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5. Sports Medicine MCQs

Practice Set 357 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 7121

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic shoulder pain and weakness with overhead activities. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. Which of the following physical examination findings is most likely to be positive in this patient?

. Weakness in external rotation with the arm at the side
. Positive lift-off test
. Weakness in active shoulder abduction
. Positive O'Brien test
. Weakness in internal rotation

Correct Answer & Explanation

. Weakness in active shoulder abduction

Explanation

Correct Answer: Weakness in active shoulder abductionThe supraspinatus is the most frequently torn rotator cuff muscle. Its primary function is to initiate shoulder abduction. Therefore, a tear typically presents with weakness in active shoulder abduction, often assessed clinically using the Jobe (empty can) test. Weakness in external rotation points to the infraspinatus or teres minor, while a positive lift-off test indicates a subscapularis tear.

Question 7122

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic right shoulder pain and weakness, particularly with overhead activities. Physical examination reveals a positive Jobe's (empty can) test. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. Where does this specific tendon anatomically insert?

. Lesser tuberosity of the humerus
. Greater tuberosity of the humerus
. Coracoid process
. Bicipital groove
. Glenoid labrum

Correct Answer & Explanation

. Greater tuberosity of the humerus

Explanation

Correct Answer: BThe supraspinatus is the most commonly torn tendon of the rotator cuff. It originates from the supraspinous fossa of the scapula and inserts onto the superior facet of the greater tuberosity of the humerus. Its primary function is the initiation of shoulder abduction (first 15 degrees) and stabilization of the humeral head within the glenoid. The subscapularis is the only rotator cuff muscle that inserts onto the lesser tuberosity.

Question 7123

Topic: 5. Sports Medicine

When analyzing outcomes and complications following anterior cruciate ligament (ACL) reconstruction, bone-patellar tendon-bone (BPTB) autografts are associated with a higher incidence of which postoperative issue compared to quadrupled hamstring autografts?

. Graft rupture
. Anterior knee pain and kneeling pain
. Deep surgical site infection
. Loss of knee flexion
. Contralateral ACL tear

Correct Answer & Explanation

. Anterior knee pain and kneeling pain

Explanation

BPTB autografts are historically and biomechanically associated with a higher incidence of anterior knee pain and discomfort during kneeling at the donor site compared to hamstring autografts. Rates of graft rupture and infection are generally comparable between the two graft types.

Question 7124

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination reveals a significant glenohumeral internal rotation deficit (GIRD). MRI arthrogram shows a partial articular-sided supraspinatus tendon tear and posterosuperior labral fraying. This pathoanatomy is primarily driven by contracture of which capsular structure?

. Anterior band of the inferior glenohumeral ligament
. Posterior band of the inferior glenohumeral ligament
. Middle glenohumeral ligament
. Coracohumeral ligament
. Superior glenohumeral ligament

Correct Answer & Explanation

. Posterior band of the inferior glenohumeral ligament

Explanation

Internal impingement in overhead athletes is strongly associated with GIRD, which is caused by a contracture of the posteroinferior capsule, specifically the posterior band of the inferior glenohumeral ligament (IGHL). This alters glenohumeral kinematics, leading to posterosuperior labral and rotator cuff pathology.

Question 7125

Topic: 5. Sports Medicine

A 24-year-old professional soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. During the 'ligamentization' process, the graft goes through predictable physiological phases. At what postoperative timeframe is the graft structurally at its weakest point?

. 1 to 2 weeks
. 6 to 12 weeks
. 6 to 8 months
. 12 to 18 months
. 24 to 36 months

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The autograft undergoes a phase of ischemic necrosis followed by early revascularization and cellular proliferation between 6 and 12 weeks. During this early remodeling phase, the mechanical strength of the graft drops significantly, making it the most vulnerable period for re-rupture.

Question 7126

Topic: Shoulder & Hip Sports

A 55-year-old male carpenter presents with a 3-month history of right shoulder pain and weakness, particularly when reaching overhead. He has a positive Jobe's (empty can) test and a positive drop arm test. MRI confirms a full-thickness tear of the supraspinatus tendon with 2 cm of retraction. Which of the following biomechanical consequences is most likely to occur if this tear is left untreated and progresses to massive size?

. Superior migration of the humeral head
. Inferior subluxation of the humeral head
. Anterior instability of the glenohumeral joint
. Increased acromiohumeral distance
. Medialization of the center of rotation

Correct Answer & Explanation

. Superior migration of the humeral head

Explanation

Correct Answer: AThe supraspinatus, along with the rest of the rotator cuff, functions to depress and stabilize the humeral head within the glenoid during arm elevation, counteracting the upward pull of the deltoid muscle. A massive, chronic tear of the supraspinatus (and often infraspinatus) leads to a loss of this compressive force, allowing the unopposed pull of the deltoid to cause superior migration of the humeral head. This decreases the acromiohumeral distance and can eventually lead to rotator cuff arthropathy.

Question 7127

Topic: Shoulder & Hip Sports

A 55-year-old male carpenter presents with chronic right shoulder pain and weakness, particularly when lifting objects above his head. Physical examination reveals a positive Jobe's (empty can) test and weakness in active shoulder abduction. Which of the following muscles is most likely affected?

. Subscapularis
. Infraspinatus
. Teres minor
. Supraspinatus
. Deltoid

Correct Answer & Explanation

. Supraspinatus

Explanation

Correct Answer: DAnatomy:The rotator cuff consists of four muscles: Supraspinatus, Infraspinatus, Teres minor, and Subscapularis.Pathology:The supraspinatus is the most commonly torn rotator cuff tendon, largely due to its vulnerable location in the subacromial space where it is susceptible to impingement and hypovascularity (critical zone).Clinical Testing:The Jobe's test (empty can test) specifically isolates the supraspinatus muscle. The patient abducts the arms to 90 degrees, angles them forward 30 degrees (scapular plane), and internally rotates the arms (thumbs pointing down). The examiner then applies downward pressure. Pain or weakness indicates supraspinatus pathology.

Question 7128

Topic: Shoulder & Hip Sports

A 55-year-old male undergoes arthroscopic rotator cuff repair for a massive tear involving the supraspinatus and infraspinatus tendons. During the procedure, the surgeon must be careful to avoid injury to the suprascapular nerve. At which anatomical location is the suprascapular nerve most vulnerable to injury during medial mobilization of a retracted infraspinatus tendon?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: C (Spinoglenoid notch)The suprascapular nerve passes through the suprascapular notch (where it innervates the supraspinatus) and then winds around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus. It is most vulnerable to traction injury at the spinoglenoid notch during excessive medial mobilization of a retracted infraspinatus tendon. Mobilization greater than 1 to 2 cm medial to the glenoid rim significantly increases the risk of iatrogenic nerve injury.

Question 7129

Topic: Shoulder & Hip Sports

A 55-year-old male presents with right shoulder pain and weakness after lifting a heavy box. Physical examination reveals a positive drop arm test and weakness with resisted shoulder abduction in the scapular plane. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. Where does this specific tendon insert anatomically?

. Lesser tuberosity of the humerus
. Superior facet of the greater tuberosity
. Middle facet of the greater tuberosity
. Inferior facet of the greater tuberosity
. Bicipital groove

Correct Answer & Explanation

. Superior facet of the greater tuberosity

Explanation

Correct Answer: BThe supraspinatus is the most commonly torn rotator cuff tendon. It functions to initiate shoulder abduction and provides dynamic stabilization of the glenohumeral joint. Anatomically, the supraspinatus inserts onto the superior facet of the greater tuberosity of the humerus. The infraspinatus inserts on the middle facet, and the teres minor inserts on the inferior facet. The subscapularis, which internally rotates the shoulder, inserts on the lesser tuberosity.

Question 7130

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic shoulder pain and weakness in abduction and external rotation. MRI confirms a massive, retracted tear of the supraspinatus and infraspinatus tendons. Which of the following nerves provides the primary motor innervation to both of these affected muscles, and through which anatomical structure does it pass to reach the infraspinatus?

. Axillary nerve; quadrangular space
. Suprascapular nerve; spinoglenoid notch
. Suprascapular nerve; suprascapular notch
. Subscapular nerve; triangular space
. Musculocutaneous nerve; coracobrachialis muscle

Correct Answer & Explanation

. Suprascapular nerve; spinoglenoid notch

Explanation

Correct Answer: Suprascapular nerve; spinoglenoid notchThe suprascapular nerve, arising from the upper trunk of the brachial plexus (C5, C6), provides motor innervation to both the supraspinatus and infraspinatus muscles. It first passes through the suprascapular notch (under the transverse scapular ligament) to innervate the supraspinatus. It then continues laterally and inferiorly, passing through the spinoglenoid notch (under the spinoglenoid ligament) to reach and innervate the infraspinatus. Compression at the suprascapular notch affects both muscles, whereas compression at the spinoglenoid notch (e.g., by a paralabral cyst) results in isolated infraspinatus weakness.

Question 7131

Topic: 5. Sports Medicine

Which of the following is a recognized biomechanical consequence of harvesting a semitendinosus and gracilis (hamstring) autograft for anterior cruciate ligament (ACL) reconstruction?

. Loss of knee extension strength
. Increased risk of anterior knee pain
. Decreased deep knee flexion strength
. Increased incidence of patellar tendon rupture
. Permanent loss of ankle plantarflexion strength

Correct Answer & Explanation

. Decreased deep knee flexion strength

Explanation

Harvest of the hamstring tendons for ACL reconstruction can result in a measurable deficit in deep knee flexion and internal rotation strength. Unlike bone-patellar tendon-bone autografts, hamstring grafts are not typically associated with chronic anterior knee pain.

Question 7132

Topic: Knee Sports

A 22-year-old female collegiate soccer player sustains a non-contact rotational knee injury. Examination reveals a positive Lachman test and a positive pivot shift test, and MRI confirms an isolated, complete rupture of the anterior cruciate ligament (ACL). Regarding the native biomechanical anatomy of the ACL, which of the following statements is most accurate regarding its distinct bundles?

. The posterolateral bundle is tight in flexion and is the primary restraint to anterior translation.
. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation.
. The anteromedial bundle is tight in extension and primarily controls rotatory stability.
. The posterolateral bundle originates on the medial wall of the lateral femoral condyle and inserts on the medial meniscus.
. Both bundles maintain equal tension throughout the entire range of knee motion.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation.

Explanation

The anteromedial (AM) bundle of the ACL is tight in flexion and serves as the primary restraint to anterior tibial translation. Conversely, the posterolateral (PL) bundle is tight in extension and primarily acts to control rotatory stability of the knee.

Question 7133

Topic: Shoulder & Hip Sports

A 22-year-old collegiate offensive lineman presents with recurrent posterior shoulder instability. He has not had any frank dislocations but experiences subluxations when blocking. He wishes to pursue non-operative management. A physical therapy program is initiated. Which of the following muscle groups should be the primary focus of his strengthening program?

. Pectoralis major and latissimus dorsi
. Infraspinatus, teres minor, and posterior deltoid
. Subscapularis and anterior deltoid
. Trapezius and levator scapulae
. Biceps brachii and coracobrachialis

Correct Answer & Explanation

. Infraspinatus, teres minor, and posterior deltoid

Explanation

Correct Answer: BConservative management of recurrent unidirectional posterior shoulder instability focuses heavily on strengthening the dynamic posterior stabilizers of the shoulder. These primarily include the external rotators (infraspinatus and teres minor) and the posterior head of the deltoid. Strengthening these muscles helps to dynamically resist posterior translation of the humeral head during provocative activities, such as blocking in football.

Question 7134

Topic: Shoulder & Hip Sports

A 35-year-old male with a history of poorly controlled epilepsy presents to the clinic with chronic right shoulder pain and limited range of motion following a seizure 3 weeks ago. He is unable to externally rotate his right shoulder past neutral. An AP radiograph of the shoulder reveals a symmetric appearance of the humeral head with loss of the normal half-moon overlap. Which of the following additional radiographic findings is most specific for his suspected diagnosis?

. Hill-Sachs lesion
. Bony Bankart lesion
. Trough line sign
. Superior migration of the humeral head
. Calcific tendinitis of the supraspinatus

Correct Answer & Explanation

. Trough line sign

Explanation

Correct Answer: CThe patient has a missed posterior shoulder dislocation, which is a common complication following seizures. The AP radiograph describes the "lightbulb sign," which is a symmetric appearance of the humeral head due to fixed internal rotation. The "trough line sign" represents a reverse Hill-Sachs lesion (an impaction fracture of the anteromedial humeral head against the posterior glenoid rim), which is highly specific for a posterior dislocation.

Question 7135

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a chronic, locked posterior shoulder dislocation that occurred during an electrocution injury 4 weeks ago. A CT scan reveals an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 35% of the articular surface. Which of the following surgical interventions is most appropriate?

. Closed reduction and spica casting
. Arthroscopic posterior labral repair
. Open reduction and transfer of the lesser tuberosity into the defect
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Open reduction and transfer of the lesser tuberosity into the defect

Explanation

Correct Answer: CFor a reverse Hill-Sachs lesion involving 20% to 40% of the articular surface, the modified McLaughlin procedure is indicated. This involves the transfer of the lesser tuberosity with its attached subscapularis tendon into the anteromedial defect to prevent recurrent engagement of the defect on the posterior glenoid rim. Defects greater than 40-50% typically require arthroplasty.

Question 7136

Topic: Shoulder & Hip Sports

A 21-year-old rugby player sustains a posterior shoulder dislocation after falling on an outstretched, internally rotated arm. Following closed reduction, an MRI is obtained. It reveals a detachment of the posterior labrum and posterior capsule from the glenoid rim. What is the eponymous name for this specific lesion?

. Bankart lesion
. ALPSA lesion
. Reverse Bankart lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Reverse Bankart lesion

Explanation

Correct Answer: CA reverse Bankart lesion is an avulsion of the posterior labrum and posterior capsular complex from the posterior glenoid rim. It is the posterior equivalent of the classic anterior Bankart lesion and is commonly seen following a traumatic posterior shoulder dislocation.

Question 7137

Topic: Shoulder & Hip Sports

Posterior shoulder dislocations account for approximately 2-5% of all shoulder dislocations. While trauma is a common cause, non-traumatic etiologies are classically associated with this injury due to intense, uncoordinated muscle contractions. Which of the following muscles' overpowering force is primarily responsible for posterior dislocation during a seizure?

. Pectoralis major, latissimus dorsi, and subscapularis
. Infraspinatus and teres minor
. Deltoid and supraspinatus
. Biceps brachii and coracobrachialis
. Trapezius and rhomboids

Correct Answer & Explanation

. Pectoralis major, latissimus dorsi, and subscapularis

Explanation

Correct Answer: ADuring a seizure or electrocution, the strong internal rotators of the shoulder (pectoralis major, latissimus dorsi, and subscapularis) overpower the relatively weaker external rotators (infraspinatus and teres minor). This massive, uncoordinated contraction forces the humeral head into severe internal rotation and drives it posteriorly out of the glenoid fossa.

Question 7138

Topic: Shoulder & Hip Sports

A surgeon is performing an open posterior stabilization for recurrent posterior shoulder instability. The classic posterior approach to the shoulder utilizes an internervous plane. Which of the following describes the correct internervous plane for this approach?

. Between the supraspinatus (suprascapular nerve) and infraspinatus (suprascapular nerve)
. Between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve)
. Between the teres minor (axillary nerve) and teres major (lower subscapular nerve)
. Between the deltoid (axillary nerve) and pectoralis major (medial and lateral pectoral nerves)
. Between the subscapularis (upper and lower subscapular nerves) and supraspinatus (suprascapular nerve)

Correct Answer & Explanation

. Between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve)

Explanation

Correct Answer: BThe classic open posterior approach to the shoulder utilizes the true internervous plane between the infraspinatus (innervated by the suprascapular nerve) and the teres minor (innervated by the axillary nerve). This approach allows safe access to the posterior capsule and glenoid without denervating the posterior rotator cuff musculature.

Question 7139

Topic: Shoulder & Hip Sports

A 22-year-old collegiate offensive lineman presents with recurrent posterior shoulder instability. He has not experienced any frank dislocations but reports a sensation of the shoulder 'slipping out' posteriorly when blocking. MRI shows a nondisplaced posterior labral tear without significant glenoid bone loss. He elects to undergo conservative management. A targeted physical therapy program should primarily emphasize strengthening of which of the following muscle groups?

. Pectoralis major and subscapularis
. Infraspinatus, teres minor, and posterior deltoid
. Supraspinatus and anterior deltoid
. Latissimus dorsi and teres major
. Serratus anterior and trapezius

Correct Answer & Explanation

. Infraspinatus, teres minor, and posterior deltoid

Explanation

Correct Answer: BConservative management of posterior shoulder instability focuses on strengthening the dynamic posterior stabilizers of the shoulder. These include the infraspinatus, teres minor, and the posterior head of the deltoid. Strengthening these muscles helps to dynamically resist posterior translation of the humeral head during provocative positions, such as when the arm is flexed, adducted, and internally rotated.

Question 7140

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a locked posterior shoulder dislocation that occurred 3 weeks ago following an unrecognized seizure. CT scan demonstrates a reverse Hill-Sachs lesion involving 35% of the articular surface. Which of the following is the most appropriate surgical management for this osseous defect?

. Closed reduction and spica casting
. Arthroscopic posterior labral repair
. Transfer of the lesser tuberosity and subscapularis tendon into the defect
. Transfer of the greater tuberosity and infraspinatus tendon into the defect
. Latarjet procedure

Correct Answer & Explanation

. Transfer of the lesser tuberosity and subscapularis tendon into the defect

Explanation

Correct Answer: CThe management of a reverse Hill-Sachs lesion depends on the size of the articular defect. Defects <20% can often be managed with closed reduction and immobilization if stable. Defects between 20% and 40% are typically managed with a modified McLaughlin procedure, which involves the transfer of the lesser tuberosity (along with the attached subscapularis tendon) into the anteromedial humeral head defect to prevent engagement on the posterior glenoid rim. Defects >40-50% generally require hemiarthroplasty or total shoulder arthroplasty.

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