Sports Medicine — MCQs
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Painful arc syndrome is characterized by pain during which movement?
What is the primary pathology in Athletic Pubalgia?
Pain and tenderness over the lateral condyle of the humerus with painful dorsiflexion of the wrist is indicative of which of the following conditions?
What is true regarding Jumper's Knee?
Which test is used to assess for an ACL injury?
Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?
Which of the following statements about the Anterior Cruciate Ligament (ACL) is false?
Which of the following is NOT a feature of patellofemoral stress syndrome?
A footballer sustained a blow on the lateral side of the knee. X-ray showed no bony injuries. On examination, the Drawer tests were negative and McMurray's test was positive. Which structure is most likely injured?
A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?
Sports Medicine Indian Medical PG Practice Questions and MCQs
Question 1: Painful arc syndrome is characterized by pain during which movement?
- A. Initial abduction
- B. Terminal abduction
- C. Mid-range abduction (Correct Answer)
- D. Full range of abduction
Explanation: **Explanation:** **Painful Arc Syndrome** is a clinical sign typically associated with **Subacromial Impingement Syndrome**. It occurs when the structures within the subacromial space (most commonly the Supraspinatus tendon or the subacromial bursa) become compressed between the greater tuberosity of the humerus and the acromion process. 1. **Why Mid-range Abduction is Correct:** During abduction, the subacromial space is at its narrowest between **60° and 120°**. In this range, the inflamed or degenerated tendon is pinched against the acromial arch, eliciting sharp pain. This is the "mid-range" of motion. 2. **Analysis of Incorrect Options:** * **Initial Abduction (0°–15°):** Pain here usually indicates a complete Supraspinatus tear (inability to initiate) or severe tendonitis, but the subacromial space is not yet maximally compromised. * **Terminal Abduction (120°–180°):** Pain at the very end of abduction is characteristic of **Acromioclavicular (AC) joint arthritis**, not impingement. * **Full Range:** Pain throughout the entire range is more suggestive of adhesive capsulitis (Frozen Shoulder) or acute calcific tendonitis rather than a classic "arc." **Clinical Pearls for NEET-PG:** * **Neer’s Test and Hawkins-Kennedy Test:** These are the specific clinical provocative tests used to confirm subacromial impingement. * **The "Critical Zone":** The area of the Supraspinatus tendon roughly 1 cm proximal to its insertion is relatively avascular and is the most common site for pathology in this syndrome. * **Management:** Initial treatment is conservative (NSAIDs, PT, subacromial steroid injection). Surgical decompression (Acromioplasty) is reserved for refractory cases.
Question 2: What is the primary pathology in Athletic Pubalgia?
- A. Abdominal muscle strain (Correct Answer)
- B. Rectus femoris strain
- C. Gluteus medius strain
- D. Hamstring strain
Explanation: **Athletic Pubalgia**, commonly referred to as a "Sports Hernia," is a clinical syndrome characterized by chronic groin pain in athletes. Despite the name, there is no true clinical hernia present. ### **Explanation of the Correct Answer** The primary pathology involves a **strain or weakening of the posterior inguinal wall** and the **rectus abdominis insertion** onto the pubis. * **The Mechanism:** The rectus abdominis and the adductor longus act as antagonists. In high-intensity sports involving sudden changes in direction (soccer, hockey), the strong pull of the adductor muscles against a relatively weaker abdominal wall leads to micro-tears in the **rectus abdominis fascia** or the **external oblique aponeurosis**. This imbalance causes instability at the pubic symphysis. ### **Why Other Options are Incorrect** * **B. Rectus femoris strain:** This typically presents with anterior thigh pain and tenderness at the Anterior Inferior Iliac Spine (AIIS), often following explosive kicking or sprinting. * **C. Gluteus medius strain:** This causes lateral hip pain and weakness in abduction (Trendelenburg gait), not groin pain. * **D. Hamstring strain:** This involves the posterior compartment of the thigh, usually presenting with pain at the ischial tuberosity or the mid-muscle belly. ### **High-Yield Clinical Pearls for NEET-PG** * **Clinical Presentation:** Insidious onset of exercise-induced groin pain that radiates to the adductor region or testicles; pain is aggravated by Valsalva maneuvers or resisted sit-ups. * **Investigation of Choice:** **MRI** is the gold standard to visualize "cleft signs" or edema at the rectus abdominis-adductor longus attachment. * **Management:** Initial treatment is conservative (rest and PT). Surgery (pelvic floor repair or adductor tenotomy) is reserved for refractory cases. * **Differential Diagnosis:** Must be distinguished from **Osteitis Pubis**, which shows characteristic bony erosions and sclerosis on X-ray.
Question 3: Pain and tenderness over the lateral condyle of the humerus with painful dorsiflexion of the wrist is indicative of which of the following conditions?
- A. Golfer's Elbow
- B. Tennis Elbow (Correct Answer)
- C. Pitcher's Elbow
- D. Cricket Elbow
Explanation: **Explanation:** The clinical presentation described is a classic case of **Tennis Elbow**, also known as **Lateral Epicondylitis**. **1. Why Tennis Elbow is Correct:** Tennis elbow is a clinical condition characterized by pain and tenderness over the **lateral epicondyle** of the humerus. It is caused by repetitive strain and microtrauma at the common extensor origin, primarily involving the **Extensor Carpi Radialis Brevis (ECRB)** muscle. Since the ECRB is a primary wrist extensor, **resisted dorsiflexion (extension)** of the wrist exacerbates the pain, as it puts tension on the inflamed tendon origin. **2. Why Other Options are Incorrect:** * **Golfer’s Elbow (Medial Epicondylitis):** This involves the common flexor origin. Pain and tenderness are located over the **medial epicondyle**, and symptoms are aggravated by resisted **palmar flexion** of the wrist. * **Pitcher’s Elbow:** This refers to medial epicondyle apophysitis or ulnar collateral ligament (UCL) injury, typically seen in adolescent baseball players due to extreme valgus stress during throwing. * **Cricket Elbow:** This is a non-specific term but often refers to injuries like olecranon bursitis or posterior impingement due to repetitive bowling actions. **3. NEET-PG High-Yield Pearls:** * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Cozen’s Test:** Pain on resisted wrist extension with the elbow flexed (Diagnostic for Tennis Elbow). * **Mill’s Test:** Pain on passive wrist flexion and forearm pronation with the elbow extended. * **Maudsley’s Test:** Pain on resisted extension of the middle finger (due to ECRB tension). * **Treatment:** Conservative management (Rest, NSAIDs, bracing) is the first line. Refractory cases may require corticosteroid or PRP injections, or surgical release (Nirschl procedure).
Question 4: What is true regarding Jumper's Knee?
- A. Apophysitis of the patellar tendon as it inserts into the patella. (Correct Answer)
- B. Apophysitis of the patellar tendon as it inserts into the tibia.
- C. Apophysitis of the quadriceps tendon as it inserts into the patella.
- D. Apophysitis of the hamstring tendon as it inserts into the tibia.
Explanation: **Explanation:** **Jumper’s Knee**, also known as **Sinding-Larsen-Johansson (SLJ) syndrome** in the pediatric population, is a traction-related overuse injury. It is characterized by **apophysitis** (inflammation of the growth plate) or tendinopathy at the **inferior pole of the patella**, where the patellar tendon originates. This occurs due to repetitive stress from jumping and running, leading to microtrauma at the bone-tendon interface. **Analysis of Options:** * **Option A (Correct):** Jumper’s knee specifically involves the proximal attachment of the patellar tendon at the inferior pole of the patella. * **Option B (Incorrect):** Apophysitis at the insertion of the patellar tendon into the **tibial tuberosity** is known as **Osgood-Schlatter Disease**. This is the most common cause of knee pain in active adolescents. * **Option C (Incorrect):** Inflammation at the quadriceps tendon insertion (superior pole of the patella) is less common and is typically referred to as Quadriceps Tendinitis. * **Option D (Incorrect):** Hamstring insertions (like the Pes Anserinus) are located medially or posteriorly on the tibia; inflammation here is termed Pes Anserine Bursitis, not Jumper's Knee. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Point tenderness at the inferior pole of the patella, exacerbated by resisted knee extension. * **Radiology:** X-rays may show calcification or fragmentation at the inferior pole of the patella in chronic cases (SLJ syndrome). * **Management:** Primarily conservative, involving rest, ice, activity modification, and eccentric strengthening of the quadriceps. * **Differential:** Always differentiate from Osgood-Schlatter (tibial tuberosity) and Patellar Tendonitis (adult version without apophysitis).
Question 5: Which test is used to assess for an ACL injury?
- A. Lachman test (Correct Answer)
- B. Bryant's test
- C. Jobe's test
- D. Hamilton's test
Explanation: **Explanation:** The **Lachman test** is considered the most sensitive and reliable clinical test for diagnosing an acute **Anterior Cruciate Ligament (ACL)** injury. It is performed with the knee in 20–30° of flexion. The examiner stabilizes the femur with one hand and applies an anterior force to the proximal tibia with the other. A positive result is indicated by increased anterior translation of the tibia or a "soft/mushy" end-point compared to the unaffected side. **Analysis of Incorrect Options:** * **Bryant's test:** Used in the assessment of **Developmental Dysplasia of the Hip (DDH)**. It involves measuring the vertical distance between the anterior superior iliac spine (ASIS) and the greater trochanter (Bryant’s triangle). * **Jobe’s test (Empty Can test):** Used to evaluate the **Supraspinatus muscle/tendon** (Rotator cuff). Pain or weakness when resisting downward pressure with the arms abducted and internally rotated suggests a tear or impingement. * **Hamilton’s test (Ruler test):** Used to diagnose **Shoulder Dislocation**. In a normal shoulder, a straight edge cannot touch the acromion and the lateral epicondyle of the humerus simultaneously; in dislocation, it can. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Clinical Test for ACL:** Lachman Test (Sensitivity ~95%). * **Pivot Shift Test:** Most specific test for ACL deficiency, indicating anterolateral rotatory instability. * **Anterior Drawer Test:** Less sensitive than Lachman in acute cases due to protective hamstring spasms and "meniscal wedge" effect. * **Segond Fracture:** An avulsion fracture of the lateral tibial plateau; it is pathognomonic for an ACL tear.
Question 6: Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?
- A. Patellar tendon (Correct Answer)
- B. Palmaris longus tendon
- C. Plantaris tendon
- D. None of the above
Explanation: **Explanation:** The **Patellar tendon** (specifically the central third Bone-Patellar Tendon-Bone or BPTB graft) is considered the "gold standard" for ACL reconstruction. 1. **Why it is correct:** The BPTB graft involves taking the middle third of the patellar tendon along with small bone plugs from the patella and the tibial tuberosity. This allows for **bone-to-bone healing** within the femoral and tibial tunnels, which is faster and stronger (occurring in about 6 weeks) compared to soft tissue-to-bone healing. It provides excellent structural stability and allows for aggressive postoperative rehabilitation. 2. **Why other options are incorrect:** * **Palmaris longus:** This is a weak, vestigial tendon in the forearm. While commonly used for hand surgery (tendon transfers) or medial collateral ligament (MCL) reconstruction of the elbow, it lacks the tensile strength required to replace the ACL. * **Plantaris tendon:** This is a small, thin tendon in the posterior leg. It is often used as a graft for small joint reconstructions or hand surgery but is insufficient for the biomechanical demands of the knee. **High-Yield Clinical Pearls for NEET-PG:** * **Common Grafts:** Apart from the Patellar tendon, the **Hamstring tendon** (Semitendinosus and Gracilis) is the other most common choice. * **Complication:** The most common complication of using a Patellar tendon graft is **anterior knee pain** and pain while kneeling. * **Lachman Test:** This is the most sensitive clinical test for diagnosing an acute ACL tear. * **Pivot Shift Test:** This is the most specific test for ACL insufficiency. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.
Question 7: Which of the following statements about the Anterior Cruciate Ligament (ACL) is false?
- A. It prevents posterior motion of the femur relative to the tibia. (Correct Answer)
- B. It prevents anterior motion of the tibia relative to the femur.
- C. It provides some secondary varus-valgus stability.
- D. It is taut in extension of the knee.
Explanation: ### Explanation The **Anterior Cruciate Ligament (ACL)** is a critical intra-articular stabilizer of the knee. Understanding its biomechanics is essential for diagnosing ligamentous injuries. **1. Why Option A is the Correct Answer (The False Statement):** The primary function of the ACL is to prevent **anterior translation of the tibia** relative to the femur. While this is biomechanically equivalent to preventing **posterior motion of the femur** relative to the tibia, the option as phrased in many standard textbooks and exams describes the **Posterior Cruciate Ligament (PCL)** function when discussing femoral displacement. In the context of the ACL, the standard definition focuses on its role in limiting anterior tibial excursion. (Note: In some mechanical interpretations, A and B are mirrors; however, in medical examinations, the ACL is strictly defined by its resistance to anterior tibial translation). **2. Analysis of Other Options:** * **Option B:** This is the **primary function** of the ACL. It acts as the main restraint against anterior tibial displacement. * **Option C:** While its primary role is sagittal stability, the ACL acts as a **secondary stabilizer** against varus and valgus stresses, especially when the collateral ligaments are compromised. * **Option D:** The ACL consists of two bundles (anteromedial and posterolateral). The **posterolateral bundle** becomes particularly taut in **extension**, providing maximum stability in this position. **3. High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** Primarily from the **Middle Genicular Artery**. * **Nerve Supply:** Posterior articular nerve (branch of the Tibial nerve). * **Mechanism of Injury:** Non-contact pivoting injury or sudden deceleration. * **Clinical Tests:** **Lachman Test** (most sensitive), Anterior Drawer Test, and Pivot Shift Test (most specific). * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.
Question 8: Which of the following is NOT a feature of patellofemoral stress syndrome?
- A. Giving way and then falling (Correct Answer)
- B. Chronic anterior knee pain
- C. Worsening of pain with prolonged standing
- D. Worsening of pain on going upstairs
Explanation: **Explanation:** **Patellofemoral Stress Syndrome (PFSS)**, commonly known as "Runner’s Knee," is a clinical syndrome characterized by diffuse anterior knee pain caused by abnormal tracking of the patella within the femoral trochlear groove. **Why "Giving way and then falling" is the correct answer:** While "giving way" (instability) is a frequent subjective complaint in PFSS due to reflex inhibition of the quadriceps muscle triggered by pain, it **rarely leads to an actual fall**. True instability resulting in a fall is more characteristic of **patellar dislocation/subluxation** or a **ligamentous injury** (like an ACL tear). In PFSS, the "giving way" is a pseudo-instability rather than a structural failure. **Analysis of Incorrect Options:** * **Chronic anterior knee pain:** This is the hallmark symptom of PFSS. The pain is typically insidious, peripatellar or retropatellar, and exacerbated by activities that increase patellofemoral compressive forces. * **Worsening of pain with prolonged standing/sitting:** Also known as the **"Movie Theater Sign,"** pain occurs during prolonged knee flexion (sitting) or static loading (standing) as these positions maintain high pressure on the patellar articular surface. * **Worsening of pain on going upstairs:** Ascending or descending stairs significantly increases the joint reaction forces (up to 3–5 times body weight) at the patellofemoral joint, making this a classic provocative activity. **High-Yield Clinical Pearls for NEET-PG:** * **Q-Angle:** An increased Q-angle (normal: 13° in men, 18° in women) is a common predisposing factor for lateral patellar tracking. * **J-Sign:** Lateral deviation of the patella during the final stages of knee extension. * **Treatment:** Primarily conservative, focusing on **Vastus Medialis Obliquus (VMO) strengthening** and stretching of the lateral retinaculum and hamstrings.
Question 9: A footballer sustained a blow on the lateral side of the knee. X-ray showed no bony injuries. On examination, the Drawer tests were negative and McMurray's test was positive. Which structure is most likely injured?
- A. Anterior cruciate ligament
- B. Lateral collateral ligament
- C. Lateral meniscus (Correct Answer)
- D. Posterior cruciate ligament
Explanation: ### Explanation The correct answer is **Lateral meniscus**. **1. Why the Correct Answer is Right:** The diagnosis is based on the clinical examination findings. **McMurray’s test** is a specific provocative maneuver used to identify meniscal tears. A positive result (a palpable or audible click/clunk) indicates a tear of either the medial or lateral meniscus. In this scenario, a blow to the **lateral side** of the knee (valgus stress) often compresses the lateral compartment, leading to a lateral meniscus injury. Since the Drawer tests are negative, a ligamentous rupture is unlikely, pointing directly to the meniscus. **2. Why the Incorrect Options are Wrong:** * **Anterior Cruciate Ligament (ACL):** Injury to the ACL would result in a positive **Anterior Drawer test** or Lachman test. * **Posterior Cruciate Ligament (PCL):** Injury to the PCL would result in a positive **Posterior Drawer test** or Posterior Sag sign. * **Lateral Collateral Ligament (LCL):** An LCL injury is typically caused by a blow to the *medial* side of the knee (varus stress). It is assessed using the **Varus Stress Test**, not McMurray’s. **3. Clinical Pearls for NEET-PG:** * **McMurray’s Test:** Internal rotation of the tibia tests the **Lateral Meniscus**; External rotation tests the **Medial Meniscus**. * **O’Donoghue’s Triad (Unhappy Triad):** Involves injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest Lateral Meniscus is more common in acute ACL tears). * **Gold Standard Investigation:** MRI is the investigation of choice for soft tissue injuries of the knee, but **Diagnostic Arthroscopy** remains the "Gold Standard." * **Lachman Test:** The most sensitive clinical test for an acute ACL tear.
Question 10: A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?
- A. Avulsion of tibial tubercle
- B. Meniscal tear (Correct Answer)
- C. Tearing of lateral collateral ligament
- D. Tear of anterior cruciate ligament
Explanation: **Explanation:** The clinical presentation of a **twisting injury** followed by **locking** of the knee is a classic hallmark of a **Meniscal Tear**. 1. **Why Meniscal Tear is correct:** The menisci are C-shaped fibrocartilage structures that act as shock absorbers. A rotational (twisting) force on a weight-bearing, flexed knee can cause a tear. "True locking" occurs when a detached fragment (commonly a **bucket-handle tear**) gets displaced into the joint space, mechanically obstructing full extension. This is the most specific diagnostic sign for meniscal pathology. 2. **Why other options are incorrect:** * **Avulsion of tibial tubercle:** Typically seen in adolescents (Osgood-Schlatter disease or acute trauma). It presents with localized pain and swelling over the tubercle, not joint locking. * **Lateral Collateral Ligament (LCL) tear:** Caused by a varus stress. It presents with lateral joint line pain and instability, but not locking. * **Anterior Cruciate Ligament (ACL) tear:** Usually presents with a "pop" sound, immediate profuse swelling (hemarthrosis), and a feeling of "giving way" (instability). While an ACL tear can coexist with a meniscal tear, isolated ACL tears do not cause mechanical locking. **High-Yield Clinical Pearls for NEET-PG:** * **McMurray’s Test:** The most specific clinical test for meniscal tears. * **Apley’s Grinding Test:** Positive for meniscal tears; **Apley’s Distraction Test** helps differentiate ligamentous from meniscal injuries. * **Triad of O'Donoghue:** Injury involving the ACL, MCL, and Medial Meniscus. * **Investigation of Choice:** MRI is the gold standard for diagnosis. * **Management:** Peripheral tears (vascular zone) may be repaired; central tears (avascular zone) often require partial meniscectomy.
Practice by Chapter
Sports Injuries: Epidemiology and Prevention
Practice Questions
Knee Ligament Injuries
Practice Questions
Meniscal Injuries
Practice Questions
Shoulder Instability
Practice Questions
Rotator Cuff Pathology
Practice Questions
Tendinopathies
Practice Questions
Muscle Strains and Contusions
Practice Questions
Ankle Sprains and Instability
Practice Questions
Overuse Injuries
Practice Questions
Return to Play Criteria
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Sports-Specific Conditioning
Practice Questions
Performance Enhancement
Practice Questions
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