

O'Brien's Test (Active Compression Test) is often used to detect SLAP lesions, with pain during internal rotation and relief with external rotation. While not perfectly specific, it is specifically designed to stress the superior labrum. Neer and Empty Can tests primarily assess rotator cuff pathology/impingement. Apprehension tests instability, and the External Rotation Lag Sign assesses infraspinatus/teres minor. Therefore, O'Brien's is the most helpful differentiator for SLAP vs. RC tears in this context.

Question 6694

Topic: Shoulder & Hip Sports

An examiner asks about the 'painful arc' sign. What is its typical presentation and what pathology does it most commonly suggest?

. Pain during the first 30 degrees of abduction, suggesting adhesive capsulitis.
. Pain during the last 30 degrees of abduction, suggesting AC joint pathology.
. Pain between 60 and 120 degrees of abduction, suggesting subacromial impingement or rotator cuff pathology.
. Pain during resisted external rotation, suggesting infraspinatus tendinopathy.
. Pain with internal rotation and adduction, suggesting posterior impingement.

Correct Answer & Explanation

. Pain between 60 and 120 degrees of abduction, suggesting subacromial impingement or rotator cuff pathology.

Explanation

The 'painful arc' sign is characterized by pain occurring specifically between 60 and 120 degrees of active abduction, which then subsides with further elevation. This finding is highly suggestive of subacromial impingement syndrome or rotator cuff pathology (tendinopathy or partial tear) because the rotator cuff tendons are compressed under the acromion during this arc of motion. Pain at other arcs suggests different pathologies.

Question 6695

Topic: 5. Sports Medicine

You are asked about the management of glenohumeral internal rotation deficit (GIRD) in a throwing athlete. What is the cornerstone of its non-operative management?

. Surgical release of the posterior capsule.
. Aggressive external rotation strengthening exercises.
. Posterior shoulder stretching program, particularly 'sleeper stretches'.
. Corticosteroid injections into the posterior joint capsule.
. Prolonged rest from throwing activities.

Correct Answer & Explanation

. Posterior shoulder stretching program, particularly 'sleeper stretches'.

Explanation

Glenohumeral internal rotation deficit (GIRD) is a common adaptation in throwing athletes characterized by a loss of internal rotation. The cornerstone of its non-operative management is a specific stretching program, with 'sleeper stretches' being particularly effective, to restore internal rotation and address posterior capsular tightness. Surgical release is reserved for severe, refractory cases. While rest is important, it's not the primary 'cornerstone' of managing the deficit itself. Strengthening is important, but posterior stretching directly addresses the tightness.

Question 6696

Topic: Shoulder & Hip Sports

When discussing imaging for a suspected anterior labral tear in a patient with recurrent instability, what characteristic finding on MRI is highly suggestive of a Bankart lesion?

. Fluid signal within the subacromial bursa.
. Edema within the greater tuberosity.
. Separation of the anterior-inferior labrum from the glenoid rim.
. Thickening of the superior glenohumeral ligament.
. Cystic changes at the inferior glenoid.

Correct Answer & Explanation

. Separation of the anterior-inferior labrum from the glenoid rim.

Explanation

A Bankart lesion is a traumatic avulsion of the anterior-inferior labrum from the glenoid rim, often associated with a tear of the anterior-inferior glenohumeral ligament. On MRI, this presents as a separation or detachment of the labrum from the glenoid, often with surrounding fluid or edema. Fluid in the bursa suggests impingement, greater tuberosity edema can be from contusion or RC tear, and other options are less specific to Bankart.

Question 6697

Topic: Shoulder & Hip Sports

An examiner asks about a patient with a neglected posterior shoulder dislocation. What is the most significant concern regarding reduction in such a case?

. Increased risk of brachial plexus injury.
. Difficulty in achieving reduction due to muscle contracture.
. High likelihood of avascular necrosis of the humeral head following reduction.
. Increased risk of iatrogenic fracture of the humeral head during reduction.
. Increased risk of recurrent dislocation after reduction.

Correct Answer & Explanation

. Increased risk of iatrogenic fracture of the humeral head during reduction.

Explanation

In a neglected posterior shoulder dislocation (typically beyond 3 weeks), the most significant concern during attempted closed reduction is the increased risk of iatrogenic fracture of the humeral head (especially if there's a large reverse Hill-Sachs lesion) due to the humeral head being locked on the posterior glenoid. Avascular necrosis is also a concern, but the acute risk during reduction is fracture. The difficulty in reduction is true, but the primary complication to prevent is bony damage. Recurrence is more an issue of stability after reduction.

Question 6698

Topic: Shoulder & Hip Sports

When discussing the choice between open and arthroscopic repair for a traumatic Bankart lesion in a young, active athlete with recurrent dislocations but minimal bone loss, what is a key advantage of the arthroscopic approach you would highlight?

. Lower recurrence rate compared to open repair.
. Stronger repair construct.
. Better visualization of posterior pathology.
. Less post-operative stiffness.
. Avoidance of subscapularis detachment and potentially faster return to sport.

Correct Answer & Explanation

. Avoidance of subscapularis detachment and potentially faster return to sport.

Explanation

A key advantage of arthroscopic Bankart repair, especially when comparing it to traditional open Bankart repair, is the avoidance of subscapularis detachment. This theoretically leads to less post-operative pain, potentially faster rehabilitation, and an earlier return to sport, as the subscapularis is a critical anterior stabilizer and external rotator. While recurrence rates can be similar in experienced hands with appropriate patient selection, the avoidance of muscle detachment is a clear technical advantage. Less post-operative stiffness is a potential benefit, but avoidance of subscapularis compromise is a more direct advantage.

Question 6699

Topic: Shoulder & Hip Sports

You are asked about the typical presentation of a patient with a full-thickness rotator cuff tear (not acute traumatic). What is the most characteristic finding on physical examination?

. Severe limitation of passive range of motion.
. Gross instability with apprehension tests.
. Weakness and pain with active elevation, especially against resistance.
. Localized tenderness over the bicipital groove.
. Significant crepitus on shoulder circumduction.

Correct Answer & Explanation

. Weakness and pain with active elevation, especially against resistance.

Explanation

For a full-thickness rotator cuff tear, the most characteristic finding on physical examination is weakness and pain with active elevation, particularly against resistance (e.g., positive Empty Can, Jobe's test, or weakness in external rotation against resistance). While pain is common, true weakness in active motion out of proportion to pain is a strong indicator of a tear. Limitation of passive ROM suggests adhesive capsulitis, instability suggests instability, and bicipital groove tenderness suggests biceps pathology.

Question 6700

Topic: 5. Sports Medicine

When providing a differential diagnosis for isolated posterior shoulder pain in an overhead athlete, which condition is most likely to be high on your list?

. Bicipital tendinitis.
. Acromioclavicular joint osteoarthritis.
. Internal (posterior-superior) impingement.
. Adhesive capsulitis.
. Subacromial impingement.

Correct Answer & Explanation

. Internal (posterior-superior) impingement.

Explanation

Internal (or posterior-superior) impingement is a common cause of posterior shoulder pain in overhead athletes. It occurs during the late cocking phase of throwing, where the posterior-superior labrum and articular side of the rotator cuff (infraspinatus/supraspinatus) impinge against the posterior-superior glenoid. Bicipital tendinitis and subacromial impingement typically cause anterior/anterolateral pain. AC joint OA causes superior pain. Adhesive capsulitis causes global pain and stiffness.

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