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5. Sports Medicine MCQs

Practice Set 76 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 1501

Topic: 5. Sports Medicine
A 19-year-old football player is taken off the field because of fatigue. Examination reveals a rash shown in Figure A. Oral examination reveals findings shown in Figure B. Posterior cervical glands are palpable. A mass is palpable in the left upper quadrant. Which of the following is true regarding the most likely diagnosis?
. There is a risk of splenic abscess
. Blood-borne transmission results in more severe symptoms
. He can return to play 3 weeks after he is asymptomatic
. Amoxicillin will allow faster return to play
. He should be isolated for 48 hours after symptom onset

Correct Answer & Explanation

. He can return to play 3 weeks after he is asymptomatic

Explanation

This patient has infectious mononucleosis (IM). Return to play should occur 3 weeks after symptom resolution. IM is caused by the Epstein-Barr virus (EBV). Annual incidence is 1-3% in college freshmen. It is characterized by Hoagland's triad (fever, pharyngitis, lymphadenopathy). Some have rash and splenomegaly. Splenic rupture is rare (0.1-0.2% of patients). It is caused by sudden increase in portal venous pressure from a simple Valsalva maneuver or from external trauma. The risk of rupture is highest in the first 3 weeks of illness. Putukian et al. reviewed IM and athletic participation. They recommend return to LIGHT activity after 3 weeks from symptom onset when the athlete is afebrile, has a good energy level, and does not have any significant associated abnormalities. They recommend returning to CONTACT sports after at least 3 weeks when the athlete has no remaining clinical symptoms, is afebrile, and has a normal energy level. Jaworski et al. discussed infectious diseases in athletes. They state that splenic rupture occurs because of lymphocytic infiltration that distorts the support structure of the spleen, leading to fragility. They recommend return to light, non-contact activities once the athlete is afebrile and appropriately hydrated, fatigue has improved, and a minimum period of 3 weeks has passed from symptom onset. Figure A shows a petechial rash, which can be seen in IM. Amoxicillin increases the risk of rash. Figure B shows unilateral exudative pharyngitis. The left tonsil is covered by a white exudate/pseudomembrane.

Question 1502

Topic: Shoulder & Hip Sports
A football lineman who sustained a traumatic injury while blocking during a game now reports that his shoulder is slipping while pass blocking. Examination reveals no apprehension in abduction and external rotation; however, he reports pain with posterior translation of the shoulder. He has full strength in external rotation, internal rotation, and supraspinatus testing. What is the pathology most likely responsible for his symptoms?
. Anterior glenoid rim fracture tear
. Anterior inferior labral tear
. Posterior labral tear
. Total capsular laxity
. Osteochondral defect of the humeral head

Correct Answer & Explanation

. Posterior labral tear

Explanation

Traumatic posterior instability is a common finding in football players. A traumatic blow to the outstretched arm results in posterior glenohumeral forces. Labral detachment at the glenoid rim is common. Patients report slipping or pain with posteriorly directed pressure. Posterior repair has been shown to be successful in the treatment of traumatic instability.

Question 1503

Topic: 5. Sports Medicine

A 39-year-old male with chronic renal disease and type 2 diabetes mellitus fell 1 week ago after slipping on ice. He is unable to bear weight on the right lower extremity or perform active knee extension. He reports no prior history of knee pain or instability. Lachman, posterior drawer, posterolateral recurvatum testing are deferred secondary to patient's pain. He has a palpable dorsalis pedis pulse but does have neuropathy as determined by Semmes-Weinstein filament testing. His radiograph is shown in Figure A and MR images in Figures B and C. What is the most appropriate initial plan for management? Review Topic

. Primary repair of injured structure
. Primary repair of injured structure combined with anterior and medial tibial tubercle transfer
. Immobilization of knee in full extension with a progressive weight-bearing exercise program
. Semitendinosus or gracilis tendon autograft reconstruction of the injured structure
. CT angiography followed by primary repair of injured structure if the limb has vascular stability

Correct Answer & Explanation

. Primary repair of injured structure

Explanation

The clinical presentation, exam, and images are consistent with an acute patellar tendon rupture.Primary surgical repair within 2 weeks of injury is recommended to prevent extensor mechanism contracture. Patellar tendon ruptures typically occur in patients younger than 40 years old. Most ruptures occur at the junction of the tendon and distal pole of the patella.Matava et al. presents a level 5 review on patellar tendon ruptures and states that active knee extension is permitted at 3 weeks postoperatively. Non-weightbearing movement exercises like heel slides are encouraged. This can incorporate active knee flexion with passive extension. Alternatively, active knee flexion in the prone position with passive knee extension can be performed. Open chain strengthening exercises such as leg extensions are started later, as are weight bearing resistance exercises like squats, lunges and leg presses.Volk et al. discuss potential complications and pitfalls of patients with the management of extensor mechanism injuries. They warn that complications can consist of misdiagnosis, delayed surgery, failed repair due to poor surgical planning of injury site, or wound infection.Figure A demonstrates patella alta which in this case is indicative of complete patellar tendon rupture. Patella alta can be quantified by using the Insall-Salvati ratio (patellar tendon length / patellar bone length): PTL/PBL normal =1, >1.2 is patella alta, <0.8 is patella baja) with the knee flexed to 30 degrees. Figure B and C are sagittal T1 and T2 images showing complete patellar tendon rupture.Incorrect answers:

Question 1504

Topic: Shoulder & Hip Sports

Figures 76a and 76b are the sagittal T1-weighted MRI scans of an active 27-year-old man who has had left dominant extremity shoulder pain and weakness for the past 5 months. He denies any history of a precipitating event but recalls that the pain began around the time he started lifting weights after a year off from lifting. Examination reveals full range of active and passive motion, negative Hawkins and Neer impingement signs, 5/5 abduction strength, 5/5 external rotation strength with arm adducted at his side, and a negative belly press, Gerber lift-off, and O'Brien's test. He does have weakness with resisted external rotation with the arm abducted to 90 degrees. Radiographs are unremarkable. An MRI arthrogram shows no rotator cuff tear or labral tears. What is the most likely diagnosis? Review Topic

. Scapular dyskenisia
. Quadrilateral space syndrome
. Subacromial impingement syndrome
. Suprascapular nerve compression by a spinoglenoid notch
. Suprascapular nerve compression at the suprascapular notch

Correct Answer & Explanation

. Scapular dyskenisia

Explanation

Examination reveals weakness of the teres minor muscle, and the MRI scan shows moderate isolated atrophy of the teres minor muscle belly. This is consistent with quadrilateral space syndrome, which is compression of the axillary nerve and posterior circumflex humeral artery in the quadrilateral space (bounded by the teres minor, teres major, long head of triceps and the humerus). This syndrome has been related to compression of the neurovascular structures by muscle hypertrophy consistent with the patient's history of lifting weights near the onset of symptoms. The next step in confirming the diagnosis is a subclavian arteriogram with the arm in adduction as well as in abduction and external rotation. Suprascapular nerve compression would be manifested by atrophy and weakness of both the supraspinatus and infraspinatus (if occurring at the suprascapular notch) or just infraspinatus (if occurring at the spinoglenoid notch). The patient does not demonstrate signs or symptoms of either impingement syndrome or scapular dyskenisia.

Question 1505

Topic: Shoulder & Hip Sports

Figure 4a shows the radiograph of a 20-year-old man who has an injury to the right shoulder. Figure 4b shows an arthroscopic view (posterior portal). The arrow points to a Review Topic

. rotator cuff tear.
. bare area.
. Hill-Sachs defect.
. Bankart tear.
. glenoid fracture.

Correct Answer & Explanation

. rotator cuff tear.

Explanation

The radiograph shows an anterior dislocation of the shoulder. A frequently encountered sequela of this is a compression fracture of the posterolateral humeral head, commonly referred to as a Hill-Sachs defect. The arthroscopic view of the glenohumeral joint visualizes the posterior aspect of the humeral head. In the image, the area devoid of cartilage to the right is the bare area. The indentation seen to the left is a Hill-Sachs defect.

Question 1506

Topic: 5. Sports Medicine
Figures 1 through 3 show the radiograph and MR arthrograms obtained from a 25-year-old woman who has had right groin pain since joining the military 4 years ago. She has undergone treatment with NSAIDs, physical therapy, and activity modification. Examination reveals positive flexion abduction and external rotation, a positive external log roll, and increased range of motion. What is the most appropriate treatment?
. Viscosupplementation of the right hip
. Hip arthroscopy with labral repair
. Periacetabular osteotomy
. Total hip arthroplasty

Correct Answer & Explanation

. Periacetabular osteotomy

Explanation

This patient has symptomatic hip dysplasia that has been recalcitrant to nonsurgical management. Radiographs reveal an upsloping sourcil and a lateral center edge angle of 14, with posterior uncovering. Appropriate surgical management for symptomatic hip dysplasia in a young patient is periacetabular osteotomy.

Question 1507

Topic: Knee Sports

An 18-year-old woman injures her left knee playing soccer. At the time of anterior cruciate ligament (ACL) reconstruction, she was noted to have an irreparable posterior horn medial meniscus tear. Partial meniscectomy will have what primary effect? Review Topic

. Increase medial femoral-tibial peak contact loads
. Increase medial compartment contact area
. Decrease in situ forces in the ACL graft
. Decrease anterior tibial translation
. Increase posterior tibial translation

Correct Answer & Explanation

. Increase medial femoral-tibial peak contact loads

Explanation

The medial meniscus distributes force through the medial compartment. Peak loads in the affected compartment are increased by partial and complete meniscectomy. The posterior horn of the medial meniscus is also an important secondary restraint to anterior tibial translation in the ACL-deficient knee. In situ forces in the reconstructed ACL are increased with loss of the posterior horn of the medial meniscus.

Question 1508

Topic: 5. Sports Medicine
Following reconstruction of the anterior cruciate ligament (ACL), which of the following rehabilitation exercises has the greatest potential to harm the graft?
. Active knee flexion from 45 to 90 degrees
. Active knee extension from 90 to 45 degrees
. Simultaneous isometric contraction of the quadriceps and hamstrings with a knee flexion angle between 30 and 60 degrees
. Isometric quadriceps contraction with a knee flexion angle between 0 and 30 degrees
. Isometric quadriceps contraction with a knee flexion angle between 60 and 90 degrees

Correct Answer & Explanation

. Isometric quadriceps contraction with a knee flexion angle between 0 and 30 degrees

Explanation

Isometric quadriceps contraction between 15 and 30 degrees of flexion creates significant strain in the ACL and potential damage to the reconstructed graft. Isolated quadriceps contraction with knee flexion of greater than 60 degrees, hamstring contraction at any angle of knee flexion, and active knee motion between 35 and 90 degrees of flexion create substantially less strain in the properly implanted ACL graft.

Question 1509

Topic: 5. Sports Medicine
Anabolic steroid use has which of the following effects on serum lipoprotein levels?
. Decrease in low-density lipoprotein only
. Decrease in high-density lipoprotein only
. Increase in high-density lipoprotein only
. Increase in low-density lipoprotein only
. Increase in both high- and low-density lipoproteins

Correct Answer & Explanation

. Decrease in high-density lipoprotein only

Explanation

The use of anabolic steroids causes a decrease in high-density lipoprotein levels but has no effect on low-density lipoprotein levels. An abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete.

Question 1510

Topic: Shoulder & Hip Sports

Figures 26a through 26c show the MRI scans of a 47-year-old man who underwent arthroscopic shoulder surgery 6 months ago and continues to have pain despite a prolonged course of rehabilitation. Management should now consist of Review Topic

. rotator cuff repair.
. revision acromioplasty.
. fragment excision.
. open reduction and internal fixation.
. continued rehabilitation.

Correct Answer & Explanation

. fragment excision.

Explanation

The MRI scans show an os acromiale of the mesoacromion type. This represents an unfused acromial apophysis. Pain is thought to be caused by either motion at the site or downward displacement of the anterior aspect of the acromion onto the rotator cuff, causing impingement. Most patients can be treated nonsurgically as they are usually asymptomatic. In those patients with persistent symptoms of pain and tenderness over the acromion, surgery consisting of rigid internal fixation and bone grafting has yielded satisfactory results. Excision may be a viable treatment option for the preacromion type.

Question 1511

Topic: 5. Sports Medicine
A 28-year-old woman who is an avid runner reports pain about the left hip with activities. Nonsurgical management has failed to provide relief. An MRI arthrogram is shown in Figure 47. What is the most likely diagnosis?
. Osteonecrosis
. Transient osteoporosis
. Loose chondral fragment
. Labral tear
. Femoral neck stress fracture

Correct Answer & Explanation

. Labral tear

Explanation

DISCUSSION: The MRI arthrogram reveals dye extravasation into the labrum, consistent with a labral tear. The MRI findings are not typical of osteonecrosis, stress fracture, or transient osteoporosis. There is no increase in bone marrow edema in the neck or femoral head. REFERENCES: Guanche CA, Sikka RS: Acetabular labral tears with underlying chondralmalacia: A possible association with high-level running. Arthroscopy 2005;21:580-585. McCarthy JC: The diagnosis and treatment of labral and chondral injuries. Instr Course Lect 2004;53:573-577.

Question 1512

Topic: 5. Sports Medicine
Which of the following muscle tendons inserts just lateral to the long head of the biceps tendon on the proximal humerus?
. Teres major
. Latissimus dorsi
. Short head of the biceps
. Pectoralis major
. Subscapularis

Correct Answer & Explanation

. Pectoralis major

Explanation

DISCUSSION: The pectoralis major insertion is just lateral to the long head of the biceps tendon. Medial to the biceps is the insertion for the teres major and latissimus dorsi. The short head of the biceps originates on the coracoid process. The subscapularis inserts on the lesser tuberosity just medial to the biceps. REFERENCE: Bal GK, Basamania CJ: Pectoralis major tendon ruptures: Diagnosis and treatment. Tech Shoulder Elbow Surg 2005;6:128-134.

Question 1513

Topic: 5. Sports Medicine

The images reveal T2-weighted MRI sequences with edema isolated to the infraspinatus. In the absence of a tear in the infraspinatus tendon, the edema is most likely due to compression of the suprascapular nerve in the spinoglenoid notch. As this pathology persists, progressive muscle atrophy and fatty infiltration can result. Compression of the suprascapular nerve in the suprascapular notch would have resulted in edema and weakness in both the supra- and infraspinatus muscles. Compression is commonly caused by cysts from the joint secondary to labral tears. A rotator cuff tear of the infraspinatus is not identified on these images, and there is no history of trauma provided. There is no evidence of an anteroinferior labral tear, nor would this be expected to result in external rotation weakness or MRI abnormality of the infraspinatus. Quadrilateral space syndrome results in compression of the axillary nerve, which supplies the teres minor. Correcr answer : C 40- A 41-year-old right-hand-dominant man has been treated nonsurgically for right elbow arthritis. His radiographs reveal end-stage ulnohumeral arthritis with complete loss of the joint space. He reports pain during the mid-arc of elbow flexion and extension. During the last 8 years, he has attempted activity modification, medication, physical therapy, and multiple cortisone injections. His symptoms have progressed, resulting in constant pain, loss of a functional range of motion, and an inability to perform many activities of daily living. Secondary to his age and activity demands, he undergoes a soft-tissue interposition arthroplasty of his elbow with an Achilles allograft. Which presurgical finding correlates with elevated risk for postsurgical complications?

. Inflammatory elbow arthritis
. A presurgical flexion-extension elbow arc of approximately 50°
. Retained distal humerus hardware on presurgical radiographs
. Evidence of presurgical elbow instabilityEnd-stage posttraumatic or inflammatory elbow arthritis in active, high-demand patients remains difficult to treat. Traditional total elbow arthroplasty is discouraged in this demographic secondary to concerns about implant longevity. Soft-tissue interposition arthroplasty does not necessitate the same activity and weight restrictions for patients after surgery and remains a reasonable salvage procedure. Larson and Morrey published their findings on38 patients with a mean age of 39 years following soft-tissue interposition arthroplasty for posttraumatic and inflammatory end-stage elbow arthritis. These investigators reported a significant improvement in Mayo Elbow Performance Score in addition to improvement in the flexion-extension arc from 51° to 97° after surgery. They reported worse results and elevated incidence of complications for patients with presurgical elbow instability. Retained hardware from prior surgery was not deemed a contraindication.

Correct Answer & Explanation

. Evidence of presurgical elbow instabilityEnd-stage posttraumatic or inflammatory elbow arthritis in active, high-demand patients remains difficult to treat. Traditional total elbow arthroplasty is discouraged in this demographic secondary to concerns about implant longevity. Soft-tissue interposition arthroplasty does not necessitate the same activity and weight restrictions for patients after surgery and remains a reasonable salvage procedure. Larson and Morrey published their findings on38 patients with a mean age of 39 years following soft-tissue interposition arthroplasty for posttraumatic and inflammatory end-stage elbow arthritis. These investigators reported a significant improvement in Mayo Elbow Performance Score in addition to improvement in the flexion-extension arc from 51° to 97° after surgery. They reported worse results and elevated incidence of complications for patients with presurgical elbow instability. Retained hardware from prior surgery was not deemed a contraindication.

Explanation

Figure 1 is the radiograph of a 12-year-old baseball player who has posterolateral elbow pain with throwing. The area of interest is designated by the black arrow. His range of motion and strength are full. No previous treatment has been provided. What is the most appropriate initial treatment?A. Elbow arthroscopy with debridementB. Immobilization and rest for 6 weeksC. Corticosteroid injectionD. Open osteochondral autograft transferOsteochondritis dissecans of the capitellum is a painful condition that affects immature athletes who undergo repetitive compression of the radiocapitellar joint. Management is based primarily on the integrity of the articular cartilage surface and the stability of the lesion. Nonsurgical treatment is typically selected for patientswith early-grade, stable lesions, and it involves activity modification with cessation of sports participation. The duration of activity modification is dictated by symptoms, with 3 to 6 weeks of rest followed by return to sport in 3 to 6 months commonly used as a guideline. Strengthening and stretching exercises are commonly incorporated after the pain has subsided. Surgical intervention or corticosteroid injection would not be first-line treatment.42- Figures 1 and 2 are the radiographs of a 69-year-old man with a history of treated prostate cancer and hemodialysis-dependent end- stage renal disease who presents to the emergency department with progressively worsening right shoulder pain and stiffness. Laboratory tests reveal a white blood cell count of 17,000, erythrocyte sedimentation rate, 75, and CRP, 10.1. He has a draining sinus located along the anterior shoulder. What is the best next step?

Question 1514

Topic: 5. Sports Medicine
A 21-year-old college defensive lineman sustains a minimally displaced (less than 1 mm) midthird scaphoid fracture during the first game of the season. Management should consist of:
. cast immobilization and a return to play as symptoms allow.
. cast immobilization and a return to play when union is achieved.
. open reduction and internal fixation, followed by early range of motion with a return to play when union is achieved.
. open reduction and internal fixation, followed by a return to play with protective casting.
. symptomatic treatment, with definitive treatment at the end of the season.

Correct Answer & Explanation

. cast immobilization and a return to play as symptoms allow.

Explanation

DISCUSSION: The union rate for minimally displaced midthird scaphoid fractures is quite high with cast immobilization while allowing a return to sports. Inadequate immobilization results in a much higher nonunion rate. Early fixation and rehabilitation have been proposed for sports or positions that are not amenable to cast immobilization. While immobilization of a nondisplaced fracture results in an acceptably high union rate, there is no advantage to fixation in conjunction with immobilization in the course of healing. With adequate immobilization and protection, play restrictions until healing has occurred are unnecessary. REFERENCES: Rettig AC, Kollias SC: Internal fixation of acute stable scaphoid fractures in the athlete. Am J Sports Med 1996;24:182-186. Rettig AC, Weidenbener EJ, Gloyeske R: Alternative management in midthird scaphoid fractures in the athlete. Am J Sports Med 1994;22:711-714. Riester JN, Baker BE, Mosher JF, Lowe D: A review of scaphoid fracture healing in competitive athletes. Am J Sports Med 1985;13:159-161.

Question 1515

Topic: Shoulder & Hip Sports

What complication is most likely to occur following proximal humeral fixation with a locked plate-and-screw construct?

. Screw penetration
. Rotator cuff injury
. Axillary nerve damage
. Fracture of the humeral shaft
. Impingement

Correct Answer & Explanation

. Screw penetration

Explanation

Proximal humeral locking plates have been associated with screw penetration (incidence 23%). The rotator cuff injury is not due to the plate or its application and is associated with dislocations in the elderly. Axillary nerve damage, while possible, has a low reported incidence from open reduction and internal fixation of the proximal humerus with locking constructs. Impingement and fracture of the humeral shaft are also unlikely. More likely but not offered as a choice is the problem of varusreduction which can result in failure. However, penetration of the screws remains the most commonly reported complication.

Question 1516

Topic: Knee Sports

Figures 2a and 2b 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

DISCUSSIONThis 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 incompetence and the need for reconstruction.

Question 1517

Topic: Shoulder & Hip Sports

A 67-year-old woman is seen in the emergency department after falling at home. Radiographs before and after treatment are shown in Figures 49a and

. Axillary nerve palsy
. Spinal accessory nerve palsy
. Deltoid avulsion
. Rotator cuff tear
. Unreduced posterior glenohumeral dislocation

Correct Answer & Explanation

. Rotator cuff tear

Explanation

Patients older than age 40 years at the time of initial anterior dislocation have low rates of redislocation; however, 15% of these patients experience a rotator cuff tear. Moreover, there is a dramatic increase (up to 40%) in the incidence of rotator cuff tears in patients older than age 60 years. Axillary nerve injury may occur but is less common than rotator cuff tear.

Question 1518

Topic: Shoulder & Hip Sports

A 17-year-old quarterback reports shoulder pain localized over the anterior aspect of the shoulder that occurs during the follow through phase of throwing. The pain worsens toward the end of the game, but becomes asymptomatic the next day. He denies any pain during the cocking phase of throwing or during normal daily activities. Examination reveals a negative relocation test and a negative posterior load and shift test. Motion of the shoulder is normal. An MRI arthrogram is shown in Figure 75. Based on the history, examination, and MRI findings, what initial treatment should be recommended? Review Topic

. Labrum repair
. Capsular release
. Labrum debridement
. Physical therapy emphasizing a throwing program
. Physical therapy emphasizing an internal rotation stretching program

Correct Answer & Explanation

. Physical therapy emphasizing a throwing program

Explanation

The MRI scan shows a small amount of contrast between the posterior labrum and the glenoid, suggesting a posterior labral tear. The patient's symptoms are more consistent, however, with rotator cuff deconditioning because of the timing of his pain during the throwing motion and increased severity at the end of the game. Treatment should focus on reconditioning of the rotator cuff and scapular stabilizers, combined with a return to throw program. Posterior labral tears are often found on MRI scans of asymptomatic throwers, and therefore, should not be considered the primary cause of a patient's symptoms unless it is supported by the history and physical examination. Internal rotation contractures can cause a similar pain pattern, but this patient has full and equal range of motion.

Question 1519

Topic: Shoulder & Hip Sports
  • A right-handed, 53 year old man reports pain in the left shoulder following a fall on an abducted externally rotated shoulder 3 months ago. Examination reveals pain on elevation and tenderness localized to the anterior aspect of the shoulder. Results of the lift-off test are inconclusive due to limited internal rotation. Figure 2 shows the T1-weighted axial image from an MRI-arthrogram. Treatment should include
. Labral repair
. acromioplasty
. excision of the coracoid process
. an arthroscopic Bankart procedure
. subscapularis repair

Correct Answer & Explanation

. subscapularis repair

Explanation

Subscapularis repair-Traumatic rupture of the tendon of the subscapularis muscle is caused by forceful hyperextension or external rotation of the adducted arm. A simple clinical maneuver called the "lift-off test", reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon.

Question 1520

Topic: Shoulder & Hip Sports
A 54-year-old man has left shoulder pain and weakness after falling while skiing 4 months ago. Examination reveals full range of motion passively, but he has a positive abdominal compression test and weakness with the lift-off test. External rotation strength with the arm at the side and strength with the arm abducted and internally rotated are normal. MRI scans are shown in Figures 1a and 1b. Treatment should consist of:
. Arthroscopy and labral repair.
. Arthroscopy and supraspinatus repair.
. Arthroscopy and subscapularis repair.
. Arthroscopy and supraspinatus and infraspinatus repair.
. Open repair of the pectoralis major.

Correct Answer & Explanation

. Arthroscopy and subscapularis repair.

Explanation

DISCUSSION: The examination findings are consistent with subscapularis muscle weakness but normal supraspinatus and infraspinatus strength. The lift-off test and abdominal compression test are specific for subscapularis function. The MRI scan reveals a chronic avulsion and retraction of the subscapularis. The transverse image reveals a normal infraspinatus muscle, and the sagittal image reveals an atrophic subscapularis. Surgical repair of the isolated subscapularis tendon is indicated. REFERENCES: Iannotti JP, Williams GR: Disorders of the Shoulder: Diagnosis and Management, ed 1. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, pp 31-56. Gerber C, Hersche O, Farron A: Isolated rupture of the subscapularis tendon: Results of operative treatment. J Bone Joint Surg Am 1996;78:1015-1023.

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