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5. Sports Medicine MCQs

Practice Set 73 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 1441

Topic: 5. Sports Medicine

A patient has right shoulder pain. Figure 1a shows a gadolinium-enhanced transverse MRI scan at the level of the coracoid. Figure 1b shows an arthroscopic view of the anterior structures from a posterior portal. These images reveal which of the following findings?

. Normal anatomic variant (Buford complex)
. Glenoid labral tear (superior labrum anterior and posterior)
. Bankart lesion
. Avulsion of the biceps tendon
. Subscapularis tendinitis

Correct Answer & Explanation

. Normal anatomic variant (Buford complex)

Explanation

DISCUSSION: The area shown in the arthroscopic view and MRI scan is referred to as a Buford complex and represents a normal labral variant.  It consists of a thickened, cord-like middle glenohumeral ligament, a superior labral attachment of the middle glenohumeral ligament just anterior to the biceps tendon, and absence of the anterosuperior labrum.  This combination of findings can be confusing and may simulate labral pathology.  Mistaken repair of the lesion back to the glenoid rim can result in significant loss of external rotation.  A Bankart lesion would be located at the inferior anterior glenoid rim.  The subscapularis is seen anterior to the labrum.  Normal variations that occur in the anterosuperior labrum can simulate pathology.REFERENCES: Gusmer PB, Potter HG, Schatz JA, et al: Labral injuries: Accuracy of detection with unenhanced MR imaging of the shoulder.  Radiology 1996;200:519-524.Griffin LY (ed): Orthopaedic Knowledge Update: Sports Medicine.  Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 47-63.Williams MM, Snyder SJ, Buford D Jr: The Buford complex: The “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex. A normal anatomic capsulolabral variant.  Arthroscopy 1994;10:241-247.

Question 1442

Topic: Shoulder & Hip Sports

Figure 1 is the clinical photograph of a 22-year-old college pitcher who complains of posterior shoulder pain and feelings of shoulder weakness. He denies shoulder trauma. Evaluation should include

. CT scan of the shoulder.
. ultrasonography of the rotator cuff.
. vascular studies of the upper extremity.
. electrodiagnostic studies.The patient has atrophy of the infraspinatus. This would be consistent with either a massive rotator cuff tear or suprascapular neuropathy/compression. Given thepatient's age and the atraumatic onset of symptoms, a significant rotator cuff injury is unlikely, making a suprascapular nerve issue the most likely diagnosis. Electrodiagnostic studies would be most accurate in confirming nerve compression and would aid in localizing the area of compression between the spinoglenoid notch and the suprascapular notch. An MRI scan also would be beneficial to evaluate for any compressive lesion on the nerve, such as a paralabral cyst. Because rotator cuff pathology is unlikely, ultrasonography of the rotator cuff would be of little benefit. CT scan of the shoulder may allow grading of the atrophy of the muscle, but will not be as sensitive for a paralabral cyst/labral tear. Vascular studies would not aid in the diagnosis.

Correct Answer & Explanation

. CT scan of the shoulder.

Explanation

Figures 1 and 2 are the CT and MRI scans of a 23-year-old man with a history of recurrent anterior shoulder dislocations. He had his first dislocation while in basic training for the military 4 years ago. Since that time, his shoulder has dislocated with less and less provocation, to the point that it now dislocates in his sleep. Examination demonstrates significant apprehension with abduction/external rotation. What is the most appropriate treatment to prevent recurrent shoulder instability?

Question 1443

Topic: Shoulder & Hip Sports

Figure 1 is the T2 coronal MRI scan of a 52-year-old woman with a 6- month history of shoulder pain. She does not recall a history of trauma. Physical therapy is recommended. What is the most significant predictor of failure of nonoperative treatment?

. Tear size
. Pain scale score
. Strength deficit
. Patient expectationsThe MRI reveals a large full thickness supraspinatus tear. A large, prospective study showed that physical therapy can be effective in the treatment of atraumatic full-thickness rotator cuff tears. Patient expectations regarding the role of rehabilitation were the strongest predictor of surgery. Otherfactors associated with surgery were higher activity level and not smoking. Anatomic features of the rotator cuff tear and the severity of patient’s reported pain did not predict failure of nonoperative treatment. Patients who have low expectations regarding the effectiveness of physical therapy are more likely to fail nonoperative treatment.

Correct Answer & Explanation

. Tear size

Explanation

Figures 1 through 3 are the MRI scans of a 51-year-old active man who injured his right shoulder after a fall while sailing 4 days ago. Optimal surgical management of the patient’s pathology is expected to involve

Question 1444

Topic: 5. Sports Medicine

-The patient asks if something about her anatomy has resulted in this injury. ACL anatomy differs between men and women in what manner?

. There is no significant difference in ACL anatomy between men and women.
. A woman’s ACL has a smaller cross-sectional area.
. The cross-sectional area of a woman’s ACL is larger.
. The intercondylar notch is wider in women than in men.

Correct Answer & Explanation

. There is no significant difference in ACL anatomy between men and women.

Explanation

DISCUSSION FOR QUESTIONS 18 THROUGH 20This patient has the clinical findings of an ACL rupture that is confirmed on MRI scan. She is a professional athlete and would like to return to her sport. Immediate ACL reconstruction in the setting of a knee with limited motion carries an increased risk for postsurgical stiffness. Delayed surgery after the patient regains range of motion is the preferred response. It has been shown that a woman’s ACL is smaller in the cross-sectional area.

Question 1445

Topic: 5. Sports Medicine

A 17-year-old football player is injured during a play and reports abdominal pain that is soon followed by nausea and vomiting. What organ has most likely been injured?

. Liver
. Pancreas
. Spleen
. Kidney
. Large intestine

Correct Answer & Explanation

. Liver

Explanation

DISCUSSION: The spleen is the most common organ injured in the abdomen as the result of blunt trauma.  It is also the most common cause of death because of an abdominal injury. The liver is the second most commonly injured organ.  Injury to the other organs is rare.  The diagnosis can be made with CT.  Treatment ranges from observation to splenectomy, depending on the severity of injury.REFERENCES: Green GA: Gastrointestinal disorders in the athlete.  Clin Sports Med 1992;11:453-470.Kibler WB (ed): ACSM’s Handbook for Team Physician.  Philadelphia, PA,Williams & Wilkins, 1996, p 151.

Question 1446

Topic: 5. Sports Medicine

A coach of three football teams—the B team, junior varsity team, and varsity team—wants to study the
average times in the 40-yard dash for his players. Which test would help him determine if the mean 40-yard dash times for the athletes on one team are different from those on the other teams?

. Independent 2-samplettest
. Analysis of variance (ANOVA)
. Chi-square test
. Fisher's exact test

Correct Answer & Explanation

. Analysis of variance (ANOVA)

Explanation

Data collected in research studies fall into one of two categories—continuous or discrete. Continuous data can be displayed on a curve. Examples include height, weight, and time recorded in a 40-yard dash. Discrete data represent data that fall into specific categories such as gender or the presence or absence of a risk factor. ANOVA is used to determine statistical significance in mean values of continuous data when there are more than two independent samples. The 2-samplettest compares mean values of continuous data between two independent groups. The Chi-square test and Fisher's exact tests are tests used to analyze discrete data.

Question 1447

Topic: 5. Sports Medicine

Figures 1 and 2 are the radiographs of a 20-year-old college multisport athlete who has had longstanding pain in his left hip. He denies any specific event that initiated his pain, but he notes that he had hip problems when he was an infant. He denies pain with activities of daily living, but he believes his pain is increasingly limiting his ability to exercise. He localizes the pain to his groin. He denies low-back or buttock pain or pain that radiates down his leg. Images from an MRI scan of this patient's left hip are shown in Figures 3 through 5. What is the most likely cause of his acute pain?




. Significant cartilage loss on the acetabulum
. Labral tear
. Femoral neck stress fracture
. Tendinopathy of the rectus femoris

Correct Answer & Explanation

. Labral tear

Explanation

This patient has cam-type femoroacetabular impingement. Decreased internal rotation and a positive impingement test (forced flexion, adduction, and internal rotation) are classic findings. The lack of pain with resisted hip flexion makes hip flexor strain unlikely, and the lack of tenderness at the greater trochanter renders trochanteric bursitis unlikely. Although athletic pubalgia can be a source of long-standing groin pain, he lacks the pain with a resisted sit-up and tenderness along the pubic ramus that is frequently noted in patients with pubalgia. His radiographs reveal a focal femoral neck prominence consistent with cam impingement, although pistol grip deformities and flattening of the lateral femoral head are often present as well. His MRI scan shows a labral tear, which is common in cam impingement. Surgical treatment for cam impingement can be effective for symptomatic patients. Even among high-level athletes, open surgical dislocation of the hip has been shown to have good results. Most patients with cam impingement can be treated with arthroscopic osteoplasty and achieve results comparable with those realized with open surgical dislocation. The literature describes success in terms of athletes returning to sports (even professional athletes) to be approximately 90% after arthroscopic treatment. Byrd and Jones described five patients who developed transient neurapraxias that resolved uneventfully. The patients in his series who had concomitant microfracture had a 92% return to sports within the follow-up period. Cam impingement has long been thought to be associated with a history of a slipped capital femoral epiphysis. The capitis in these patients is displaced posteriorly, resulting in a prominent anterior femoral neck and decreased hip internal rotation. Pincer impingement is associated with a deep acetabulum, such as protrusion acetabula and acetabular retroversion. A patient who underwent aperiacetabular osteotomy can develop a more retroverted acetabulum as well.

Question 1448

Topic: Knee Sports

What is the effect on knee kinematics following placement of an anterior cruciate ligament (ACL) graft at the 12 o’clock position? Review Topic

. Decreased rotational stability
. Decreased anterior-posterior stability
. Decreased flexion
. Decreased extension
. Graft failure secondary to impingement

Correct Answer & Explanation

. Decreased rotational stability

Explanation

Endoscopic ACL reconstructive techniques may result in a vertical graft placement. The reconstructed ligament will resist anterior translation of the tibia but the graft will not restore rotatory stability. Decreased flexion and extension are caused by placement of the femoral tunnel too anterior and posterior, respectively. Impingement of the graft on the femoral notch is caused by anterior placement of the tibial tunnel or inadequate notchplasty.

Question 1449

Topic: Knee Sports

A 16-year-old boy falls while playing soccer. He reports that his knee buckled when he planted his leg to kick a ball. He noticed an obvious deformity of his knee, which spontaneously resolved with a “clunk.” He could not finish the game but was able to bear weight with a limp. He has had two similar episodes but has never sought medical attention. An initial examination demonstrated an effusion, tenderness at the proximal medial collateral region and medial patellofemoral retinaculum, decreased range of motion, and patella apprehension. A lateral patellar glide performed at 30° of flexion was 3+. He was otherwise ligamentously stable, and there were no other noteworthy findings.Figures 3 and 4 are this patient's proton density fat-saturated MR images. His tibial tubercle-trochlear groove (TT-TG) distance is 12 mm, and he has normal limb-alignment film findings. Treatment at this stage should include

. hinged knee bracing, protected weight bearing, and physical therapy.
. anteromedialization of the tibial tubercle.
. internal fixation and medial patellofemoral ligament (MPFL) reconstruction.
. arthroscopic lateral retinacular release.

Correct Answer & Explanation

. internal fixation and medial patellofemoral ligament (MPFL) reconstruction.

Explanation

This patient’s examination and history indicate recurrent patellar dislocations. Radiographs show an osseous or osteochondral loose fragment. There is no evidence of an obvious nondisplaced fracture or physeal changes. In the setting of suspected patella dislocation or subluxation with loose fragment seen on radiograph, an MRI is indicated. Lateral release alone is seldom indicated in a knee that is normal before injury. The examination and MRI do not indicate a need for medial collateral ligament repair.Treatment should consist of arthroscopy or arthrotomy and attempted internal fixation of this fragment. If fixation is not possible, the loose body can be removed. Normal TT-TG values, an increased lateral patellar glide, and a history of recurrent patellar dislocations after trauma suggest MPFL incompetenceand the need for reconstruction.

Question 1450

Topic: Shoulder & Hip Sports

A 45-year-old man sustained the injury seen in Figure 130a 6 weeks ago. He denies any prior injury to his shoulder. After treatment of the injury in the emergency department, he was noted to have significant weakness with empty can testing and external rotation at the side. He has full passive range of motion with forward flexion, abduction, and internal and external rotation, but has difficulty initiating abduction with his arm at his side. He has negative apprehension and relocation signs. A detailed neurologic examination shows no deficits. A coronal image from a follow-up MRI scan is seen in Figure 130b. Follow-up radiographs reveal no fractures. What is the most appropriate next step in his treatment? Review Topic

. Coracoid transfer
. Rotator cuff repair
. Reverse total shoulder arthroplasty
. Arthroscopic anteroinferior labral repair
. Physical therapy for range of motion and strength improvements

Correct Answer & Explanation

. Rotator cuff repair

Explanation

The most likely concern, in a patient older than age 40 having a first-time shoulder dislocation, is a rotator cuff tear. The MRI scan shows a tear of the supraspinatus tendon. Recurrent instability is less likely to be a problem, so an external rotation brace for an extended period of time is unnecessary. The patient already has good passive range of motion, and with a full-thickness rotator cuff tear, physical therapy alone is unlikely to return him to full function. The MRI scan shows no labral tear, so arthroscopic or open repair is not indicated.

Question 1451

Topic: Shoulder & Hip Sports

Figure 1 is the radiograph of a 21-year-old college lacrosse player who has a 2-year history of progressive left groin pain that is exacerbated by activity. Pain is preventing him from participating with his team. Examination reveals a fit man without tenderness to palpation around the hip. No clicking or popping occurs with hip range of motion. Strength of all muscles about the hip is normal, but there is some mild pain with resisted hip flexion and hip adduction. While lying supine, progressive hip flexion with internal rotation and adduction reproduces his groin pain. The patient experiences little improvement with activity modification and more physical therapy. An intra-articular corticosteroid injection provides excellent relief, but relief only lasts for 1 month. The player requests further treatment for his hip and is counseled regarding surgical intervention. Hip arthroscopy is performed. Intraoperatively, a capsulolabral separation is observed with an underlying pincer lesion. No articular cartilage injury is seen. Which treatment is most appropriate considering these findings?

. Debridement of the labral tear plus bony resection of the pincer lesion
. Debridement of the labral tear and no bony resection of the pincer lesion
. Femoral neck osteoplasty plus labral repair using suture anchor
. Resection of the bony pincer lesion plus labral repair using suture anchor

Correct Answer & Explanation

. Resection of the bony pincer lesion plus labral repair using suture anchor

Explanation

This clinical scenario describes a patient with FAI attributable to pincer (acetabular) deformity. This form of FAI, which involves prominence of the anterosuperior acetabular lip, may be more common among women. Decreased range of motion and pain occur secondary to the abutment of the femoral head against the acetabular labrum and rim. Hip flexion, combined with adduction and internal rotation, recreates this contact and causes pain, but CAM or pincer etiology remains unknown. The differential diagnosis of hip pain in a young athlete includes femoral neck stress reaction/fracture, sacroiliac arthritis, intra-articular loose body, trochanteric bursitis, osteitis pubis, and hernia. No information presented in this scenario suggests any of these causes. Diagnosis of FAI is best performed via MR imaging, with an arthrogram increasing the sensitivity and specificity for labral pathology. Ultrasonography may be useful in the diagnosis of dysplasia or for dynamic assessment of a snapping hip, but ultrasonography is not commonly used to diagnose labral pathology. Although concomitant chondral lesions of the femoral head are uncommon, the forced leverage of the anterosuperior femoral neck upon the anterior acetabulum may result in a “contra-coup” chondral injury on the posteroinferior acetabulum. This is the most common location of chondral lesions in this scenario. Without bony resection to prevent further impingement, this patient will continue to experience symptoms. Because there is no evidence of femoral neck prominence (CAM lesion), there is no indication for osteoplasty of the femoral neck; resection of the pincer lesion is necessary. This will often require take-down of the labrum in this location. If possible, iatrogenic or traumatic labral tears should subsequently be repaired after pincer debridement because the labrum hasimportant functions for hip stability and maintenance of the suction seal of the joint.

Question 1452

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player has dull posterior shoulder pain. An examination reveals moderate external rotation weakness with his arm at his side, but normal strength on supraspinatus isolation. Deltoid and supraspinatus bulk appear normal, although there appears to be mild infraspinatus atrophy. Sensation is normal throughout the shoulder and shoulder girdle. What is the most likely diagnosis?

. Calcified transverse scapular ligament
. Parsonage-Turner syndrome
. Spinoglenoid notch cyst
. Quadrilateral space syndrome

Correct Answer & Explanation

. Spinoglenoid notch cyst

Explanation

DISCUSSIONThis clinical scenario describes a patient with an isolated injury affecting the infraspinatus muscle. The anatomic location of such a lesion would be at the spinoglenoid notch, at which the suprascapular nerve may be compressed distal to its innervation of the supraspinatus but proximal to the infraspinatus innervation. A calcified transverse scapular ligament would also affect the suprascapular nerve but is proximal to the innervation of both muscles. Quadrilateral space syndrome would affect innervation of the deltoid (and teres minor). Parsonage-Turner syndrome is a more diffuse, and often severely painful, brachial plexus neuropathy.

Question 1453

Topic: Shoulder & Hip Sports

A 40-year-old man has had hip pain with increased activity over the past year. Examination reveals restriction of motion and tenderness with combined hip flexion, adduction, and internal rotation. An AP radiograph is shown in Figure 34. What is the most likely diagnosis?

. Developmental dysplasia of the hip
. Osteonecrosis
. Perthes disease
. Pseudogout
. Femoral acetabular impingement

Correct Answer & Explanation

. Femoral acetabular impingement

Explanation

DISCUSSION: Femoral acetabular impingement (FAI) is a pathologic entity leading to pain, reduced range of motion in flexion and internal rotation, and development of secondary arthritis of the hip.  There are two types of FAI:  cam impingement and pincher impingement.  Cam impingement is seen when a nonspherical femoral head produces a cam effect when the prominent portion to the femoral head rotates into the joint.  This mechanism produces shear forces that damage articular cartilage.  Radiographs reveal early joint degeneration and flattening of the head neck junction (the so-called “pistol grip deformity”) as seen in this image.  The pincher type of impingement involves abnormal contact between the femoral head neck junction and the acetabulum, in the presence of a spherical femoral head.REFERENCES: Beall DP, Sweet CF, Martin HD, et al: Imaging findings of femoraoacetabular impingement syndrome.  Skeletal Radiol 2005;34:691-701.Mardones RM, Gonzalez C, Chen Q, et al: Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection.  J Bone Joint Surg Am 2006;88:84-91.

Question 1454

Topic: 5. Sports Medicine
  • A 12-year-old Little League pitcher has had pain in the dominant shoulder for the past week that prevents him from pitching. Examination reveals normal strength, full range of motion, normal stability, and mild tenderness about the proximal humerus. Radiographs with comparison views of the opposite shoulder show widening of the proximal humerus physis. Management should include
. Diagnostic arthroscopy
. Arthroscopy and subacromial decompression
. Reduction and fixation of the proximal humeral epiphysis
. Temporary cessation of throwing
. Physical therapy for rotator cuff strengthening

Correct Answer & Explanation

. Temporary cessation of throwing

Explanation

Little League’s shoulder is a stress fracture of the proximal humeral epiphyseal plate. The classic history is the adolescent pitcher who has increased his pitching level and now has poorly localized aching shoulder pain after attempts to throw. PE will show discomfort at the proximal humerus and weakness. Early x-ray may show no pathology. Later it shows physis widening, fragmentation, demineralization, periosteal stripping, callus.Treatment requires cessation of repetitive physeal stress. There is no long-term sequelae. The athlete can return to same sports in the following season with emphasis on preseason conditioning.

Question 1455

Topic: Shoulder & Hip Sports

A 20-year-old collegiate pitcher has had a 5-month history of shoulder pain while throwing, decreased velocity, and difficulty with location of his pitches despite multiple attempts at rest. He reports no traumatic event. Examination with his throwing arm abducted at 90 degrees reveals external rotation to 110 degrees and internal rotation to 70 degrees when compared with his nonthrowing shoulder which has external rotation to 95 degrees and internal rotation to 85 degrees. He has a positive O'Brien's sign, positive modified Jobe's relocation test, full rotator cuff strength, no obvious muscular atrophy, and no scapular winging. Radiographs of the affected shoulder show no abnormalities. What is the next most appropriate step in management? Review Topic

. Dynamic ultrasound examination of the rotator cuff
. Electrodiagnostic testing of the throwing shoulder
. MR arthrogram of the throwing shoulder
. Referral to a physical therapist to concentrate on range of motion
. Laboratory studies to evaluate C-reactive protein and erythrocyte sedimentation rate

Correct Answer & Explanation

. MR arthrogram of the throwing shoulder

Explanation

The study of choice to evaluate the superior labrum is an MR arthrogram. The patient has symptoms suspicious for superior labral pathology (ie, positive O'Brien's test, Jobe's relocation test, pain with throwing, loss of velocity and location). Whereas he does have increased external rotation and decreased internal rotation of his throwing arm compared with his non-throwing arm, the total arc of motion is 180 degrees and this is considered a normal adaptive change in the overhead throwing athlete; therefore, ultrasound is not considered appropriate management. There are no signs of weakness or rotator cuff pathology to suggest suprascapular nerve compression or a full-thickness rotator cuff tear; therefore, electrodiagnostic testing or physical therapy are inappropriate. There are also no signs or symptoms suggesting infection or rheumatologic issues; therefore, laboratory studies are unnecessary. If the MR arthrogram shows a labral tear, the initial management would include posterior capsular stretching and rotator cuff strengthening.

Question 1456

Topic: 5. Sports Medicine

Which group experiences the highest rate of anterior cruciate ligament (ACL) tears?

. Female athletes with valgus knee alignment and small femoral notch width
. Female athletes with valgus knee alignment and large ACL width
. Male athletes with valgus knee alignment and small ACL width
. Male athletes with varus knee alignment and small femoral notch width

Correct Answer & Explanation

. Female athletes with valgus knee alignment and small femoral notch width

Explanation

DISCUSSIONACL tears are several times more common among women than men. Women who land from jumps in increased valgus and external rotation are at particularly increased risk for ACL tears. Women have smaller notch widths and a smaller ACL cross-sectional area than men, but these factors have not been proven to increase risk for ACL tears.CLINICAL SITUATION FOR QUESTIONS 64 THROUGH 67Figure 64 is the radiograph of a 21-year-old college lacrosse player who has a 2-year history of progressive left groin pain that is exacerbated by activity. Pain is preventing him from participating with his team. Examination reveals a fit man without tenderness to palpation around the hip. No clicking or popping occurs with hip range of motion. Strength of all muscles about the hip is normal, but there is some mild pain with resisted hip flexion and hip adduction. While lying supine, progressive hip flexion with internal rotation and adduction reproduces his groin pain.

Question 1457

Topic: 5. Sports Medicine

What is the most common behavioral effect of anabolic steroid use in athletes? Review Topic

. Increased aggression
. Psychosis
. Drug dependence
. Depression
. Mania

Correct Answer & Explanation

. Increased aggression

Explanation

Users of anabolic steroids often display increased feelings of hostility and aggression. Although reports of psychotic, depressive, and manic behavior have been reported with the use of steroids, they are rare. Drug dependence, such as seen with narcotics, is not a feature of steroid use.

Question 1458

Topic: Shoulder & Hip Sports

-A collegiate offensive football lineman has decreased bench-press strength and shoulder pain as off-season workouts begin. Examination revealed no atrophy, and deltoid and rotator cuff strength testing findings were normal. Translational testing was difficult to achieve because of his large size.Apprehension and relocation test findings were negative. An O’Brien’s active compression test result was negative. Jerk testing was positive on the affected side. Which diagnosis is most likely revealed on an MRI arthrogram?

. SLAP tear
. Subscapularis tear
. Supraspinatous tear
. Anterior labral tear
. Posterior labral tear

Correct Answer & Explanation

. SLAP tear

Explanation

Question 1459

Topic: Shoulder & Hip Sports

Decreased risk of shoulder and elbow injury in a throwing athlete has been demonstrated with which of the following? Review Topic

. Rotator cuff strengthening
. Superior labral repair
. Posterior capsular stretching
. Periscapular muscle strengthening
. Repair of partial-thickness rotator cuff tears

Correct Answer & Explanation

. Rotator cuff strengthening

Explanation

Posterior capsular contracture has been demonstrated to significantly impair the ability of the humeral head to translate anterior and inferiorly during the late cocking and early acceleration phases of the throwing motion. This results in an obligatory posterosuperior translation of the humeral head that may contribute to posterior superior glenohumeral internal impingement with posterosuperior labral and articular-sided rotator cuff pathology. Posterior capsular stretching in throwing athletes has been demonstrated to decrease the likelihood of clinically significant shoulder or elbow injury. Periscapular muscle and rotator cuff strengthening are important for optimal scapulothoracic rhythm, stable scapular position for throwing, and rotator cuff function but less directly established to result in a decreased risk of shoulder and elbow injury than posterior capsular stretching. Partial-thickness rotator cuff repair and superior labral repair may be necessary for treatment of symptomatic lesions unresponsive to nonsurgical management, but these do not necessarily correlate with decreased shoulder and elbow injury risk.

Question 1460

Topic: 5. Sports Medicine

A college athlete on a scholarship has a medical condition that you feel presents a life-threatening risk to him with participation in athletics. Because of the gravity of this decision and the potential effect it can have on the student/athlete's future, the college asks for your guidance. As the team physician for the college, what is your ethical obligation?

. Ban the athlete from sports participation.
. Allow the athlete to participate as it is his constitutional right to do so.
. Advise the college to revoke the athlete's college scholarship.
. Offer no opinion as it is a matter strictly between the college and the athlete.
. Recuse yourself from all decision making and advise the athlete to get an opinion from a third-party physician who is not employed by the college or university.

Correct Answer & Explanation

. Ban the athlete from sports participation.

Explanation

There is legal precedent for banning a scholarship athlete from participation in college athletics if the physician feels that it presents a significant physical risk to the athlete. The courts have decided that the athlete has no constitutional right to participate in NCAA sports, and as a team physician you must advise your athlete and the school as to the best course of action. The athlete must be allowed to keep his or her college scholarship.

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