Overuse Injuries — MCQs
A 35-year-old tennis player presents with pain on the outer aspect of the elbow that worsens with gripping activities and wrist extension. The pain is localized over the lateral epicondyle. This condition most likely involves:
The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?
Ruptured tendons are most commonly seen in
Cozen test is positive in :-
An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
Sudden dorsiflexion of the foot may lead to which of the following injuries?
Which muscle is tested using the empty can test in shoulder injuries?
Most common cause of insertional tendonitis of Achilles tendon is -
Tennis elbow is -
A young athlete complains of pain in the groin and weakness in the hip following a sports injury. An MRI shows a tear in which muscle that is commonly associated with groin injuries?
Overuse Injuries Indian Medical PG Practice Questions and MCQs
Question 1: A 35-year-old tennis player presents with pain on the outer aspect of the elbow that worsens with gripping activities and wrist extension. The pain is localized over the lateral epicondyle. This condition most likely involves:
- A. Inflammation of the flexor tendons at the medial epicondyle of the humerus
- B. Inflammation of the biceps tendon at the shoulder
- C. Inflammation of the triceps tendon at the elbow
- D. Inflammation of the extensor tendons at the lateral epicondyle of the humerus (Correct Answer)
Explanation: ***Inflammation of the extensor tendons at the lateral epicondyle of the humerus*** - Pain on the **outer aspect of the elbow** that worsens with gripping and wrist extension is characteristic of **lateral epicondylitis**, also known as **tennis elbow**. - This condition involves inflammation and degeneration of the common **extensor tendons** originating from the **lateral epicondyle**, particularly the **extensor carpi radialis brevis**. *Inflammation of the flexor tendons at the medial epicondyle of the humerus* - This describes **medial epicondylitis**, or **golfer's elbow**, which causes pain on the **inner aspect of the elbow**. - It involves the **flexor-pronator mass tendons** and is aggravated by wrist flexion and forearm pronation, not wrist extension. *Inflammation of the biceps tendon at the shoulder* - **Bicipital tendonitis** presents with pain in the **anterior shoulder**, often radiating down the arm, and is typically exacerbated by lifting or overhead activities. - The pain is localized to the shoulder region and is not associated with wrist movements or elbow epicondyles. *Inflammation of the triceps tendon at the elbow* - **Triceps tendonitis** causes pain at the **posterior aspect of the elbow**, primarily with activities involving elbow extension against resistance. - While it affects the elbow, its location and aggravating factors differ from the described lateral elbow pain with gripping and wrist extension.
Question 2: The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?
- A. APB & EPL
- B. APL & EPB (Correct Answer)
- C. APB & EPB
- D. APL & EPL
Explanation: ***APL & EPB*** - Pain around the base of the thumb, especially with movement, is characteristic of De Quervain's tenosynovitis [1]. This condition involves the **abductor pollicis longus (APL)** and **extensor pollicis brevis (EPB)** tendons [1]. - These two tendons share a common synovial sheath as they pass through the first dorsal compartment of the wrist, making them susceptible to inflammation and friction [1]. *APB & EPL* - **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle found in the thenar eminence, primarily involved in thumb abduction, and is not typically associated with De Quervain's tenosynovitis. - **EPL (Extensor Pollicis Longus)** is part of the third dorsal compartment and its tendon crosses over the other thumb tendons, and is not inflamed in De Quervain's tenosynovitis. *APB & EPB* - As mentioned, **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle, not involved in De Quervain's tenosynovitis. - While **EPB (Extensor Pollicis Brevis)** is involved, its combination with APB incorrectly identifies the primary tendons affected in the first dorsal compartment. *APL & EPL* - **APL (Abductor Pollicis Longus)** is one of the correct tendons involved. - **EPL (Extensor Pollicis Longus)** belongs to the third dorsal compartment of the wrist and is not typically affected in De Quervain's tenosynovitis, differentiating it from the tendons in the first dorsal compartment [1].
Question 3: 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 4: Cozen test is positive in :-
- A. Tennis elbow (Correct Answer)
- B. Skiers thumb
- C. Golfer's elbow
- D. Pulled elbow
Explanation: ***Tennis elbow*** - The **Cozen test** is a specific diagnostic maneuver used to assess for **lateral epicondylitis**, commonly known as tennis elbow. - A positive test indicates pain over the **lateral epicondyle** with resisted wrist extension, confirming inflammation or degeneration of the common extensor tendons. *Skiers thumb* - This condition involves injury to the **ulnar collateral ligament of the thumb**, typically due to hyperextension and abduction forces. - The Cozen test is **irrelevant** for diagnosing thumb ligament injuries. *Golfer's elbow* - Also known as **medial epicondylitis**, this involves inflammation of the **flexor-pronator tendons** at the medial epicondyle. - The Cozen test specifically evaluates the extensor tendons, and a comparable test for golfer's elbow would involve resisted wrist flexion. *Pulled elbow* - This refers to **radial head subluxation**, a common injury in children where the radius slips out of the annular ligament. - It is an injury related to joint displacement, not tendon pathology, and therefore the Cozen test is not applicable.
Question 5: An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
- A. Clinical examination
- B. Arthroscopy (Correct Answer)
- C. Arthrotomy
- D. X-ray
Explanation: ***Arthroscopy*** - **Arthroscopy** is the definitive investigation for **cartilage damage** as it allows for direct visualization of the knee joint's internal structures. - It not only confirms the diagnosis but can also facilitate simultaneous **repair or débridement** of damaged cartilage. *X-ray* - **X-rays** are primarily used to assess **bone structures** and detect fractures or significant joint space narrowing, not soft tissue injuries like cartilage. - They are generally **insufficient** for diagnosing subtle or early cartilage damage. *Clinical examination* - A **clinical examination** is crucial for initial assessment and suspicion of cartilage injury, but it cannot definitively diagnose the extent or type of cartilage damage. - It helps guide further investigations but is **not specific enough** to confirm cartilage integrity. *Arthrotomy* - **Arthrotomy** involves a larger incision to open the joint, which is more **invasive** than arthroscopy and typically reserved for open surgical repairs or complex reconstructions, not as a primary diagnostic tool for cartilage. - It carries a **higher risk of complications**, such as infection and prolonged recovery, compared to arthroscopy.
Question 6: Sudden dorsiflexion of the foot may lead to which of the following injuries?
- A. Anterior talofibular ligament injury
- B. Tendo Achilles avulsion injury (Correct Answer)
- C. Rupture of deltoid ligament
- D. Tarsal tunnel syndrome
Explanation: ***Tendo Achilles avulsion injury*** - **Sudden dorsiflexion** of the foot, especially if forced or excessive, can cause extreme stretch on the **Achilles tendon**, potentially leading to its avulsion or rupture. - This mechanism often occurs during activities requiring a forceful push-off or landing with the foot in dorsiflexion, placing significant tensile stress on the tendon. *Anterior talofibular ligament injury* - This injury typically results from an **inversion sprain** of the ankle, where the foot is forcefully turned inward, causing damage to the lateral ankle ligaments. - **Dorsiflexion** alone is not the primary mechanism for injury to the **anterior talofibular ligament**. *Rupture of deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and is most commonly injured with an **eversion sprain**, where the foot rolls outward. - While extreme dorsiflexion can put some strain on anterior fibers, it is not the primary mechanism, and a concomitant eversion force would likely be required for rupture. *Tarsal tunnel syndrome* - This condition involves **compression of the tibial nerve** as it passes through the tarsal tunnel, typically causing pain, numbness, and tingling in the sole of the foot. - It is often caused by chronic factors such as swelling, repetitive stress, or structural abnormalities, rather than an acute traumatic event like sudden dorsiflexion.
Question 7: Which muscle is tested using the empty can test in shoulder injuries?
- A. Infraspinatus
- B. Supraspinatus (Correct Answer)
- C. Subscapularis
- D. Biceps brachii
Explanation: **Supraspinatus** - The **empty can test** (also known as the Jobe test) specifically assesses the integrity and strength of the **supraspinatus muscle** and tendon. - The test involves abducting the arm to 90 degrees, internally rotating it ("empty can" position), and then asking the patient to resist a downward force, which elicits pain or weakness if the supraspinatus is injured. *Infraspinatus* - The **infraspinatus muscle** is primarily responsible for external rotation of the shoulder. - It is typically tested with specific **external rotation resistance tests**, not the empty can test. *Subscapularis* - The **subscapularis muscle** is the primary internal rotator of the shoulder. - It is evaluated using specific tests like the **Gerber Lift-off test** or the **belly-press test**. *Biceps brachii* - The **biceps brachii** muscle is involved in shoulder flexion and elbow flexion and supination. - Its integrity is assessed with tests like **Speed's test** or **Yergason's test**, which evaluate the long head of the biceps tendon.
Question 8: Most common cause of insertional tendonitis of Achilles tendon is -
- A. Improper shoe wear
- B. Overuse (Correct Answer)
- C. Infections from the ankle joint
- D. Steroid injections
Explanation: ***Overuse*** - **Repetitive strain** on the Achilles tendon, often from activities like running or jumping, is the most common etiology for **insertional Achilles tendonitis**. - **Microtrauma** from excessive loading leads to inflammation and degeneration at the tendon's insertion point on the calcaneus. *Improper shoe wear* - While **inappropriate footwear** can contribute to Achilles tendonitis by altering foot mechanics or providing inadequate support, it is less frequently the primary cause compared to overwhelming **overuse**. - It often exacerbates existing issues or contributes to the development of tendonitis in conjunction with high-impact activities. *Infections from the ankle joint* - **Infections** of the ankle joint (septic arthritis) are a rare cause of localized Achilles tendonitis and would present with systemic signs of infection and severe joint involvement. - Tendonitis from infection is specifically known as **infectious tenosynovitis**, and usually involves adjacent structures, not typically causing isolated insertional tendonitis of the Achilles tendon directly. *Steroid injections* - **Steroid injections** near the Achilles tendon are generally *avoided* due to the risk of **tendon rupture**, not because they are a common cause of insertional tendonitis. - While they can have adverse effects, they are not typically a primary initiating factor for the condition itself.
Question 9: Tennis elbow is -
- A. Lateral Epicondylitis (Correct Answer)
- B. Radial head subluxation
- C. Ulnar collateral ligament injury
- D. Medial Epicondylitis
Explanation: ***Lateral Epicondylitis*** - **Tennis elbow** is the common term for **lateral epicondylitis**, an overuse injury causing pain on the **outer side of the elbow**. - It is typically caused by repetitive wrist extension and supination movements, leading to **tendinopathy** of the **extensor carpi radialis brevis** muscle origin. *Radial head subluxation* - This condition, commonly known as **nursemaid's elbow**, involves the displacement of the **radial head** from the annular ligament. - It is usually caused by a sudden pull on an outstretched arm, typically in young children, and presents with immediate pain and refusal to move the arm. *Ulnar collateral ligament injury* - An injury to the **ulnar collateral ligament (UCL)**, often seen in overhead throwing athletes, is sometimes called **"Tommy John injury"**. - It involves damage to the ligament on the **inner side of the elbow** and can lead to instability and pain during throwing motions. *Medial Epicondylitis* - This condition, known as **golfer's elbow**, involves pain on the **inner side of the elbow**. - It is caused by overuse of the forearm flexor muscles that originate from the **medial epicondyle**, due to repetitive wrist flexion and pronation.
Question 10: A young athlete complains of pain in the groin and weakness in the hip following a sports injury. An MRI shows a tear in which muscle that is commonly associated with groin injuries?
- A. Adductor longus (Correct Answer)
- B. Iliopsoas
- C. Rectus femoris
- D. Gluteus medius
Explanation: ***Adductor longus*** - The **adductor longus** is a primary **groin muscle** involved in hip adduction and commonly injured during sports activities requiring sudden changes in direction or kicking. - A tear in this muscle is a frequent cause of **groin pain** and weakness in athletes. *Iliopsoas* - The **iliopsoas** is a powerful hip flexor, and while injuries can cause pain in the groin region, a tear typically manifests as weakness in **hip flexion**, not primarily adduction. - Pain from an iliopsoas injury is often felt deeper in the groin or hip, sometimes radiating down the thigh. *Rectus femoris* - The **rectus femoris** is one of the quadriceps muscles that crosses both the hip and knee joints; tears cause pain and weakness in **hip flexion** and **knee extension**. - Injuries are more common with activities involving sprinting or kicking, but the primary pain location is usually more anterior thigh rather than deep groin. *Gluteus medius* - The **gluteus medius** is a primary hip abductor and stabilizer; injuries typically cause pain on the **lateral aspect of the hip** or buttock, not the groin. - Weakness in this muscle would primarily affect hip abduction and stability during weight-bearing.
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