Sports Medicine Practice Questions

Q: Which ligament injury is shown?

Anterior cruciate ligament. ***Anterior cruciate ligament*** - The **Anterior Cruciate Ligament (ACL)** is the most commonly injured ligament in the knee, often occurring in sports involving sudden **deceleration**, **pivoting**, or **cutting maneuvers**. - Physical examination typically reveals a positive **Anterior Drawer Test** or **Lachman test**, indicating increased anterior translation of the tibia relative to the femur. *Posterior cruciate ligament* - The **Posterior Cruciate Ligament (PCL)** is injured by a high-energy **posteriorly directed force** against the proximal tibia while the knee is flexed, commonly known as a **'dashboard injury'**. - Physical examination reveals a positive **Posterior Drawer Test**, which tests for posterior tibial sag or displacement. *Medial cruciate ligament* - The **Medial Collateral Ligament (MCL)** injury typically results from a **valgus stress** on the knee, affecting the stability of the medial compartment. - Clinical assessment involves a positive **valgus stress test**, where the knee is stressed into abduction, demonstrating laxity on the medial side. *Lateral cruciate ligament* - The **Lateral Collateral Ligament (LCL)**, also known as the fibular collateral ligament, is injured by a **varus stress** force applied to the knee. - Injury is less common than MCL or ACL tears and is assessed via a **varus stress test**, revealing laxity when the knee is stressed into adduction.

Q: In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Lachman's test. **Explanation:** The **Lachman’s test** is the most sensitive clinical test for diagnosing an acute Anterior Cruciate Ligament (ACL) injury. In the acute phase, knee injuries are often accompanied by significant swelling (hemarthrosis) and protective muscle spasms (hamstring guarding). * **Why Lachman’s is the correct answer:** The test is performed at **20–30° of flexion**. At this angle, the bony geometry of the femoral condyles does not stabilize the tibia, and the hamstrings are relatively relaxed, minimizing the effect of muscle spasms. This allows for the detection of even subtle anterior translation and the assessment of the "endpoint" (firm vs. soft). * **Why other options are incorrect:** * **Anterior Drawer Test:** Performed at 90° of flexion. In acute injuries, the hamstrings go into spasm at this angle, preventing anterior translation and leading to high false-negative rates. Additionally, the posterior horn of the medial meniscus can "wedge" against the femoral condyle, blocking movement. * **Pivot Shift Test:** While it is the most **specific** test for ACL insufficiency (indicating rotatory instability), it is very difficult to perform in an acute setting because it is painful and requires complete muscle relaxation. It is often only reliable under anesthesia. * **Apley’s Grinding Test:** This test is used to evaluate **meniscal injuries**, not ligamentous laxity. **Clinical Pearls for NEET-PG:** * **Most Sensitive Test (Overall & Acute):** Lachman’s Test. * **Most Specific Test:** Pivot Shift Test. * **Gold Standard Investigation:** MRI Knee. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

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: McMurray's test is a useful clinical test to assess injury to which structure?

Meniscus. **Explanation:** **McMurray’s Test** is a classic clinical maneuver used to diagnose tears in the **menisci** (fibrocartilaginous structures) of the knee. The test works by trapping a torn meniscal fragment between the femoral condyles and the tibial plateau. When the knee is rotated and extended, the displaced fragment causes a palpable or audible **"thud" or "click,"** often accompanied by pain. * **Medial Meniscus:** Tested by externally rotating the foot and applying valgus stress while extending the knee. * **Lateral Meniscus:** Tested by internally rotating the foot and applying varus stress while extending the knee. **Why other options are incorrect:** * **Collateral Ligaments (A & B):** These are assessed using the **Valgus Stress Test** (for Medial Collateral Ligament) and **Varus Stress Test** (for Lateral Collateral Ligament) at 0° and 30° of knee flexion. * **Cruciate Ligaments (D):** The Anterior Cruciate Ligament (ACL) is assessed via the **Lachman test** (most sensitive), Anterior Drawer test, and Pivot Shift test. The Posterior Cruciate Ligament (PCL) is assessed via the **Posterior Drawer test** and the Sag sign. **High-Yield Clinical Pearls for NEET-PG:** 1. **Apley’s Grinding Test:** Another specific test for meniscal injuries (Distraction helps differentiate ligamentous from meniscal pain). 2. **Thessaly Test:** Performed by having the patient stand on one leg and rotate; it is considered more sensitive than McMurray’s in some clinical settings. 3. **Triad of O'Donoghue:** Includes injury to the ACL, MCL, and Medial Meniscus. 4. **Gold Standard Diagnosis:** While McMurray’s is a high-yield clinical test, **MRI** is the investigation of choice for meniscal tears.

Q: Which of the following bones is not typically involved in a stress fracture?

Metacarpals. **Explanation:** Stress fractures occur due to repetitive submaximal loading on a bone, where the rate of bone resorption by osteoclasts exceeds the rate of bone formation by osteoblasts. This typically occurs in **weight-bearing bones** of the lower limb. **Why Metacarpals are the correct answer:** Metacarpals are non-weight-bearing bones. While they can sustain traumatic fractures (e.g., Boxer’s fracture), they are rarely subjected to the repetitive, rhythmic loading required to cause a stress fracture. Stress fractures in the upper limb are rare and usually limited to specific athletes (e.g., olecranon in throwers or ribs in rowers). **Analysis of Incorrect Options:** * **Metatarsals:** The **2nd and 3rd metatarsals** are the most common sites for stress fractures (known as **March Fractures**), frequently seen in military recruits and long-distance runners. * **Tibia:** The tibia is the **most common overall site** for stress fractures in athletes, typically occurring at the junction of the middle and distal thirds. * **Calcaneus:** This is a common site for stress fractures in military trainees and runners, often presenting as heel pain that is reproducible by medial-lateral compression of the calcaneal body (Squeeze test). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** **MRI** is the most sensitive and specific investigation (shows marrow edema). * **X-ray finding:** Often negative in the first 2–3 weeks; later shows a "dreaded black line" or periosteal reaction/callus. * **Female Athlete Triad:** Amenorrhea, disordered eating, and osteoporosis significantly increase the risk of stress fractures. * **Commonest site:** Tibia. * **Commonest tarsal bone:** Navicular.

Q: A patient sustained a left knee injury in a road traffic accident, and the Dial test was positive. What is the most likely cause?

Posterolateral Corner Injury. **Explanation:** The **Dial Test** (also known as the Tibial External Rotation Test) is the clinical gold standard for diagnosing injuries to the **Posterolateral Corner (PLC)** of the knee. **1. Why Option B is Correct:** The PLC consists of the popliteus tendon, fibular (lateral) collateral ligament, and popliteofibular ligament. These structures primarily resist **external rotation** of the tibia. During the Dial Test, the patient is prone, and the clinician externally rotates the feet. * An increase in external rotation of **>10°** compared to the normal side at **30° of knee flexion** indicates an isolated **PLC injury**. * If the instability persists or increases at **90° of flexion**, it suggests a combined injury of the PLC and the **Posterior Cruciate Ligament (PCL)**. **2. Why Other Options are Incorrect:** * **Option A (MCL):** Evaluated using the Valgus Stress Test. MCL injuries cause medial joint line opening, not isolated rotational instability. * **Options C & D (Meniscal Tears):** Diagnosed via McMurray’s test, Apley’s Grind test, or Thessaly test. While meniscal tears cause clicking or locking, they do not result in the specific rotational laxity seen in a positive Dial test. **Clinical Pearls for NEET-PG:** * **Components of PLC:** Popliteus muscle/tendon, LCL, and Popliteofibular ligament (The "Unholy Trio" of the lateral side). * **Common Nerve Injury:** PLC injuries are frequently associated with **Peroneal Nerve (Common Fibular Nerve)** palsy, leading to foot drop. * **Gait Sign:** Patients with chronic PLC deficiency often exhibit a **varus thrust gait**.

Q: A tennis player presented with pain and tenderness at the lateral epicondyle of the humerus. These findings are consistent with which diagnosis?

Tennis elbow. ### Explanation **Correct Option: A. Tennis Elbow** Tennis elbow, or **Lateral Epicondylitis**, is a clinical condition characterized by pain and tenderness over the lateral epicondyle of the humerus. It is caused by repetitive stress and microtrauma to the common extensor origin, specifically involving the **Extensor Carpi Radialis Brevis (ECRB)** muscle. Despite the name, it is more common in non-athletes performing repetitive gripping or wrist extension tasks. Pain is typically exacerbated by resisted wrist extension and supination. **Incorrect Options:** * **B. Golfer’s Elbow:** Also known as **Medial Epicondylitis**, this involves the common flexor origin (primarily Pronator teres and Flexor carpi radialis). Pain is localized to the *medial* epicondyle and is aggravated by resisted wrist flexion. * **C. Fibrositis:** This is an older term for Fibromyalgia. It involves chronic, widespread musculoskeletal pain and specific "tender points" across the body, rather than localized inflammation at a bony epicondyle. * **D. Dupuytren’s Contracture:** This is a progressive fibrosis of the **palmar fascia**, leading to permanent flexion deformities of the fingers (most commonly the ring and little fingers). It does not involve the elbow. **High-Yield Clinical Pearls for NEET-PG:** * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Clinical Tests:** * **Cozen’s Test:** Pain on resisted wrist extension with the elbow flexed. * **Mill’s Test:** Pain on passive wrist flexion and forearm pronation while extending the elbow. * **Management:** Primarily conservative (Rest, NSAIDs, bracing, and eccentric exercises). Refractory cases may require corticosteroid or PRP injections, or surgical release (Nirschl procedure).

Q: Which of the following is a false statement regarding Patellofemoral stress syndrome?

Decreased Q angle. **Explanation:** Patellofemoral Stress Syndrome (PFSS), often referred to as **Chondromalacia Patellae** in its later stages, is a common cause of anterior knee pain caused by abnormal tracking of the patella within the femoral groove. **Why "Decreased Q angle" is the correct (false) statement:** The Q-angle (Quadriceps angle) represents the lateral pull of the quadriceps on the patella. An **increased Q-angle** (normal is ~13° for men and ~18° for women) is a major predisposing factor for PFSS. A high Q-angle causes the patella to track laterally, leading to increased pressure on the lateral facet and subsequent retropatellar pain. Therefore, a *decreased* Q-angle is not associated with this syndrome. **Analysis of other options:** * **Movie sign (Theatre sign):** Patients experience dull, aching pain when sitting with knees flexed for prolonged periods (e.g., in a cinema). This occurs because prolonged flexion increases the contact pressure between the patella and the femur. * **Difficulty in climbing stairs:** Activities that involve eccentric loading of the quadriceps or deep knee flexion (like climbing stairs or squatting) significantly increase patellofemoral joint reaction forces, exacerbating the pain. * **Patellofemoral grinding test (Clarke’s test):** This is a classic physical exam finding where pain is elicited when the patient contracts the quadriceps while the examiner applies downward pressure on the patella. **Clinical Pearls for NEET-PG:** * **Epidemiology:** Most common in young female athletes ("Runner's knee"). * **Management:** Primarily conservative, focusing on **Vastus Medialis Obliquus (VMO) strengthening** and hamstring stretching. * **Radiology:** The **Skyline view** (Laurin or Merchant view) is the best X-ray projection to visualize the patellofemoral joint space.

Question 1

Which ligament injury is shown?

Accepted Answer

Anterior cruciate ligament

Answer

Posterior cruciate ligament

Answer

Medial cruciate ligament

Answer

Lateral cruciate ligament

Question 2

In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Accepted Answer

Lachman's test

Answer

Pivot shift test

Answer

Apley's grinding test

Answer

Anterior drawer test

Question 3

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 4

McMurray's test is a useful clinical test to assess injury to which structure?

Accepted Answer

Meniscus

Answer

Medial collateral ligament

Answer

Lateral collateral ligament

Answer

Cruciate ligament

Question 5

Which of the following bones is not typically involved in a stress fracture?

Accepted Answer

Metacarpals

Answer

Metatarsals

Answer

Tibia

Answer

Calcaneus

Question 6

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 7

A patient sustained a left knee injury in a road traffic accident, and the Dial test was positive. What is the most likely cause?

Accepted Answer

Posterolateral Corner Injury

Answer

Medial Collateral Ligament Injury

Answer

Lateral Meniscus Tear

Answer

Medial Meniscal Injury

Question 8

A 25-year-old male presented with pain and swelling around the right knee, loss of full range of motion, and discomfort while walking for 2 days following a fall while playing football. Examination revealed joint line tenderness. An X-ray of the knee was performed, and a specific physical examination test was conducted (image not provided). This test is used to check the integrity of which ligament of the knee?

Accepted Answer

Lateral collateral ligament

Answer

Anterior cruciate ligament

Answer

Posterior cruciate ligament

Answer

Medial collateral ligament

Question 9

A tennis player presented with pain and tenderness at the lateral epicondyle of the humerus. These findings are consistent with which diagnosis?

Accepted Answer

Tennis elbow

Answer

Golfer's elbow

Answer

Fibrositis

Answer

Dupuytren's contracture

Question 10

Which of the following is a false statement regarding Patellofemoral stress syndrome?

Accepted Answer

Decreased Q angle

Answer

Movie sign positive

Answer

Difficulty in climbing stairs

Answer

Positive Patellofemoral grinding test

Sports Medicine — MCQs

Sports Medicine — MCQs

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