Sports Medicine Practice Questions

Q: Best initial treatment for acute calcific tendinitis of shoulder?

NSAIDs and Physical Therapy. ***NSAIDs and Physical Therapy*** - **NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)** are the first-line treatment for acute pain and inflammation associated with calcific tendinitis. - **Physical therapy** helps maintain joint mobility, reduce stiffness, and strengthen surrounding muscles, preventing chronic issues. *Surgical Removal* - **Surgical removal** of calcium deposits is typically reserved for cases that are refractory to conservative treatments after several months or for severe, disabling symptoms. - It is an **invasive procedure** and not the initial approach for acute presentation. *Steroid Injection* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation, but they do not address the underlying calcium deposits. - Repeated injections can have adverse effects on tendon health and are generally considered after **NSAIDs** have failed. *Ultrasound Therapy* - **Ultrasound therapy** may be used as an adjunct treatment to help break down calcium deposits or to reduce inflammation, but it is not typically the sole initial treatment. - Its effectiveness is **variable**, and it is often combined with other modalities like NSAIDs and physical therapy.

Q: 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?

Anterior Cruciate Ligament. ***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.

Q: Which muscle is tested using the empty can test in shoulder injuries?

Supraspinatus. **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.

Q: A 35-year-old athlete has persistent groin pain and a clicking sound during hip movements. MRI reveals labral tears and femoral acetabular impingement. What is the best intervention?

Arthroscopic labral repair. ***Arthroscopic labral repair*** - A 35-year-old athlete with **persistent groin pain**, **clicking during hip movements**, **labral tears**, and **femoral acetabular impingement (FAI)** is best treated with arthroscopic labral repair. - This procedure directly addresses both the **torn labrum** and the **FAI** morphology, which is crucial for pain relief and preventing further joint damage. *Physiotherapy* - While physiotherapy can help with **muscle strengthening** and **pain management** in the short term, it generally does not resolve structural issues such as a **torn labrum** or **FAI** that are likely causing persistent mechanical symptoms in an active individual. - It's often used as an adjunct to surgery or for mild cases without significant structural pathology. *Hip resurfacing* - This procedure is typically reserved for younger, active patients with **severe, diffuse osteoarthritis** of the hip, which is not indicated by the current presentation of isolated labral tears and FAI. - It involves reshaping the femoral head and placing a metal cap, a more extensive intervention than needed for labral pathology. *Core decompression* - **Core decompression** is a surgical procedure used to treat **avascular necrosis (AVN)** of the femoral head, aiming to improve blood flow and prevent collapse. - The patient's symptoms and MRI findings of labral tears and FAI do not suggest AVN as the primary pathology.

Q: What is the most appropriate surgical management for a patient with a bucket-handle tear of the medial meniscus?

Arthroscopic meniscal repair. ***Arthroscopic meniscal repair*** - A **bucket-handle tear** is a longitudinal tear where the inner portion of the meniscus displaces centrally, often causing **mechanical locking** of the knee. Repair is crucial to restore meniscal function and prevent further damage. - **Arthroscopic repair** is preferred as it is less invasive and aims to preserve the meniscus, which is vital for **load distribution** and **joint stability**. *Arthroscopic lavage* - This procedure involves flushing the joint with saline and is typically used for conditions like **osteoarthritis** to remove debris, not to address structural tears. - It does not reconstruct or repair damaged tissue, and thus, cannot fix a bucket-handle tear. *Total knee replacement* - This is a major surgical procedure reserved for end-stage **osteoarthritis** or severe joint destruction, not an isolated meniscal tear. - Performing a total knee replacement for a bucket-handle tear would be an **overtreatment** and is not indicated. *Non-operative physiotherapy* - While physiotherapy is beneficial for rehabilitation post-surgery or for less severe meniscal injuries, it cannot heal a **bucket-handle tear**. - A bucket-handle tear often leads to **mechanical symptoms** (e.g., locking) that require surgical intervention to resolve.

Q: Which test is most commonly used to assess an anterior cruciate ligament (ACL) injury?

Lachman test. ***Lachman test*** - The **Lachman test** is considered the most sensitive and reliable clinical test for assessing **ACL integrity**, particularly in the acute setting. - It involves evaluating anterior tibial translation with the knee in **20-30 degrees of flexion**, allowing for isolated assessment of the ACL. *McMurray test* - The **McMurray test** is primarily used to detect meniscal tears, not ACL injuries. - It involves flexing and extending the knee with internal and external rotation to stress the **medial and lateral menisci**. *Pivot shift test* - The **pivot shift test** is highly specific for ACL rupture but is often difficult to perform in acute settings due to pain and guarding. - It assesses for **anterolateral rotatory instability** of the tibia on the femur, indicating a significant ACL injury. *Thessaly test* - The **Thessaly test** is used to diagnose meniscal tears and is performed with the patient standing on one leg while twisting their body. - It involves placing stress on the meniscus through knee flexion and rotation, which is not specific for ACL evaluation.

Q: 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?

Adductor longus. ***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.

Q: Which structure is commonly injured in a knee ligament tear?

Anterior cruciate ligament. ***Anterior cruciate ligament*** - The **anterior cruciate ligament (ACL)** is the most frequently injured ligament in the knee, especially in **non-contact athletic injuries** involving sudden changes in direction or pivoting. - ACL tears are often associated with a **'popping' sensation** at the time of injury, followed by swelling and instability. *Medial collateral ligament* - The **medial collateral ligament (MCL)** is commonly injured by a **valgus stress** to the knee, often from a direct blow to the outside of the knee. - While MCL injuries are common, they are generally **less severe** and heal more frequently without surgery compared to ACL tears. *Posterior cruciate ligament* - The **posterior cruciate ligament (PCL)** is much stronger than the ACL and less commonly injured, usually requiring a powerful force such as a direct blow to the **anterior tibia** (e.g., dashboard injury). - PCL tears typically present with **posterior sag** of the tibia relative to the femur. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** is the least commonly injured of the major knee ligaments and is typically damaged by a **varus stress** to the knee. - LCL injuries are often associated with other ligamentous or meniscal damage due to the significant force required.

Question 1

Best initial treatment for acute calcific tendinitis of shoulder?

Accepted Answer

NSAIDs and Physical Therapy

Answer

Surgical Removal

Answer

Steroid Injection

Answer

Ultrasound Therapy

Question 2

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?

Accepted Answer

Anterior Cruciate Ligament

Answer

Posterior Cruciate Ligament

Answer

Lateral Collateral Ligament

Answer

Medial Collateral Ligament

Question 3

Which muscle is tested using the empty can test in shoulder injuries?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Subscapularis

Answer

Biceps brachii

Question 4

A 35-year-old athlete has persistent groin pain and a clicking sound during hip movements. MRI reveals labral tears and femoral acetabular impingement. What is the best intervention?

Accepted Answer

Arthroscopic labral repair

Answer

Physiotherapy

Answer

Hip resurfacing

Answer

Core decompression

Question 5

What is the most appropriate surgical management for a patient with a bucket-handle tear of the medial meniscus?

Accepted Answer

Arthroscopic meniscal repair

Answer

Arthroscopic lavage

Answer

Total knee replacement

Answer

Non-operative physiotherapy

Question 6

Which test is most commonly used to assess an anterior cruciate ligament (ACL) injury?

Accepted Answer

Lachman test

Answer

McMurray test

Answer

Pivot shift test

Answer

Thessaly test

Question 7

Which structures are typically involved in the 'unhappy triad' injury of the knee?

Accepted Answer

Medial collateral ligament, anterior cruciate ligament, and medial meniscus

Answer

Posterior cruciate ligament, medial collateral ligament, and medial meniscus

Answer

Medial collateral ligament, anterior cruciate ligament, and lateral meniscus

Answer

Lateral collateral ligament, posterior cruciate ligament, and lateral meniscus

Question 8

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?

Accepted Answer

Adductor longus

Answer

Iliopsoas

Answer

Rectus femoris

Answer

Gluteus medius

Question 9

Which structure is commonly injured in a knee ligament tear?

Accepted Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Posterior cruciate ligament

Answer

Lateral collateral ligament

Question 10

A 25-year-old athlete experiences recurrent anterior shoulder dislocations despite conservative management. Analyze the patient's condition using the provided image and suggest the most appropriate surgical intervention.

Accepted Answer

Bankart repair for recurrent anterior shoulder dislocations.

Answer

Putti-Platt procedure for shoulder stabilization.

Answer

Reverse shoulder arthroplasty for shoulder arthritis.

Answer

Rotator cuff repair for shoulder instability.

Sports Medicine — MCQs

Sports Medicine — MCQs

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