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5. Sports Medicine MCQs

Practice Set 342 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 6821

Topic: 5. Sports Medicine

In an orthopedic viva, you are asked about the management of osteochondritis dissecans (OCD) of the knee. The examiner asks, 'What is the most significant prognostic factor in determining the outcome and guiding management for an OCD lesion?'

. The patient's Body Mass Index (BMI).
. The duration of symptoms before diagnosis.
. The skeletal maturity of the patient (open vs. closed physes), the size and stability of the lesion, and the presence of loose bodies.
. The specific location of the lesion (medial vs. lateral femoral condyle).
. The patient's preferred level of sports activity.

Correct Answer & Explanation

. The skeletal maturity of the patient (open vs. closed physes), the size and stability of the lesion, and the presence of loose bodies.

Explanation

The most significant prognostic factors in osteochondritis dissecans (OCD) of the knee are the skeletal maturity of the patient (whether growth plates are open or closed), the size of the lesion, and its stability (stable vs. unstable or displaced). In skeletally immature patients, stable lesions often have a higher chance of healing with non-operative management. Larger, unstable, or displaced lesions, especially in skeletally mature patients, typically require surgical intervention and have a poorer prognosis for complete healing. Other factors are less dominant. Duration of symptoms (B) is related to stability but less direct. BMI (A), location (D), and activity level (E) are secondary considerations.

Question 6822

Topic: Knee Sports

You are asked about the management of an acute posterolateral corner (PLC) knee injury. The examiner states, 'You've discussed acute management. Now, if this injury is not adequately treated, what is the most significant long-term consequence for the knee?'

. Increased risk of patellofemoral pain syndrome.
. Progressive medial compartment osteoarthritis due to altered biomechanics and chronic varus thrust.
. Development of a symptomatic popliteal cyst (Baker's cyst).
. Increased risk of deep vein thrombosis.
. Chronic anterior knee pain from quadriceps weakness.

Correct Answer & Explanation

. Progressive medial compartment osteoarthritis due to altered biomechanics and chronic varus thrust.

Explanation

Inadequate treatment of a posterolateral corner (PLC) knee injury leads to persistent posterolateral rotatory instability and chronic varus (bowleg) thrust during gait. This alters the knee's biomechanics, significantly increasing stress on the medial compartment. The most significant long-term consequence is the progressive development of medial compartment osteoarthritis. Patellofemoral pain (A), popliteal cyst (C), DVT (D), and chronic anterior knee pain (E) are less direct or less significant long-term consequences directly attributable to untreated PLC instability leading to altered varus alignment and thrust.

Question 6823

Topic: 5. Sports Medicine
A patient presents with a Rockwood Type III AC joint dislocation. Which of the following statements best describes the typical controversy surrounding its management?
. The choice between open reduction internal fixation (ORIF) and arthroscopic stabilization.
. The debate over immediate surgical intervention versus a trial of conservative management.
. The specific type of allograft versus autograft for ligament reconstruction.
. The role of acromial resection in conjunction with AC joint repair.
. The optimal rehabilitation protocol following surgical repair.

Correct Answer & Explanation

. The debate over immediate surgical intervention versus a trial of conservative management.

Explanation

The primary controversy for Rockwood Type III AC joint injuries revolves around whether to manage them conservatively (non-operatively) or surgically. While many patients do well with conservative management, athletes and manual laborers may opt for surgery to restore anatomy and strength, but studies have shown mixed results regarding long-term functional advantages of surgery over non-operative treatment for all patients. The other options pertain to surgical techniques or rehabilitation rather than the fundamental 'surgical vs. non-surgical' debate for Type III.

Question 6824

Topic: 5. Sports Medicine

A 22-year-old athlete presents with a Rockwood Type V AC joint dislocation. Which of the following best describes the typical extent of soft tissue injury associated with this type?

. Isolated AC ligament sprain.
. Complete AC ligament tear with partial CC ligament disruption.
. Complete AC and CC ligament disruption with posterior clavicle displacement into the trapezius.
. Complete AC and CC ligament disruption with significant superior clavicle displacement AND stripping of the deltoid and trapezius from the distal clavicle.
. Complete AC and CC ligament disruption with inferior clavicle displacement.

Correct Answer & Explanation

. Complete AC and CC ligament disruption with significant superior clavicle displacement AND stripping of the deltoid and trapezius from the distal clavicle.

Explanation

Rockwood Type V is characterized by complete disruption of both the AC and CC ligaments, resulting in severe superior displacement of the clavicle (often 100% or more of the acromial height) AND extensive stripping of the deltoid and trapezius muscle attachments from the distal clavicle. This degree of soft tissue stripping contributes to the marked displacement and often necessitates surgical intervention. Type IV involves posterior displacement. Type VI involves inferior displacement.

Question 6825

Topic: 5. Sports Medicine
A 30-year-old active duty military officer sustained a Rockwood Type III AC separation. He expresses strong desire to return to full, unrestricted combat duties as soon as possible. Considering the controversial nature of Type III management, what might be a reasonable initial management approach, keeping his goals in mind?
. Immediate operative stabilization to ensure anatomical reduction.
. A period of conservative management, followed by surgery only if functional deficits persist.
. Strict immobilization in a shoulder spica cast for 6 weeks.
. AC joint arthrodesis to ensure maximal stability.
. Delaying any intervention until symptoms become unbearable.

Correct Answer & Explanation

. Immediate operative stabilization to ensure anatomical reduction.

Explanation

For a highly active individual, particularly one in the military or a high-demand athlete, with a Rockwood Type III AC separation, immediate operative stabilization may be considered to achieve anatomical reduction and facilitate an earlier return to full function, despite the ongoing debate for the general population. While a trial of conservative management is often valid, the patient's explicit high-demand goals might tip the balance towards earlier surgical intervention. Strict immobilization in a spica cast is outdated and risks stiffness. Arthrodesis is overly aggressive for primary Type III. Delaying intervention is not proactive for his goals.

Question 6826

Topic: Shoulder & Hip Sports

In assessing the integrity of the AC joint on physical examination, direct palpation over the joint elicits pain. Which other maneuver is particularly helpful in localizing pain to the AC joint?

. Apprehension test
. Relocation test
. Speed's test
. Cross-body adduction (or 'scarf') test
. Empty can test

Correct Answer & Explanation

. Cross-body adduction (or 'scarf') test

Explanation

The cross-body adduction test, also known as the 'scarf test', specifically compresses the AC joint. When the arm is adducted across the chest, the acromion and distal clavicle are pushed together, often exacerbating pain originating from the AC joint, making it a useful diagnostic maneuver. The other tests assess glenohumeral instability (apprehension, relocation), biceps pathology (Speed's), or rotator cuff pathology (empty can).

Question 6827

Topic: Shoulder & Hip Sports
For a patient presenting with an AC joint injury, what is the primary role of an MRI in the diagnostic workup, especially when plain radiographs are equivocal?
. To confirm the presence of a clavicle fracture.
. To assess for associated rotator cuff tears.
. To precisely delineate the extent of ligamentous and soft tissue injury (AC and CC ligaments, deltoid/trapezius fascia).
. To evaluate for brachial plexus involvement.
. To rule out a glenohumeral joint dislocation.

Correct Answer & Explanation

. To precisely delineate the extent of ligamentous and soft tissue injury (AC and CC ligaments, deltoid/trapezius fascia).

Explanation

While plain radiographs are the cornerstone for initial AC joint diagnosis and classification, MRI can provide a more detailed assessment of the extent of ligamentous (AC and CC) and surrounding soft tissue (deltoid and trapezius fascia) injury. This can be particularly useful in equivocal cases or for surgical planning in higher-grade injuries, as it can help differentiate between Type II and III, or identify fascial stripping (Type V). It can also identify associated rotator cuff tears, but its primary utility for AC joint injury itself is detailed soft tissue assessment.

Question 6828

Topic: 5. Sports Medicine
Which surgical technique is commonly employed for acute, high-grade AC joint dislocations (e.g., Rockwood Type III in athletes, Type IV, V, VI) that aims to anatomically reduce and stabilize the clavicle relative to the coracoid process?
. Mumford procedure (distal clavicle excision)
. Rotator cuff repair
. Coracoclavicular (CC) ligament reconstruction/repair (e.g., using a hook plate, suture button, or autograft/allograft)
. Bankart repair
. Subacromial decompression

Correct Answer & Explanation

. Coracoclavicular (CC) ligament reconstruction/repair (e.g., using a hook plate, suture button, or autograft/allograft)

Explanation

For acute, high-grade AC joint dislocations requiring surgical intervention, the primary goal is often to anatomically reduce the clavicle and stabilize it to the coracoid process, thereby reconstructing or repairing the coracoclavicular ligaments. This can be achieved through various methods including temporary fixation (hook plates, screws), dynamic stabilization (suture buttons like the TightRope), or more definitive ligament reconstruction using grafts. The Mumford procedure is for chronic AC joint pain/arthritis. Rotator cuff and Bankart repairs are for different pathologies. Subacromial decompression is for impingement.

Question 6829

Topic: 5. Sports Medicine
Which of the following is considered a relative indication for surgical intervention in a Rockwood Type III AC joint injury?
. Sedentary lifestyle.
. Older patient with low functional demands.
. High-demand overhead athlete or heavy manual laborer.
. Presence of minimal cosmetic deformity.
. Pain controlled with oral NSAIDs and activity modification.

Correct Answer & Explanation

. High-demand overhead athlete or heavy manual laborer.

Explanation

For Rockwood Type III AC joint injuries, a high-demand overhead athlete or heavy manual laborer is often considered a relative indication for surgical intervention. While conservative management yields good results for many, these individuals may benefit from surgical stabilization to ensure optimal restoration of strength, stability, and earlier return to high-level activities. The other options generally favor conservative management.

Question 6830

Topic: Shoulder & Hip Sports
What is the clinical significance of a positive 'piano key' sign in an AC joint injury?
. Indicates an isolated AC ligament sprain (Type I).
. Suggests a partial tear of the AC ligaments only (Type II).
. Confirms complete disruption of the coracoclavicular ligaments (Type III or higher).
. Points to posterior displacement of the clavicle (Type IV).
. Suggests an associated rotator cuff tear.

Correct Answer & Explanation

. Confirms complete disruption of the coracoclavicular ligaments (Type III or higher).

Explanation

The 'piano key' sign, where the distal clavicle can be depressed but springs back up, signifies a complete loss of the vertical stabilizing effect of the coracoclavicular ligaments. This finding is indicative of a complete tear of the CC ligaments, which is characteristic of Rockwood Type III and higher AC joint dislocations. It is not present in Type I or II where CC ligaments are intact or only partially torn.

Question 6831

Topic: Shoulder & Hip Sports

When performing a clinical examination for AC joint pathology, what is the best way to differentiate pain originating from the AC joint versus the subacromial space?

. Resisted external rotation (for rotator cuff).
. Pain with cross-body adduction (for AC joint) vs. pain with internal rotation/impingement tests (for subacromial).
. Palpation over the bicipital groove.
. Apprehension test (for instability).
. Sulcus sign (for instability).

Correct Answer & Explanation

. Pain with cross-body adduction (for AC joint) vs. pain with internal rotation/impingement tests (for subacromial).

Explanation

Pain with cross-body adduction specifically loads the AC joint, making it a good discriminator for AC joint pathology. In contrast, subacromial pathology (e.g., impingement, bursitis, rotator cuff tendinopathy) is typically exacerbated by overhead movements, internal rotation, and specific impingement tests (Neer, Hawkins-Kennedy). While rotator cuff tests can indirectly differentiate, the direct comparison of AC loading vs. subacromial loading is key.

Question 6832

Topic: Shoulder & Hip Sports
In a patient undergoing surgical repair for a Rockwood Type III AC joint injury, what type of sling or brace is typically used post-operatively to support the arm and protect the repair?
. Figure-of-eight clavicle brace.
. Gunslinger brace.
. Shoulder immobilizer with an abduction pillow.
. Standard arm sling or a sling with a waist strap.
. Dynamic shoulder orthosis.

Correct Answer & Explanation

. Standard arm sling or a sling with a waist strap.

Explanation

Following surgical repair of an AC joint injury, a standard arm sling or a sling with a waist strap is typically used for comfort and to protect the repair by limiting abduction and rotation. A figure-of-eight brace is for clavicle shaft fractures. A gunslinger brace is for certain glenohumeral injuries. An abduction pillow immobilizer is commonly used after rotator cuff repair or shoulder instability surgery. Dynamic orthoses are for complex rehab. The key is protection without excessive immobility.

Question 6833

Topic: Shoulder & Hip Sports
A 35-year-old weightlifter presents with chronic pain and clicking at his right AC joint following an untreated Rockwood Type III injury 2 years prior. He has significant distal clavicle prominence and pain with overhead pressing. What salvage procedure might be considered for his symptoms?
. Acute CC ligament reconstruction.
. Arthroscopic Bankart repair.
. Distal clavicle excision (Mumford procedure).
. Total shoulder arthroplasty.
. Rotator cuff repair.

Correct Answer & Explanation

. Distal clavicle excision (Mumford procedure).

Explanation

For chronic, symptomatic AC joint injuries, particularly those with persistent pain, clicking, or degenerative changes often leading to impingement after a previous dislocation, distal clavicle excision (Mumford procedure) is a common salvage procedure. This involves resecting a small portion of the distal clavicle to create space and alleviate pain, typically performed either open or arthroscopically. Acute CC ligament reconstruction is for acute instability. Other options are for different pathologies.

Question 6834

Topic: 5. Sports Medicine

Which age group is most susceptible to AC joint injuries due to their participation in contact sports and recreational activities?

. Children (0-10 years)
. Adolescents and young adults (15-35 years)
. Middle-aged adults (40-60 years)
. Elderly adults (65+ years)
. Infants (0-1 year)

Correct Answer & Explanation

. Adolescents and young adults (15-35 years)

Explanation

AC joint injuries are most common in adolescents and young adults (typically 15-35 years old). This demographic is highly active in contact sports (e.g., football, rugby, hockey) and activities with a high risk of falls (e.g., cycling, skiing), which are common mechanisms for AC joint dislocations.

Question 6835

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness in external rotation. Exam reveals normal internal rotation and abduction strength. MRI demonstrates a paralabral cyst located strictly in the spinoglenoid notch. Which muscle is predominantly affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Infraspinatus

Explanation

A cyst in the spinoglenoid notch compresses the distal suprascapular nerve, specifically and exclusively affecting the infraspinatus muscle. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6836

Topic: Shoulder & Hip Sports

A 32-year-old male presents with a locked posterior shoulder dislocation and a 30% reverse Hill-Sachs defect following an unprovoked seizure. What is the most appropriate surgical treatment to address the humeral head defect and prevent recurrent instability?

. Arthroscopic Bankart repair
. Latarjet procedure
. Transfer of the subscapularis tendon into the defect (McLaughlin procedure)
. Remplissage procedure
. Hemiarthroplasty

Correct Answer & Explanation

. Transfer of the subscapularis tendon into the defect (McLaughlin procedure)

Explanation

For reverse Hill-Sachs defects between 20-40% associated with posterior shoulder instability, transferring the lesser tuberosity or the subscapularis tendon into the defect (McLaughlin or modified McLaughlin procedure) is indicated. Defects >40-50% typically require arthroplasty.

Question 6837

Topic: Shoulder & Hip Sports

A 21-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% anterior glenoid bone loss. Postoperatively, he exhibits weakness in elbow flexion and decreased sensation over the lateral forearm. Which nerve was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis approximately 3-8 cm distal to the coracoid process. It is at significant risk during coracoid osteotomy, mobilization, and transfer in the Latarjet procedure.

Question 6838

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 28% anterior glenoid bone loss and a significant engaging Hill-Sachs lesion. Which of the following procedures is most appropriate to restore stability?

. Arthroscopic Bankart repair
. Open capsular shift
. Arthroscopic Remplissage alone
. Latarjet procedure
. Subscapularis advancement

Correct Answer & Explanation

. Latarjet procedure

Explanation

The Latarjet procedure (coracoid transfer) is indicated for recurrent anterior shoulder instability with critical glenoid bone loss (>20-25%). It provides stability via the triple-blocking effect: bone block, sling effect of the conjoined tendon, and capsular repair.

Question 6839

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. CT imaging reveals a 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Coracoid transfer (Latarjet procedure)
. Open inferior capsular shift

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

Critical anterior glenoid bone loss (>20-25%) in a young, high-demand collision athlete is an absolute indication for a bony augmentation procedure like the Latarjet. Soft tissue stabilization alone (Bankart repair) in this scenario has an unacceptably high recurrence rate.

Question 6840

Topic: Shoulder & Hip Sports

A 50-year-old laborer presents with pseudoparalysis of external rotation due to a massive, irreparable tear of the supraspinatus and infraspinatus. His subscapularis is intact, and he has no glenohumeral arthritis. Which of the following is the most appropriate tendon transfer?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Either Latissimus dorsi or Lower trapezius transfer

Correct Answer & Explanation

. Either Latissimus dorsi or Lower trapezius transfer

Explanation

Latissimus dorsi and lower trapezius tendon transfers are both indicated to restore active external rotation and forward elevation in young patients with massive, irreparable posterosuperior rotator cuff tears without arthropathy. Pectoralis major transfer is indicated for irreparable subscapularis tears.

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