Biomechanics of Sports Injuries — MCQs
Which among the following results in a combination of elastic and viscous behavior, where only the elastic component is recovered when the stress is removed?
Ruptured tendons are most commonly seen in
While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?
False about fracture of vertebrae
A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured
An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
Manoeuvre carried out for diagnosing medial meniscus injury is:
A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
Hill-Sach's lesion is seen in:
A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?
Biomechanics of Sports Injuries Indian Medical PG Practice Questions and MCQs
Question 1: Which among the following results in a combination of elastic and viscous behavior, where only the elastic component is recovered when the stress is removed?
- A. Elastic deformation
- B. Plastic deformation
- C. Viscoelastic deformation (Correct Answer)
- D. None of the options
Explanation: ***Viscoelastic deformation*** - This type of deformation involves both **elastic** and **viscous** components, meaning that biological materials exhibit characteristics of both solids (elastic) and fluids (viscous). - Upon removal of the applied stress, only the **elastic strain** is recovered immediately, while the **viscous component** results in time-dependent behavior such as stress relaxation and creep. - This is the characteristic behavior of biological tissues, cell membranes, and cytoplasm, which demonstrate **viscoelastic properties** essential for physiological function. *Elastic deformation* - Involves only **elastic strain**, meaning the material fully recovers its original shape instantaneously once the applied stress is removed. - There is no time-dependent behavior or permanent deformation, as observed in materials within their elastic limit. *Plastic deformation* - Occurs when a material is stressed beyond its **yield point**, resulting in a permanent change in shape even after the stress is removed. - This is primarily due to **irreversible structural rearrangements** and does not involve time-dependent viscous flow. - This is not characteristic of normal physiological tissue behavior. *None of the options* - This option is incorrect because **viscoelastic deformation** accurately describes the phenomenon where biological materials exhibit a combination of elastic and viscous behavior, with only the elastic component being immediately recoverable.
Question 2: Ruptured tendons are most commonly seen in
- A. Overuse (Correct Answer)
- B. Direct trauma from injury
- C. Structural abnormalities from birth
- D. Tumor-related structural changes
Explanation: ***Overuse*** - Chronic **overuse** leads to **microtrauma and degeneration** within the tendon, weakening it over time and making it susceptible to rupture even with minimal acute stress. - This is particularly common in tendons that experience **repetitive strain**, such as the Achilles tendon, rotator cuff, and patellar tendon. *Direct trauma from injury* - While acute, high-impact **direct trauma** can cause tendon ruptures, it is not the most common mechanism overall. - Many traumatic ruptures occur in tendons already weakened by **chronic degeneration**, rather than purely healthy tendons. *Structural abnormalities from birth* - **Congenital structural abnormalities** are relatively rare causes of primary tendon rupture. - These conditions usually present earlier in life with functional limitations rather than sudden rupture in adulthood. *Tumor-related structural changes* - **Tumors** can, in rare cases, weaken tendons and lead to rupture, but this is a far less common cause compared to overuse. - Tendon compromise due to a tumor usually involves direct invasion or pressure, which is not the predominant etiology for the majority of tendon ruptures.
Question 3: While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?
- A. Tear of the medial meniscus (Correct Answer)
- B. Ruptured fibular collateral ligament
- C. Tenderness on pressure along the fibular collateral ligament
- D. Injured posterior cruciate ligament
Explanation: **Tear of the medial meniscus** - A **twisting injury** to the knee, especially when tackled from the lateral side (which can force the leg into valgus stress), commonly causes a **tear of the medial meniscus**. - The **medial meniscus** is less mobile and more firmly attached than the lateral meniscus, making it more susceptible to injury during twisting forces. *Ruptured fibular collateral ligament* - A rupture of the **fibular collateral ligament (FCL)**, also known as the **lateral collateral ligament (LCL)**, typically results from a **varus stress** (a blow to the medial side of the knee), which is contrary to a tackle from the lateral side. - While twisting can contribute to knee injuries, isolate FCL tears from a lateral-side tackle are less likely than meniscal damage. *Tenderness on pressure along the fibular collateral ligament* - Tenderness along the **fibular collateral ligament** would indicate an injury to this structure, but a twisting injury from the lateral side is less likely to directly damage the FCL compared to the medial structures. - This symptom alone does not fully explain the mechanism of injury and the common resulting pathology in this scenario. *Injured posterior cruciate ligament* - The **posterior cruciate ligament (PCL)** is most commonly injured by a direct blow to the anterior tibia when the knee is flexed (a **dashboard injury**) or by a hyperflexion injury. - A twisting injury from the lateral side is a less common mechanism for isolated PCL injury.
Question 4: False about fracture of vertebrae
- A. Fracture dislocation is common in flexion rotation injury
- B. Chance fracture occurs due to flexion distraction injury
- C. Wedge compression causes flexion injury
- D. Anterior longitudinal ligament runs along the posterior surface of vertebral bodies (Correct Answer)
Explanation: ***Anterior longitudinal ligament runs along the posterior surface of vertebral bodies*** - The **anterior longitudinal ligament (ALL)** runs along the **anterior aspect** of the vertebral bodies, preventing hyperextension. - The **posterior longitudinal ligament (PLL)** runs along the posterior surface of the vertebral bodies, within the vertebral canal. *Fracture dislocation is common in flexion rotation injury* - **Flexion-rotation injuries** are highly unstable and frequently lead to **fracture-dislocations** of the vertebral column. - The combined forces cause significant disruption of both bony and ligamentous structures, increasing the likelihood of displacement. *Chance fracture occurs due to flexion distraction injury* - A **Chance fracture** (or seatbelt fracture) is caused by a **flexion-distraction injury**, typically seen in individuals wearing lap belts during deceleration. - This mechanism results in a horizontal splitting of the vertebral body and posterior elements. *Wedge compression causes flexion injury* - A **wedge compression fracture** is the most common type of vertebral fracture and results from a **flexion injury** (hyperflexion). - The anterior portion of the vertebral body collapses, creating a wedge shape, while the posterior column remains intact.
Question 5: A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured
- A. Medial collateral ligament
- B. Medial meniscus
- C. Anterior cruciate ligament (Correct Answer)
- D. Lateral collateral ligament
Explanation: ***Anterior cruciate ligament*** - A fracture of the **intercondylar eminence** typically involves the avulsion of the **tibial attachment** of the anterior cruciate ligament (ACL). - The ACL's fibers attach to the **tibial intercondylar area**, making it highly susceptible to injury with a fracture in this region. *Medial collateral ligament* - The **medial collateral ligament** (MCL) originates from the medial femoral epicondyle and attaches to the medial tibia, primarily resisting valgus forces. - While knee trauma can affect the MCL, a fracture of the intercondylar eminence specifically points to an injury involving a structure attached to that area. *Medial meniscus* - The **medial meniscus** is a C-shaped cartilage in the knee joint and can be injured by rotational forces or compression. - Its injury is not directly linked to an intercondylar eminence fracture, although severe trauma can injure multiple structures. *Lateral collateral ligament* - The **lateral collateral ligament** (LCL) originates from the lateral femoral epicondyle and attaches to the fibular head, resisting varus forces. - An injury to the LCL is less likely with an intercondylar eminence fracture, as the LCL does not attach to this specific tibial region.
Question 6: An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?
- A. Posterior Cruciate Ligament
- B. Anterior Cruciate Ligament (Correct Answer)
- C. Lateral Collateral Ligament
- D. Medial Collateral Ligament
Explanation: ***Anterior Cruciate Ligament*** - The **Lachman test** is the most sensitive clinical test for diagnosing an **ACL tear**, indicating anterior tibial translation. - **Pivoting injuries** and **hemarthrosis** (blood in the joint) are classic signs of a severe ACL injury, often involving bone bruising. *Posterior Cruciate Ligament* - PCL injuries are less common and typically result from a direct blow to the **anterior tibia** while the knee is flexed or a hyperextension injury. - The primary test for PCL integrity is the **posterior drawer test**, which assesses posterior tibial translation. *Lateral Collateral Ligament* - LCL injuries usually result from a **varus stress** to the knee, often in contact sports, and can cause pain on the lateral aspect of the knee. - The **varus stress test** is used to assess LCL integrity, but it does not cause hemarthrosis as frequently as an ACL tear. *Medial Collateral Ligament* - MCL injuries are common and result from a **valgus stress** to the knee (a blow to the outside of the knee). - The **valgus stress test** assesses MCL integrity, causing pain on the medial aspect of the knee and typically not resulting in acute hemarthrosis unless other structures are also injured.
Question 7: Manoeuvre carried out for diagnosing medial meniscus injury is:
- A. McMurray's test (Correct Answer)
- B. Valgus stress test
- C. Lachmann's test
- D. Varus stress test
Explanation: ***McMurray's test*** - This test is specifically designed to assess for meniscal tears, particularly the **medial meniscus**. - A positive test involves eliciting a **click or pain** when extending the knee from a fully flexed position while internally and externally rotating the tibia. *Valgus stress test* - This test evaluates the integrity of the **medial collateral ligament (MCL)**. - It involves applying a valgus (outward) force to the knee while stabilizing the thigh, looking for increased gapping or pain. *Lachmann's test* - This is the most sensitive test for assessing the integrity of the **anterior cruciate ligament (ACL)**. - It involves gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees, looking for excessive anterior translation. *Varus stress test* - This test assesses the integrity of the **lateral collateral ligament (LCL)**. - It involves applying a varus (inward) force to the knee while stabilizing the thigh, looking for increased gapping or pain.
Question 8: A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
- A. Anterior cruciate ligament tear (Correct Answer)
- B. Posterior cruciate ligament tear
- C. Medial meniscus tear
- D. Medial collateral ligament tear
Explanation: ***Anterior cruciate ligament tear*** - The image depicts the **Lachman test**, a highly sensitive and specific clinical test for **ACL integrity**. - A positive Lachman test, characterized by *increased anterior tibial translation* and a *soft or absent endpoint*, confirms an **ACL tear**. *Posterior cruciate ligament tear* - A PCL tear is identified by tests like the **posterior drawer test** or **posterior sag sign**, which show *posterior tibial translation*. - The test shown in the image specifically assesses **anterior stability**, not posterior. *Medial meniscus tear* - Medial meniscus tears are typically diagnosed with tests like **McMurray's test** or **Apley's grind test**, which involve *rotation* and *compression* of the knee. - While a crucial knee structure, the meniscus does not primarily contribute to **anterior-posterior stability** in the way the ACL does. *Medial collateral ligament tear* - An MCL tear is detected by applying a **valgus stress** to the knee at various degrees of flexion. - This tear presents with *medial joint line pain* and *instability to valgus stress*, which is not assessed by the depicted test.
Question 9: Hill-Sach's lesion is seen in:
- A. Anterior dislocation of hip
- B. Posterior dislocation of hip
- C. Recurrent dislocation of shoulder (Correct Answer)
- D. Posterior dislocation of shoulder
Explanation: ***Recurrent dislocation of shoulder*** - A **Hill-Sach's lesion** is a **compression fracture** of the posterolateral part of the humeral head, occurring as the humeral head impacts the anterior rim of the glenoid during **anterior shoulder dislocation**. - It is particularly associated with **recurrent anterior shoulder dislocations** due to repeated impaction. *Anterior dislocation of hip* - This condition involves the femoral head moving anteriorly out of the acetabulum and is not associated with a Hill-Sach's lesion. - While it causes significant pain and immobility, the specific bone lesion known as Hill-Sach's involves the humerus, not the femur. *Posterior dislocation of hip* - A posterior hip dislocation involves the femoral head moving posteriorly out of the acetabulum and is not linked to a Hill-Sach's lesion. - This type of injury is often seen in high-impact trauma, such as car accidents, and can be associated with acetabular fractures or sciatic nerve injury. *Posterior dislocation of shoulder* - This involves the humeral head dislocating posteriorly relative to the glenoid, and while bone lesions can occur, they are typically **reverse Hill-Sach's lesions** (on the anterior aspect of the humeral head) or **bony Bankart lesions** of the posterior glenoid. - A standard Hill-Sach's lesion specifically refers to the posterolateral humeral head defect seen in **anterior dislocations**.
Question 10: A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?
- A. Frozen shoulder (Correct Answer)
- B. Bacterial arthritis
- C. Osteoarthritis
- D. Rotator cuff tear
Explanation: ***Frozen shoulder*** - The patient's presentation with **increasing pain** and **difficulty with overhead abduction** of the shoulder, especially in the context of long-standing **diabetes**, is highly characteristic of **adhesive capsulitis** (frozen shoulder). - This condition is marked by **progressive stiffness** and **restricted range of motion** in the shoulder joint due to inflammation and fibrosis of the joint capsule. *Bacterial arthritis* - **Bacterial arthritis** typically presents with an **acutely painful**, **swollen**, and **erythematous joint**, often accompanied by systemic symptoms like **fever** and **malaise**. - The chronic, progressive nature of the patient's symptoms and the absence of acute inflammatory signs or fever make bacterial arthritis less likely. *Osteoarthritis* - While **osteoarthritis** can cause shoulder pain and stiffness, it usually presents with **pain that worsens with activity** and is relieved by rest, often with **crepitus** and a more gradual loss of range of motion. - The pronounced restriction in **overhead abduction** in this patient, particularly given the diabetic history, points away from primary osteoarthritis as the most likely cause. *Rotator cuff tear* - A **rotator cuff tear** typically presents with pain and weakness, especially during **abduction** or **external rotation**, and may have a specific mechanism of injury. - While abduction can be difficult, the classic presentation of a frozen shoulder with severe, global restriction of both active and passive range of motion is a stronger fit for the described symptoms.
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