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5. Sports Medicine MCQs

Practice Set 336 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 6701

Topic: Shoulder & Hip Sports

An examiner asks about the appropriate immobilization following a surgical repair of a large rotator cuff tear. What is the generally recommended position and duration for initial immobilization?

. Sling with arm internally rotated for 2 weeks.
. Sling with arm in neutral rotation for 6-8 weeks.
. Abduction pillow sling with arm in slight external rotation for 4-6 weeks.
. Shoulder brace allowing full range of motion immediately.
. Sling without restriction for 1 week.

Correct Answer & Explanation

. Abduction pillow sling with arm in slight external rotation for 4-6 weeks.

Explanation

Following repair of a large rotator cuff tear, immobilization in an abduction pillow sling (or similar device) with the arm in slight abduction and external rotation for 4-6 weeks is a common and generally recommended protocol. This position helps reduce tension on the repair site. While specific protocols vary, prolonged immobilization (e.g., 6-8 weeks in neutral) can lead to stiffness, and insufficient immobilization can jeopardize the repair. Immediate full ROM or internal rotation are generally contraindicated.

Question 6702

Topic: Shoulder & Hip Sports

You are discussing a patient with chronic shoulder pain and a positive 'drop arm test'. What does this test specifically indicate, and what type of pathology is it highly suggestive of?

. Bicipital tendinopathy.
. Glenohumeral instability.
. Full-thickness rotator cuff tear, particularly supraspinatus.
. Adhesive capsulitis.
. Acromioclavicular joint injury.

Correct Answer & Explanation

. Full-thickness rotator cuff tear, particularly supraspinatus.

Explanation

The Drop Arm Test is highly indicative of a full-thickness tear of the rotator cuff, most commonly the supraspinatus tendon. A positive test occurs when the patient cannot smoothly lower their arm from a position of 90 degrees of abduction (after the examiner passively places it there) and the arm 'drops' uncontrollably. It signifies an inability to maintain active abduction against gravity. The other conditions are not primarily assessed by this test.

Question 6703

Topic: Shoulder & Hip Sports

An examiner asks you about the optimal approach for assessing glenoid bone loss in a patient with recurrent anterior shoulder instability. Which imaging modality and specific measurement technique would you recommend?

. Plain AP radiograph with the 'perfect circle' technique.
. MRI with 3D reconstruction using a bone defect angle measurement.
. CT scan with 3D reconstruction using the 'inverted pear' or 'glenoid track' concept.
. Ultrasound with dynamic assessment.
. Plain axillary lateral radiograph to estimate glenoid width.

Correct Answer & Explanation

. CT scan with 3D reconstruction using the 'inverted pear' or 'glenoid track' concept.

Explanation

A CT scan with 3D reconstruction is the gold standard for accurately assessing glenoid bone loss in anterior shoulder instability. Techniques like the 'inverted pear' sign, which compares the width of the inferior glenoid to the mid-glenoid, or direct measurements of the bone defect area on an en face view, and the 'glenoid track' concept, are used to quantify bone loss and guide surgical decision-making. While MRI can show bone loss, CT is superior for precise quantification of bony defects.

Question 6704

Topic: Shoulder & Hip Sports

An examiner asks you about the primary anatomical structure involved in 'Os Acromiale' and its clinical significance.

. A fracture of the acromion.
. A non-union of the coracoid process.
. A failure of fusion of the acromial apophysis.
. An accessory ossicle within the supraspinatus tendon.
. A congenital anomaly of the glenoid.

Correct Answer & Explanation

. A failure of fusion of the acromial apophysis.

Explanation

An os acromiale is a failure of fusion of one or more of the four ossification centers of the acromion, resulting in a separate bone segment. This unfused segment can be mobile and impinge on the rotator cuff, causing subacromial impingement syndrome and predisposing to rotator cuff tears. It is not a fracture, nor is it related to the coracoid, supraspinatus, or glenoid.

Question 6705

Topic: 5. Sports Medicine

When advising a patient on return to sport following an arthroscopic Bankart repair, what is the most important factor to emphasize for a safe return to collision sports?

. Achievement of full passive range of motion.
. Complete absence of pain.
. Successful completion of a sport-specific rehabilitation program with demonstrated strength and stability.
. At least 6 months post-operative.
. Ability to lift light weights without discomfort.

Correct Answer & Explanation

. Successful completion of a sport-specific rehabilitation program with demonstrated strength and stability.

Explanation

Return to collision sports after an arthroscopic Bankart repair requires rigorous criteria to minimize the risk of re-dislocation. The most important factor is the successful completion of a comprehensive, sport-specific rehabilitation program that demonstrates not only full range of motion and strength but also dynamic stability, proprioception, and functional ability to withstand the forces encountered in their specific sport. While time frames (e.g., 6 months) are guidelines, functional readiness is paramount. Pain absence and full passive ROM are necessary but not sufficient criteria.

Question 6706

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. An MRI shows an engaging Hill-Sachs lesion. According to the glenoid track concept, which of the following best describes the criteria for an 'off-track' Hill-Sachs lesion?

. The Hill-Sachs interval (HSI) is less than the glenoid track width.
. The Hill-Sachs interval (HSI) is greater than the glenoid track width.
. The glenoid bone loss is greater than 10% of the native glenoid width.
. The Hill-Sachs lesion involves the anterior 20% of the humeral head.
. The width of the glenoid track is greater than the bare area of the glenoid.

Correct Answer & Explanation

. The Hill-Sachs interval (HSI) is greater than the glenoid track width.

Explanation

According to the glenoid track concept described by Di Giacomo et al., if the Hill-Sachs interval (HSI) - defined as the width of the Hill-Sachs lesion plus the intact anterior bone bridge - is greater than the glenoid track width (which is 83% of the intact glenoid width minus any anterior bone loss), the lesion will engage the anterior glenoid rim. This is termed an 'off-track' lesion.

Question 6707

Topic: 5. Sports Medicine

A 52-year-old recreational tennis player presents with persistent anterior shoulder pain and mechanical symptoms. An MRI arthrogram confirms an isolated Type II SLAP tear. After failed conservative management, what is the most appropriate surgical intervention for this patient?

. SLAP repair with suture anchors
. Biceps tenotomy without repair
. Biceps tenodesis
. Arthroscopic debridement of the superior labrum
. Coracoacromial ligament release

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In older or middle-aged patients (typically >40-45 years), particularly those who are not elite overhead athletes, biceps tenodesis provides more predictable pain relief and functional improvement with fewer complications (like postoperative stiffness) compared to a formal Type II SLAP repair.

Question 6708

Topic: 5. Sports Medicine

A 50-year-old patient with an irreparable posterosuperior rotator cuff tear requires a tendon transfer to restore external rotation. Which of the following tendon transfers provides a line of pull that most closely replicates the native infraspinatus muscle vector?

. Latissimus dorsi
. Pectoralis major
. Lower trapezius
. Teres major
. Levator scapulae

Correct Answer & Explanation

. Lower trapezius

Explanation

The lower trapezius transfer (typically using an Achilles or hamstring tendon allograft for length) has a line of pull that very closely matches the native vector of the infraspinatus, making it biomechanically superior to the latissimus dorsi for primarily restoring external rotation in massive posterosuperior cuff tears.

Question 6709

Topic: Shoulder & Hip Sports

A 29-year-old male volleyball player presents with isolated weakness in external rotation of the right shoulder. Forward elevation strength is 5/5. MRI reveals a paralabral cyst. At which anatomical location is the cyst most likely compressing the suprascapular nerve?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Triangular interval
. Coracoid base

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus muscle and then passes through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (commonly by a paralabral cyst associated with a posterior labral tear) causes isolated infraspinatus weakness (external rotation deficit). Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6710

Topic: Shoulder & Hip Sports

A 24-year-old rugby player has recurrent anterior shoulder instability. CT evaluation demonstrates an engaging Hill-Sachs lesion ('off-track') with 10% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Open Bankart repair with inferior capsular shift
. Humeral head structural allograft reconstruction

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

In the setting of recurrent anterior instability with 'subcritical' glenoid bone loss (typically <15-20%) but an off-track (engaging) Hill-Sachs lesion, arthroscopic Bankart repair combined with a Remplissage procedure (infraspinatus tenodesis and capsulodesis into the defect) effectively converts the lesion to 'on-track' and prevents engagement. Latarjet is generally reserved for critical bone loss (>20%).

Question 6711

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with painless weakness of her dominant shoulder. Physical examination reveals isolated atrophy of the infraspinatus with normal supraspinatus bulk and strength. Where is the most likely site of nerve compression?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. Compression at the suprascapular notch affects both muscles. However, as the nerve traverses the spinoglenoid notch, it innervates only the infraspinatus. Therefore, a lesion at the spinoglenoid notch (commonly a paralabral cyst associated with a posterior labral tear) results in isolated infraspinatus atrophy and weakness.

Question 6712

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer with an irreparable posterosuperior rotator cuff tear is evaluated for a latissimus dorsi tendon transfer. He has intact forward elevation to 100 degrees but persistent pain and severe external rotation weakness. Which of the following preoperative findings is a recognized contraindication to a successful latissimus dorsi transfer?

. Gouty arthropathy of the acromioclavicular joint
. An intact teres minor
. Infraspinatus atrophy (Goutallier stage 3)
. An irreparable tear of the subscapularis
. Mild glenohumeral osteoarthritis

Correct Answer & Explanation

. An irreparable tear of the subscapularis

Explanation

A successful latissimus dorsi transfer for a massive posterosuperior cuff tear relies on an intact force couple in the transverse plane. An irreparable subscapularis tear compromises the anterior aspect of this force couple, making a latissimus dorsi transfer functionally ineffective and historically a strict contraindication. Advanced age, deltoid deficiency, and pseudoparalysis are also contraindications.

Question 6713

Topic: 5. Sports Medicine

During shoulder arthroscopy for recurrent anterior instability in a 25-year-old athlete, the surgeon notes an intact labrum but an avulsion of the inferior glenohumeral ligament from the anatomic neck of the humerus. Which associated injury has a notable incidence with this specific lesion?

. Bony Bankart lesion
. Subscapularis tendon tear
. Isolated loss of internal rotation
. Subluxation of the long head of the biceps
. Type 4 SLAP tear

Correct Answer & Explanation

. Subscapularis tendon tear

Explanation

The scenario describes a HAGL (Humeral Avulsion of the Glenohumeral Ligament) lesion. HAGL lesions are an important cause of recurrent instability in patients without a Bankart lesion. They have a known and notable association with subscapularis tendon tears (often occurring concomitantly during the traumatic event), and the subscapularis must be carefully evaluated.

Question 6714

Topic: 5. Sports Medicine

A 14-year-old female gymnast presents with chronic, dull lateral elbow pain and catching. Radiographs demonstrate a radiolucent lesion in the capitellum. MRI confirms a 12 mm osteochondral defect with a detached, loose fragment and underlying sclerotic subchondral bone. What is the most appropriate definitive management?

. Casting in 90 degrees of flexion for 6 weeks
. Arthroscopic fragment excision and microfracture of the capitellum
. In situ headless compression screw fixation
. Osteochondral autograft transfer system (OATS) procedure
. Radial head excision

Correct Answer & Explanation

. Arthroscopic fragment excision and microfracture of the capitellum

Explanation

The patient has Osteochondritis Dissecans (OCD) of the capitellum, typically seen in adolescent athletes with repetitive compressive forces (gymnasts, pitchers). Because the MRI demonstrates a detached fragment and underlying sclerotic bone, the lesion is unstable and unlikely to heal with in situ fixation. For unstable lesions without a salvable bone fragment (sclerotic base), the standard of care is fragment excision and marrow stimulation (microfracture) to encourage fibrocartilage fill. OATS is typically reserved for large, uncontained defects or failures of primary microfracture.

Question 6715

Topic: Shoulder & Hip Sports

A 25-year-old minor league pitcher is evaluated for a decline in throwing velocity and vague shoulder pain. Range of motion testing reveals 30 degrees of internal rotation and 120 degrees of external rotation in his throwing shoulder, compared to 60 degrees of internal rotation and 90 degrees of external rotation in his non-throwing shoulder. What is the most appropriate initial management for this condition?

. Arthroscopic SLAP repair
. Diagnostic arthroscopy with posterior capsular release
. Physical therapy focusing on posterior capsular 'sleeper' stretches
. Anterior capsulorrhaphy
. Subacromial corticosteroid injection

Correct Answer & Explanation

. Physical therapy focusing on posterior capsular 'sleeper' stretches

Explanation

The patient demonstrates Glenohumeral Internal Rotation Deficit (GIRD). The definition of pathologic GIRD is a loss of internal rotation (IR) that exceeds the gain in external rotation (ER), leading to an overall loss of total arc of motion compared to the contralateral side. In this case, the throwing shoulder has a total arc of 150 (30+120) compared to the normal 150 (60+90), which represents a symmetric shift in the arc of motion (adaptive GIRD), rather than pathologic. However, regardless of whether it is adaptive or early pathologic GIRD, the initial treatment is always conservative, centered on a posterior capsular stretching program ('sleeper stretches') to address the acquired posterior capsular contracture.

Question 6716

Topic: Shoulder & Hip Sports

A 55-year-old patient presents with acute anterior shoulder pain and weakness after a fall on an outstretched hand. On examination, the patient has a positive belly-press test and a positive bear-hug test. The 'lift-off' test cannot be performed due to restricted internal rotation. These examination findings indicate a tear of which structure?

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

Correct Answer & Explanation

. Subscapularis tendon

Explanation

The belly-press, bear-hug, and lift-off tests are all specific physical examination maneuvers designed to evaluate the integrity of the subscapularis tendon. The subscapularis is the primary internal rotator of the shoulder. The belly-press and bear-hug tests are particularly useful when the lift-off test cannot be performed because the patient lacks the necessary passive internal rotation to place their hand behind their lower back.

Question 6717

Topic: Shoulder & Hip Sports

A 45-year-old male presents with a 2-week history of severe, unremitting, burning right shoulder pain that woke him from sleep. The pain has recently subsided, but he now has profound weakness in overhead elevation and external rotation. He reports no preceding trauma. An MRI of the shoulder is unremarkable without evidence of rotator cuff tearing. EMG performed 4 weeks later shows acute denervation potentials isolated to the supraspinatus and infraspinatus muscles. What is the most likely diagnosis?

. Cervical spondylotic myelopathy
. Parsonage-Turner syndrome (Neuralgic amyotrophy)
. Suprascapular nerve entrapment at the spinoglenoid notch
. Quadrilateral space syndrome
. Thoracic outlet syndrome

Correct Answer & Explanation

. Parsonage-Turner syndrome (Neuralgic amyotrophy)

Explanation

Parsonage-Turner syndrome (acute brachial neuritis or neuralgic amyotrophy) is characterized by the sudden onset of severe, unremitting pain about the shoulder girdle (often waking the patient at night), followed by patchy muscle weakness and atrophy as the pain begins to subside. The suprascapular nerve (innervating the supraspinatus and infraspinatus) is commonly involved, mimicking a massive rotator cuff tear. The absence of trauma, normal shoulder MRI, and EMG findings confirm a neurogenic etiology. Suprascapular nerve entrapment at the spinoglenoid notch would typically present with isolated infraspinatus involvement without the antecedent severe, acute pain phase.

Question 6718

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of right shoulder weakness. Examination reveals isolated atrophy of the infraspinatus with preserved supraspinatus bulk. External rotation strength is 3/5. Which of the following is the most likely etiology?

. Suprascapular nerve entrapment at the suprascapular notch
. Quadrilateral space syndrome
. Paralabral cyst at the spinoglenoid notch
. Parsonage-Turner syndrome
. Subcoracoid impingement

Correct Answer & Explanation

. Paralabral cyst at the spinoglenoid notch

Explanation

Isolated infraspinatus atrophy implies compression of the suprascapular nerve distal to its innervation of the supraspinatus. This typically occurs at the spinoglenoid notch. In overhead athletes, this is frequently associated with posterior superior labral tears that act as a one-way valve, leading to a paralabral cyst that compresses the nerve in the spinoglenoid notch.

Question 6719

Topic: 5. Sports Medicine

A 13-year-old elite baseball pitcher presents with vague shoulder pain during the late cocking and early acceleration phases of throwing. Radiographs show widening and sclerosis of the proximal humeral physis. What is the most appropriate initial management?

. Diagnostic arthroscopy to rule out SLAP tear
. Physical therapy focusing on scapular stabilization while continuing to pitch
. Corticosteroid injection into the subacromial space
. Absolute rest from throwing for 3 months
. Proximal humeral epiphysiodesis

Correct Answer & Explanation

. Absolute rest from throwing for 3 months

Explanation

'Little League shoulder' is a proximal humeral epiphysiolysis (stress fracture of the physis) caused by repetitive torsional forces during throwing. Treatment involves absolute cessation of throwing (usually for 3 months) until symptoms resolve and radiographs show healing, followed by a gradual return-to-throwing program.

Question 6720

Topic: Shoulder & Hip Sports

A 30-year-old recreational weightlifter complains of vague posterior shoulder pain and weakness. An MRI reveals an isolated paralabral cyst in the quadrilateral space. Which muscle is most likely to demonstrate denervation changes on electromyography (EMG)?

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

Correct Answer & Explanation

. Teres minor

Explanation

The quadrilateral space contains the axillary nerve and the posterior humeral circumflex artery. Compression here (Quadrilateral Space Syndrome) predominantly affects the axillary nerve branches, notably causing denervation and atrophy of the teres minor muscle, and sometimes the deltoid.

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