Sports Medicine Practice Questions

Q: Painful arc syndrome is characterized by pain during which movement?

Mid-range abduction. **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.

Q: Pain and tenderness over the lateral condyle of the humerus with painful dorsiflexion of the wrist is indicative of which of the following conditions?

Tennis Elbow. **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).

Q: Which test is used to assess for an ACL injury?

Lachman test. **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.

Q: Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?

Patellar tendon. **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.

Q: Which of the following is NOT a feature of patellofemoral stress syndrome?

Giving way and then falling. **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.

Q: 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?

Lateral meniscus. ### 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.

Q: A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?

Meniscal tear. **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.

Question 1

Painful arc syndrome is characterized by pain during which movement?

Accepted Answer

Mid-range abduction

Answer

Initial abduction

Answer

Terminal abduction

Answer

Full range of abduction

Question 2

What is the primary pathology in Athletic Pubalgia?

Accepted Answer

Abdominal muscle strain

Answer

Rectus femoris strain

Answer

Gluteus medius strain

Answer

Hamstring strain

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?

Accepted Answer

Tennis Elbow

Answer

Golfer's Elbow

Answer

Pitcher's Elbow

Answer

Cricket Elbow

Question 4

What is true regarding Jumper's Knee?

Accepted Answer

Apophysitis of the patellar tendon as it inserts into the patella.

Answer

Apophysitis of the patellar tendon as it inserts into the tibia.

Answer

Apophysitis of the quadriceps tendon as it inserts into the patella.

Answer

Apophysitis of the hamstring tendon as it inserts into the tibia.

Question 5

Which test is used to assess for an ACL injury?

Accepted Answer

Lachman test

Answer

Bryant's test

Answer

Jobe's test

Answer

Hamilton's test

Question 6

Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?

Accepted Answer

Patellar tendon

Answer

Palmaris longus tendon

Answer

Plantaris tendon

Answer

None of the above

Question 7

Which of the following statements about the Anterior Cruciate Ligament (ACL) is false?

Accepted Answer

It prevents posterior motion of the femur relative to the tibia.

Answer

It prevents anterior motion of the tibia relative to the femur.

Answer

It provides some secondary varus-valgus stability.

Answer

It is taut in extension of the knee.

Question 8

Which of the following is NOT a feature of patellofemoral stress syndrome?

Accepted Answer

Giving way and then falling

Answer

Chronic anterior knee pain

Answer

Worsening of pain with prolonged standing

Answer

Worsening of pain on going upstairs

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?

Accepted Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Answer

Posterior cruciate ligament

Question 10

A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?

Accepted Answer

Meniscal tear

Answer

Avulsion of tibial tubercle

Answer

Tearing of lateral collateral ligament

Answer

Tear of anterior cruciate ligament

Sports Medicine — MCQs

Sports Medicine — MCQs

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