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5. Sports Medicine MCQs

Practice Set 52 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 1021

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious posterior shoulder pain and weakness. Physical exam reveals isolated weakness in external rotation with the arm at the side. The infraspinatus demonstrates profound atrophy, but the supraspinatus muscle bulk and strength are completely normal. Where is the most likely site of nerve compression?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Spiral groove
. Cubital tunnel

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the branch to the infraspinatus, causing isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 1022

Topic: Shoulder & Hip Sports

The Remplissage procedure is utilized to manage significant engaging Hill-Sachs lesions following anterior shoulder dislocations. It involves capsulodesis and tenodesis of which muscle into the humeral head defect?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Long head of the biceps

Correct Answer & Explanation

. Infraspinatus

Explanation

The Remplissage procedure effectively converts an intra-articular engaging Hill-Sachs lesion into an extra-articular defect. It is performed by suturing the posterior capsule and the infraspinatus tendon into the bony defect of the posterolateral humeral head.

Question 1023

Topic: 5. Sports Medicine

A 22-year-old female undergoes ACL reconstruction with a bone-patellar tendon-bone autograft. Six months postoperatively, she complains of anterior knee pain and difficulty ascending stairs. Exam shows a 10-degree extension deficit. What is the most likely cause of her extension deficit?

. Femoral tunnel placed too anteriorly
. Tibial tunnel placed too anteriorly
. Femoral tunnel placed too posteriorly
. Tibial tunnel placed too posteriorly
. Inadequate notchplasty

Correct Answer & Explanation

. Tibial tunnel placed too anteriorly

Explanation

A tibial tunnel placed too anteriorly can cause graft impingement against the intercondylar roof during extension, leading to an extension deficit and anterior knee pain. Conversely, a femoral tunnel placed too anteriorly typically results in increased graft tension during flexion, causing a flexion deficit.

Question 1024

Topic: Shoulder & Hip Sports

A 55-year-old male undergoes arthroscopic evaluation of a massive rotator cuff tear involving the supraspinatus and infraspinatus. Preoperatively, he exhibited a positive 'horn blower's' sign. Which muscle is primarily deficient?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Teres minor

Explanation

The horn blower's sign indicates weakness of external rotation with the arm abducted to 90 degrees and specifically evaluates the integrity of the teres minor. A positive sign suggests teres minor deficiency or profound fatty infiltration.

Question 1025

Topic: 5. Sports Medicine

Which of the following radiographic anatomical features is most strongly associated with an increased risk of primary anterior cruciate ligament (ACL) rupture in female athletes?

. Decreased posterior tibial slope
. Increased posterior tibial slope
. Increased intercondylar notch width
. Decreased Q-angle
. Patella baja

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

An increased posterior tibial slope increases anterior tibial translation under axial load. This anatomical variant is a recognized independent risk factor for both primary and revision non-contact ACL injuries.

Question 1026

Topic: Knee Sports

The examiner asks about other causes for one or two loose bodies in a joint, and the candidate mentions osteoarthritis. The examiner then asks about multiple loose bodies. What is the most common diagnosis when multiple loose bodies are observed in an elbow joint?

. Osteochondritis dissecans
. Post-traumatic osteochondral fragments
. Primary synovial chondromatosis
. Rheumatoid arthritis
. Gouty arthritis

Correct Answer & Explanation

. Primary synovial chondromatosis

Explanation

Correct Answer: CExplanation:When multiple loose bodies are observed in an elbow joint, the most common diagnosis isprimary synovial chondromatosis. This is a benign condition characterized by metaplastic changes in the synovial membrane, leading to the formation of cartilaginous nodules within the synovium. These nodules can then detach and become free-floating loose bodies within the joint, often calcifying over time and appearing as multiple, variably sized, calcified bodies on radiographs. Osteochondritis dissecans (A) typically results in one or a few loose bodies from a specific lesion. Post-traumatic osteochondral fragments (B) are usually limited in number. Rheumatoid arthritis (D) and gouty arthritis (E) are inflammatory conditions that do not typically produce multiple, calcified loose bodies as a primary feature, although joint destruction in severe cases could lead to some fragments.

Question 1027

Topic: 5. Sports Medicine

A 15-year-old baseball pitcher has a capitellar OCD lesion. MRI shows a 10 mm lesion with intact overlying cartilage and no fluid behind the fragment, but mechanical pain persists despite 6 months of absolute rest. What is the most appropriate surgical intervention?

. Arthroscopic transarticular or retroarticular drilling
. Arthroscopic loose body removal only
. Osteochondral autograft transfer (OATS)
. Capitellar resurfacing arthroplasty
. Open reduction and internal fixation of the lesion

Correct Answer & Explanation

. Arthroscopic transarticular or retroarticular drilling

Explanation

For stable, non-fragmented OCD lesions that fail nonoperative management (rest), arthroscopic drilling (transarticular or retroarticular) is indicated to stimulate revascularization and healing of the subchondral bone.

Question 1028

Topic: 5. Sports Medicine

A 16-year-old weightlifter presents with a capitellar OCD lesion. MRI demonstrates a 15 mm detached osteochondral fragment with underlying extensive cystic changes in the capitellum. What is the most appropriate surgical treatment?

. Arthroscopic microfracture
. In situ retrograde drilling
. Excision of the fragment without cartilage restoration
. Osteochondral autograft transfer (OATS)
. Fragment fixation with bioabsorbable pins

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

Large (>10 mm), unstable, or detached OCD lesions with subchondral cystic changes lack adequate bone stock for primary fixation or microfracture. Osteochondral autograft transfer (OATS) is indicated to restore both the articular surface and the subchondral bone defect.

Question 1029

Topic: 5. Sports Medicine

A 15-year-old baseball pitcher has advanced capitellar OCD with a 1.5 cm unstable, hinged osteochondral flap and underlying subchondral cyst seen on MRI. What is the most appropriate surgical management?

. Arthroscopic microfracture alone
. In situ drilling of the capitellum
. Osteochondral autograft transfer (OATS)
. Simple excision of the flap without marrow stimulation
. Radial head excision

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For large (>1 cm), unstable OCD lesions of the capitellum with underlying cystic changes or lack of viable subchondral bone, osteochondral autograft transfer (OATS) is indicated. This restores the structural integrity of the articular surface.

Question 1030

Topic: 5. Sports Medicine

What is the primary mechanical etiology driving the development of capitellar osteochondritis dissecans (OCD) in overhead throwing athletes?

. Repetitive valgus stress causing radiocapitellar compression
. Varus overload causing medial joint distraction
. Hyperextension causing olecranon impingement
. Excessive forearm pronation leading to annular ligament strain
. Direct axial loading during triceps contraction

Correct Answer & Explanation

. Repetitive valgus stress causing radiocapitellar compression

Explanation

During the late cocking and early acceleration phases of throwing, extreme valgus stress creates tension medially and high compressive forces laterally across the radiocapitellar joint. This repetitive microtrauma to the vulnerable capitellum vascular supply leads to OCD.

Question 1031

Topic: 5. Sports Medicine

A 12-year-old male gymnast is diagnosed with a stable capitellar OCD lesion based on MRI (no cystic changes, intact overlying cartilage). What is the most appropriate initial management?

. Immediate arthroscopic drilling
. Cessation of weight-bearing upper extremity activities for 3-6 months
. Corticosteroid injection into the radiocapitellar joint
. Physical therapy focusing on aggressive range of motion stretching
. Osteochondral autograft transfer

Correct Answer & Explanation

. Cessation of weight-bearing upper extremity activities for 3-6 months

Explanation

Stable OCD lesions in patients with open physes have a high potential for healing with non-operative management. Strict cessation of the offending repetitive activity (e.g., gymnastics, throwing) for 3 to 6 months is the mainstay of initial treatment.

Question 1032

Topic: Knee Sports

In the surgical management of an unstable capitellar OCD lesion with a loose body, what size threshold generally supports arthroscopic fragment excision and microfracture over an osteochondral autograft transfer (OATS)?

. Lesions less than 1 cm in diameter without lateral wall involvement
. Lesions greater than 1.5 cm with lateral wall blowout
. Lesions greater than 2 cm with deep subchondral cysts
. Any lesion with associated radial head chondromalacia
. Any lesion in a patient older than 18 years

Correct Answer & Explanation

. Lesions less than 1 cm in diameter without lateral wall involvement

Explanation

Arthroscopic excision and microfracture are typically successful for smaller, contained capitellar OCD lesions (<1 cm). Larger lesions (>1 cm), especially those compromising the lateral capitellar wall, generally require cartilage restoration techniques like OATS.

Question 1033

Topic: 5. Sports Medicine

A 14-year-old elite female gymnast presents with insidious onset of lateral elbow pain, worsened with weight-bearing activities. Examination reveals a 15-degree extension deficit. What biomechanical force is primarily responsible for her most likely diagnosis?

. Valgus overload resulting in medial tension
. Varus overload resulting in lateral tension
. Repetitive radiocapitellar compressive forces
. Posteromedial shear forces on the olecranon
. Direct axial distraction forces

Correct Answer & Explanation

. Repetitive radiocapitellar compressive forces

Explanation

Capitellar osteochondritis dissecans (OCD) is predominantly seen in adolescent athletes (such as pitchers and gymnasts) subjected to repetitive compressive forces across the radiocapitellar joint. Associated valgus stress can further exacerbate this lateral compression.

Question 1034

Topic: Knee Sports

In a 13-year-old baseball pitcher with capitellar osteochondritis dissecans, which of the following MRI findings most strongly indicates an unstable lesion requiring surgical intervention?

. Subchondral bone marrow edema surrounding the lesion
. Intact overlying articular cartilage over a subchondral cyst
. A high-signal T2 line between the lesion and native bone
. Focal flattening of the capitellum without cartilage breach
. Thickened radiocapitellar synovial plica

Correct Answer & Explanation

. A high-signal T2 line between the lesion and native bone

Explanation

A T2 high-signal rim intervening between the OCD fragment and the underlying bone indicates synovial fluid has tracked under the fragment. This strongly suggests instability that often warrants surgical management.

Question 1035

Topic: Knee Sports

A 45-year-old male presents with mechanical elbow pain, catching, and limited range of motion. Radiographs show multiple uniform, round, ossified bodies within the joint space with preserved radiocapitellar and ulnohumeral joint spaces. What is the most likely underlying pathophysiology?

. Synovial metaplasia
. Advanced osteoarthritis
. Neuropathic arthropathy
. Unhealed osteochondritis dissecans
. Rheumatoid arthritis

Correct Answer & Explanation

. Synovial metaplasia

Explanation

Primary synovial chondromatosis is a benign condition characterized by synovial metaplasia producing multiple loose bodies of relatively uniform size. It typically presents in the absence of severe degenerative joint disease.

Question 1036

Topic: Knee Sports

A 15-year-old right-hand-dominant baseball pitcher presents with a symptomatic 12 mm capitellar OCD lesion. Intraoperatively, the articular cartilage is breached, and the fragment is loose but unfragmented with adequate bone. What is the most appropriate surgical management?

. Arthroscopic debridement and microfracture
. In situ retrograde drilling
. Open osteochondral autograft transfer (OATS)
. Internal fixation of the fragment
. Excision of the fragment without marrow stimulation

Correct Answer & Explanation

. Internal fixation of the fragment

Explanation

For a large (>10 mm), unstable but intact (unfragmented) OCD lesion with sufficient attached bone, internal fixation is the preferred treatment to restore the native articular surface. Microfracture or OATS are reserved for non-salvageable or fragmented defects.

Question 1037

Topic: Knee Sports

In the management of capitellar osteochondritis dissecans (OCD), osteochondral autograft transfer (OATS) is most strongly indicated for which of the following lesions?

. A 5 mm intact lesion in a 12-year-old patient
. A 14 mm fragmented lesion involving the lateral capitellar margin
. A stable lesion with subchondral edema on MRI
. A loose, unfragmented lesion with adequate subchondral bone
. Panner's disease refractory to 3 months of rest

Correct Answer & Explanation

. A 14 mm fragmented lesion involving the lateral capitellar margin

Explanation

OATS is indicated for large, unsalvageable (fragmented), or cystic capitellar OCD lesions. It is particularly necessary for lesions involving the lateral capitellar margin, where simple excision and microfracture have poorer clinical outcomes due to loss of lateral containment.

Question 1038

Topic: Knee Sports

A 16-year-old baseball pitcher presents with a 4-month history of lateral elbow pain, clicking, and a 20-degree flexion contracture. MRI reveals an 8 mm unstable capitellar osteochondral lesion with an intra-articular loose body. What is the most appropriate surgical treatment?

. Arthroscopic in situ screw fixation of the lesion
. Arthroscopic loose body removal and capitellar microfracture
. Open osteochondral autograft transfer (OATS)
. Ulnar collateral ligament reconstruction
. Arthroscopic synovectomy only

Correct Answer & Explanation

. Arthroscopic loose body removal and capitellar microfracture

Explanation

For symptomatic, unstable capitellar OCD lesions with a loose body and a small defect (typically <10 mm), the recommended treatment is loose body removal, debridement of the crater, and marrow stimulation (microfracture) to promote fibrocartilage healing. OATS is generally reserved for larger lesions (>10 mm) or failed microfracture.

Question 1039

Topic: Knee Sports

The meniscofemoral ligaments (of Humphry and Wrisberg) are associated with which meniscal horn and may provide some additional stabilization?

. Anterior horn of the medial meniscus.
. Posterior horn of the medial meniscus.
. Anterior horn of the lateral meniscus.
. Posterior horn of the lateral meniscus.
. Mid-body of the medial meniscus.

Correct Answer & Explanation

. Posterior horn of the lateral meniscus.

Explanation

Correct Answer: DThe meniscofemoral ligaments (MFLs) are typically associated with the posterior horn of the lateral meniscus. The ligament of Wrisberg passes posterior to the PCL, and the ligament of Humphry passes anterior to the PCL. While their primary function is debated, they are thought to provide some accessory stabilization to the posterior horn of the lateral meniscus and may provide stability in the setting of an absent or deficient PCL.

Question 1040

Topic: Knee Sports

Which statement best describes the healing potential of a longitudinal tear in the inner one-third (white-white zone) of the meniscus?

. Excellent, due to high cellularity and direct synovial fluid nutrient access.
. Good, if associated with an anterior cruciate ligament injury.
. Poor, due to the inherent avascularity of the region.
. Moderate, if treated with percutaneous suturing.
. Variable, dependent on the patient's age.

Correct Answer & Explanation

. Poor, due to the inherent avascularity of the region.

Explanation

Correct Answer: CThe inner one-third (white-white zone) of the meniscus is avascular. Without a direct blood supply, intrinsic healing of tears in this region is extremely poor to non-existent. Surgical repair in this zone is generally not indicated as it has a very low success rate, hence partial meniscectomy is often the treatment. While age can influence healing, the primary determinant in this zone is the lack of vascularity.

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