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5. Sports Medicine MCQs

Practice Set 39 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 761

Topic: Shoulder & Hip Sports

Three weeks following an acute anterior shoulder dislocation, a 60-year-old male complains of continued weakness and an inability to bring his hand to his abdomen. You suspect a concomitant rotator cuff injury. Which of the following physical examination maneuvers would most specifically isolate the affected tendon in this scenario?

. Jobe's test (Empty can test)
. Hornblower's sign
. Bear hug test
. Neer impingement sign
. Speed's test

Correct Answer & Explanation

. Bear hug test

Explanation

The Bear hug test, along with the belly-press and lift-off tests, evaluates the integrity of the subscapularis tendon. Subscapularis tears are a common structural injury in older patients following an anterior shoulder dislocation.

Question 762

Topic: Shoulder & Hip Sports

A 62-year-old male is incidentally found to have an asymptomatic, full-thickness, 1.5 cm supraspinatus tear on an MRI ordered for a suspected cervical spine issue. What is the most likely natural history of this rotator cuff tear if observed conservatively over the next 2 to 3 years?

. Spontaneous healing of the tendon back to the footprint
. Decrease in tear size secondary to compensatory hypertrophy
. Enlargement of the tear with a high likelihood of becoming symptomatic
. Stable tear size with an absolute lack of clinical symptom progression
. Rapid progression to severe cuff tear arthropathy within 6 months

Correct Answer & Explanation

. Enlargement of the tear with a high likelihood of becoming symptomatic

Explanation

Longitudinal studies demonstrate that asymptomatic full-thickness rotator cuff tears have a high probability of enlarging over time. Furthermore, approximately 50% will become clinically symptomatic within 2 to 3 years as they progress in size.

Question 763

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. He has had 5 dislocations over the past year. Advanced imaging reveals a 25% anterior glenoid bone loss. Which of the following surgical interventions is most appropriate to minimize his risk of recurrent dislocation?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Open Latarjet procedure
. Open capsulolabral shift
. Putti-Platt procedure

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

The open Latarjet procedure (coracoid transfer) is indicated for patients with recurrent anterior shoulder instability and significant glenoid bone loss, typically defined as greater than 20-25%. An arthroscopic Bankart repair alone in the setting of critical bone loss carries an unacceptably high failure rate.

Question 764

Topic: Shoulder & Hip Sports

A 45-year-old male with a history of poorly controlled epilepsy presents with right shoulder pain following a generalized tonic-clonic seizure. Examination reveals the arm locked in internal rotation. A CT scan confirms a locked posterior shoulder dislocation with an associated reverse Hill-Sachs lesion involving 35% of the articular surface. What is the most appropriate surgical management?

. Closed reduction and spica cast immobilization
. Arthroscopic posterior capsulolabral repair
. Open reduction with transfer of the lesser tuberosity into the defect (Modified McLaughlin)
. Anatomic total shoulder arthroplasty
. Structural iliac crest bone grafting to the glenoid

Correct Answer & Explanation

. Open reduction with transfer of the lesser tuberosity into the defect (Modified McLaughlin)

Explanation

For posterior dislocations with an anteromedial humeral head defect (reverse Hill-Sachs) involving 20% to 40% of the articular surface, a modified McLaughlin procedure (transferring the subscapularis/lesser tuberosity into the defect) is indicated to restore stability. Arthroplasty is generally reserved for defects >40-50% or older patients with concurrent arthritis.

Question 765

Topic: Shoulder & Hip Sports
A 32-year-old male presents to the emergency department after a generalized tonic-clonic seizure. He complains of severe left shoulder pain and inability to move his arm. Physical examination reveals the arm held in internal rotation and adduction, with a flattened anterior deltoid contour. Radiographs are obtained. Based on the provided image and clinical scenario, which of the following is the most likely diagnosis and a common associated bony lesion?
. Anterior glenohumeral dislocation with a Hill-Sachs lesion.
. Inferior glenohumeral dislocation (luxatio erecta) with a greater tuberosity fracture.
. Posterior glenohumeral dislocation with a reverse Hill-Sachs lesion.
. Acromioclavicular joint separation (Type III) with a coracoid fracture.
. Scapular fracture with an associated rotator cuff tear.

Correct Answer & Explanation

. Posterior glenohumeral dislocation with a reverse Hill-Sachs lesion.

Explanation

The clinical presentation of an arm held in internal rotation and adduction, especially following a seizure, is highly classic for a posterior glenohumeral dislocation. The 'lightbulb sign' on radiographs and an overlap of the humeral head with the glenoid are indicative of a posterior dislocation. A reverse Hill-Sachs lesion, an impression fracture on the anteromedial aspect of the humeral head, is a common associated bony lesion that occurs when the posterior glenoid rim impacts the humeral head during a posterior dislocation.

Question 766

Topic: Shoulder & Hip Sports

A 28-year-old professional weightlifter presents with chronic, deep-seated posterior shoulder pain and a sensation of 'clunking' during overhead lifts, particularly during bench press. He denies any acute traumatic event but reports a gradual onset of symptoms over 6 months. Physical examination reveals a positive Jerk test and apprehension with combined adduction, internal rotation, and flexion. An MR Arthrography (MRA) is performed.

Based on the clinical presentation and the provided MRA image, which of the following soft tissue lesions is MOST likely present and contributes significantly to his symptoms?

. Anterior Bankart lesion.
. Superior Labrum Anterior Posterior (SLAP) tear.
. Kim lesion.
. Rotator cuff tear of the supraspinatus.
. Subscapularis tendon avulsion.

Correct Answer & Explanation

. Kim lesion.

Explanation

Correct Answer: CThe patient's history of chronic posterior shoulder pain, clunking during overhead activities (especially bench press, which involves adduction and internal rotation), and positive Jerk test are highly suggestive of posterior glenohumeral instability. The MRA image, which is the gold standard for evaluating soft tissue lesions, would be used to identify specific pathology. The case content specifically mentions the 'Kim lesion' as an avulsion of the posterior-inferior labrum from the glenoid rim with an associated partial tear or delamination of the glenoid cartilage, often subtle and potentially missed. This type of lesion is consistent with chronic microtrauma in athletes like weightlifters and contributes to posteroinferior instability.Option A (Anterior Bankart lesion) is associated with anterior instability and would present with different symptoms and physical exam findings.Option B (SLAP tear) typically presents with pain during overhead activities, but the primary instability symptoms and positive Jerk test point more specifically to posterior instability.Option D (Rotator cuff tear of the supraspinatus) would primarily cause pain with abduction and external rotation, and weakness, rather than clunking and apprehension in adduction/internal rotation.Option E (Subscapularis tendon avulsion) is associated with anterior instability or trauma and would affect internal rotation strength and anterior stability.

Question 767

Topic: Shoulder & Hip Sports

A 40-year-old male presents with recurrent posterior shoulder subluxations following a fall onto an outstretched hand (FOOSH) 6 months prior. Conservative management has failed. Pre-operative imaging includes a 3D CT scan, which reveals significant posterior glenoid bone loss. The image below is representative of such a finding.

Given the finding of significant posterior glenoid bone loss, which of the following surgical interventions is MOST appropriate to restore glenoid articular arc and prevent recurrence?

. Arthroscopic posterior labral repair with capsular plication.
. Arthroscopic remplissage procedure.
. Open posterior glenoid augmentation with an autogenous iliac crest bone graft.
. Arthroscopic biceps tenodesis.
. Open anterior Latarjet procedure.

Correct Answer & Explanation

. Open posterior glenoid augmentation with an autogenous iliac crest bone graft.

Explanation

Correct Answer: CThe case content explicitly states that open posterior approaches are indicated for cases with substantial posterior glenoid bone loss (>15-20%). For significant glenoid bone loss, augmentation of the posterior glenoid rim is necessary, typically with an autogenous bone graft (e.g., iliac crest) or allograft, which is shaped and fixed to the posterior glenoid neck to effectively extend the posterior glenoid rim. The 3D CT image is essential for quantifying this bone loss, making an open bone grafting procedure the most appropriate choice to restore the glenoid articular arc and provide a stable platform.Option A (Arthroscopic posterior labral repair with capsular plication) is generally preferred for isolated soft tissue lesions without significant bone loss. It would be insufficient for substantial bone loss.Option B (Arthroscopic remplissage procedure) addresses an engaging reverse Hill-Sachs lesion on the humeral head, not glenoid bone loss.Option D (Arthroscopic biceps tenodesis) is for biceps pathology and does not address glenohumeral instability or bone loss.Option E (Open anterior Latarjet procedure) is for anterior glenoid bone loss, not posterior, and would be inappropriate in this context.

Question 768

Topic: 5. Sports Medicine

A 22-year-old college football lineman presents with recurrent posterior shoulder instability. He reports that his shoulder 'pops out' when he is blocking opponents, often with his arm in a position of adduction, internal rotation, and flexion. He has failed a 3-month course of physical therapy focusing on rotator cuff and scapular strengthening. Pre-operative planning is underway for arthroscopic posterior stabilization. During patient positioning, the surgeon opts for the lateral decubitus position.

Which of the following is a critical step in patient positioning for arthroscopic posterior stabilization in the lateral decubitus position to prevent nerve injury?

. Placing the operative arm in maximal external rotation.
. Ensuring the head is hyperextended to facilitate airway management.
. Applying an axillary roll in the contralateral axilla.
. Positioning the patient with the operative shoulder down.
. Applying excessive traction (>25 lbs) to the operative arm.

Correct Answer & Explanation

. Applying an axillary roll in the contralateral axilla.

Explanation

Correct Answer: CThe case content explicitly states that for arthroscopic posterior stabilization in the lateral decubitus position, 'An axillary roll is placed in the contralateral axilla to protect the brachial plexus and prevent nerve compression.' This is a critical step to prevent iatrogenic injury to the neurovascular structures in the dependent axilla due to prolonged compression.Option A (Placing the operative arm in maximal external rotation) is incorrect; the arm is typically suspended in abduction and slight forward flexion, and maximal external rotation is avoided, especially in posterior instability cases, as it can stress the anterior capsule.Option B (Ensuring the head is hyperextended) is incorrect and can lead to cervical spine issues or compromise cerebral perfusion, especially in the beach chair position, but generally not a recommended practice.Option D (Positioning the patient with the operative shoulder down) is incorrect; in the lateral decubitus position, the operative shoulder is positioned UP to allow access for arthroscopy.Option E (Applying excessive traction) is incorrect; the case specifies gentle traction (typically 10-15 lbs) to distract the joint. Excessive traction can lead to brachial plexus neuropraxia.

Question 769

Topic: Shoulder & Hip Sports

A 25-year-old male presents with chronic posterior shoulder pain and a feeling of instability. He is a competitive swimmer and experiences symptoms during freestyle strokes. MRI reveals a posterior labral tear and mild capsular laxity. A CT scan is also performed to rule out bony pathology. The CT scan shows normal glenoid retroversion and no significant glenoid bone loss. Which of the following is the MOST appropriate initial surgical management for this patient?

. Open posterior glenoid osteotomy to correct retroversion.
. Open posterior Latarjet procedure.
. Arthroscopic posterior labral repair with capsular plication.
. Arthroscopic remplissage procedure.
. Total shoulder arthroplasty.

Correct Answer & Explanation

. Arthroscopic posterior labral repair with capsular plication.

Explanation

Correct Answer: CThe case content states that 'Arthroscopic stabilization is generally preferred for isolated posterior labral tears (reverse Bankart lesions) and capsular laxity without significant bone loss.' This patient has a posterior labral tear and mild capsular laxity, with no significant glenoid bone loss or abnormal retroversion, and no mention of an engaging reverse Hill-Sachs lesion. Therefore, arthroscopic posterior labral repair with capsular plication is the most appropriate initial surgical management, aiming to reattach the labrum and tighten the posterior capsule.Option A (Open posterior glenoid osteotomy) would be indicated for significant glenoid retroversion, which is not present here.Option B (Open posterior Latarjet procedure) is a complex procedure for significant glenoid bone loss, which is also not present.Option D (Arthroscopic remplissage procedure) is indicated for an engaging reverse Hill-Sachs lesion, which is not mentioned as present.Option E (Total shoulder arthroplasty) is a salvage procedure for severe arthritis or irreparable damage, not indicated for this patient's condition.

Question 770

Topic: Shoulder & Hip Sports

A 29-year-old professional baseball pitcher presents with persistent posterior shoulder pain and a sense of instability, particularly during the follow-through phase of his pitching motion. He has failed extensive non-operative management. MRI reveals a subtle posterior-inferior labral avulsion with associated partial delamination of the glenoid cartilage, but no discrete labral tear. A 3D CT scan shows no significant glenoid bone loss or engaging reverse Hill-Sachs lesion. Given these findings, which specific soft tissue lesion is MOST likely present and requires careful identification during arthroscopy?

. Anterior Bankart lesion.
. SLAP tear (Type II).
. Reverse Bankart lesion.
. Kim lesion.
. Posterior superior labral tear.

Correct Answer & Explanation

. Kim lesion.

Explanation

Correct Answer: DThe patient's symptoms of posterior shoulder pain and instability, especially in a high-demand overhead athlete, combined with the MRI findings of a 'subtle posterior-inferior labral avulsion with associated partial delamination of the glenoid cartilage, but no discrete labral tear,' are highly characteristic of a Kim lesion. The case content defines a Kim lesion as 'An avulsion of the posterior-inferior labrum from the glenoid rim with an associated partial tear or delamination of the glenoid cartilage, but without a discrete labral tear. This lesion is often subtle and can be missed.' This description perfectly matches the MRI findings and the clinical scenario.Option A (Anterior Bankart lesion) is for anterior instability.Option B (SLAP tear) involves the superior labrum and biceps anchor, not primarily the posterior-inferior aspect.Option C (Reverse Bankart lesion) is a discrete posterior labral tear, which the description explicitly states is 'without a discrete labral tear' in the Kim lesion definition.Option E (Posterior superior labral tear) is a different location and typically presents differently.

Question 771

Topic: Shoulder & Hip Sports

A 42-year-old male presents with a chronic, unreduced posterior glenohumeral dislocation following a motor vehicle accident 3 months prior. He has significant pain and functional limitation. Pre-operative imaging reveals a large, engaging reverse Hill-Sachs lesion occupying approximately 30% of the humeral head articular surface, in addition to a posterior labral tear. The glenoid morphology is otherwise normal. Which of the following surgical strategies is MOST appropriate to address the engaging reverse Hill-Sachs lesion in this scenario?

. Arthroscopic posterior labral repair only.
. Open posterior glenoid bone block augmentation.
. Arthroscopic remplissage procedure (infraspinatus tenodesis).
. Debridement of the reverse Hill-Sachs lesion.
. Total shoulder arthroplasty.

Correct Answer & Explanation

. Arthroscopic remplissage procedure (infraspinatus tenodesis).

Explanation

Correct Answer: CThe case content specifically addresses the management of engaging reverse Hill-Sachs lesions: 'For engaging reverse Hill-Sachs lesions (often those occupying >25% of the humeral head articular surface), a remplissage procedure (French for 'to fill in') can be performed. This involves tenodesing the infraspinatus tendon and posterior capsule into the humeral head defect using suture anchors. This effectively fills the defect, preventing it from engaging the posterior glenoid rim during internal rotation and adduction.' Given the large, engaging nature of the lesion (30% of the articular surface), a remplissage procedure is the most appropriate strategy to prevent recurrent engagement and instability.Option A (Arthroscopic posterior labral repair only) would not address the engaging bony defect, leading to high recurrence rates.Option B (Open posterior glenoid bone block augmentation) is for glenoid bone loss, not for a humeral head defect.Option D (Debridement of the reverse Hill-Sachs lesion) would remove articular cartilage and potentially worsen the defect, not stabilize it.Option E (Total shoulder arthroplasty) is an extreme measure for severe arthritis or irreparable damage, not indicated as a primary treatment for an engaging Hill-Sachs lesion in an otherwise normal glenoid.

Question 772

Topic: 5. Sports Medicine

Following lateral proximal tibial hemiepiphysiodesis, which aspect of post-operative care is most critical for ensuring a successful outcome and preventing complications like overcorrection or undercorrection?

. Strict non-weight-bearing for 6 weeks to protect the surgical site.
. Aggressive physical therapy focusing on high-impact activities to strengthen the limb.
. Regular clinical and radiographic follow-up every 3-6 months with standing full-length AP radiographs.
. Immediate return to full sports activities to promote bone remodeling.
. Prophylactic long-term antibiotic therapy to prevent infection.

Correct Answer & Explanation

. Regular clinical and radiographic follow-up every 3-6 months with standing full-length AP radiographs.

Explanation

Correct Answer: CThe 'Monitoring and Correction Phase' section of the 'Post-Operative Rehabilitation Protocols' explicitly states: 'Regular Clinical and Radiographic Follow-up: This is the most critical aspect of the post-operative protocol. Frequency: Typically every 3-6 months until desired correction is achieved. Radiographs: Standing full-length AP radiographs (mechanical axis views) are essential at each visit.' This close monitoring is crucial for determining the precise timing of hardware removal to achieve optimal alignment and prevent overcorrection or undercorrection. The procedure typically allows early weight-bearing. Aggressive or high-impact activities are generally avoided initially. Long-term antibiotics are not indicated for routine hemiepiphysiodesis.

Question 773

Topic: 5. Sports Medicine

A 45-year-old male presents with an acute Achilles tendon rupture. He is a highly active individual who desires to return to competitive sports as quickly and safely as possible. He has no significant comorbidities. The rupture gap is 1.2 cm. Based on the summary of key literature and guidelines, which treatment approach is most aligned with his goals and injury characteristics?

. Non-operative management with prolonged immobilization to ensure maximal healing.
. Percutaneous repair with delayed weight-bearing to minimize wound complications.
. Open operative repair combined with early functional rehabilitation, due to a potentially lower rerupture rate and better strength outcomes for active individuals.
. Non-operative management with an accelerated rehabilitation protocol, as it has been proven to have a lower rerupture rate than operative repair.
. Open operative repair with a V-Y lengthening procedure to accommodate the 1.2 cm gap.

Correct Answer & Explanation

. Open operative repair combined with early functional rehabilitation, due to a potentially lower rerupture rate and better strength outcomes for active individuals.

Explanation

Correct Answer: CThe "Current Guidelines and Consensus" section states: "For young, active individuals seeking to return to high-level sports, operative repair combined with early functional rehabilitation is often preferred due to a potentially lower rerupture rate and better strength outcomes." This patient fits this description perfectly (45-year-old, highly active, desires quick return to competitive sports, 1.2 cm gap which is >1cm favoring surgery).Option A is incorrect; prolonged immobilization is outdated and leads to worse outcomes. Option B is incorrect; while percutaneous repair aims to reduce wound complications, the case highlights that open repair allows for a more robust repair, especially for active individuals, and early functional rehab is key. Option D is incorrect; while modern non-operative protocols have reduced rerupture rates, operative management still generally shows a statistically lower rerupture rate, and the text states operative is 'often preferred' for this demographic. Option E is incorrect; V-Y lengthening is typically for chronic ruptures with significant contracture, not an acute 1.2 cm gap.

Question 774

Topic: Shoulder & Hip Sports

A 22-year-old collegiate linebacker presents with recurrent anterior shoulder instability. CT scan demonstrates 22% anterior glenoid bone loss. Which of the following procedures is most appropriate to prevent recurrent instability?

. Arthroscopic Bankart repair alone
. Open Bankart repair with inferior capsular shift
. Coracoid transfer (Latarjet procedure)
. Arthroscopic Remplissage alone
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

In a collision athlete with critical anterior glenoid bone loss (typically >15-20%), soft tissue stabilization alone has an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the most reliable option for restoring stability.

Question 775

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, the "glenoid track" concept is utilized to determine the risk of engagement of a Hill-Sachs lesion. Which of the following defines an "off-track" lesion?

. The Hill-Sachs interval is greater than the intact glenoid track width
. The Hill-Sachs interval is less than the intact glenoid track width
. The intact glenoid track width is 83% of the normal glenoid width
. The Hill-Sachs lesion involves less than 15% of the humeral head diameter
. The glenoid bone loss is isolated to the posteroinferior quadrant

Correct Answer & Explanation

. The Hill-Sachs interval is greater than the intact glenoid track width

Explanation

An "off-track" lesion occurs when the Hill-Sachs interval (width of the defect plus the medial bone bridge) is greater than the intact glenoid track width. This indicates the lesion will engage the anterior glenoid rim during abduction and external rotation.

Question 776

Topic: Shoulder & Hip Sports

During an arthroscopic stabilization for recurrent anterior shoulder instability, the surgeon visualizes the anterior labrum healed medially along the scapular neck. Which of the following best describes this lesion?

. Bankart lesion
. GLAD lesion
. ALPSA lesion
. HAGL lesion
. Perthes lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the torn anterior labrum displaces medially and heals to the scapular neck. It must be mobilized and shifted laterally back to the glenoid rim during repair.

Question 777

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness in elbow flexion and decreased sensation over the lateral forearm. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at risk during the Latarjet procedure as it enters the coracobrachialis 5-8 cm distal to the coracoid process.

Question 778

Topic: Shoulder & Hip Sports

A 25-year-old male with recurrent anterior shoulder instability undergoes an arthroscopic stabilization. He is noted to have 10% glenoid bone loss and a large, engaging Hill-Sachs lesion. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open capsular shift
. Humeral head allograft

Correct Answer & Explanation

. Arthroscopic Bankart repair with remplissage

Explanation

An engaging Hill-Sachs lesion with subcritical glenoid bone loss (<20%) is best treated with an arthroscopic Bankart repair combined with a remplissage procedure.

Question 779

Topic: Shoulder & Hip Sports

A 45-year-old male presents to the ED after an electrical shock. His arm is locked in internal rotation and adduction. Radiographs show a 'lightbulb' sign. What associated bony defect is most commonly seen?

. Bankart lesion
. Hill-Sachs lesion
. Reverse Hill-Sachs lesion
. ALPSA lesion
. GLAD lesion

Correct Answer & Explanation

. Reverse Hill-Sachs lesion

Explanation

Electrical shocks and seizures commonly cause posterior shoulder dislocations. These are frequently associated with a reverse Hill-Sachs lesion, which is an impaction fracture of the anteromedial humeral head.

Question 780

Topic: Shoulder & Hip Sports

A 16-year-old female gymnast complains of bilateral shoulder pain and a sensation of her shoulder 'slipping' during activities. She has generalized ligamentous laxity. Sulcus sign is positive. What is the most appropriate initial management?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Physical therapy focusing on periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy
. Latarjet procedure

Correct Answer & Explanation

. Physical therapy focusing on periscapular and rotator cuff strengthening

Explanation

The initial management for multidirectional instability (MDI) is a prolonged course of physical therapy. It should focus heavily on strengthening the rotator cuff and periscapular stabilizers.

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