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5. Sports Medicine MCQs

Practice Set 59 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 1161

Topic: Shoulder & Hip Sports

A 28-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with critical glenoid bone loss. Postoperatively, the patient reports numbness and weakness in the biceps and brachialis muscles. Which of the following nerves is most likely injured during the procedure?

. Axillary nerve
. Radial nerve
. Ulnar nerve
. Musculocutaneous nerve
. Suprascapular nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

Correct Answer: DExplanation:Understanding the neurovascular anatomy around the shoulder is crucial for preventing and identifying complications during Latarjet surgery.Option D (Musculocutaneous nerve)is the correct answer. The case explicitly states under 'Intraoperative Complications' that 'The musculocutaneous nerve enters the conjoint tendon as proximally as 3 to 5 cm distal to the coracoid tip and is at risk during graft harvest and retraction.' The musculocutaneous nerve innervates the biceps brachii and brachialis muscles, and its injury would lead to the described symptoms of numbness and weakness in these muscles.Option A (Axillary nerve)is also at risk during the Latarjet procedure, particularly during inferior capsular release and subscapularis split. Injury to the axillary nerve would primarily affect deltoid function (shoulder abduction) and sensation over the regimental badge area, which is different from the symptoms described.Option B (Radial nerve)injury would typically manifest as wrist drop and weakness in forearm extensors, which is not consistent with the patient's symptoms.Option C (Ulnar nerve)injury would affect intrinsic hand muscles and sensation along the medial forearm and hand, which is not consistent with the patient's symptoms.Option E (Suprascapular nerve)injury would primarily affect the supraspinatus and infraspinatus muscles, leading to weakness in shoulder abduction and external rotation, not biceps/brachialis weakness.

Question 1162

Topic: Shoulder & Hip Sports

The biomechanical concept of the 'glenoid track' is central to understanding recurrent anterior shoulder instability with bipolar bone loss. For the 28-year-old rugby player, if his intact inferior glenoid width is measured at 25 mm, what is the calculated width of his glenoid track?

. Approximately 15 mm
. Approximately 20.75 mm
. Approximately 25 mm
. Approximately 13.5 mm
. Approximately 8.3 mm

Correct Answer & Explanation

. Approximately 20.75 mm

Explanation

Correct Answer: BExplanation:The glenoid track concept is a critical biomechanical principle for surgical decision-making in shoulder instability.Option B (Approximately 20.75 mm)is the correct answer. The case states, 'The glenoid track is the zone of contact between the humeral head and the glenoid during maximum abduction and external rotation. Its width is calculated as 83 percent of the intact inferior glenoid width.' Therefore, for an intact inferior glenoid width of 25 mm, the glenoid track width would be 0.83 * 25 mm = 20.75 mm.Option A (Approximately 15 mm)is incorrect. This value is not derived from the 83% calculation.Option C (Approximately 25 mm)is incorrect. This represents the full intact glenoid width, not the glenoid track width.Option D (Approximately 13.5 mm)is incorrect. This value is mentioned in the case as a threshold for glenoid bone loss (13.5-15%), not the glenoid track calculation.Option E (Approximately 8.3 mm)is incorrect. This value is not derived from the 83% calculation.

Question 1163

Topic: Shoulder & Hip Sports

The 28-year-old rugby player has a history of three anterior glenohumeral dislocations. The case highlights that 'failure to address bipolar bone loss is the leading cause of surgical failure following isolated arthroscopic soft-tissue stabilization.' Which of the following patient characteristics or findings would most strongly indicate a need for an osseous augmentation procedure (e.g., Latarjet) rather than an isolated arthroscopic Bankart repair?

. First-time dislocation in a high-demand contact athlete.
. An 'on-track' Hill-Sachs lesion with minimal glenoid bone loss (<13.5%).
. A positive sulcus sign indicating generalized ligamentous laxity.
. Critical glenoid bone loss (>15%) and an 'off-track' Hill-Sachs lesion.
. Age over 30 years with a sedentary lifestyle.

Correct Answer & Explanation

. Critical glenoid bone loss (>15%) and an 'off-track' Hill-Sachs lesion.

Explanation

Correct Answer: DExplanation:The decision between soft-tissue repair and osseous augmentation is primarily driven by the extent of bone loss and the engagement of the Hill-Sachs lesion.Option D (Critical glenoid bone loss (>15%) and an 'off-track' Hill-Sachs lesion)is the correct answer. The case explicitly states under 'Indications and Contraindications' that 'Open Latarjet Procedure' is indicated for 'Critical glenoid bone loss (> 15%)' and 'Off-track Hill-Sachs lesions.' This combination represents the highest risk for recurrence with soft-tissue repair alone and necessitates bone augmentation.Option A (First-time dislocation in a high-demand contact athlete)might warrant an arthroscopic Bankart repair, but without recurrent instability or quantified bone loss, it does not automatically indicate an osseous augmentation procedure. The case lists 'First-time dislocators in high-demand sports' as an indication for 'Arthroscopic Bankart Repair.'Option B (An 'on-track' Hill-Sachs lesion with minimal glenoid bone loss (<13.5%))would typically be managed with an arthroscopic Bankart repair, possibly with a remplissage if the Hill-Sachs is 'off-track' but glenoid bone loss is subcritical. This scenario does not necessitate a Latarjet.Option C (A positive sulcus sign indicating generalized ligamentous laxity)is a risk factor for instability but does not, by itself, mandate osseous augmentation. It might influence the choice of soft-tissue repair technique (e.g., more aggressive capsular plication) but is not the primary driver for bone grafting.Option E (Age over 30 years with a sedentary lifestyle)generally correlates with a lower risk of recurrence compared to younger, active individuals. This demographic might even be considered for non-operative management if it were a first-time dislocation, but it does not indicate a need for osseous augmentation.

Question 1164

Topic: Shoulder & Hip Sports

During the postoperative rehabilitation for an arthroscopic Bankart repair, the patient is in the early protective phase (Weeks 0 to 4). Which of the following is the most appropriate instruction regarding external rotation?

. Passive external rotation to 45 degrees is permitted.
. Active external rotation to 30 degrees is encouraged.
. External rotation is strictly limited to 0 degrees.
. Active-assisted external rotation to tolerance is allowed.
. No restrictions on external rotation, as long as it is pain-free.

Correct Answer & Explanation

. External rotation is strictly limited to 0 degrees.

Explanation

Correct Answer: CExplanation:The early protective phase of rehabilitation is crucial for protecting the surgical repair and preventing re-injury.Option C (External rotation is strictly limited to 0 degrees)is the correct answer. The case states under 'Early Protective Phase' (Weeks 0 to 4) for arthroscopic Bankart repairs, 'external rotation is strictly limited to 0 degrees to protect the anterior capsular repair and the subscapularis split.' This restriction is vital to prevent undue stress on the reattached labrum and tightened capsule, which are most vulnerable in external rotation.Option A (Passive external rotation to 45 degrees is permitted)is incorrect. This level of external rotation is typically introduced later, in the intermediate mobilization phase (Weeks 4 to 8), and even then, it is gradually increased.Option B (Active external rotation to 30 degrees is encouraged)is incorrect. Active motion, especially against resistance, is generally avoided in the early protective phase to prevent stress on the repair.Option D (Active-assisted external rotation to tolerance is allowed)is incorrect for the early protective phase. Any significant external rotation, even active-assisted, can jeopardize the repair.Option E (No restrictions on external rotation, as long as it is pain-free)is incorrect and dangerous. Pain is not the sole indicator of safety in the early postoperative period; strict adherence to protocol is necessary to protect the healing tissues.

Question 1165

Topic: Shoulder & Hip Sports

The case describes the Latarjet procedure's 'triple-blocking effect.' Which of the following components contributes to this effect?

. The tenodesis of the infraspinatus into the Hill-Sachs lesion.
. The restoration of the glenoid track width by the coracoid graft.
. The dynamic sling effect of the conjoint tendon traversing the subscapularis.
. The increased concavity compression provided by the rotator cuff.
. The repair of the posterior capsule to the coracoacromial ligament stump.

Correct Answer & Explanation

. The dynamic sling effect of the conjoint tendon traversing the subscapularis.

Explanation

Correct Answer: CExplanation:The Latarjet procedure provides stability through a combination of mechanisms, known as the triple-blocking effect.Option C (The dynamic sling effect of the conjoint tendon traversing the subscapularis)is the correct answer. The case explicitly states, 'The Latarjet procedure is the workhorse for recurrent instability associated with critical glenoid bone loss (> 15%) or in high-demand contact athletes. It relies on a triple-blocking effect: the osseous augmentation of the glenoid, the dynamic sling effect of the conjoint tendon traversing the subscapularis, and the capsular repair to the coracoacromial ligament stump.' The conjoint tendon (biceps short head and coracobrachialis) acts as a dynamic restraint, particularly with the arm in abduction and external rotation.Option A (The tenodesis of the infraspinatus into the Hill-Sachs lesion)describes the remplissage procedure, which is a different technique used for off-track Hill-Sachs lesions, not a component of the Latarjet's triple-blocking effect.Option B (The restoration of the glenoid track width by the coracoid graft)is partially correct in that the osseous augmentation restores the glenoid's articular arc, but the 'glenoid track' is a concept for Hill-Sachs engagement, not a direct component of the Latarjet's triple-blocking effect as described. The osseous augmentation is one of the three effects, but this option describes it in terms of glenoid track width restoration, which is not the primary description of the triple-blocking effect.Option D (The increased concavity compression provided by the rotator cuff)refers to the general dynamic stability provided by the rotator cuff, which is not specific to the Latarjet procedure's unique blocking mechanisms.Option E (The repair of the posterior capsule to the coracoacromial ligament stump)is incorrect. The repair is of thenative capsuleto thestump of the coracoacromial ligament, and it is theanteriorcapsule, not posterior, that is repaired to the stump. This capsular repair is indeed one of the three blocking effects, but the option incorrectly states 'posterior capsule.'

Question 1166

Topic: 5. Sports Medicine

A 28-year-old right-hand dominant male presents with his third episode of anterior glenohumeral dislocation. The mechanism of injury involved direct impact to the posterior aspect of the shoulder while the arm was abducted and externally rotated. The patient is an active participant in competitive contact sports. Based on the epidemiological data and clinical presentation in the case, which of the following statements regarding his risk of recurrence is most accurate?

. His risk of recurrence is low due to his age being over 25.
. Non-operative management would likely result in a recurrence rate approaching 90%.
. His risk of recurrence is primarily due to generalized ligamentous laxity.
. The high-energy mechanism of injury suggests a lower risk of recurrence compared to atraumatic dislocations.
. The risk of recurrence is negligible after the third dislocation, as the joint has 'stretched out'.

Correct Answer & Explanation

. Non-operative management would likely result in a recurrence rate approaching 90%.

Explanation

Correct Answer: BExplanation:The case provides specific epidemiological data and patient characteristics that influence the risk of recurrence.Option B (Non-operative management would likely result in a recurrence rate approaching 90%)is the correct answer. The case states, 'Studies have demonstrated that patients under the age of 20 face a recurrence rate approaching 90 percent with non-operative management.' While this patient is 28, he is a young, competitive contact athlete with a history of recurrent dislocations. The case also lists 'Recurrent instability with significant bone loss; Young, competitive contact athletes' as contraindications for non-operative management, implying a very high risk of failure if non-operative management were pursued. Given his history of three dislocations and participation in contact sports, his risk with non-operative management would be extremely high, likely similar to or exceeding the 90% for those under 20.Option A (His risk of recurrence is low due to his age being over 25)is incorrect. While the risk decreases with age, a 28-year-old competitive contact athlete with recurrent dislocations still has a very high risk, especially if bone loss is present. The case highlights that 'males in their second and third decades of life engaged in contact sports' have a significant predilection for primary dislocations and high recurrence rates.Option C (His risk of recurrence is primarily due to generalized ligamentous laxity)is not explicitly stated as the primary cause in the case. While hyperlaxity can contribute, the case emphasizes 'progressive structural damage, most notably bipolar bone loss' as a consequence of recurrent instability.Option D (The high-energy mechanism of injury suggests a lower risk of recurrence compared to atraumatic dislocations)is incorrect. High-energy trauma, especially in contact sports, is associated with significant structural damage (like bone loss) that increases the risk of recurrence, not lowers it. Atraumatic dislocations often have different underlying etiologies (e.g., multidirectional instability).Option E (The risk of recurrence is negligible after the third dislocation, as the joint has 'stretched out')is incorrect. This is a dangerous misconception. Each subsequent dislocation exacerbates structural damage, making recurrence more likely and leading to progressive joint degeneration. The case states, 'Recurrent instability inevitably leads to progressive structural damage.'

Question 1167

Topic: Shoulder & Hip Sports

During preoperative planning for an anterior shoulder stabilization, the concept of the "glenoid track" is utilized to evaluate bipolar bone loss. A Hill-Sachs lesion is considered "off-track" if its medial margin extends medial to what specific landmark or measurement?

. The intact anterior glenoid rim
. 83% of the intact glenoid width minus the anterior glenoid bone defect
. 100% of the native glenoid width
. 50% of the humeral head diameter
. The medial border of the lesser tuberosity

Correct Answer & Explanation

. 83% of the intact glenoid width minus the anterior glenoid bone defect

Explanation

The glenoid track is calculated as 83% of the intact glenoid width. In the presence of anterior glenoid bone loss, this defect width must be subtracted from the 83% value to accurately determine the functional track; lesions extending medial to this are "off-track."

Question 1168

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a seizure and is found to have a locked posterior shoulder dislocation. CT imaging reveals a reverse Hill-Sachs lesion (anteromedial humeral head defect) involving 35% of the articular surface. The glenoid is intact. What is the most appropriate surgical management?

. Closed reduction and immobilization in internal rotation
. Arthroscopic posterior Bankart repair alone
. Transfer of the subscapularis tendon and lesser tuberosity into the defect
. Anterior Latarjet procedure
. Glenohumeral arthrodesis

Correct Answer & Explanation

. Transfer of the subscapularis tendon and lesser tuberosity into the defect

Explanation

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

Question 1169

Topic: Shoulder & Hip Sports

During arthroscopic stabilization for recurrent anterior shoulder instability, the surgeon identifies an ALPSA lesion. Which of the following best describes the anatomic pathomorphology of this specific lesion?

. Avulsion of the glenohumeral ligament directly from its humeral attachment
. The anterior labrum is avulsed and displaced medially and inferiorly along the glenoid neck
. A superior labral tear that extends from anterior to posterior
. A non-detached cartilage flap tear of the anterior inferior glenoid
. A bony avulsion of the anterior-inferior glenoid rim

Correct Answer & Explanation

. The anterior labrum is avulsed and displaced medially and inferiorly along the glenoid neck

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior labrum and periosteum are stripped and displaced medially down the anterior glenoid neck. It differs from a classic Bankart lesion, where the labrum is detached but remains roughly in its anatomic position.

Question 1170

Topic: Shoulder & Hip Sports

A surgeon plans an arthroscopic Bankart repair with Remplissage for a patient with 10% anterior glenoid bone loss and an "off-track" Hill-Sachs lesion. Which structure is tenodesed into the humeral head defect during the Remplissage portion of the procedure?

. Subscapularis tendon
. Supraspinatus tendon
. Infraspinatus tendon
. Teres major tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Infraspinatus tendon

Explanation

The Remplissage procedure (French for "to fill in") involves capsulotenodesis of the posterior capsule and the infraspinatus tendon into the posterior/posterolateral humeral head defect (Hill-Sachs lesion) to prevent it from engaging the anterior glenoid.

Question 1171

Topic: Shoulder & Hip Sports

A 19-year-old gymnast complains of bilateral shoulder pain and a sensation that her shoulders are "slipping out of place." Physical examination demonstrates generalized ligamentous laxity, a positive sulcus sign of 2.5 cm bilaterally, and apprehension with anterior and posterior translation. What is the most appropriate initial management?

. Arthroscopic anterior capsular plication
. Open inferior capsular shift
. Latarjet procedure
. Prolonged physical therapy focusing on scapular and rotator cuff strengthening
. Immobilization in external rotation for 4 weeks

Correct Answer & Explanation

. Prolonged physical therapy focusing on scapular and rotator cuff strengthening

Explanation

This patient has Multidirectional Instability (MDI). The cornerstone and most appropriate initial management for MDI is a dedicated physical therapy program focusing on dynamic stabilizers, specifically the rotator cuff and periscapular musculature.

Question 1172

Topic: Shoulder & Hip Sports

A 24-year-old athlete with recurrent anterior shoulder instability undergoes an arthroscopic Bankart repair. Preoperative imaging demonstrated 10% glenoid bone loss and an 'off-track' Hill-Sachs lesion. Which of the following is the most appropriate concurrent procedure?

. Open Latarjet procedure
. Arthroscopic Remplissage
. Arthroscopic capsular shift
. Iliac crest bone grafting
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Arthroscopic Remplissage

Explanation

An 'off-track' Hill-Sachs lesion with subcritical glenoid bone loss (<15-20%) is best managed with a Bankart repair and concurrent arthroscopic Remplissage (infraspinatus tenodesis) to prevent engagement. Latarjet is generally reserved for critical bone loss (>15-20%).

Question 1173

Topic: Shoulder & Hip Sports

A 45-year-old male presents to the emergency department after a seizure. He complains of right shoulder pain and an inability to rotate the arm externally. Radiographs show a 'lightbulb' sign on the AP view. What is the most likely associated osseous defect?

. Posterolateral humeral head impaction fracture (Hill-Sachs)
. Anteromedial humeral head impaction fracture (Reverse Hill-Sachs)
. Anterior glenoid rim fracture (Bony Bankart)
. Greater tuberosity avulsion fracture
. Coracoid process fracture

Correct Answer & Explanation

. Anteromedial humeral head impaction fracture (Reverse Hill-Sachs)

Explanation

The patient has a posterior shoulder dislocation, commonly occurring after seizures or electrical shocks. It is frequently associated with an anteromedial humeral head impaction fracture, known as a reverse Hill-Sachs lesion.

Question 1174

Topic: Shoulder & Hip Sports

A 38-year-old male suffers a posterior shoulder dislocation. Imaging reveals an anteromedial humeral head defect comprising 30% of the articular surface. Which of the following surgical interventions is most appropriate?

. Arthroscopic posterior labral repair
. Open reduction and transfer of the subscapularis tendon into the defect
. Open reduction and transfer of the infraspinatus tendon into the defect
. Coracoid transfer to the posterior glenoid
. Total shoulder arthroplasty

Correct Answer & Explanation

. Open reduction and transfer of the subscapularis tendon into the defect

Explanation

For reverse Hill-Sachs lesions involving 20-40% of the articular surface, a modified McLaughlin procedure is indicated. This involves the transfer of the subscapularis tendon and/or lesser tuberosity into the defect to prevent it from engaging the anterior glenoid rim.

Question 1175

Topic: Shoulder & Hip Sports

A 16-year-old female swimmer presents with bilateral shoulder pain and a sensation of her shoulders 'slipping out' during her stroke. Physical exam shows a positive sulcus sign and generalized ligamentous laxity. After a 6-month trial of directed physical therapy, she remains highly symptomatic. Which surgical procedure is most indicated?

. Open Latarjet procedure
. Arthroscopic capsular plication and shift
. Remplissage
. Putti-Platt procedure
. Biceps tenodesis

Correct Answer & Explanation

. Arthroscopic capsular plication and shift

Explanation

The patient has Multidirectional Instability (MDI). When conservative management (PT focusing on periscapular stabilizers) fails, the surgical treatment of choice is an arthroscopic or open capsular plication/shift to reduce capsular volume and redundancy.

Question 1176

Topic: Shoulder & Hip Sports

During an arthroscopic stabilization for anterior shoulder instability, the surgeon notes that the anterior labroligamentous complex is avulsed from the glenoid and has healed medially on the anterior neck of the scapula with an intact periosteal sleeve. This finding is best described as which of the following?

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

Correct Answer & Explanation

. ALPSA lesion

Explanation

An Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion occurs when the torn labrum displaces medially and heals to the anterior scapular neck. It must be fully mobilized laterally during repair to restore normal anatomy, unlike a classic Bankart lesion where the periosteum ruptures.

Question 1177

Topic: Shoulder & Hip Sports

A 19-year-old male recreational basketball player undergoes an arthroscopic Bankart repair for recurrent anterior shoulder instability. Which of the following factors is associated with the highest risk of recurrent instability following this procedure?

. Age younger than 20 years
. Presence of a SLAP tear
. Use of bioabsorbable anchors
. Delay to surgery > 6 weeks
. Greater tuberosity fracture

Correct Answer & Explanation

. Age younger than 20 years

Explanation

Young age (typically <20 or <22 years) and participation in competitive or contact sports are among the most significant independent risk factors for failure of isolated arthroscopic Bankart repairs.

Question 1178

Topic: Shoulder & Hip Sports

The 'glenoid track' is a critical concept in evaluating shoulder instability. How is the width of the normal glenoid track calculated relative to the uninjured glenoid width (D)?

. 63% of D
. 75% of D
. 83% of D
. 90% of D
. 100% of D

Correct Answer & Explanation

. 83% of D

Explanation

The width of the normal glenoid track is calculated as 83% of the width of the intact glenoid (D). If there is anterior glenoid bone loss (d), the true glenoid track width becomes 0.83D - d. A Hill-Sachs lesion extending beyond this track is considered 'off-track'.

Question 1179

Topic: Shoulder & Hip Sports

A 22-year-old overhead athlete presents with recurrent anterior shoulder instability. A 3D CT scan is ordered to evaluate for glenoid bone loss. The concept of the 'glenoid track' is utilized to determine if a Hill-Sachs lesion will engage the anterior glenoid rim. Which of the following formulas correctly calculates the width of the glenoid track?

. 0.83 x (diameter of normal glenoid) - (width of glenoid defect)
. 0.83 x (diameter of normal glenoid) + (width of glenoid defect)
. 1.0 x (diameter of normal glenoid) - (width of glenoid defect)
. 0.50 x (diameter of normal glenoid) - (width of glenoid defect)
. 0.75 x (diameter of normal glenoid) + (width of glenoid defect)

Correct Answer & Explanation

. 0.83 x (diameter of normal glenoid) - (width of glenoid defect)

Explanation

The glenoid track width is calculated as 83% (0.83) of the normal glenoid diameter minus the width of the anterior glenoid bone defect. If a Hill-Sachs lesion is wider than this track, it is considered 'off-track' and is at high risk for engagement and recurrent dislocation.

Question 1180

Topic: Shoulder & Hip Sports

A 26-year-old male is scheduled for a Latarjet procedure due to a 20% anterior glenoid bone defect. During the procedure, the coracoid is osteotomized and transferred to the anterior glenoid. The 'sling effect' contributes significantly to the stability provided by this procedure. This dynamic effect is primarily created by the conjoint tendon compressing against which structure?

. The superior labrum
. The inferior capsule and subscapularis muscle
. The long head of the biceps tendon
. The middle glenohumeral ligament
. The pectoralis minor muscle

Correct Answer & Explanation

. The inferior capsule and subscapularis muscle

Explanation

The Latarjet procedure provides stability via a 'triple blocking' effect. The most significant soft-tissue stabilizing mechanism is the dynamic sling effect, where the conjoint tendon acts as a sling across the inferior capsule and the lower fibers of the subscapularis when the arm is abducted and externally rotated.

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