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5. Sports Medicine MCQs

Practice Set 341 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 6801

Topic: 5. Sports Medicine

A 28-year-old baseball pitcher presents with chronic shoulder pain, especially during the late cocking phase of throwing. He describes a 'dead arm' sensation and clicking. Examination reveals tenderness at the posterior-superior glenoid, a positive O'Brien's test (active compression test), and a positive Speed's test. MRI shows a superior labral anterior-posterior (SLAP) tear extending into the biceps anchor. What is the most appropriate management for this high-level overhead athlete?

. Conservative management with rest, NSAIDs, and physical therapy
. Arthroscopic debridement of the labral tear
. Arthroscopic SLAP repair
. Biceps tenodesis
. Subacromial decompression

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

For a high-level overhead athlete with a symptomatic SLAP tear (especially Type II or IV involving the biceps anchor) confirmed by MRI and clinical examination, arthroscopic SLAP repair is generally the most appropriate treatment to restore stability and function for throwing activities. Conservative management may be attempted initially but is often unsuccessful in athletes with mechanical symptoms. Arthroscopic debridement is reserved for degenerative or stable tears without significant biceps involvement. Biceps tenodesis is typically considered for older, less active patients or when the biceps anchor is significantly diseased/degenerate, as it removes the biceps from the glenoid and alters shoulder kinematics. Subacromial decompression addresses impingement, not a labral tear.

Question 6802

Topic: Shoulder & Hip Sports

A 48-year-old male presents with worsening right shoulder pain and weakness for the past 6 months. He denies trauma. Physical examination reveals a positive impingement sign, painful arc of motion, and weakness with external rotation against resistance. MRI shows a full-thickness rotator cuff tear of the supraspinatus tendon, measuring 1.5 cm. There is no significant fatty infiltration or muscle atrophy. What is the most appropriate management for this active, non-throwing patient?

. Physical therapy focusing on strengthening and stretching
. Subacromial corticosteroid injection
. Arthroscopic rotator cuff repair
. Open rotator cuff repair
. Hemiarthroplasty

Correct Answer & Explanation

. Arthroscopic rotator cuff repair

Explanation

For an active patient with a symptomatic, full-thickness rotator cuff tear, especially a relatively small (1.5 cm) tear with good tissue quality (no significant fatty infiltration or atrophy), surgical repair is generally recommended to restore function, relieve pain, and prevent tear enlargement. Arthroscopic repair is the gold standard approach, offering less morbidity than open repair while achieving comparable outcomes. Conservative management (PT, injections) may be attempted but often fails to provide lasting relief in full-thickness tears. Hemiarthroplasty is for advanced cuff tear arthropathy.

Question 6803

Topic: Knee Sports

A 55-year-old male undergoes arthroscopic ACL reconstruction using an autologous hamstring graft. Two months post-operatively, he complains of anterior knee pain and crepitus with knee flexion. Examination reveals localized tenderness over the patellar tendon insertion and pain with resisted knee extension. Radiographs are normal. What is the most likely diagnosis?

. Graft failure
. Patellar tendinopathy
. Cyclops lesion
. Arthrofibrosis
. Medial collateral ligament (MCL) sprain

Correct Answer & Explanation

. Cyclops lesion

Explanation

The symptoms of anterior knee pain, crepitus, and catching with flexion after ACL reconstruction, especially at 2 months post-op, are classic for a Cyclops lesion. This is a nodule of fibrous tissue that forms anterior to the ACL graft in the intercondylar notch, causing impingement and blocking full extension. Patellar tendinopathy is less common with hamstring grafts, and graft failure would usually present with instability. Arthrofibrosis would present with more global stiffness and loss of range of motion. An MCL sprain would cause medial knee pain and instability.

Question 6804

Topic: Shoulder & Hip Sports

A 68-year-old male with a history of chronic kidney disease and hypertension presents with shoulder pain and weakness. Imaging reveals extensive calcific deposits within the rotator cuff tendons, particularly the supraspinatus. What is the most likely underlying metabolic etiology?

. Gout
. Hyperparathyroidism
. Calcium pyrophosphate dihydrate (CPPD) deposition disease
. Oxalosis
. Milwaukee shoulder syndrome

Correct Answer & Explanation

. Hyperparathyroidism

Explanation

The presence of extensive calcific deposits within the rotator cuff tendons, especially in a patient with chronic kidney disease, is highly suggestive of secondary hyperparathyroidism. Chronic kidney disease leads to impaired phosphate excretion and decreased vitamin D activation, resulting in hypocalcemia, which stimulates parathyroid hormone (PTH) release. High PTH levels can cause ectopic calcification in soft tissues, including tendons. Gout involves urate crystals. CPPD deposition (pseudogout) can cause calcific tendinitis, but hyperparathyroidism is a more direct cause in CKD. Oxalosis is rare. Milwaukee shoulder syndrome involves basic calcium phosphate crystals leading to rapid destructive arthropathy, often in older females.

Question 6805

Topic: Knee Sports

A 22-year-old football player sustains an injury to his knee during a tackle, resulting in a large hemarthrosis. Examination reveals a positive Lachman test and pivot shift test. MRI confirms a complete tear of the anterior cruciate ligament (ACL) and a medial meniscal tear. What is the optimal timing for ACL reconstruction in this patient?

. Immediately, within 24-48 hours of injury
. Within 1 week of injury to prevent muscle atrophy
. Delayed until knee inflammation subsides and full range of motion is achieved, typically 3-6 weeks post-injury
. After 3 months of aggressive quadriceps strengthening
. Only if the patient experiences recurrent instability during daily activities

Correct Answer & Explanation

. Delayed until knee inflammation subsides and full range of motion is achieved, typically 3-6 weeks post-injury

Explanation

For an acute ACL tear, especially with an associated meniscal tear, the optimal timing for reconstruction is typically delayed until the acute inflammation has subsided, and the patient has regained a near-full range of motion, usually 3-6 weeks post-injury. Early surgery (within 1-2 weeks) is associated with a significantly higher risk of arthrofibrosis (stiff knee syndrome). Waiting for full range of motion allows the knee to 'cool down,' improving surgical outcomes and rehabilitation potential. Delaying for 3 months or waiting for recurrent instability might be options for less active patients, but not typically for a football player aiming for return to sport.

Question 6806

Topic: Shoulder & Hip Sports

You are presenting a case of recurrent shoulder instability in a viva. To demonstrate a high level of expertise, you should primarily focus on:

. Reciting the surgical steps for a Latarjet procedure.
. Discussing all possible causes of shoulder pain.
. Systematically assessing patient factors, anatomy, imaging findings (e.g., glenoid bone loss, Hill-Sachs lesion), and considering individualized management algorithms.
. Emphasizing only the most common cause (anterior dislocation).
. Stating that the patient needs an MRI.

Correct Answer & Explanation

. Systematically assessing patient factors, anatomy, imaging findings (e.g., glenoid bone loss, Hill-Sachs lesion), and considering individualized management algorithms.

Explanation

For complex conditions like recurrent shoulder instability, a high-scoring candidate will integrate various factors. This includes patient age, activity level, direction of instability, the presence and severity of bony lesions (glenoid bone loss, Hill-Sachs), and soft tissue pathology. This leads to an individualized management algorithm, reflecting advanced clinical reasoning and the ability to tailor treatment, which is highly valued by examiners.

Question 6807

Topic: 5. Sports Medicine

When discussing bone grafting techniques in an exam, what key distinction should you highlight between autograft and allograft for an examiner?

. Autograft is always superior in all scenarios.
. Allograft is never incorporated into the host bone.
. Autograft provides osteoconduction, osteoinduction, and osteogenesis (gold standard), while allograft primarily offers osteoconduction and is immunologically inert (but lacks osteogenic cells).
. Autograft is more expensive than allograft.
. Allograft requires prolonged immobilization.

Correct Answer & Explanation

. Autograft provides osteoconduction, osteoinduction, and osteogenesis (gold standard), while allograft primarily offers osteoconduction and is immunologically inert (but lacks osteogenic cells).

Explanation

A high-scoring answer differentiates between autograft and allograft based on their biological properties. Autograft is the 'gold standard' because it provides all three components (osteoconduction, osteoinduction, osteogenesis). Allograft, while providing an osteoconductive scaffold and being immunologically inert (if processed), lacks viable osteogenic cells. Understanding these biological distinctions is crucial for appropriate graft selection.

Question 6808

Topic: Knee Sports

In a scenario involving multiple ligament knee injury (MLKI), what concept is most important to convey to an examiner regarding the treatment philosophy for optimal outcome?

. All ligaments should be repaired immediately regardless of injury pattern.
. Complete non-operative management is always preferred.
. Early, accurate diagnosis and reduction/stabilization of the knee joint, often requiring a staged approach for ligament reconstruction based on injury pattern, patient factors, and rehabilitation potential, with a focus on restoring stability.
. Focusing solely on ACL reconstruction.
. Ignoring associated neurovascular injuries.

Correct Answer & Explanation

. Early, accurate diagnosis and reduction/stabilization of the knee joint, often requiring a staged approach for ligament reconstruction based on injury pattern, patient factors, and rehabilitation potential, with a focus on restoring stability.

Explanation

MLKIs are severe and complex. A high-scoring answer will emphasize accurate diagnosis, early reduction and stabilization (often with external fixation), and a carefully planned, often staged, surgical approach for reconstruction of the injured ligaments. The goal is to restore stability and alignment while considering the overall limb viability (neurovascular checks are paramount). Ignoring associated injuries or applying a 'one-size-fits-all' approach is suboptimal.

Question 6809

Topic: Shoulder & Hip Sports

When discussing rotator cuff tears, what is the most important element for an examiner to hear regarding optimal management strategy, beyond just surgical technique?

. Only the size of the tear.
. That all tears require surgery.
. Patient age, activity demands, chronicity of symptoms, size and retractibility of the tear, fatty infiltration of the muscle, and the presence of associated pathology, all guiding a shared decision-making process for conservative vs. surgical management.
. The type of suture used for repair.
. Ignoring patient's pain level.

Correct Answer & Explanation

. Patient age, activity demands, chronicity of symptoms, size and retractibility of the tear, fatty infiltration of the muscle, and the presence of associated pathology, all guiding a shared decision-making process for conservative vs. surgical management.

Explanation

Optimal management of rotator cuff tears is highly individualized. A high-scoring answer will integrate patient factors (age, demands, activity level, comorbidities), tear characteristics (size, chronicity, retractibility, fatty infiltration), and associated pathology to inform a shared decision-making process between conservative and surgical options. Simply focusing on tear size or immediate surgery is insufficient and demonstrates a lack of nuanced understanding.

Question 6810

Topic: 5. Sports Medicine

In an exam scenario discussing the role of bracing for knee osteoarthritis, which statement best reflects an evidence-based approach to patient selection and expected outcomes?

. Bracing is only useful for highly active athletes.
. Bracing offers no benefit and should not be used.
. Unloader braces can be considered for medial or lateral compartment osteoarthritis, aiming to reduce pain and improve function by shifting load away from the affected compartment, particularly in patients with varus or valgus malalignment who are not surgical candidates or are awaiting surgery.
. Bracing cures osteoarthritis.
. All patients with knee osteoarthritis should use a brace.

Correct Answer & Explanation

. Unloader braces can be considered for medial or lateral compartment osteoarthritis, aiming to reduce pain and improve function by shifting load away from the affected compartment, particularly in patients with varus or valgus malalignment who are not surgical candidates or are awaiting surgery.

Explanation

For knee osteoarthritis, unloader braces are a valid, evidence-based non-operative option for selected patients. A high-scoring answer would identify their mechanism of action (shifting load), indications (medial/lateral compartment OA, appropriate alignment), and realistic goals (pain reduction, functional improvement), primarily for patients who are not surgical candidates or as a bridge to surgery. This demonstrates a nuanced understanding of their therapeutic niche.

Question 6811

Topic: Knee Sports

You are presenting a case of recurrent patellar dislocation. Which element of the workup is most crucial for identifying the underlying cause and guiding management for optimal marks?

. Only asking about pain.
. Focusing solely on the acute dislocation event.
. Detailed assessment of predisposing anatomical factors (e.g., trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance [TT-TG], ligamentous laxity), patient activity level, and previous treatment failures, using specialized imaging (MRI/CT).
. Assuming all cases are due to trauma.
. Recommending immediate arthroscopic repair.

Correct Answer & Explanation

. Detailed assessment of predisposing anatomical factors (e.g., trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance [TT-TG], ligamentous laxity), patient activity level, and previous treatment failures, using specialized imaging (MRI/CT).

Explanation

Recurrent patellar dislocation often has complex underlying anatomical predispositions. A high-scoring answer will emphasize a detailed workup that identifies these factors, such as trochlear dysplasia, patella alta, increased TT-TG distance, and ligamentous laxity (e.g., MPFL insufficiency), using specialized imaging like MRI or CT. Understanding these factors is key to tailoring management (conservative vs. MPFL reconstruction, osteotomy) and preventing recurrence, demonstrating a deep understanding of patellofemoral biomechanics.

Question 6812

Topic: 5. Sports Medicine

When advising a patient on return to sports after ACL reconstruction, what is the most important principle to communicate that demonstrates a responsible and evidence-based approach?

. Return to sports immediately after suture removal.
. Return when the patient feels no pain.
. A progressive, criterion-based rehabilitation program, rather than time-based, assessing strength, neuromuscular control, balance, and psychological readiness, with a typical return-to-sport timeline of 9-12 months and acknowledging residual risk of re-injury.
. Only focusing on quadriceps strength.
. Ignoring the patient's desired sport.

Correct Answer & Explanation

. A progressive, criterion-based rehabilitation program, rather than time-based, assessing strength, neuromuscular control, balance, and psychological readiness, with a typical return-to-sport timeline of 9-12 months and acknowledging residual risk of re-injury.

Explanation

Return to sports after ACL reconstruction should be criterion-based, not merely time-based. A high-scoring answer will detail a progressive rehabilitation program, emphasizing objective functional assessments (strength, neuromuscular control, hop testing) and psychological readiness. While 9-12 months is a typical timeline, adherence to objective criteria, tailored to the patient's sport, and acknowledging the persistent risk of re-injury, demonstrates a responsible and evidence-based approach.

Question 6813

Topic: Shoulder & Hip Sports

You are presenting a case of recurrent shoulder instability in an overhead athlete. The examiner asks, 'What specific factors would lead you to favor a bony reconstructive procedure (e.g., Latarjet) over an arthroscopic soft-tissue repair (e.g., Bankart) in this patient?'

. Patient preference for a faster recovery time.
. Presence of a significant glenoid bone loss (>20-25%) or an engaging Hill-Sachs lesion.
. A history of only one prior dislocation with no apparent bone loss.
. The patient's age being under 20 years old.
. High scores on the Western Ontario Shoulder Instability Index (WOSI).

Correct Answer & Explanation

. Presence of a significant glenoid bone loss (>20-25%) or an engaging Hill-Sachs lesion.

Explanation

Significant glenoid bone loss (typically >20-25% of the inferior glenoid) or an engaging Hill-Sachs lesion (where the humeral head defect engages the anterior glenoid rim) are the primary indications to favor a bony reconstructive procedure like the Latarjet over an arthroscopic soft-tissue repair for recurrent shoulder instability. These factors are associated with higher failure rates after isolated soft tissue repair. Patient preference (A) is secondary to biomechanical stability. A single prior dislocation (C) without bone loss would typically favor soft tissue repair. Age (D) is a risk factor for recurrence, but not a direct indication for bony procedure without bone loss. WOSI scores (E) reflect the severity of instability symptoms but not necessarily the underlying pathology dictating surgical choice.

Question 6814

Topic: Shoulder & Hip Sports

You are asked about the differential diagnosis of hip pain in a young adult. After listing common causes, the examiner asks, 'What specific signs or symptoms would raise your suspicion for a rare but critical diagnosis like avascular necrosis (AVN) of the femoral head in this demographic?'

. Insidious onset of groin pain, often worse with weight-bearing, without a clear traumatic event, especially in the presence of risk factors such as corticosteroid use or alcohol abuse.
. Acute onset of severe pain after a fall onto the hip, with external rotation and shortening of the limb.
. Chronic, dull ache in the buttock radiating down the posterior thigh, exacerbated by prolonged sitting.
. Clicking or catching sensation in the hip with specific movements, often associated with a positive FADIR test.
. Sudden, sharp pain in the lateral hip, reproducible with palpation over the greater trochanter.

Correct Answer & Explanation

. Insidious onset of groin pain, often worse with weight-bearing, without a clear traumatic event, especially in the presence of risk factors such as corticosteroid use or alcohol abuse.

Explanation

Avascular necrosis (AVN) of the femoral head typically presents with insidious onset of deep, aching groin pain, often made worse with weight-bearing, in the absence of a clear acute traumatic event. The presence of risk factors (e.g., steroid use, excessive alcohol, sickle cell disease, lupus, trauma with vascular disruption) significantly increases suspicion. Acute pain with external rotation/shortening (B) is classic for hip fracture/dislocation. Buttock pain radiating down the posterior thigh (C) suggests piriformis syndrome or sacroiliac joint dysfunction. Clicking/catching with FADIR (D) is indicative of femoroacetabular impingement (FAI) or labral tear. Lateral hip pain (E) points to trochanteric bursitis.

Question 6815

Topic: 5. Sports Medicine

During a viva, the examiner presents a case of a patient with knee pain after a twisting injury. You diagnose an ACL tear. The examiner then asks, 'What are the key patient factors you would consider when deciding between operative (ACL reconstruction) and non-operative management in this patient?'

. The patient's Body Mass Index (BMI) and dietary habits.
. The patient's age, activity level, functional demands (e.g., participation in pivoting sports), presence of meniscal or collateral ligament injuries, and psychological readiness.
. The patient's socioeconomic status and access to rehabilitation facilities.
. The specific graft choice available at your institution (autograft vs. allograft).
. The patient's preference for crutches versus walking boot post-injury.

Correct Answer & Explanation

. The patient's age, activity level, functional demands (e.g., participation in pivoting sports), presence of meniscal or collateral ligament injuries, and psychological readiness.

Explanation

The decision between operative and non-operative management for an ACL tear is highly individualized and multifactorial. Key patient factors include age (younger patients, especially those returning to high-demand sports, tend to have better outcomes with surgery), activity level and functional demands (pivoting/cutting sports highly recommend surgery), presence of concomitant injuries (meniscal tears, collateral ligament injuries often push towards surgery), and the patient's psychological readiness and commitment to rehabilitation. BMI (A) and graft choice (D) are considerations forsurgicaltechnique or outcomes but not primary drivers for operative vs. non-operative. Socioeconomic status (C) is a practical consideration, but not a primary clinical indication. Crutch preference (E) is trivial.

Question 6816

Topic: Knee Sports

You are presenting a case of recurrent patellar dislocation in an adolescent. The examiner asks, 'What specific anatomical or biomechanical factors predispose a patient to recurrent patellar instability, and how do you assess them?'

. Quadriceps muscle weakness, assessed by manual muscle testing.
. Excessive genu varum and external tibial torsion, assessed by clinical examination.
. Trochlear dysplasia, patella alta, increased tibial tuberosity-trochlear groove (TT-TG) distance, and generalized ligamentous laxity. These are assessed clinically (e.g., J-sign, apprehension test) and with imaging (radiographs for patella alta, MRI/CT for trochlear morphology and TT-TG distance).
. Lateral retinacular tightness, assessed by palpation.
. Meniscal tears, assessed by MRI.

Correct Answer & Explanation

. Trochlear dysplasia, patella alta, increased tibial tuberosity-trochlear groove (TT-TG) distance, and generalized ligamentous laxity. These are assessed clinically (e.g., J-sign, apprehension test) and with imaging (radiographs for patella alta, MRI/CT for trochlear morphology and TT-TG distance).

Explanation

Recurrent patellar instability is typically multifactorial. Key predisposing factors include osseous abnormalities such as trochlear dysplasia (a shallow or flat trochlear groove), patella alta (high-riding patella), and an increased tibial tuberosity-trochlear groove (TT-TG) distance, which indicates lateralization of the patellar tendon insertion. Ligamentous laxity, especially medial patellofemoral ligament (MPFL) insufficiency, is also critical. These are assessed through clinical examination (e.g., patellar apprehension test, J-sign) and advanced imaging (MRI for trochlear morphology and MPFL integrity, CT for accurate TT-TG measurement). Quadriceps weakness (A) and retinacular tightness (D) are usually secondary or less dominant factors. Genu varum (B) is less common, and meniscal tears (E) are not a primary predisposing factor for patellar instability.

Question 6817

Topic: 5. Sports Medicine

You are discussing the management of a stress fracture in a professional athlete. The examiner asks, 'What is the most critical factor to identify and address in a non-healing or recurrent stress fracture in an athlete, beyond just rest and immobilization?'

. The athlete's preferred sport, as some sports are more prone to stress fractures.
. The athlete's bone mineral density and underlying nutritional status, hormonal balance, and training errors (e.g., sudden increases in intensity or volume, inadequate recovery).
. The type of shoe the athlete uses for training.
. The specific analgesic medications the athlete is taking for pain control.
. The family history of stress fractures.

Correct Answer & Explanation

. The athlete's bone mineral density and underlying nutritional status, hormonal balance, and training errors (e.g., sudden increases in intensity or volume, inadequate recovery).

Explanation

Beyond initial rest and immobilization, the most critical factors for non-healing or recurrent stress fractures, especially in athletes, are underlying physiological and biomechanical imbalances. This includes assessing bone mineral density (for conditions like osteoporosis), nutritional status (e.g., vitamin D, calcium, energy availability in female athlete triad), hormonal balance (e.g., amenorrhea), and meticulous review of training errors (e.g., overtraining, rapid increase in load, inadequate recovery, poor technique). Addressing these systemic and biomechanical factors is crucial for successful long-term management and prevention of recurrence. Other factors are less critical or directly modifiable.

Question 6818

Topic: Shoulder & Hip Sports

You are asked about the management of a patient with chronic shoulder pain, and you suspect rotator cuff tendinopathy. The examiner asks, 'What is the most important component of conservative management for this condition?'

. Repeated corticosteroid injections into the subacromial space.
. Complete immobilization of the shoulder for 6 weeks.
. A structured, progressive physical therapy program focusing on rotator cuff strengthening, scapular stabilization, and postural correction.
. Oral non-steroidal anti-inflammatory drugs (NSAIDs) as needed.
. Immediate referral for surgical repair of the rotator cuff.

Correct Answer & Explanation

. A structured, progressive physical therapy program focusing on rotator cuff strengthening, scapular stabilization, and postural correction.

Explanation

The most important component of conservative management for rotator cuff tendinopathy is a structured, progressive physical therapy program. This focuses on improving rotator cuff strength and endurance, enhancing scapular mechanics and stability, and addressing any postural imbalances. This approach aims to restore proper shoulder biomechanics and reduce impingement. While NSAIDs (D) can help with pain, and injections (A) can offer short-term relief, they are adjuncts, not the primary management. Complete immobilization (B) is detrimental. Immediate surgical referral (E) is not indicated for tendinopathy unless it progresses to a tear failing conservative management.

Question 6819

Topic: 5. Sports Medicine

You are presenting a case of failed primary anterior cruciate ligament (ACL) reconstruction. The examiner asks, 'What are the most common identifiable reasons for failure of a primary ACL reconstruction?'

. Inadequate post-operative pain control and early return to sports.
. Malpositioning of the femoral or tibial tunnels, residual knee laxity, and significant concomitant meniscal or collateral ligament injuries that were not adequately addressed.
. Patient non-compliance with antibiotic prophylaxis and graft rejection.
. Use of an allograft instead of an autograft.
. Excessive rehabilitation and early full weight-bearing.

Correct Answer & Explanation

. Malpositioning of the femoral or tibial tunnels, residual knee laxity, and significant concomitant meniscal or collateral ligament injuries that were not adequately addressed.

Explanation

The most common identifiable reasons for failure of a primary ACL reconstruction are technical errors, particularly malpositioning of the femoral or tibial tunnels, which leads to non-anatomic graft placement and persistent instability. Other factors include significant concomitant injuries (meniscal tears, collateral ligament injuries) that were not adequately addressed, and biological factors like graft healing or tensioning. Early return to sports without adequate rehabilitation is also a factor, but tunnel malposition is often a primary cause. Inadequate pain control (A) is not a direct cause of failure. Graft rejection (C) is rare. Allograft (D) may have a higher failure rate than autograft in some populations but is not themost commonoverall reason. Excessive rehabilitation (E) is generally not the cause; inadequate or poor rehabilitation is.

Question 6820

Topic: Shoulder & Hip Sports

In a viva, you are asked about the surgical management of rotator cuff tears. The examiner asks, 'What is the primary rationale for repairing a symptomatic, full-thickness rotator cuff tear in an active individual, even if symptoms have been long-standing?'

. To prevent the development of shoulder adhesive capsulitis.
. To restore rotator cuff function, improve pain, and prevent tear propagation and the eventual development of rotator cuff arthropathy.
. To enable the patient to lift heavy weights above their head immediately post-operatively.
. To avoid the need for any further physical therapy.
. To reduce the risk of deep vein thrombosis.

Correct Answer & Explanation

. To restore rotator cuff function, improve pain, and prevent tear propagation and the eventual development of rotator cuff arthropathy.

Explanation

The primary rationale for repairing a symptomatic, full-thickness rotator cuff tear in an active individual is to restore the normal biomechanics and function of the rotator cuff, alleviate pain, prevent the tear from propagating (enlarging), and, critically, to avert the long-term development of rotator cuff arthropathy (cuff tear arthropathy), which is a much more debilitating condition. Repair allows for better long-term functional outcomes. Preventing adhesive capsulitis (A) is not the primary reason. Lifting heavy weights (C) is an unrealistic immediate goal. Avoiding physical therapy (D) is incorrect; rehabilitation is vital. DVT risk reduction (E) is a general surgical benefit.

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