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5. Sports Medicine MCQs

Practice Set 343 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 6841

Topic: Shoulder & Hip Sports

During an anatomic Total Shoulder Arthroplasty (TSA), which surgical management of the subscapularis has been biomechanically shown to provide the highest rate of structural healing?

. Subscapularis tenotomy
. Subscapularis peel from the lesser tuberosity
. Lesser tuberosity osteotomy (LTO)
. Z-lengthening of the subscapularis tendon

Correct Answer & Explanation

. Lesser tuberosity osteotomy (LTO)

Explanation

A lesser tuberosity osteotomy (LTO) utilizes bone-to-bone healing, which provides the strongest and most reliable structural healing of the subscapularis footprint. Soft tissue healing in tenotomy or peel techniques has historically shown higher rates of failure and subsequent subscapularis insufficiency.

Question 6842

Topic: Shoulder & Hip Sports

A 55-year-old male presents with severe anterior shoulder pain and internal rotation weakness following a fall on the ice. Which of the following physical exam findings is most specific for a full-thickness tear of the upper border of the subscapularis?

. Positive Jobe's test
. Positive Hornblower's sign
. Positive Bear Hug test
. Positive O'Brien's test

Correct Answer & Explanation

. Positive Bear Hug test

Explanation

The Bear Hug test and the Belly Press test are specific clinical maneuvers designed to evaluate the integrity of the subscapularis. A positive test indicates subscapularis weakness or tearing. Hornblower's assesses the teres minor.

Question 6843

Topic: 5. Sports Medicine

A 29-year-old weightlifter feels a tearing sensation in his anterior axilla while bench pressing. He is diagnosed with a pectoralis major tendon rupture. Which portion of the tendon is most commonly injured due to bearing maximal tension in this position?

. Clavicular head, which inserts distally on the humerus
. Sternal head, which inserts proximally on the humerus
. Clavicular head, which inserts proximally on the humerus
. Sternal head, which inserts distally on the humerus

Correct Answer & Explanation

. Sternal head, which inserts distally on the humerus

Explanation

The pectoralis major tendon twists 90 degrees before its insertion on the humerus. This causes the sternal head to insert superiorly (proximally) and the clavicular head to insert inferiorly (distally). The sternal head is placed under maximum tension during the eccentric phase of a bench press and is most frequently torn.

Question 6844

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is transferred to the anterior glenoid neck. Which anatomical structures make up the 'conjoined tendon' that provides the dynamic sling effect in this transfer?

. Short head of the biceps and coracobrachialis
. Long head of the biceps and coracobrachialis
. Pectoralis minor and short head of the biceps
. Short head of the biceps and brachialis

Correct Answer & Explanation

. Short head of the biceps and coracobrachialis

Explanation

The conjoined tendon attached to the tip of the coracoid consists of the short head of the biceps brachii and the coracobrachialis. When transferred through the subscapularis split in a Latarjet, these muscles create a dynamic sling that reinforces the anterior inferior capsule when the arm is abducted and externally rotated.

Question 6845

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. A preoperative 3D CT scan reveals a 28% anteroinferior glenoid bone defect. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with remplissage
. Arthroscopic thermal capsulorrhaphy
. Latarjet procedure
. Putti-Platt procedure
. Open Bankart repair without bone grafting

Correct Answer & Explanation

. Latarjet procedure

Explanation

Anteroinferior glenoid bone loss exceeding 20-25% is a critical defect that typically results in the failure of soft-tissue only stabilization. A bone block augmentation procedure, such as the Latarjet (coracoid transfer), is indicated to restore glenohumeral stability.

Question 6846

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. MRI reveals a paralabral cyst in the spinoglenoid notch. Which physical exam finding is most likely present?

. Atrophy of both the supraspinatus and infraspinatus
. Isolated atrophy of the infraspinatus
. Positive lift-off test
. Scapular winging with forward flexion against resistance
. Complete loss of active forward elevation

Correct Answer & Explanation

. Isolated atrophy of the infraspinatus

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch selectively affects the infraspinatus muscle, leading to isolated atrophy and external rotation weakness. Proximal compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6847

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer presents with a massive, irreparable posterosuperior rotator cuff tear. He has no significant glenohumeral osteoarthritis. A latissimus dorsi tendon transfer is being considered. Which of the following is an absolute prerequisite for a successful functional outcome following this procedure?

. Intact coracoacromial ligament
. Intact subscapularis function
. Complete tear of the teres minor
. Preoperative forward flexion of at least 150 degrees
. Advanced fatty infiltration of the subscapularis

Correct Answer & Explanation

. Intact subscapularis function

Explanation

A latissimus dorsi transfer requires an intact and functioning subscapularis (as well as an intact deltoid) to provide an anterior counterforce for the transferred tendon. Subscapularis deficiency is a contraindication to this procedure.

Question 6848

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher presents with posterior shoulder pain. Examination reveals a significant glenohumeral internal rotation deficit (GIRD) of his throwing shoulder compared to the contralateral side. What is the initial treatment of choice?

. Posterior capsular stretching program
. Arthroscopic posterior capsular release
. Arthroscopic SLAP repair
. Anterior capsuloplication
. Open anterior capsular shift

Correct Answer & Explanation

. Posterior capsular stretching program

Explanation

GIRD is caused by contracture of the posterior inferior capsule and is initially treated with a targeted posterior capsular stretching program (e.g., sleeper stretches). Surgical intervention is reserved for refractory cases.

Question 6849

Topic: Shoulder & Hip Sports

The Latarjet procedure provides anterior shoulder stability through a "triple blocking" effect. Which of the following provides the dynamic sling effect when the arm is abducted and externally rotated?

. The coracoacromial ligament
. The conjoint tendon
. The inferior glenohumeral ligament
. The subscapularis muscle
. The long head of the biceps

Correct Answer & Explanation

. The conjoint tendon

Explanation

The dynamic stabilization (sling effect) in the Latarjet procedure is provided by the conjoint tendon acting across the anteroinferior capsule when the arm is placed in abduction and external rotation.

Question 6850

Topic: Knee Sports

A 25-year-old female presents with persistent deep ankle pain following an inversion sprain 6 months ago. MRI reveals a 12 mm x 10 mm anterolateral osteochondral lesion of the talar dome with intact overlying cartilage. What is the most appropriate initial surgical management after failed conservative therapy?

. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Autologous chondrocyte implantation (ACI)
. Ankle arthrodesis
. Total ankle arthroplasty

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary osteochondral lesions of the talus smaller than 1.5 cm squared, arthroscopic bone marrow stimulation is the recommended first-line surgical treatment. OATS or ACI are typically reserved for larger lesions or failures of primary microfracture.

Question 6851

Topic: 5. Sports Medicine

A professional football player sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI shows complete rupture of the plantar plate and proximal migration of the sesamoids. What is the most appropriate management?

. Taping and immediate return to play
. Stiff-soled shoe for 2 weeks followed by return to play
. Primary surgical repair of the plantar plate
. First MTP arthrodesis
. Sesamoidectomy

Correct Answer & Explanation

. Primary surgical repair of the plantar plate

Explanation

A complete rupture of the plantar plate with proximal migration of the sesamoids represents a Grade 3 Turf Toe injury. In competitive athletes, Grade 3 injuries typically require primary surgical repair to restore the push-off strength and stability of the first MTP joint.

Question 6852

Topic: 5. Sports Medicine

A 32-year-old recreational athlete sustains an acute Achilles tendon rupture. He is considering operative versus non-operative management. According to recent high-level evidence utilizing early functional rehabilitation, what is the most accurate statement regarding outcomes?

. Operative treatment significantly reduces the rerupture rate compared to early functional rehabilitation.
. Non-operative treatment has a significantly higher rate of deep vein thrombosis.
. Functional rehabilitation protocols yield similar rerupture rates to operative repair.
. Operative treatment yields significantly higher plantar flexion strength at 2 years.
. Non-operative management mandates 8 weeks of strict non-weight-bearing in a equinus cast.

Correct Answer & Explanation

. Functional rehabilitation protocols yield similar rerupture rates to operative repair.

Explanation

Recent high-level studies show that when early functional rehabilitation protocols are utilized, the rerupture rates and functional outcomes between operative and non-operative management of acute Achilles tendon ruptures are statistically similar. Operative treatment carries a higher risk of soft-tissue complications.

Question 6853

Topic: 5. Sports Medicine

A 24-year-old professional football player sustains a hyperdorsiflexion injury to his first metatarsophalangeal (MTP) joint. Exam reveals profound ecchymosis and a lack of push-off strength. MRI confirms a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?

. Rigid carbon fiber shoe insert and play as tolerated
. Corticosteroid injection and taping
. Primary surgical repair of the plantar plate
. First MTP arthrodesis
. Excision of the sesamoids

Correct Answer & Explanation

. Primary surgical repair of the plantar plate

Explanation

This is a Grade 3 turf toe injury with complete disruption of the plantar plate and proximal sesamoid migration. In a high-level athlete with a complete tear, primary surgical repair is indicated to restore push-off strength and joint stability.

Question 6854

Topic: 5. Sports Medicine

A 22-year-old basketball player lands awkwardly on another player's foot and complains of lateral foot pain. Radiographs demonstrate a fracture at the diaphyseal-metaphyseal junction of the fifth metatarsal. He wishes to return to play as soon as possible. What is the most appropriate treatment?

. Non-weight-bearing cast for 6 weeks
. Hard-soled shoe weight-bearing as tolerated
. Intramedullary screw fixation
. Excision of the proximal pole
. Plate and screw construct

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Zone 2 (Jones) fracture. In high-level athletes, early intramedullary screw fixation is recommended to decrease the time to union, minimize the risk of nonunion, and expedite return to play.

Question 6855

Topic: 5. Sports Medicine
A professional football player hyperextends his great toe on artificial turf. MRI confirms a complete tear of the plantar plate with proximal retraction of the medial sesamoid. What is the recommended management?
. Taping and immediate return to play
. Stiff-soled shoe with weight-bearing as tolerated for 6 weeks
. Surgical repair of the plantar plate
. Excision of the medial sesamoid
. First MTP joint arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

This is a Grade III turf toe injury with sesamoid retraction indicating gross instability of the MTP joint. Surgical repair of the plantar plate and soft tissue structures is recommended for high-level athletes with complete, retracted tears to restore push-off strength.

Question 6856

Topic: 5. Sports Medicine

A 26-year-old professional football player suffers an acute hyperextension injury to his first MTP joint. MRI reveals a complete rupture of the plantar plate with 4 mm of proximal retraction of the sesamoids. What is the most appropriate management?

. Taping and stiff-soled shoe for 6 weeks
. Corticosteroid injection and immediate return to play
. Operative repair of the plantar plate
. First MTP joint arthrodesis
. Excision of the medial sesamoid

Correct Answer & Explanation

. Operative repair of the plantar plate

Explanation

Grade 3 turf toe injuries with complete plantar plate rupture, gross instability, or sesamoid retraction >3 mm in high-demand athletes warrant surgical repair. Nonoperative management in this demographic usually leads to chronic pain and push-off weakness.

Question 6857

Topic: Shoulder & Hip Sports

A 23-year-old overhead athlete presents with recurrent anterior shoulder instability. Advanced imaging is obtained.

The concept of the 'glenoid track' is utilized to evaluate his bipolar bone loss. Which of the following defines an 'off-track' Hill-Sachs lesion?

. The medial margin of the Hill-Sachs lesion remains lateral to the glenoid track during abduction and external rotation.
. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating it will engage the anterior glenoid rim.
. The lateral margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating an intact capsular attachment.
. The subchondral bone of the humerus is entirely intact without impaction.
. The glenoid bone loss is greater than 25% but the humerus is entirely normal.

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track, indicating it will engage the anterior glenoid rim.

Explanation

The glenoid track is the contact zone of the glenoid on the humeral head during shoulder abduction and external rotation. If the medial margin of a Hill-Sachs lesion extends further medially than the medial border of the glenoid track, it is considered 'off-track'. This means the lesion will slide over and 'engage' the anterior glenoid rim, causing a dislocation. Such lesions require specific treatment (like a remplissage or Latarjet) in addition to an anterior stabilization.

Question 6858

Topic: Shoulder & Hip Sports

During the arthroscopic repair of a massive rotator cuff tear, preserving the 'suspensory cable' of the shoulder is deemed critical for mechanical function. The rotator cable is a thick, fibrous bundle that extends primarily between which two structures?

. Coracoid process and the greater tuberosity
. Biceps brachii long head tendon and the inferior glenohumeral ligament
. Coracohumeral ligament and the triceps tendon
. Anterior aspect of the supraspinatus and the inferior aspect of the infraspinatus
. Acromion and the lesser tuberosity

Correct Answer & Explanation

. Anterior aspect of the supraspinatus and the inferior aspect of the infraspinatus

Explanation

The rotator cable is a thick bundle of fibers running perpendicular to the rotator cuff tendon fibers. It acts like a suspension bridge, shielding the thinner, avascular 'crescent' region from excess stress. It spans from anterior to the biceps tendon (anterior margin of the supraspinatus) to the inferior margin of the infraspinatus tendon.

Question 6859

Topic: Knee Sports

During reconstruction of the Anterior Cruciate Ligament (ACL), the surgeon places the femoral tunnel too anteriorly (i.e., too high and shallow in the intercondylar notch). What is the primary clinical consequence of this specific technical error?

. The graft will be tight in flexion and loose in extension.
. The graft will be tight in extension and loose in flexion.
. The graft will impinge on the PCL during extension.
. The graft will experience isolated rotational instability only.
. There will be increased risk of patellar fracture if a BTB graft is used.

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension.

Explanation

Proper femoral tunnel placement is critical for the isometric function of an ACL graft. If the femoral tunnel is placed too anteriorly (high in the notch) relative to the anatomic footprint, the distance between the femoral and tibial attachments increases as the knee bends. This results in a graft that becomes excessively tight in flexion (often leading to a loss of full knee flexion) and loose in extension.

Question 6860

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft tissue undergoes a biologic process known as creeping substitution. What is the correct chronological order of the healing phases during this incorporation process?

. Proliferation, Necrosis, Remodeling, Revascularization
. Necrosis, Revascularization, Cellular Proliferation, Remodeling
. Revascularization, Necrosis, Remodeling, Proliferation
. Cellular Proliferation, Remodeling, Necrosis, Revascularization
. Remodeling, Revascularization, Necrosis, Proliferation

Correct Answer & Explanation

. Necrosis, Revascularization, Cellular Proliferation, Remodeling

Explanation

Graft incorporation progresses through four distinct phases: (1) Necrosis (the graft is initially avascular and undergoes ischemic necrosis post-operatively), (2) Revascularization (vascular buds invade the tissue), (3) Cellular proliferation (fibroblasts populate the graft), and (4) Remodeling (ligamentization, where collagen aligns to mechanical stress).

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