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5. Sports Medicine MCQs

Practice Set 46 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 901

Topic: Shoulder & Hip Sports

The 76-year-old gentleman is diagnosed with rotator cuff tear arthropathy. Which of the following is the primary pathophysiological mechanism leading to the characteristic radiographic findings and symptoms in RCAT?

. Chronic inflammation and fibrosis of the glenohumeral joint capsule.
. Degenerative changes of the articular cartilage due to primary osteoarthritis.
. Loss of superior humeral head containment due to massive rotator cuff tear, leading to deltoid-driven superior migration.
. Repetitive microtrauma to the biceps tendon, causing tenosynovitis and pain.
. Impingement of the rotator cuff tendons against the coracoacromial arch.

Correct Answer & Explanation

. Loss of superior humeral head containment due to massive rotator cuff tear, leading to deltoid-driven superior migration.

Explanation

Correct Answer: CThe primary pathophysiology of RCAT is the loss of the superior stabilizing force of the rotator cuff due to a massive, irreparable tear. This allows the deltoid muscle to pull the humeral head superiorly, leading to proximal migration. This superior migration causes abnormal articulation between the humeral head and the acromion/coracoacromial arch, resulting in erosion of the articular cartilage of both the humeral head and the glenoid, and eventually arthritic changes. Chronic inflammation (Option A) and primary osteoarthritis (Option B) are not the initiating factors for RCAT. Biceps tendinopathy (Option D) can be associated but is not the primary mechanism of arthropathy. While impingement (Option E) can be a precursor to rotator cuff tears, RCAT represents a more advanced stage where the cuff is massively torn, and the primary issue is the loss of humeral head depression and centering.

Question 902

Topic: Shoulder & Hip Sports

The candidate correctly explains that reverse shoulder arthroplasty (RSA) brings the center of rotation of the glenohumeral joint medially and increases the moment arm of the deltoid. How does this biomechanical change primarily contribute to improved shoulder function in patients with rotator cuff tear arthropathy?

. It directly repairs the torn rotator cuff tendons, restoring their function.
. It decreases the load on the glenoid, preventing further erosion.
. It allows the deltoid muscle to effectively abduct the arm in the absence of a functional rotator cuff.
. It increases the range of internal and external rotation.
. It reduces pain by denervating the joint capsule.

Correct Answer & Explanation

. It allows the deltoid muscle to effectively abduct the arm in the absence of a functional rotator cuff.

Explanation

Correct Answer: CThe key biomechanical advantage of reverse shoulder arthroplasty (RSA) in rotator cuff tear arthropathy (RCAT) is its ability to restore active elevation (abduction and forward flexion) in the absence of a functional rotator cuff. By medializing and distalizing the center of rotation, the RSA effectively lengthens the deltoid muscle and increases its moment arm. This allows the deltoid to become the primary abductor and elevator of the arm, compensating for the deficient rotator cuff. It does not directly repair the cuff (Option A). While it can reduce glenoid erosion by providing a stable articulation, this is a secondary effect, not the primary mechanism for improved function (Option B). It typically improves abduction and flexion but may compromise rotation (Option D). Pain relief is a major goal, but it's achieved through restoring stability and function, not denervation (Option E).

Question 903

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. Computed tomography shows a 28% anterior glenoid bone loss. An open Latarjet procedure is planned. Which structure passes through the "split" of the subscapularis during this procedure?

. Long head of the biceps tendon
. Coracoacromial ligament
. Conjoined tendon
. Pectoralis minor tendon
. Axillary nerve

Correct Answer & Explanation

. Conjoined tendon

Explanation

During a Latarjet procedure, the coracoid process with the attached conjoined tendon (short head of biceps and coracobrachialis) is transferred to the anterior glenoid neck. It is passed through a split in the subscapularis muscle, creating a dynamic sling.

Question 904

Topic: 5. Sports Medicine

A 40-year-old recreational athlete presents with an acute anterior sternoclavicular joint dislocation after a fall onto an outstretched arm. Clinical examination confirms an anterior displacement, and plain radiographs (including a serendipity view) show no associated fractures. He has mild pain and full, albeit uncomfortable, shoulder range of motion. There are no signs of neurovascular compromise.

What is the most appropriate initial management strategy for this patient?

. Emergent closed reduction under general anesthesia
. Open reduction and internal fixation with K-wires
. Non-operative management with a sling for comfort and early range of motion
. Immediate referral for surgical ligament reconstruction
. CT angiogram to rule out vascular injury

Correct Answer & Explanation

. Non-operative management with a sling for comfort and early range of motion

Explanation

Correct Answer: CAcute anterior sternoclavicular (SC) joint dislocations are most commonly managednon-operatively. Even if closed reduction is attempted and initially successful, recurrence is common due to the inherent instability of the joint and the difficulty in maintaining reduction. However, these recurrences are usually asymptomatic and rarely cause significant functional impairment or chronic pain. Initial management involves ice, analgesia, and a sling for comfort for 1-3 weeks, followed by gradual return to activities as tolerated. Emergent closed reduction (A) is often attempted but not strictly necessary if asymptomatic. Open reduction and K-wire fixation (B) is generally avoided for acute anterior dislocations due to the high complication rate of K-wires and the good outcomes with non-operative care. Surgical ligament reconstruction (D) is reserved for chronic, symptomatic instability. A CT angiogram (E) is not indicated for an anterior dislocation without signs of vascular compromise.

Question 905

Topic: Shoulder & Hip Sports

A patient has just undergone a successful open reduction and ligament reconstruction for a chronic posterior sternoclavicular joint dislocation. The surgeon is discussing the immediate post-operative rehabilitation protocol with the physical therapist.

During the initial 0-6 week post-operative phase, which of the following is a critical precaution or restriction that MUST be strictly adhered to?

. Full active range of motion of the shoulder, including overhead activities
. Immediate return to light resistance exercises for the rotator cuff
. Strict avoidance of abduction and external rotation of the ipsilateral arm
. Unrestricted weight-bearing on the affected arm
. Discontinuation of all pain medication to assess true pain levels

Correct Answer & Explanation

. Strict avoidance of abduction and external rotation of the ipsilateral arm

Explanation

Correct Answer: CDuring the initial 0-6 week post-operative phase following sternoclavicular (SC) joint reconstruction, the primary goal is protection of the surgical repair to allow tissue healing. For posterior repairs,strict avoidance of abduction and external rotation of the ipsilateral armis a critical precaution. The arm is typically immobilized in a sling or figure-of-8 bandage. Full active range of motion, including overhead activities (A), and immediate return to resistance exercises (B) are contraindicated as they would stress the healing repair. Unrestricted weight-bearing (D) is also not allowed. Discontinuation of pain medication (E) is medically inappropriate and unrelated to rehabilitation precautions.

Question 906

Topic: Shoulder & Hip Sports

A 24-year-old male presents with recurrent anterior shoulder instability. MRI arthrogram reveals an avulsion of the anterior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL) from the glenoid rim. This lesion is formally known as:

. Hill-Sachs lesion
. ALPSA lesion
. Bankart lesion
. HAGL lesion
. SLAP tear

Correct Answer & Explanation

. Bankart lesion

Explanation

A Bankart lesion is the classic detachment of the anteroinferior labrum and the attached inferior glenohumeral ligament from the glenoid rim. It is the essential lesion in most traumatic anterior shoulder dislocations.

Question 907

Topic: Shoulder & Hip Sports

During arthroscopic stabilization for recurrent anterior shoulder instability, the surgeon notes an intact anterior labrum but an avulsion of the inferior glenohumeral ligament from its humeral insertion. What is the appropriate terminology for this lesion?

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

Correct Answer & Explanation

. HAGL lesion

Explanation

HAGL stands for Humeral Avulsion of the Glenohumeral Ligament. It is a cause of anterior instability where the IGHL tears off the humerus rather than the glenoid, often requiring open or arthroscopic repair.

Question 908

Topic: 5. Sports Medicine

A 24-year-old male presents with a confirmed anterior sternoclavicular joint dislocation. The overlying skin is intact. What is the most appropriate definitive management for this injury?

. Closed reduction and immobilization in a figure-of-8 brace
. Open reduction and internal fixation with K-wires
. Sling immobilization for comfort followed by early range of motion
. Ligamentous reconstruction using a semitendinosus autograft
. Medial clavicle excision

Correct Answer & Explanation

. Sling immobilization for comfort followed by early range of motion

Explanation

Anterior sternoclavicular dislocations are typically well tolerated functionally. Because closed reduction has a high recurrence rate and operative fixation carries a high complication profile (especially K-wire migration), symptomatic treatment with a sling is the standard of care.

Question 909

Topic: 5. Sports Medicine

A patient requires surgical stabilization for a chronic, painful posterior sternoclavicular joint dislocation that cannot be reduced closed. If a figure-of-eight ligament reconstruction is planned using a tendon graft, what structure is most typically used as the graft source?

. Achilles tendon allograft
. Semitendinosus autograft
. Palmaris longus autograft
. Patellar tendon autograft
. Fascia lata autograft

Correct Answer & Explanation

. Semitendinosus autograft

Explanation

In cases of chronic sternoclavicular instability requiring reconstruction, a figure-of-eight reconstruction is commonly performed. A semitendinosus or gracilis autograft is the most frequently utilized graft to reconstruct the stabilizing ligaments.

Question 910

Topic: Shoulder & Hip Sports

A 50-year-old patient presents with acute shoulder pain after a seizure. On examination, the arm is held in internal rotation, and the anterior shoulder appears flattened. External rotation is severely restricted. Which radiographic finding on an AP shoulder view is pathognomonic for a posterior shoulder dislocation?

. Hill-Sachs lesion
. Bankart lesion
. Trough line sign
. Humeral avulsion of the glenohumeral ligaments (HAGL) lesion
. Os acromiale

Correct Answer & Explanation

. Trough line sign

Explanation

Correct Answer: CThe Trough line sign (or reverse Hill-Sachs lesion) is an impaction fracture on the anterior-medial aspect of the humeral head, often seen with posterior dislocations. The other options are incorrect: Hill-Sachs and Bankart lesions are typically associated with anterior dislocations. HAGL lesions are avulsions of the glenohumeral ligaments, often associated with anterior dislocations. Os acromiale is an anatomical variant.

Question 911

Topic: Shoulder & Hip Sports

A 70-year-old male sustains an anterior shoulder dislocation. After reduction, plain radiographs show a concomitant fracture. Which fracture is MOST commonly associated with anterior shoulder dislocation in this age group?

. Hill-Sachs lesion
. Greater tuberosity fracture
. Surgical neck fracture of the humerus
. Bony Bankart lesion
. Clavicle fracture

Correct Answer & Explanation

. Greater tuberosity fracture

Explanation

Correct Answer: BWhile Hill-Sachs and Bankart lesions are very common with anterior dislocations, in older patients, a greater tuberosity fracture is particularly common (up to 30% in some series) due to the weaker bone and the forces involved in the injury. The rotator cuff avulses a piece of the tuberosity during the dislocation. Surgical neck fracture is also possible but less frequent than greater tuberosity in direct association with dislocation. Clavicle fractures are less directly associated with glenohumeral dislocation mechanism.

Question 912

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a posterior shoulder dislocation during a seizure. After successful closed reduction, a CT scan reveals a reverse Hill-Sachs defect involving 25% of the humeral head articular surface. Which of the following is the most appropriate surgical management to prevent recurrent instability?

. Arthroscopic posterior Bankart repair alone
. Latarjet procedure
. Transfer of the lesser tuberosity into the defect
. Humeral head resurfacing
. Total shoulder arthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect

Explanation

For reverse Hill-Sachs defects between 20% and 40% of the articular surface, a modified McLaughlin procedure (transfer of the lesser tuberosity and subscapularis into the defect) is indicated to prevent the defect from engaging the posterior glenoid rim.

Question 913

Topic: 5. Sports Medicine

A 25-year-old overhead athlete suffers an anterior shoulder dislocation. Post-reduction radiographs demonstrate concentric reduction of the glenohumeral joint but reveal an isolated greater tuberosity fracture displaced 6 mm superiorly. What is the most appropriate next step in management?

. Immobilization in a sling for 6 weeks
. Open reduction and internal fixation of the greater tuberosity
. Closed reduction and spica casting in external rotation
. Hemiarthroplasty of the shoulder
. Diagnostic arthroscopy with rotator cuff debridement

Correct Answer & Explanation

. Open reduction and internal fixation of the greater tuberosity

Explanation

Greater tuberosity fractures displaced > 5 mm in the general population, or > 3 mm in overhead athletes (especially with superior displacement), require operative fixation. Nonoperative management of this displacement leads to severe subacromial impingement and block to elevation.

Question 914

Topic: Shoulder & Hip Sports

A 60-year-old male presents with persistent shoulder weakness 4 weeks after an anterior shoulder dislocation that was successfully reduced. He has full passive range of motion but positive bear-hug and belly-press tests. What is the most likely diagnosis?

. Axillary nerve neurapraxia
. Supraspinatus tendon tear
. Subscapularis tendon tear
. Bankart lesion
. Biceps tendon rupture

Correct Answer & Explanation

. Subscapularis tendon tear

Explanation

Older patients (>40 years) are at a high risk for rotator cuff tears following anterior shoulder dislocations. A positive bear-hug and belly-press test indicates a subscapularis tendon tear.

Question 915

Topic: Shoulder & Hip Sports

In the setting of recurrent anterior shoulder instability, what is the primary anatomical indication for performing a 'remplissage' procedure in conjunction with an arthroscopic Bankart repair?

. A deficient anterior glenoid rim with >25% bone loss
. An off-track, engaging Hill-Sachs lesion
. A concomitant subscapularis tear
. An ALPSA lesion
. A SLAP type II lesion

Correct Answer & Explanation

. An off-track, engaging Hill-Sachs lesion

Explanation

The remplissage procedure involves insetting the infraspinatus tendon into a large, engaging (off-track) Hill-Sachs defect. This converts an intra-articular defect into an extra-articular one, preventing engagement on the anterior glenoid rim.

Question 916

Topic: Shoulder & Hip Sports

A 45-year-old trauma patient sustains a highly comminuted scapular body and neck fracture. Which of the following radiographic parameters represents a widely accepted indication for operative fixation of the scapular neck?

. Glenopolar angle (GPA) of 40 degrees
. Medial lateral translation of 5 mm
. Glenopolar angle (GPA) of 20 degrees
. Angulation of 10 degrees
. Inferior displacement of 5 mm

Correct Answer & Explanation

. Glenopolar angle (GPA) of 20 degrees

Explanation

A glenopolar angle (GPA) of less than 22 degrees alters rotator cuff biomechanics and represents a significant rotational deformity. Restoration of the GPA through open reduction and internal fixation is indicated to prevent severe functional deficits.

Question 917

Topic: 5. Sports Medicine

A 35-year-old overhead athlete sustains an isolated, closed greater tuberosity fracture. Radiographs show superior displacement of the fragment. At what minimum amount of superior displacement is operative fixation strongly recommended in this patient population?

. 2 mm
. 5 mm
. 10 mm
. 15 mm
. 20 mm

Correct Answer & Explanation

. 5 mm

Explanation

In active individuals, especially overhead athletes, greater tuberosity fractures with >5 mm of superior displacement are generally treated operatively. This prevents altered rotator cuff biomechanics and debilitating subacromial impingement.

Question 918

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a missed posterior shoulder dislocation resulting in a reverse Hill-Sachs lesion involving 30% of the humeral head articular surface. Which of the following is the most appropriate surgical treatment?

. Closed reduction and shoulder spica cast
. Arthroscopic Bankart repair
. Transfer of the lesser tuberosity into the defect
. Total shoulder arthroplasty
. Latarjet procedure

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect

Explanation

For a reverse Hill-Sachs defect involving 20% to 40% of the articular surface, transferring the lesser tuberosity with the subscapularis tendon into the defect (modified McLaughlin procedure) is indicated. Defects >40% typically require arthroplasty, while those <20% can often be managed nonoperatively after reduction.

Question 919

Topic: 5. Sports Medicine

A 26-year-old rugby player presents after an awkward fall onto his left knee during a tackle. Clinical examination reveals a posterior sag and a positive posterior drawer test. Radiographs and MRI are obtained, as shown below.

Based on the provided images and clinical scenario, what is the most accurate diagnosis?

. A. Isolated Posterior Cruciate Ligament (PCL) mid-substance tear
. B. Anterior Cruciate Ligament (ACL) avulsion fracture
. C. PCL avulsion fracture from its tibial insertion
. D. Medial Collateral Ligament (MCL) rupture with associated meniscal tear
. E. Patellar tendon rupture

Correct Answer & Explanation

. C. PCL avulsion fracture from its tibial insertion

Explanation

Correct Answer: CThe case explicitly states, 'The most obvious abnormality is cortical disruption at the site of PCL insertion with displaced avulsed fragment. The lateral radiograph shows this is a large fragment which is displaced into the joint.' This directly describes a PCL avulsion fracture from its tibial insertion. The images, particularly the lateral radiograph, would show a bony fragment pulled off the posterior tibia.Option A (Isolated PCL mid-substance tear)is incorrect because the case clearly identifies a bony avulsion, not a mid-substance ligament tear.Option B (ACL avulsion fracture)is incorrect. While avulsion fractures can occur with the ACL (e.g., Segond fracture or tibial spine avulsion), the case specifically identifies the PCL as the injured structure.Option D (MCL rupture with associated meniscal tear)is incorrect. The clinical presentation (posterior sag, posterior drawer) and imaging description point to a PCL injury, not an MCL rupture or meniscal tear.Option E (Patellar tendon rupture)is incorrect. A patellar tendon rupture would typically present with patella alta and an inability to actively extend the knee, which is not described as the primary injury in this case.

Question 920

Topic: Knee Sports

A 26-year-old rugby player sustains a PCL avulsion fracture from its tibial insertion, as depicted in the provided images.

Given the patient's age, activity level, and the nature of the injury (displaced bony avulsion), what is the most appropriate initial surgical management strategy?

. A. Non-operative management with bracing and physical therapy
. B. Arthroscopic debridement of the avulsed fragment
. C. Open reduction and internal fixation (ORIF) of the PCL avulsion via a posterior approach
. D. Primary arthroscopic PCL reconstruction with an allograft
. E. Delayed PCL reconstruction after 6-8 weeks of immobilization

Correct Answer & Explanation

. C. Open reduction and internal fixation (ORIF) of the PCL avulsion via a posterior approach

Explanation

Correct Answer: CThe candidate in the case explicitly states, 'I would offer this patient reattachment of the PCL avulsion through open procedure.' The examiner then probes about the posterior approach, which the candidate confirms. For displaced bony avulsions of the PCL, particularly in active individuals, open reduction and internal fixation (ORIF) is the standard of care to restore anatomical alignment and stability. The posterior approach is well-suited for direct visualization and fixation of these fragments.Option A (Non-operative management)is generally reserved for non-displaced or minimally displaced avulsions, or for mid-substance tears in less active individuals. A displaced fragment in a rugby player warrants surgical intervention.Option B (Arthroscopic debridement)is incorrect. Debridement would remove the fragment, leading to PCL insufficiency. The goal is reattachment and restoration of function.Option D (Primary arthroscopic PCL reconstruction with an allograft)is incorrect. While arthroscopic PCL reconstruction is a valid procedure for mid-substance tears, for a bony avulsion, the primary goal is to reattach the native ligament with its bone fragment, which offers superior healing potential (bone-to-bone) and avoids the need for a full reconstruction with a graft.Option E (Delayed PCL reconstruction)is incorrect. For a displaced bony avulsion, early fixation is crucial to prevent malunion, nonunion, and to facilitate optimal healing and rehabilitation. Delayed reconstruction would be considered for chronic PCL insufficiency, not an acute, fixable avulsion.

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