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5. Sports Medicine MCQs

Practice Set 51 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 1001

Topic: Shoulder & Hip Sports

A 60-year-old patient is undergoing a primary total shoulder arthroplasty for glenohumeral osteoarthritis via the deltopectoral approach. After identifying and protecting the axillary nerve, the surgeon proceeds with managing the subscapularis tendon. What is the most common and standard method of subscapularis management for this procedure, as described in the case?

. Subscapularis peel (capsular-subscapularis release)
. Lesser tuberosity osteotomy
. Subscapularis splitting without detachment
. Subscapularis tenotomy
. Complete detachment of the pectoralis minor

Correct Answer & Explanation

. Subscapularis tenotomy

Explanation

Correct Answer: DExplanation:The case clearly states under "Subscapularis Management": "Subscapularis Tenotomy:This is the most common approach for shoulder arthroplasty." It further details the technique of sharply detaching the tendon from the lesser tuberosity, leaving a cuff for repair, and placing stay sutures.A. Subscapularis peel (capsular-subscapularis release):This technique is described as "Often used in instability surgery (e.g., Bankart repair)" and not the most common for arthroplasty.B. Lesser tuberosity osteotomy:This is described as "Less common, but an option for revision cases or situations requiring maximal exposure and bone integrity for reattachment." It is not the most common for primary arthroplasty.C. Subscapularis splitting without detachment:While some approaches might split muscles, the subscapularis typically requires detachment for adequate exposure of the glenohumeral joint in arthroplasty. This method is not described as standard for arthroplasty in the text.E. Complete detachment of the pectoralis minor:The pectoralis minor is deep to the pectoralis major and conjoined tendon. While its release from the coracoid is part of the Latarjet procedure, it is not a standard method of subscapularis management for TSA.

Question 1002

Topic: Shoulder & Hip Sports

A surgeon is performing a deltopectoral approach and has exposed the subscapularis muscle. Which of the following nerves is responsible for innervating the subscapularis muscle?

. Axillary nerve
. Suprascapular nerve
. Upper and lower subscapular nerves
. Long thoracic nerve
. Medial pectoral nerve

Correct Answer & Explanation

. Upper and lower subscapular nerves

Explanation

Correct Answer: CExplanation:The case explicitly states under "Deep Anatomy" and "Subscapularis Muscle": "It is innervated by theupper and lower subscapular nerves (C5-C7), which arise directly from the posterior cord of the brachial plexus."A. Axillary nerve:Innervates the deltoid and teres minor.B. Suprascapular nerve:Innervates the supraspinatus and infraspinatus muscles.D. Long thoracic nerve:Innervates the serratus anterior muscle.E. Medial pectoral nerve:Innervates the pectoralis major and pectoralis minor muscles.

Question 1003

Topic: Shoulder & Hip Sports

During a deltopectoral approach, after incising the clavipectoral fascia and retracting the conjoined tendon medially, the surgeon is preparing to expose the subscapularis. The axillary neurovascular bundle is a critical structure to protect. Where is this bundle primarily located relative to the coracoid process and pectoralis minor muscle?

. Lateral and superficial to the coracoid process.
. Superior and anterior to the pectoralis minor muscle.
. Medial and deep to the coracoid process and pectoralis minor muscle.
. Inferior and posterior to the subscapularis muscle.
. Within the deltopectoral groove, superficial to the pectoralis major.

Correct Answer & Explanation

. Medial and deep to the coracoid process and pectoralis minor muscle.

Explanation

Correct Answer: CExplanation:The case states under "Deep Anatomy" and "Axillary Neurovascular Bundle": "Situatedmedial and deep to the coracoid process. This bundle contains the axillary artery, axillary vein, and brachial plexus cords (lateral, posterior, medial)." It also mentions the pectoralis minor muscle "lies deep to the pectoralis major and superficial to the axillary neurovascular bundle," implying the bundle is deep to the pectoralis minor as well.A. Lateral and superficial to the coracoid process:This area would be more associated with the deltoid and potentially the axillary nerve as it wraps around the humerus, not the main axillary neurovascular bundle.B. Superior and anterior to the pectoralis minor muscle:The pectoralis minor muscle itself is anterior to the bundle, and the bundle is not typically superior to the coracoid.D. Inferior and posterior to the subscapularis muscle:While the axillary nerve (a branch from the brachial plexus) passes inferior to the subscapularis, the main axillary neurovascular bundle (artery, vein, and plexus cords) is more medial and deep to the coracoid and pectoralis minor.E. Within the deltopectoral groove, superficial to the pectoralis major:The deltopectoral groove contains the cephalic vein and is superficial to the pectoralis major. The axillary neurovascular bundle is much deeper.

Question 1004

Topic: Shoulder & Hip Sports

A posterior approach to the shoulder (modified Judet) is selected for open reduction and internal fixation of a displaced posterior glenoid fracture. What is the true internervous plane utilized to safely expose the posterior joint capsule?

. Supraspinatus and Infraspinatus
. Infraspinatus and Teres minor
. Teres minor and Teres major
. Deltoid and Triceps brachii
. Subscapularis and Teres minor

Correct Answer & Explanation

. Infraspinatus and Teres minor

Explanation

The posterior approach to the shoulder uses the internervous plane between the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve). Retracting these muscles exposes the posterior capsule and glenoid.

Question 1005

Topic: Shoulder & Hip Sports

A 45-year-old male undergoes open reduction and internal fixation of a posterior glenoid rim fracture. A posterior approach to the shoulder is utilized. Which of the following defines the true internervous plane for this approach?

. Teres minor and teres major
. Infraspinatus and teres minor
. Supraspinatus and infraspinatus
. Deltoid and triceps
. Infraspinatus and teres major

Correct Answer & Explanation

. Infraspinatus and teres minor

Explanation

The posterior approach to the shoulder utilizes the true internervous plane between the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve).

Question 1006

Topic: Shoulder & Hip Sports

When performing a posterior approach to the shoulder for open reduction of a posterior glenoid fracture, the surgeon develops an internervous plane between which two muscles to access the posterior joint capsule?

. Infraspinatus and Teres Minor
. Teres Minor and Teres Major
. Supraspinatus and Infraspinatus
. Deltoid and Triceps
. Infraspinatus and Deltoid

Correct Answer & Explanation

. Infraspinatus and Teres Minor

Explanation

The standard posterior approach to the shoulder utilizes the internervous plane between the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve). This plane safely exposes the posterior glenohumeral joint capsule.

Question 1007

Topic: 5. Sports Medicine

When performing an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, which of the following complications is significantly more common compared to using a hamstring autograft?

. Deep infection
. Graft rupture at 2 years
. Anterior knee pain
. Loss of deep flexion
. Saphenous nerve neuroma

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autografts are historically associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts. Rates of graft failure are generally comparable between the two.

Question 1008

Topic: Knee Sports

A 45-year-old female presents with acute medial knee pain after a squatting injury. MRI reveals a complete radial tear of the medial meniscus posterior root. Biomechanically, this injury is equivalent to which of the following?

. A total medial meniscectomy
. A bucket-handle meniscal tear
. An anterior cruciate ligament (ACL) rupture
. A medial collateral ligament (MCL) tear
. A focal chondral defect

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete medial meniscus posterior root tear disrupts the hoop stresses of the meniscus, leading to extrusion under load. Biomechanically, it alters contact pressures in the medial compartment to a degree equivalent to a total medial meniscectomy.

Question 1009

Topic: Shoulder & Hip Sports

A 22-year-old collegiate football player sustains an anterior shoulder dislocation. Advanced imaging reveals an engaging Hill-Sachs lesion and 25% anterior glenoid bone loss. Which of the following surgical procedures is MOST appropriate to restore stability?

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

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical anterior glenoid bone loss combined with an engaging Hill-Sachs lesion is a high-risk scenario for recurrent instability after soft tissue repair alone. The Latarjet procedure (coracoid transfer) is the standard of care to restore the glenoid bone arc and provide a sling effect.

Question 1010

Topic: Knee Sports

A 15-year-old male sustains a twisting injury to his knee. Plain radiographs demonstrate an avulsion fracture of the lateral tibial plateau (Segond fracture). In a clinical oral examination, you are asked about the biomechanical implications of this finding. A Segond fracture is pathognomonic for a tear of the anterior cruciate ligament (ACL) and is highly associated with injury to which of the following structures?

. Posterior cruciate ligament (PCL)
. Medial patellofemoral ligament (MPFL)
. Anterolateral ligament (ALL)
. Popliteofibular ligament
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Anterolateral ligament (ALL)

Explanation

A Segond fracture is a bony avulsion of the anterolateral capsule and is considered pathognomonic for an ACL tear. It is heavily associated with concurrent injury to the anterolateral ligament (ALL), which contributes to anterolateral rotatory instability.

Question 1011

Topic: Knee Sports

During a total knee arthroplasty on a patient with a severe fixed valgus deformity, you find that the lateral collateral ligament (LCL) and posterolateral corner remain tight in extension after your bony cuts. When sequentially releasing structures to balance a valgus knee in extension, which structure is typically released first?

. Medial collateral ligament (MCL)
. Popliteus tendon
. Lateral collateral ligament (LCL)
. Iliotibial (IT) band
. Posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Iliotibial (IT) band

Explanation

In the standard sequence for balancing a fixed valgus knee in extension, the iliotibial (IT) band is typically the first structure released (often via pie-crusting), followed by the posterolateral capsule, and then the popliteus or LCL if further correction is needed.

Question 1012

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a posterior shoulder dislocation following a seizure. CT scan reveals an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) that involves 45% of the articular surface. Which of the following surgical interventions is MOST appropriate for this patient?

. Closed reduction and spica casting
. Arthroscopic labral repair (reverse Bankart repair)
. Transfer of the subscapularis into the defect (McLaughlin procedure)
. Transfer of the lesser tuberosity into the defect (Modified McLaughlin)
. Shoulder arthroplasty (hemiarthroplasty or total shoulder)

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect (Modified McLaughlin)

Explanation

Management of a reverse Hill-Sachs lesion depends on the size of the articular defect. Defects <20% can often be observed; 20-40% are treated with subscapularis/lesser tuberosity transfer; and defects >40% typically require arthroplasty to restore joint stability and congruency.

Question 1013

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Compared to a hamstring autograft, which of the following complications is significantly more common with this graft choice?

. Graft rupture
. Deep vein thrombosis
. Anterior knee pain
. Loss of knee flexion
. Saphenous nerve injury

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone autografts are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts. Graft rupture rates are comparable or slightly lower for BTB.

Question 1014

Topic: 5. Sports Medicine

A 28-year-old rock climber presents with chronic ulnar-sided thumb pain and instability, 6 months after a fall where he sustained a similar mechanism of injury to the case patient. Clinical examination reveals gross valgus laxity of the MCP joint with a soft endpoint, and MRI confirms a complete UCL rupture with significant retraction and scarring. Based on the case's discussion of surgical decision-making, what is the most likely surgical approach for this patient?

. A. Direct primary repair of the ulnar collateral ligament with suture anchor fixation.
. B. Non-operative management with a prolonged course of thumb spica immobilization.
. C. Ligamentous reconstruction using an autograft tendon (e.g., palmaris longus).
. D. Percutaneous pinning of the MCP joint for chronic instability.
. E. Arthrodesis of the thumb MCP joint to provide stability.

Correct Answer & Explanation

. C. Ligamentous reconstruction using an autograft tendon (e.g., palmaris longus).

Explanation

Correct Answer: CThe case discusses the classification of UCL injuries by chronicity: 'Acute injuries (typically <3 weeks old) are amenable to direct primary repair. Chronic injuries (>3-4 weeks old) often present with retracted, scarred, and attenuated ligamentous tissue that is inadequate for primary repair, necessitating complex ligamentous reconstruction using autograft (e.g., palmaris longus or plantaris tendon).' A 6-month-old injury with significant retraction and scarring falls squarely into the chronic category, requiring reconstruction.Option A is incorrectbecause direct primary repair is reserved for acute injuries where the ligament tissue is healthy and can be reapproximated to its footprint. In chronic cases, the tissue is often too attenuated or scarred.Option B is incorrectbecause non-operative management is ineffective for complete ruptures, especially chronic ones with gross instability, and would lead to persistent pain and dysfunction.Option D is incorrectbecause percutaneous pinning is a temporary fixation method and does not address the underlying ligamentous deficiency in chronic instability.Option E is incorrectbecause while arthrodesis provides stability, it sacrifices motion and is typically reserved as a salvage procedure for severe, painful, degenerative arthritis or failed reconstructions, not as a primary treatment for chronic instability in an otherwise healthy joint.

Question 1015

Topic: 5. Sports Medicine

A 22-year-old college athlete sustains a 'jammed finger'. Radiographs reveal a bony avulsion fracture of the dorsal base of the distal phalanx involving 10% of the articular surface with no joint subluxation. What is the most appropriate management?

. Immediate open reduction and internal fixation
. Continuous DIP joint extension splinting for 6 to 8 weeks
. Buddy taping and immediate return to play
. Extension block pinning
. DIP joint arthrodesis

Correct Answer & Explanation

. Continuous DIP joint extension splinting for 6 to 8 weeks

Explanation

A small bony mallet fracture (<30% of the articular surface) without volar subluxation is treated successfully with conservative management, utilizing continuous DIP joint extension splinting for 6-8 weeks.

Question 1016

Topic: Knee Sports

A 28-year-old professional basketball player presents with chronic anterior knee pain and instability, worsening with activity. He previously sustained a twisting injury to his knee. Examination reveals a positive Lachman test, pivot shift test, and a firm endpoint on anterior drawer. His X-rays are normal. MRI shows a complete tear of the anterior cruciate ligament (ACL) and a horizontal tear of the posterior horn of the medial meniscus. What is the most appropriate management?

. Conservative management with physical therapy and bracing.
. ACL reconstruction alone.
. Partial meniscectomy alone.
. ACL reconstruction with repair of the medial meniscus.
. ACL reconstruction with partial meniscectomy of the medial meniscus.

Correct Answer & Explanation

. ACL reconstruction with repair of the medial meniscus.

Explanation

Correct Answer: DFor a young, active individual with a complete ACL tear and symptomatic instability, ACL reconstruction is indicated. Given the concomitant horizontal tear of the posterior horn of the medial meniscus, and assuming it's a reparable tear (e.g., in the red-red or red-white zone, stable, and of sufficient size), primary repair of the meniscus in conjunction with ACL reconstruction is often the preferred approach. ACL reconstruction provides a stable environment that can promote meniscus healing and reduces the risk of future degenerative changes. Partial meniscectomy, while common, removes meniscal tissue and increases the risk of osteoarthritis, and is generally avoided if repair is feasible, especially in younger patients with concomitant ACL injury. Conservative management is not suitable for a professional athlete with symptomatic instability.

Question 1017

Topic: Knee Sports

A 4-year-old boy presents with an asymmetric, painless swelling on the medial aspect of his left ankle. Radiographs show an irregular, ossified mass arising from the medial distal tibial epiphysis. What is the most likely diagnosis?

. Ollier disease
. Maffucci syndrome
. Dysplasia Epiphysealis Hemimelica (Trevor disease)
. Osteochondritis dissecans
. Chondroblastoma

Correct Answer & Explanation

. Dysplasia Epiphysealis Hemimelica (Trevor disease)

Explanation

Dysplasia Epiphysealis Hemimelica (Trevor disease) is a rare developmental disorder characterized by an osteochondroma-like overgrowth of cartilage arising from the epiphysis, most commonly affecting the medial side of the lower extremity joints.

Question 1018

Topic: Shoulder & Hip Sports

A 21-year-old motorcyclist sustains a traumatic scapulothoracic dissociation. Physical examination reveals massive shoulder swelling and an insensate, flail upper extremity. Which of the following injuries has the highest association with this clinical entity and largely dictates the ultimate functional prognosis?

. Subclavian artery rupture
. Complete brachial plexus avulsion
. Scapular body comminution
. Pneumothorax
. Rotator cuff tear

Correct Answer & Explanation

. Complete brachial plexus avulsion

Explanation

Scapulothoracic dissociation is characterized by lateral displacement of the scapula with an intact skin envelope. It is highly associated with devastating neurovascular injuries, particularly complete brachial plexus avulsions, which carry a grim functional prognosis.

Question 1019

Topic: 5. Sports Medicine

A 25-year-old competitive long-distance runner presents with bilateral lower leg pain consistent with Chronic Exertional Compartment Syndrome. He has failed six months of conservative management including activity modification, NSAIDs, and physiotherapy. Intracompartmental pressure monitoring confirms pathologically elevated pressures in the anterior and lateral compartments bilaterally. Given this clinical scenario, what is the most appropriate next step in management?

. Repeat a course of intensive physical therapy focusing on eccentric strengthening and gait analysis.
. Prescribe a prolonged period of complete rest from running for 3-6 months, followed by a gradual return.
. Proceed with bilateral anterolateral fasciectomy.
. Order a post-exercise MRI to confirm the diagnosis non-invasively before any intervention.
. Perform diagnostic angiography to rule out popliteal artery entrapment syndrome.

Correct Answer & Explanation

. Proceed with bilateral anterolateral fasciectomy.

Explanation

Correct Answer: CThe correct answer is C. The management algorithm for Chronic Exertional Compartment Syndrome (CECS) typically begins with conservative measures. However, in competitive athletes seeking to return to their prior level of performance, conservative measures have a notoriously high failure rate, often exceeding 80%. In this case, the patient has diligently trialed over six months of non-operative modalities without success, and the diagnosis has been definitively confirmed by intracompartmental pressure monitoring.Given the failure of conservative treatment and the clear diagnosis, operative intervention (bilateral anterolateral fasciectomy, as indicated by the pressure readings) is strongly indicated and is the most appropriate next step to allow the patient to return to elite-level running.Options A and B represent continued conservative management, which has already failed. Option D is unnecessary; intracompartmental pressure monitoring is the gold standard for diagnosis, and a post-exercise MRI is an adjunct, not a prerequisite for intervention after definitive pressure measurements. Option E is incorrect as Popliteal Artery Entrapment Syndrome has been clinically differentiated by the preservation of distal pulses and the specific pressure findings.

Question 1020

Topic: 5. Sports Medicine

What is the most effective non-operative management strategy for a recreational athlete diagnosed with chronic exertional compartment syndrome of the anterior leg?

. Botulinum toxin injection
. Hyperbaric oxygen therapy
. Cessation or modification of the inciting activity
. Custom orthotics with a medial heel wedge
. Prolonged immobilization in a cast

Correct Answer & Explanation

. Cessation or modification of the inciting activity

Explanation

The only consistently reliable non-operative treatment for CECS is cessation or modification of the inciting activity (e.g., stopping running). Orthotics, physical therapy, and NSAIDs are generally ineffective.

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