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5. Sports Medicine MCQs

Practice Set 353 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 7041

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, the surgeon inadvertently places the femoral tunnel too anteriorly (superficially) within the intercondylar notch. What is the most likely clinical consequence of this error?

. The graft will be lax in flexion and tight in extension.
. The graft will be tight in flexion and lax in extension.
. The graft will impinge on the posterior cruciate ligament (PCL).
. The knee will lack terminal extension.
. The graft will fail immediately upon weight-bearing.

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel misses the isometric point, causing the distance between the tibial and femoral attachments to increase as the knee flexes. This results in graft tightness during flexion and laxity during extension, potentially limiting flexion or stretching the graft out.

Question 7042

Topic: Knee Sports

A 24-year-old soccer player sustains a non-contact pivoting knee injury.

Radiographs reveal a small elliptical avulsion fracture of the anterolateral proximal tibia. This pathognomonic finding is most closely associated with an injury to which of the following structures?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Biceps femoris tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The Segond fracture is an avulsion of the anterolateral ligament (ALL) or lateral capsular complex from the proximal tibia. It is considered highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 7043

Topic: 5. Sports Medicine

A 22-year-old female collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. What is the most common complication specific to this graft choice when compared to a hamstring autograft?

. Anterior knee pain
. Increased rate of graft rupture
. Deep surgical site infection
. Deficit in deep knee flexion strength
. Saphenous nerve injury

Correct Answer & Explanation

. Deficit in deep knee flexion strength

Explanation

Anterior knee pain and a slight risk of patellar fracture are classic complications specific to bone-patellar tendon-bone (BTB) autografts. Hamstring grafts, conversely, are more frequently associated with saphenous nerve paresthesias and a deficit in deep knee flexion strength.

Question 7044

Topic: Shoulder & Hip Sports

An 8-year-old child presents with anterior hip pain and a 'popping' sensation during physical activity. Radiographs are normal. What condition would be least likely in the differential diagnosis given this presentation and age?

. Transient synovitis
. Labral tear
. Femoroacetabular impingement (FAI)
. Iliopectineal bursitis
. Developmental dysplasia of the hip (presenting with subtle instability)

Correct Answer & Explanation

. Developmental dysplasia of the hip (presenting with subtle instability)

Explanation

Transient synovitis is common in younger children (ages 3-8, peak at 6), often follows a viral illness, and typically causes acute, painful limp without 'popping' or chronic anterior hip pain over months. While an 8-year-old is within the age range, the chronic nature of the 'popping' and activity-related pain makes other diagnoses more likely. Labral tears, FAI, and iliopectineal bursitis can all cause anterior hip pain and mechanical symptoms like 'popping' in this age group, though FAI is typically more in adolescents. DDH, even if subclinical, can manifest with subtle instability leading to pain and 'popping' in older children.

Question 7045

Topic: Shoulder & Hip Sports

A 70-year-old active gardener develops progressive left shoulder pain and stiffness. Radiographs show joint space narrowing, subchondral sclerosis, and osteophytes. There is also evidence of superior migration of the humeral head and superior glenoid erosion. What is the most likely etiology of his glenohumeral arthritis?

. Primary (idiopathic) osteoarthritis
. Post-traumatic arthritis
. Rheumatoid arthritis
. Rotator cuff arthropathy
. Avascular necrosis of the humeral head

Correct Answer & Explanation

. Rotator cuff arthropathy

Explanation

The combination of superior migration of the humeral head, superior glenoid erosion, and degenerative changes (joint space narrowing, sclerosis, osteophytes) is highly characteristic of rotator cuff arthropathy (RCAT). RCAT results from long-standing, massive, irreparable rotator cuff tears, leading to superior subluxation of the humeral head and subsequent degenerative changes. Primary OA typically presents with concentric narrowing without superior migration unless the rotator cuff is also involved. Post-traumatic arthritis requires a history of significant trauma. Rheumatoid arthritis typically involves symmetric joint destruction, pannus formation, and may present with osteopenia rather than sclerosis, and AVN would show specific changes within the humeral head itself.

Question 7046

Topic: Shoulder & Hip Sports

A 58-year-old female undergoes a shoulder MRI for chronic pain and limited motion. The report describes extensive chondral loss on both the glenoid and humeral head, subchondral edema, and a small full-thickness tear of the supraspinatus tendon. Which of these MRI findings provides the most direct evidence of glenohumeral osteoarthritis?

. Subacromial bursitis
. Small full-thickness tear of the supraspinatus tendon
. Labral fraying
. Extensive chondral loss on the glenoid and humeral head
. Bone marrow edema in the greater tuberosity

Correct Answer & Explanation

. Extensive chondral loss on the glenoid and humeral head

Explanation

Extensive chondral loss (cartilage damage) on the articular surfaces of the glenoid and humeral head is the most direct and fundamental MRI finding indicative of glenohumeral osteoarthritis. While the other findings may be associated (subacromial bursitis, rotator cuff tears, labral fraying, and bone marrow edema from stress response or associated pathology), chondral lossisthe defining characteristic of arthritis on imaging. Subacromial bursitis and bone marrow edema in the greater tuberosity often relate to impingement or rotator cuff pathology. Labral fraying can occur in OA but is not the primary diagnostic feature.

Question 7047

Topic: Shoulder & Hip Sports

Which statement regarding the use of computed tomography (CT) scans in the workup of glenohumeral osteoarthritis is most accurate?

. CT is primarily used to assess rotator cuff integrity.
. CT is superior to MRI for evaluating chondral surface integrity.
. CT provides excellent visualization of glenoid bone loss, version, and subluxation for preoperative planning.
. CT is indicated only for suspected infection or tumor.
. CT scan radiation exposure makes it an inferior initial imaging modality compared to plain radiographs.

Correct Answer & Explanation

. CT provides excellent visualization of glenoid bone loss, version, and subluxation for preoperative planning.

Explanation

CT is particularly valuable for assessing bone morphology, glenoid bone loss, glenoid version (retroversion), and the extent of humeral head subluxation, which are critical parameters for surgical planning, especially for total shoulder arthroplasty. It provides a detailed, three-dimensional view of the bony architecture. MRI is superior for soft tissue evaluation (rotator cuff, labrum, cartilage, marrow edema). While plain radiographs are the initial imaging, CT's utility for detailed bony assessment in advanced OA for surgical planning is distinct and crucial, making the radiation exposure acceptable for specific indications.

Question 7048

Topic: Shoulder & Hip Sports

A 75-year-old patient presents with a history of long-standing, symptomatic glenohumeral osteoarthritis. On examination, you note significant atrophy of the infraspinatus and supraspinatus muscles. Plain radiographs show marked superior migration of the humeral head, severe joint space narrowing, and erosion of the superior glenoid. What is the most likely additional finding on an MRI if performed?

. Large rotator cuff tear
. Significant labral tear
. Bicipital tendinopathy with subluxation
. AC joint separation
. Subacromial bursitis

Correct Answer & Explanation

. Large rotator cuff tear

Explanation

The clinical presentation (infraspinatus/supraspinatus atrophy) combined with radiographic findings (superior migration of humeral head, severe joint space narrowing, superior glenoid erosion) are classic indicators of rotator cuff tear arthropathy (RCAT). RCAT is a specific form of shoulder osteoarthritis caused by a chronic, often massive, irreparable rotator cuff tear leading to abnormal biomechanics and superior humeral head migration. Therefore, a large rotator cuff tear would be the most likely additional finding on an MRI, as it is the underlying cause of RCAT. While other pathologies might coexist, the described presentation is directly linked to massive cuff insufficiency.

Question 7049

Topic: Shoulder & Hip Sports

Which of the following physical examination findings would be considered atypical for primary glenohumeral osteoarthritis and would prompt consideration of alternative diagnoses?

. Crepitus with circumduction
. Pain with active and passive range of motion
. Significant pain with resisted external rotation but full passive external rotation
. Stiffness worse in the morning, improving with activity
. Atrophy of the deltoid muscle

Correct Answer & Explanation

. Significant pain with resisted external rotation but full passive external rotation

Explanation

Significant pain with resisted external rotation butfull passive external rotationis highly suggestive of rotator cuff pathology (specifically the infraspinatus and teres minor tendons), rather than glenohumeral osteoarthritis. In OA, both active and passive range of motion would typically be restricted and painful due to capsular contracture and articular cartilage damage. Crepitus, generalized pain with motion, and morning stiffness improving with activity are classic signs of OA. Deltoid atrophy might be present in advanced OA due to disuse, or in RCAT where superior migration impacts the deltoid.

Question 7050

Topic: Shoulder & Hip Sports

A patient with long-standing glenohumeral osteoarthritis describes increasing pain and difficulty with sleeping on the affected side. This is most likely due to:

. Inflammation of the subacromial bursa
. Progression of articular cartilage erosion and synovitis
. Development of a full-thickness rotator cuff tear
. Increased tension in the biceps tendon
. Compression of the suprascapular nerve

Correct Answer & Explanation

. Progression of articular cartilage erosion and synovitis

Explanation

Night pain and pain with sleeping on the affected side are very common and often debilitating symptoms in advanced glenohumeral osteoarthritis. This is primarily due to the progression of articular cartilage erosion, leading to increased bone-on-bone friction, inflammation of the synovium, and capsular irritation. The lack of distracting activity at night can make the pain more noticeable. While other conditions can cause night pain, in the context of long-standing OA, direct joint pathology is the most likely cause. Rotator cuff tears, biceps pathology, or nerve compression might contribute but are not themost likelyprimary cause of night pain in progressive OA itself.

Question 7051

Topic: Shoulder & Hip Sports

Which specific type of imaging provides the most accurate and detailed information regarding the extent of articular cartilage damage and bone marrow edema in early glenohumeral osteoarthritis?

. Plain anteroposterior radiograph
. Scapular Y view radiograph
. Computed Tomography (CT) scan
. Magnetic Resonance Imaging (MRI)
. Arthrography

Correct Answer & Explanation

. Magnetic Resonance Imaging (MRI)

Explanation

Magnetic Resonance Imaging (MRI) is the gold standard for evaluating soft tissue structures, including articular cartilage, labrum, rotator cuff tendons, and assessing bone marrow edema. While plain radiographs show indirect signs of cartilage loss (joint space narrowing), and CT is excellent for bony morphology, MRI directly visualizes the cartilage layers and bone marrow changes, making it superior for assessing early chondral damage and inflammatory changes like bone marrow edema associated with OA.

Question 7052

Topic: Shoulder & Hip Sports

During the examination of a patient with suspected glenohumeral osteoarthritis, you note significant muscle atrophy. Which muscle group's atrophy is most frequently associated with rotator cuff tear arthropathy?

. Deltoid
. Pectoralis major
. Latissimus dorsi
. Supraspinatus and infraspinatus
. Biceps brachii

Correct Answer & Explanation

. Supraspinatus and infraspinatus

Explanation

Rotator cuff tear arthropathy (RCAT) is characterized by massive, irreparable tears of the rotator cuff. The supraspinatus and infraspinatus muscles are critical components of the rotator cuff. Chronic tears of these tendons, particularly the supraspinatus, lead to their disuse and subsequent atrophy, which is a common clinical finding in RCAT. While disuse can lead to general atrophy, specific atrophy of the supraspinatus and infraspinatus is highly indicative of rotator cuff pathology.

Question 7053

Topic: Shoulder & Hip Sports

A patient with long-standing glenohumeral osteoarthritis is found to have a significant loss of active external rotation, but relatively preserved passive external rotation. This specific finding should raise suspicion for what additional pathology?

. Adhesive capsulitis in the freezing phase
. AC joint impingement
. Rotator cuff tear involving the external rotators (infraspinatus/teres minor)
. Biceps tendinitis with subluxation
. Severe glenoid retroversion

Correct Answer & Explanation

. Rotator cuff tear involving the external rotators (infraspinatus/teres minor)

Explanation

When active range of motion is significantly limited but passive range of motion is relatively preserved, it suggests a problem with the motor unit (muscle-tendon unit) rather than a fixed capsular or articular restriction. In this scenario, a loss of active external rotation with preserved passive external rotation is a classic sign of a rotator cuff tear affecting the external rotators, primarily the infraspinatus and/or teres minor. Adhesive capsulitis and severe glenoid retroversion would typically limit both active and passive motion. AC joint impingement or biceps tendinitis would present differently.

Question 7054

Topic: Shoulder & Hip Sports

When conducting a physical examination for glenohumeral osteoarthritis, what is the significance of an 'empty can' test that elicits pain but no weakness?

. It is pathognomonic for a full-thickness supraspinatus tear.
. It suggests subacromial impingement or supraspinatus tendinopathy without a full tear.
. It indicates primary adhesive capsulitis.
. It is a sign of deltoid muscle paralysis.
. It is consistent with biceps tendinopathy.

Correct Answer & Explanation

. It suggests subacromial impingement or supraspinatus tendinopathy without a full tear.

Explanation

The 'empty can' (Jobe) test assesses the supraspinatus. If the test elicits pain but no weakness, it suggests irritation or tendinopathy of the supraspinatus tendon, or subacromial impingement, rather than a full-thickness tear where weakness would typically be present. A full-thickness tear would usually result in both pain and weakness (or inability to resist). It is not specific for adhesive capsulitis, deltoid paralysis, or biceps tendinopathy.

Question 7055

Topic: Shoulder & Hip Sports

Which maneuver during a shoulder examination is most useful for assessing the integrity and function of the subscapularis tendon in a patient with suspected rotator cuff tear arthropathy?

. Empty can test
. Hawkins-Kennedy test
. Lift-off test (Gerber's test)
. Speed's test
. Cross-body adduction test

Correct Answer & Explanation

. Lift-off test (Gerber's test)

Explanation

The Lift-off test (Gerber's test) is specifically designed to assess the subscapularis tendon. The patient places their hand behind their back and attempts to lift it off their back against resistance. Inability to do so, or weakness, indicates subscapularis pathology. The Empty Can test assesses the supraspinatus. The Hawkins-Kennedy test assesses for subacromial impingement (involving rotator cuff). Speed's test assesses the biceps tendon. The cross-body adduction test assesses the AC joint.

Question 7056

Topic: Shoulder & Hip Sports

What is the primary differentiating factor between a Walch A2 glenoid and a Walch B1 glenoid on imaging?

. The degree of humeral head subluxation.
. The presence of anterior glenoid erosion.
. The presence and extent of posterior glenoid erosion and retroversion.
. The severity of inferior humeral head osteophytes.
. The presence of a full-thickness rotator cuff tear.

Correct Answer & Explanation

. The presence and extent of posterior glenoid erosion and retroversion.

Explanation

The key differentiator between Walch A (centralized wear) and Walch B (posterior wear/retroversion) glenoids is the presence and extent of posterior glenoid erosion and retroversion. A2 glenoids have centralized erosion without significant posterior erosion or retroversion. B1 glenoids specifically have posterior glenoid erosion but with less than 25 degrees of retroversion and often a centered humeral head. The degree of humeral head subluxation, while often associated, is a consequence rather than the primary definer of the glenoid type itself. Osteophyte formation and rotator cuff tears are separate pathologies that can coexist.

Question 7057

Topic: Shoulder & Hip Sports

When examining a patient with suspected glenohumeral osteoarthritis, a 'grinding sensation' or crepitus elicited during range of motion is most likely due to:

. Inflammation of the subacromial bursa.
. Rotator cuff tendon rubbing against the acromion.
. Rough articular cartilage surfaces rubbing against each other.
. Loose body entrapment within the joint.
. Ligamentous laxity.

Correct Answer & Explanation

. Rough articular cartilage surfaces rubbing against each other.

Explanation

Crepitus, or a 'grinding sensation,' in the context of glenohumeral osteoarthritis, is primarily caused by the rough, denuded articular cartilage surfaces of the humeral head and glenoid rubbing against each other during joint movement. While loose bodies can also cause mechanical symptoms, crepitus due to rough articular surfaces is a hallmark of osteoarthritis. Subacromial bursitis or rotator cuff rubbing would produce crepitus more superiorly or anteriorly, but the description points to intra-articular source.

Question 7058

Topic: Shoulder & Hip Sports

A 28-year-old male athlete presents with anterior groin pain worsened by deep hip flexion. Radiographs reveal a crossover sign, a prominent ischial spine sign, and a positive posterior wall sign. Which type of femoroacetabular impingement (FAI) is most strongly suggested by these findings?

. Cam impingement
. Pincer impingement secondary to acetabular retroversion
. Pincer impingement secondary to coxa profunda
. Mixed impingement secondary to slipped capital femoral epiphysis
. Ischiofemoral impingement

Correct Answer & Explanation

. Pincer impingement secondary to acetabular retroversion

Explanation

The crossover sign, prominent ischial spine sign, and posterior wall sign are classic radiographic markers for acetabular retroversion, which causes a focal anterior overcoverage leading to pincer-type FAI.

Question 7059

Topic: Shoulder & Hip Sports

An AP pelvis radiograph of a 25-year-old man with groin pain reveals the anterior wall of the acetabulum crossing over the posterior wall before reaching the lateral sourcil. What underlying pathomorphology does this crossover sign indicate?

. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli
. Decreased femoral head-neck offset
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The crossover sign indicates acetabular retroversion, a form of pincer-type femoroacetabular impingement (FAI). This morphology causes focal anterior overcoverage of the femoral head, leading to labral damage.

Question 7060

Topic: Shoulder & Hip Sports

Cam-type femoroacetabular impingement (FAI) is most commonly characterized by abnormal bone morphology in which specific region of the proximal femur?

. Posteromedial head-neck junction
. Anteroinferior femoral neck
. Anterosuperior head-neck junction
. Lesser trochanter
. Fovea capitis

Correct Answer & Explanation

. Anterosuperior head-neck junction

Explanation

Cam impingement is defined by a loss of spherical contour and decreased offset at the femoral head-neck junction. This asphericity most commonly occurs in the anterosuperior quadrant of the proximal femur.

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