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5. Sports Medicine MCQs

Practice Set 41 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 801

Topic: 5. Sports Medicine

A 60-year-old patient is undergoing open reduction and internal fixation of a displaced proximal humerus fracture. The surgical team is preparing for patient positioning. The image provided shows a typical setup for shoulder surgery. Which of the following statements accurately describes a key advantage of the Beach Chair position, as depicted in the general context of shoulder surgery setups?

. It provides superior stability for patients with significant comorbidities compared to lateral decubitus.
. It allows for easier concurrent shoulder arthroscopy.
. It offers excellent visualization for the deltopectoral approach and allows assessment of shoulder range of motion.
. It minimizes the risk of cerebral hypoperfusion due to head elevation.
. It is primarily used for posterior approaches to the shoulder.

Correct Answer & Explanation

. It offers excellent visualization for the deltopectoral approach and allows assessment of shoulder range of motion.

Explanation

Correct Answer: CThe text states, regarding the Beach Chair Position: 'Advantages: Excellent visualization for the deltopectoral approach, allows for easy assessment of shoulder range of motion during the procedure, less blood loss due to reverse Trendelenburg, and ability to assess rotator cuff integrity.' The image depicts a patient draped for shoulder surgery, consistent with either beach chair or lateral decubitus, but the question specifically asks about the advantages of the Beach Chair position.Option A is incorrect; the text suggests lateral decubitus 'May offer improved stability for patients with certain comorbidities,' implying beach chair might be less stable in some cases.Option B is incorrect; while arthroscopy can be done in beach chair, the text mentions lateral decubitus 'Can be preferred... if shoulder arthroscopy is concurrently planned.'Option D is incorrect; the text explicitly lists 'Monitor blood pressure closely for potential cerebral hypoperfusion ("beach chair hypotension")' as a precaution, indicating a risk, not a minimization of risk.Option E is incorrect; the text states beach chair provides 'Excellent visualization for the deltopectoral approach,' which is an anterior approach. Lateral decubitus 'Can be preferred for certain posterior approaches.'

Question 802

Topic: Shoulder & Hip Sports
During the clinical examination, the patient's left hip demonstrated significantly restricted and painful range of motion (ROM). Key findings included flexion to 80° (normal >120°), extension to 0° (normal 15-20°) with a fixed flexion deformity of 10°, and internal rotation of 5° (normal 30-40°) with severe pain. This specific pattern of ROM restriction, particularly the loss of internal rotation and fixed flexion deformity, is most characteristic of which of the following hip pathologies?
. Early avascular necrosis of the femoral head.
. Inflammatory arthropathy, such as rheumatoid arthritis.
. Advanced primary osteoarthritis of the hip.
. A symptomatic labral tear with associated impingement.
. Greater trochanteric bursitis.

Correct Answer & Explanation

. Advanced primary osteoarthritis of the hip.

Explanation

The described pattern of range of motion (ROM) restriction, particularly the significant loss of internal rotation and the presence of a fixed flexion deformity, is a classic presentation of advanced primary osteoarthritis of the hip. Osteoarthritis typically affects the anterior and superior aspects of the joint first, leading to a progressive loss of internal rotation and extension.

Question 803

Topic: Shoulder & Hip Sports
Anteroposterior (AP) pelvis radiographs of the patient's left hip revealed severe tricompartmental joint space narrowing, subchondral sclerosis, extensive osteophyte formation along the femoral head-neck junction and acetabular rim, and subchondral cyst formation in both the femoral head and acetabulum. There was also evidence of mild acetabular retroversion indicated by a positive cross-over sign, and superolateral migration of the femoral head. According to the Kellgren-Lawrence classification, these findings are consistent with which grade of osteoarthritis?
. Grade I (Doubtful OA)
. Grade II (Mild OA)
. Grade III (Moderate OA)
. Grade IV (Severe OA)
. Grade V (End-stage OA with complete ankylosis)

Correct Answer & Explanation

. Grade IV (Severe OA)

Explanation

The Kellgren-Lawrence classification system is a widely used radiographic grading scale for osteoarthritis. The described findings of severe tricompartmental joint space narrowing, subchondral sclerosis, extensive osteophyte formation, subchondral cyst formation, and definite deformity of bone ends are the hallmarks of Grade IV osteoarthritis. Grade I involves doubtful narrowing and possible osteophytes. Grade II shows definite osteophytes and possible narrowing. Grade III includes moderate osteophytes, definite joint space narrowing, and some sclerosis. Grade V is not a standard Kellgren-Lawrence grade; the highest is Grade IV, which represents severe disease.

Question 804

Topic: 5. Sports Medicine

Following a successful closed reduction of a posterior hip dislocation in a 40-year-old male, a palpable clunk was noted, and the hip appears stable on clinical examination. Post-reduction AP and lateral X-rays show a seemingly concentric reduction. What is the most appropriate next diagnostic step to ensure optimal long-term outcomes?

. Discharge the patient with crutches and follow-up in 1 week.
. Order an MRI of the hip to assess for early avascular necrosis.
. Obtain a CT scan of the pelvis and hip.
. Begin immediate aggressive physical therapy to restore full range of motion.
. Perform a diagnostic hip arthroscopy to rule out labral tears.

Correct Answer & Explanation

. Obtain a CT scan of the pelvis and hip.

Explanation

Correct Answer: CThe case emphasizes that "A CT scan of the pelvis and hip is generally recommendedafter successful closed reductionto: Confirm concentric reduction. Identify incarcerated osteochondral fragments or soft tissue within the joint. Precisely characterize associated acetabular or femoral head fractures (size, displacement, articular involvement). Assess for occult femoral neck or intertrochanteric fractures missed on plain radiographs." While plain X-rays may appear concentric, a CT scan is crucial to detect subtle intra-articular fragments or occult fractures that could lead to post-traumatic arthritis or instability if not addressed. MRI is more sensitive for AVN, but AVN is a later complication, and the immediate priority after reduction is to confirm concentricity and rule out incarcerated fragments/fractures.

Question 805

Topic: Shoulder & Hip Sports

During a hemiarthroplasty for a comminuted proximal humerus fracture, proper restoration of humeral head height is crucial. Placing the prosthesis too high (proud) relative to the greater tuberosity most commonly results in which of the following complications?

. Anterior instability
. Axillary nerve palsy
. Subacromial impingement and rotator cuff dysfunction
. Postoperative stiffness with excessive external rotation
. Heterotopic ossification

Correct Answer & Explanation

. Subacromial impingement and rotator cuff dysfunction

Explanation

If a humeral prosthesis is placed too proud, it leads to over-tensioning of the rotator cuff and severe subacromial impingement. The correct height is typically achieved by aligning the top of the prosthetic head 5-8 mm above the superior tip of the greater tuberosity.

Question 806

Topic: 5. Sports Medicine

A surgeon is performing an open reduction and internal fixation of a highly comminuted proximal humerus fracture with medial calcar disruption. She decides to incorporate an intramedullary fibular strut allograft into her locked plating construct. What is the primary biomechanical advantage of this addition?

. Prevents screw cut-out by enhancing medial calcar support
. Increases the rotational flexibility of the construct
. Promotes endosteal revascularization of the humeral head
. Eliminates the need for multiple locked screws in the head
. Reduces the incidence of postoperative axillary nerve palsy

Correct Answer & Explanation

. Prevents screw cut-out by enhancing medial calcar support

Explanation

Loss of the medial hinge leads to varus collapse of the humeral head and subsequent screw cut-out. Adding an intramedullary fibular strut allograft acts as a mechanical buttress, restoring medial cortical support and significantly increasing the load-to-failure of the construct.

Question 807

Topic: Shoulder & Hip Sports

During a deltopectoral approach for open reduction and internal fixation of a 3-part proximal humerus fracture, the surgeon has successfully developed the deltopectoral interval and retracted the conjoined tendon medially. As the surgeon prepares to manage the subscapularis and anterior capsule, a blunt Hohmann retractor is placed under the inferior border of the subscapularis. What is the primary purpose of this specific maneuver?

. A. To facilitate easier tenotomy of the subscapularis tendon.
. B. To protect the musculocutaneous nerve from injury during capsular release.
. C. To protect the axillary nerve and anterior humeral circumflex artery from iatrogenic damage.
. D. To provide leverage for humeral head reduction.
. E. To prevent excessive bleeding from the subscapular artery.

Correct Answer & Explanation

. C. To protect the axillary nerve and anterior humeral circumflex artery from iatrogenic damage.

Explanation

Correct Answer: CThe case study states, 'A blunt Hohmann retractor can be placed under the inferior border of the subscapularis to protect the axillary nerve during subsequent dissection.' It further elaborates that the 'Axillary Nerve courses inferiorly and then posteriorly around the surgical neck of the humerus, approximately 5-7 cm distal to the acromion... Its close proximity to the inferior capsule and surgical neck of the humerus makes it vulnerable during capsular releases, humeral head resection, and fracture fixation. It is often accompanied by the posterior humeral circumflex artery.' The anterior humeral circumflex artery also runs in this vicinity. Therefore, placing a retractor under the inferior border of the subscapularis is a critical step to shield these vital neurovascular structures. Option A is incorrect; while it might provide some counter-traction, its primary role is protection. Option B is incorrect; the musculocutaneous nerve is associated with the conjoined tendon, not typically at risk under the inferior subscapularis. Option D is incorrect; while retractors are used for reduction, this specific placement is for protection. Option E is incorrect; the subscapular artery is deeper and not the primary concern with this specific maneuver.

Question 808

Topic: Shoulder & Hip Sports

A 35-year-old male presents with a large, retracted subscapularis tear following a work-related injury. Surgical repair via the deltopectoral approach is planned. The surgeon opts for a subscapularis tenotomy. Which of the following statements accurately describes the biomechanical implication of this approach and the subsequent repair?

. A. The deltopectoral approach primarily sacrifices the anterior deltoid fibers, leading to post-operative abduction weakness.
. B. Proper repair of the subscapularis is critical for restoring external rotation strength and preventing posterior instability.
. C. The deltopectoral approach respects the deltoid's innervation, minimizing post-operative weakness and facilitating early rehabilitation.
. D. Subscapularis tenotomy is preferred over a peel for instability cases to maximize capsular tightening.
. E. The upper and lower subscapular nerves are typically identified and protected by retracting the subscapularis medially.

Correct Answer & Explanation

. C. The deltopectoral approach respects the deltoid's innervation, minimizing post-operative weakness and facilitating early rehabilitation.

Explanation

Correct Answer: CThe case study emphasizes the biomechanical advantage of the deltopectoral approach: 'The biomechanical advantage of the deltopectoral approach lies in its respect for the integrity of the deltoid muscle. By dissecting along an internervous plane, the muscle fibers are not transected, preserving the deltoid's origin, insertion, and innervation. This minimizes post-operative weakness and facilitates early rehabilitation.' Option A is incorrect as the approach is internervous, preserving the deltoid. Option B is incorrect; the subscapularis is a primary internal rotator and anterior stabilizer, not an external rotator or posterior stabilizer. Its repair is critical for internal rotation strength and anterior stability. Option D is incorrect; the subscapularis peel is often used in instability surgery (e.g., Bankart repair) to preserve tendon length and allow for better capsular closure, whereas tenotomy is more common for arthroplasty. Option E is partially correct in that the nerves are important, but they enter the deep surface of the muscle, making muscle splitting less risky than extensive subscapularis mobilization without careful nerve identification, and they are not typically 'identified and protected by retracting the subscapularis medially' in the same way the axillary nerve is protected inferiorly.

Question 809

Topic: Shoulder & Hip Sports

A 55-year-old male with severe glenohumeral osteoarthritis is undergoing a total shoulder arthroplasty. After developing the deltopectoral interval and retracting the conjoined tendon medially, the surgeon performs a subscapularis tenotomy. Which of the following statements regarding the subsequent capsulotomy is most accurate?

. A. A straight vertical capsulotomy is always preferred to minimize nerve injury.
. B. An inverted T-capsulotomy provides the most extensile exposure for glenoid preparation.
. C. The inferior limb of a T-capsulotomy must be performed with extreme care to avoid injury to the axillary nerve.
. D. Capsular release is typically performed posteriorly to improve external rotation.
. E. The anterior capsule is usually left open to decompress the joint post-operatively.

Correct Answer & Explanation

. C. The inferior limb of a T-capsulotomy must be performed with extreme care to avoid injury to the axillary nerve.

Explanation

Correct Answer: CThe case study describes capsular management: 'Once the subscapularis is mobilized, the underlying anterior capsule is exposed. A T-Capsulotomy is a common approach... The inferior limb must be carefully performed to avoid injuring the axillary nerve.' This highlights the critical vulnerability of the axillary nerve, which courses inferior to the subscapularis and anterior capsule. Option A is incorrect; while a straight vertical capsulotomy is an option, a T-capsulotomy is common and offers excellent exposure, and the key is careful execution, not just the type of incision. Option B is incorrect; an inverted T-capsulotomy is less common, and a standard T-capsulotomy provides excellent exposure. Option D is incorrect; while posterior capsular releases can be performed, the primary capsulotomy in a deltopectoral approach is anterior, and the statement about external rotation is not the direct focus of this question. Option E is incorrect; the capsule is meticulously repaired to restore glenohumeral stability and prevent postoperative subluxation, not left open.

Question 810

Topic: Shoulder & Hip Sports

A surgeon is performing a revision total shoulder arthroplasty via the deltopectoral approach on a patient with a failed glenoid component. After mobilizing the subscapularis, the surgeon needs to achieve maximal exposure of the glenoid. Which of the following maneuvers, if performed excessively, carries the highest risk of injury to the axillary neurovascular bundle?

. A. Excessive superior retraction of the deltoid muscle.
. B. Aggressive medial retraction of the conjoined tendon and pectoralis minor.
. C. Extensive lateral retraction of the pectoralis major muscle.
. D. Deep dissection along the lateral aspect of the humeral shaft.
. E. Vigorous inferior retraction of the humeral head.

Correct Answer & Explanation

. B. Aggressive medial retraction of the conjoined tendon and pectoralis minor.

Explanation

Correct Answer: BThe case study explicitly warns about the axillary neurovascular bundle: 'Situated medial and deep to the coracoid process. This bundle contains the axillary artery, axillary vein, and brachial plexus cords (lateral, posterior, medial). Retraction of the conjoined tendon medially allows access to the subscapularis, but extreme medial retraction risks injury to this bundle.' Therefore, aggressive medial retraction of the conjoined tendon and pectoralis minor directly threatens the axillary neurovascular bundle. Option A (superior deltoid retraction) is less likely to injure the main axillary bundle, though the axillary nerve's anterior branch could be at risk. Option C (lateral pectoralis major retraction) is not the primary direction of risk for the axillary bundle. Option D (lateral humeral shaft dissection) is too distal and lateral to directly impact the axillary bundle. Option E (inferior humeral head retraction) could put the axillary nerve at risk as it wraps around the surgical neck, but the question specifically asks about the 'axillary neurovascular bundle' which is more medial and deep, and directly threatened by medial retraction of the conjoined tendon and pectoralis minor.

Question 811

Topic: Shoulder & Hip Sports

During an anatomic total shoulder arthroplasty, the surgeon elects to perform a lesser tuberosity osteotomy (LTO) rather than a subscapularis tenotomy. Based on current literature, what is the primary advantage of the LTO technique compared to tenotomy?

. Decreased risk of axillary nerve injury.
. Shorter operative time and simpler surgical exposure.
. Lower rate of postoperative anterior instability.
. Improved structural healing rates via bone-to-bone healing and better postoperative subscapularis strength.
. Elimination of the need for postoperative sling immobilization.

Correct Answer & Explanation

. Improved structural healing rates via bone-to-bone healing and better postoperative subscapularis strength.

Explanation

A lesser tuberosity osteotomy allows for bone-to-bone healing of the subscapularis insertion, which has been shown in multiple studies to result in higher rates of structural healing on ultrasound and improved postoperative subscapularis strength compared to a soft-tissue tenotomy.

Question 812

Topic: Shoulder & Hip Sports

A 70-year-old, right-hand-dominant woman presents with chronic right shoulder pain and weakness, unable to reach overhead. Physical examination reveals significant atrophy of the supraspinatus and infraspinatus, limited active range of motion, and positive drop arm and external rotation lag signs. MRI confirms a massive rotator cuff tear involving the supraspinatus and infraspinatus, with minimal atrophy, minimal fatty infiltration, and retraction to the glenoid. Given these findings, which of the following best describes the initial Goutallier classification of her rotator cuff tear?

. Stage 0
. Stage 1
. Stage 2
. Stage 3
. Stage 4

Correct Answer & Explanation

. Stage 2

Explanation

Correct Answer: CThe patient's MRI shows 'minimal atrophy, minimal fatty infiltration, and retraction to the glenoid' for both the supraspinatus and infraspinatus. According to the Goutallier classification system, which assesses fatty degeneration of the rotator cuff muscles, Stage 0 is normal, Stage 1 is minimal fatty streaks, Stage 2 is a significant amount of fatty streaks but more muscle than fat, Stage 3 is equal amounts of fat and muscle, and Stage 4 is more fat than muscle. The description 'minimal fatty infiltration' aligns most closely with Stage 2, where there are significant fatty streaks but still more muscle than fat. Stage 3 (equal fat and muscle) and Stage 4 (more fat than muscle) would imply more significant fatty infiltration, which is not indicated by 'minimal'. The image (Figure 2-18) visually demonstrates these stages, with Stage 2 showing clear muscle bulk with some interspersed fat, consistent with 'minimal fatty infiltration' compared to the more severe Stage 3 and 4 examples.

Question 813

Topic: Shoulder & Hip Sports

During arthroscopy for a massive, immobile rotator cuff tear, it is confirmed that a small part of the anterior supraspinatus remains attached to the greater tuberosity laterally, and the rotator interval is intact anteriorly. The surgeon plans to mobilize the tear to allow for repair to the greater tuberosity, followed by marginal convergence. Which specific technique is indicated to facilitate the initial mobilization of this tear?

. Posterior interval slide
. Krackow stitch
. Anterior interval slide
. Double-bundle reconstruction
. Subscapularis release

Correct Answer & Explanation

. Anterior interval slide

Explanation

Correct Answer: CThe case describes a scenario where a small part of the anterior supraspinatus is still attached to the greater tuberosity laterally and the rotator interval is intact anteriorly. The discussion explicitly states that in an anterior interval slide technique, 'there is some anterior portion of the supraspinatus still attached to the greater tuberosity laterally and rotator interval anteriorly. The greater tuberosity attachment can be incised and the rotator interval attachment can be detached by incising the coracohumeral ligament.' This technique decreases tension and improves lateral mobilization, allowing the supraspinatus to be more easily repaired. The image (Figure 2-16) illustrates this process, showing the incision of the rotator interval and coracohumeral ligament to mobilize the anterior supraspinatus. A posterior interval slide (Option A) is used when the posterior supraspinatus is attached to the infraspinatus. A Krackow stitch (Option B) is a locking stitch for tendinous repairs, not a mobilization technique for rotator cuff tears. Double-bundle reconstruction (Option D) is an ACL reconstruction technique. Subscapularis release (Option E) is not described as a primary mobilization technique for supraspinatus tears in this context.

Question 814

Topic: Shoulder & Hip Sports

A 50-year-old, healthy, active patient presents with a massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus, similar to the initial case, but without any signs of glenohumeral arthritis. He has failed extensive conservative management. Which of the following is the most appropriate surgical treatment option to restore function?

. Arthroscopic rotator cuff repair
. Subscapularis tendon transfer
. Latissimus dorsi tendon transfer
. Trapezius tendon transfer
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Latissimus dorsi tendon transfer

Explanation

Correct Answer: CFor young, active patients (like this 50-year-old) with a massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus, but without glenohumeral arthritis, a tendon transfer is the most reasonable option to restore function. The discussion specifically highlights the latissimus dorsi tendon transfer as the most popular way to restore the posterior and inferior force-couples and create an external rotation force in such cases. The image (Figure 2-19) illustrates the latissimus dorsi tendon transfer. Arthroscopic rotator cuff repair (Option A) is not indicated for an irreparable tear with significant fatty degeneration. Subscapularis tendon transfer (Option B) would not address the loss of the posterior and inferior force-couple from the torn infraspinatus. Trapezius tendon transfer (Option D) is mentioned as having some interest but is not as popular or well-established for rotator cuff tears as the latissimus dorsi transfer, and often requires allograft. Reverse total shoulder arthroplasty (Option E) is generally reserved for older, less active patients or those with cuff tear arthropathy, as it has limitations in lifting activities and a higher revision risk in younger patients.

Question 815

Topic: Shoulder & Hip Sports

A patient is diagnosed with a chronic, irreparable tear of the subscapularis tendon after failing conservative treatment. The surgeon plans a tendon transfer to restore internal rotation and humeral head centering. Which of the following tendons is the most reasonable choice for transfer in this scenario?

. Subscapularis tendon repair
. Biceps tenotomy
. Pectoralis major tendon transfer
. Reverse total shoulder arthroplasty
. Supraspinatus tendon transfer

Correct Answer & Explanation

. Pectoralis major tendon transfer

Explanation

Correct Answer: CFor a chronic, irreparable tear of the subscapularis tendon, the discussion states that using a tendon transfer is the next step. The pectoralis major tendon is highlighted as an effective choice because its force vector is similar to that of the subscapularis, allowing it to restore internal rotation and humeral head centering and compression. The surgery involves detaching the pectoralis major from its humeral insertion and moving it to the lesser tuberosity. The image (Figure 2-20) depicts the pectoralis major tendon transfer. Subscapularis tendon repair (Option A) is impossible by definition if the tear is irreparable. Biceps tenotomy (Option B) might be performed adjunctively but does not restore subscapularis function. Reverse total shoulder arthroplasty (Option D) is typically used for massive, irreparable anterosuperior rotator cuff tears, not isolated subscapularis tears. Supraspinatus tendon transfer (Option E) is not a described procedure for irreparable subscapularis tears.

Question 816

Topic: Shoulder & Hip Sports

A 60-year-old patient presents with a chronic, U-shaped rotator cuff tear that is retracted to the glenoid. The surgeon determines that the apex of the tear cannot be mobilized to the greater tuberosity. Which repair technique is most appropriate to convert this tear into a reparable configuration?

. Anterior interval slide
. Posterior interval slide
. Crescent repair
. Marginal convergence
. Double-row repair

Correct Answer & Explanation

. Marginal convergence

Explanation

Correct Answer: DThe case discussion specifically addresses U-shaped tears, stating that 'U-shaped tears have an apex that extends further medially... and this part cannot be mobilized all the way to the greater tuberosity. Because of this lack of mobility, these tears have to be repaired using marginal convergence, which is essentially zipping up the U from the apex toward the greater tuberosity using side to side sutures to bring together the anterior and posterior leaves of the U-shaped tear. In performing this marginal convergence, you essentially are converting a U-shaped tear into a crescent-shaped tear that can be relatively easily mobilized to the greater tuberosity, allowing it to be repaired.' The image (Figure 2-14) clearly illustrates this process. Anterior (Option A) and posterior (Option B) interval slides are used for massive, immobile tears with specific attachments, not primarily for U-shaped tears that are retracted to the glenoid apex. Crescent repair (Option C) is the final repair type after conversion, not the conversion technique itself. Double-row repair (Option E) is a method of fixation to bone, not a technique to mobilize or convert tear shape.

Question 817

Topic: Shoulder & Hip Sports

A 68-year-old male presents with chronic shoulder pain and weakness. MRI demonstrates a massive, retracted tear of the supraspinatus and infraspinatus tendons. The T1-weighted sagittal oblique images show that there is more fat than muscle tissue within the infraspinatus muscle belly. What Goutallier stage does this represent?

. Stage 1
. Stage 2
. Stage 3
. Stage 4
. Stage 5

Correct Answer & Explanation

. Stage 3

Explanation

In the Goutallier classification for fatty infiltration, Stage 3 indicates equal amounts of fat and muscle, while Stage 4 indicates more fat than muscle. Advanced fatty infiltration (Stages 3 and 4) is generally considered a contraindication to primary rotator cuff repair.

Question 818

Topic: Shoulder & Hip Sports

During dynamic stabilization of the glenohumeral joint, the transverse force couple is essential for maintaining the humeral head centered on the glenoid. Which muscle groups primarily constitute this anterior-posterior transverse force couple?

. Supraspinatus and Deltoid
. Subscapularis and Infraspinatus/Teres minor
. Pectoralis major and Latissimus dorsi
. Coracobrachialis and short head of the Biceps
. Rhomboids and Serratus anterior

Correct Answer & Explanation

. Subscapularis and Infraspinatus/Teres minor

Explanation

The transverse (axial) force couple of the shoulder consists of the subscapularis anteriorly and the infraspinatus and teres minor posteriorly. Intact function of this force couple is required to compress the humeral head into the glenoid and prevent superior escape.

Question 819

Topic: Shoulder & Hip Sports

A 45-year-old heavy laborer presents with a massive, irreparable posterosuperior rotator cuff tear. He has persistent pain and lack of active external rotation, but his subscapularis is fully intact and he lacks glenohumeral arthritis. Which of the following tendon transfers is most appropriate to restore external rotation and function in this patient?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Levator scapulae transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Lower trapezius transfer

Explanation

For an active, younger patient with an irreparable posterosuperior rotator cuff tear (supraspinatus/infraspinatus) and an intact subscapularis, a lower trapezius transfer is highly effective. Its line of pull closely replicates that of the infraspinatus, restoring active external rotation.

Question 820

Topic: 5. Sports Medicine

In the context of massive, irreparable rotator cuff tears, Superior Capsular Reconstruction (SCR) has emerged as a joint-preserving surgical option. What is the primary biomechanical goal of SCR?

. To physically pull the humeral head inferiorly using a dynamic muscle transfer
. To re-establish the anterior force couple by advancing the subscapularis tendon
. To statically prevent superior migration of the humeral head by restoring the superior restraint
. To stimulate biologic healing of the native supraspinatus tendon via marrow venting
. To lateralize the center of rotation and increase the moment arm of the deltoid

Correct Answer & Explanation

. To statically prevent superior migration of the humeral head by restoring the superior restraint

Explanation

Superior Capsular Reconstruction (SCR) uses a thick dermal allograft or fascia lata attached from the superior glenoid to the greater tuberosity. Its biomechanical purpose is to act as a static restraint, preventing superior humeral head migration and improving deltoid efficiency.

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