Sports Medicine Practice Questions

Q: A baseball pitcher experiences shoulder pain and weakness after a game. An MRI reveals a tear in one of the rotator cuff muscles. Which muscle is most likely affected?

Supraspinatus. ***Supraspinatus*** - The **supraspinatus muscle** is the most commonly injured rotator cuff muscle, especially in overhead athletes like baseball pitchers, due to its position and function in **abduction** and overhead movements. - Its tendon passes through a narrow space (the subacromial space) where it is prone to **impingement** and tears, particularly during repetitive forceful motions. *Infraspinatus* - The **infraspinatus** muscle primarily performs **external rotation** of the shoulder. - While it can be injured, it is less frequently torn than the supraspinatus in overhead throwing athletes, and isolated tears are uncommon. *Teres minor* - The **teres minor** also assists in **external rotation** and adduction of the shoulder. - Tears of the teres minor are rare and typically occur in conjunction with more extensive rotator cuff injuries. *Subscapularis* - The **subscapularis** muscle is responsible for **internal rotation** and adduction of the shoulder. - Tears of the subscapularis are less common in pitchers compared to supraspinatus tears, often resulting from traumatic anterior shoulder dislocations or powerful internal rotation forces.

Q: A 30-year-old athlete presents with shoulder pain after a fall. An MRI shows a tear in the rotator cuff. Which muscle is most commonly involved in rotator cuff injuries?

Supraspinatus. ***Supraspinatus*** - The **supraspinatus tendon** is the most frequently injured rotator cuff muscle due to its vulnerable position passing through the subacromial space, making it susceptible to **impingement** and **degenerative tears**. - It plays a crucial role in the **initiation of abduction** of the arm, a motion often compromised in rotator cuff tears. *Infraspinatus* - The **infraspinatus** muscle is primarily responsible for **external rotation** of the arm. - While it can be injured, isolated tears of the infraspinatus are less common than those affecting the supraspinatus. *Subscapularis* - The **subscapularis** muscle is the largest and most powerful rotator cuff muscle, crucial for **internal rotation** and adduction. - Tears of the subscapularis are typically associated with **anterior shoulder dislocation** or significant trauma, making it less commonly injured in general rotator cuff pathologies compared to the supraspinatus. *Teres minor* - The **teres minor** is also involved in **external rotation** of the arm. - Tears of the teres minor are the **least common** among the rotator cuff muscles and often occur in conjunction with other more extensive rotator cuff injuries, particularly involving the infraspinatus.

Q: A 45-year-old male presents with recurrent anterior shoulder dislocations. Which lesion is commonly associated with this condition?

Bankart lesion. ***Bankart lesion*** - A Bankart lesion is a tear of the **anterior-inferior labrum** of the glenoid, often with an associated fracture of the inferior glenoid rim, occurring during anterior shoulder dislocation. - This lesion compromises the stability of the glenohumeral joint and is a common reason for **recurrent anterior shoulder dislocations**. *Hill-Sachs lesion* - A Hill-Sachs lesion is a **compression fracture** of the posterior-superior humeral head. - While it frequently co-occurs with anterior shoulder dislocations, it is usually a **consequence** of the dislocation rather than the primary cause of recurrence. *SLAP tear* - A SLAP (Superior Labrum Anterior to Posterior) tear involves the **superior portion of the labrum**, often extending into the biceps anchor. - It's more commonly associated with overhead activities or fall on an outstretched arm rather than being the primary cause of recurrent anterior dislocations. *Rotator cuff tear* - A rotator cuff tear involves damage to one or more of the **four muscles** surrounding the shoulder joint. - While it can cause shoulder pain and weakness, it is less commonly the primary lesion directly responsible for **recurrent anterior shoulder dislocations**, especially in a younger patient without significant trauma.

Q: A 35-year-old patient with recurrent shoulder dislocations has an MRI showing an anteroinferior labral tear and glenoid bone loss. What is the next best management?

Latarjet procedure. ***Latarjet procedure*** - The presence of recurrent shoulder dislocations, an **anteroinferior labral tear**, and significant **glenoid bone loss** indicates insufficient glenoid concavity and soft tissue damage that is unlikely to be adequately addressed by a simple soft-tissue repair. - The Latarjet procedure involves transferring the **coracoid process** and its attached tendons to the anterior glenoid, augmenting bone stock and creating a "sling effect" to prevent further dislocation. It is the preferred treatment for recurrent instability with significant bone loss. *Physical therapy* - While physical therapy is crucial for rehabilitation post-surgery and for managing mild instability, it is unlikely to prevent recurrent dislocations in the presence of a **significant labral tear** and **glenoid bone loss**. - It would primarily focus on strengthening the **rotator cuff** and **scapular stabilizers**, which alone cannot overcome structural instability. *Arthroscopic Bankart repair* - An arthroscopic Bankart repair addresses the soft tissue injury (**labral tear**) by reattaching the labrum to the glenoid rim. - However, in cases with **significant glenoid bone loss** (typically >20-25%), a Bankart repair alone often has a high failure rate because it does not restore the lost bone integrity. *Rotator cuff repair* - A rotator cuff repair addresses tears in the **rotator cuff tendons**, which are important for shoulder movement and stability. - While rotator cuff tears can sometimes co-exist with instability, the primary pathology described here is recurrent dislocation and a labral tear with glenoid bone loss, not a primary rotator cuff injury.

Q: A patient presents with a painful, swollen knee following a twisting injury during soccer. What is the most likely diagnosis?

Meniscal tear. ***Meniscal tear*** - A **twisting injury** followed by a painful, swollen knee is highly suggestive of a meniscal tear, as the menisci are particularly vulnerable to rotational forces. - Patients often report **locking, catching, or giving way** of the knee and experience pain with squatting or pivoting. *Ligament sprain* - While a ligament sprain can occur with a twisting injury and cause pain and swelling, a meniscal tear is more specifically associated with the described mechanism of injury and often presents with more pronounced mechanical symptoms like **locking**. - **Ligamentous injury** might present with instability or specific pain on stress testing of the affected ligament, which is not highlighted here. *Patellar dislocation* - Patellar dislocation usually involves a feeling of the **kneecap moving out of place** with visible deformity and extreme pain, which is not mentioned in the patient's presentation. - It often occurs during **sudden changes in direction** or direct trauma to the kneecap. *Osteoarthritis exacerbation* - Osteoarthritis typically causes **chronic, progressive knee pain** that worsens with activity and improves with rest, rather than an acute onset due to a specific twisting injury. - While an acute injury can exacerbate existing OA, the primary cause of acute, significant pain and swelling following a distinct twisting incident points to an acute structural injury like a meniscal tear.

Q: What is the recommended first-line treatment approach for a patient with a rotator cuff tear that is causing shoulder weakness and pain?

Physiotherapy only. ***Physiotherapy only*** - **Physiotherapy** is the recommended **first-line treatment** for most rotator cuff tears, especially in cases of shoulder weakness and pain, as it helps improve strength and range of motion. - Early conservative management focuses on **pain control**, **restoration of motion**, and progressive **strengthening exercises** to improve shoulder function and reduce the need for surgery. *Joint replacement* - **Joint replacement** (arthroplasty) is typically reserved for severe, **irreparable rotator cuff tears** causing significant pain and loss of function, especially in older patients. - It is an **invasive surgical procedure** that is not considered a first-line treatment for a rotator cuff tear. *Subacromial injection* - **Subacromial injections**, often with corticosteroids, can provide **temporary pain relief** for rotator cuff tears or tendinitis by reducing inflammation. - However, they do not address the underlying **structural weakness** or tear, and repeated injections carry risks and can potentially weaken tendons. *Arthroscopic repair* - **Arthroscopic repair** is a surgical option considered when conservative management fails, or for **acute, full-thickness tears** in younger, active individuals. - It involves surgically repairing the torn tendon and is not the **initial approach** for most patients with rotator cuff tears.

Q: What is the most likely diagnosis?

Popeye sign. ***Popeye sign*** - The **Popeye sign** is characterized by a bulging muscle in the upper arm, indicative of a **rupture of the long head of the biceps tendon**. - This typically occurs secondary to **chronic tendinopathy** or a sudden, forceful contraction against resistance, leading to a visible retraction of the muscle belly. *Griesinger sign* - **Griesinger sign** is edema and tenderness over the **mastoid process** due to septic thrombosis of the **mastoid emissary vein**. - It is associated with conditions like **septic lateral sinus thrombosis**, often secondary to **otitis media**. *Rising sun sign* - The **rising sun sign** is a neuroimaging finding, typically seen in imaging of the **brainstem**. - It describes a characteristic appearance of the midbrain on axial imaging, often associated with **hydrocephalus** or specific **brainstem lesions**. *Winner sign* - The "Winner sign" is not a recognized clinical or radiological sign in standard medical literature. - It may be an erroneous term or a non-standard description, lacking a defined medical context.

Q: Which of the following shoulder movements is/ are weak in patients of supraspinatus tear?

Abduction. ***Abduction*** - The **supraspinatus muscle** initiates the first 15 degrees of **shoulder abduction** and is active throughout the range of abduction. - A tear in the supraspinatus would therefore significantly impair the ability to **abduct the arm**, especially against resistance. *Adduction* - **Adduction** is primarily performed by the **pectoralis major**, **latissimus dorsi**, and **teres major** muscles. - The supraspinatus muscle plays no direct role in shoulder adduction. *External rotation* - **External rotation** of the shoulder is mainly performed by the **infraspinatus** and **teres minor** muscles. - While the rotator cuff muscles work together, the supraspinatus is not the primary external rotator. *Internal rotation* - **Internal rotation** is primarily carried out by the **subscapularis**, **pectoralis major**, **latissimus dorsi**, and **teres major** muscles. - The supraspinatus muscle does not contribute to internal rotation of the shoulder.

Q: Which of the following statements is NOT true regarding ACL injury?

ACL is intrasynovial. ***ACL is intrasynovial*** - The **ACL** is located within the joint capsule but is **extrasynovial**, meaning it is surrounded by a synovial membrane, but not bathed directly by synovial fluid. - This anatomical distinction is crucial for understanding its limited healing capacity and specific surgical repair considerations. *Lachman test is the most sensitive test for ACL injury.* - The **Lachman test** is indeed considered the **most sensitive and specific clinical test** for diagnosing an acute ACL injury. - It assesses anterior tibial translation with the knee in slight flexion (around 20-30 degrees), which minimizes hamstring muscular guarding. *ACL contributes to proprioceptive function but is not primarily responsible for it.* - The **ACL contains mechanoreceptors** that contribute to **proprioception** (the sense of joint position and movement). - While it plays a role, proprioceptive function is a complex process involving multiple structures, including muscle spindles, Golgi tendon organs, and other joint mechanoreceptors. *It is a component of the O'Donoghue triad* - The **O'Donoghue triad** (also known as the "unhappy triad") classically involves injury to the **ACL**, the **medial collateral ligament (MCL)**, and the **medial meniscus**. - This common injury pattern often results from a valgus stress with rotation on a partially flexed knee.

Question 1

A baseball pitcher experiences shoulder pain and weakness after a game. An MRI reveals a tear in one of the rotator cuff muscles. Which muscle is most likely affected?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Teres minor

Answer

Subscapularis

Question 2

A 30-year-old athlete presents with shoulder pain after a fall. An MRI shows a tear in the rotator cuff. Which muscle is most commonly involved in rotator cuff injuries?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Subscapularis

Answer

Teres minor

Question 3

A 45-year-old male presents with recurrent anterior shoulder dislocations. Which lesion is commonly associated with this condition?

Accepted Answer

Bankart lesion

Answer

Hill-Sachs lesion

Answer

SLAP tear

Answer

Rotator cuff tear

Question 4

A 35-year-old patient with recurrent shoulder dislocations has an MRI showing an anteroinferior labral tear and glenoid bone loss. What is the next best management?

Accepted Answer

Latarjet procedure

Answer

Physical therapy

Answer

Arthroscopic Bankart repair

Answer

Rotator cuff repair

Question 5

A patient presents with a painful, swollen knee following a twisting injury during soccer. What is the most likely diagnosis?

Accepted Answer

Meniscal tear

Answer

Ligament sprain

Answer

Patellar dislocation

Answer

Osteoarthritis exacerbation

Question 6

What is the recommended first-line treatment approach for a patient with a rotator cuff tear that is causing shoulder weakness and pain?

Accepted Answer

Physiotherapy only

Answer

Joint replacement

Answer

Subacromial injection

Answer

Arthroscopic repair

Question 7

What is the most likely diagnosis?

Accepted Answer

Popeye sign

Answer

Griesinger sign

Answer

Rising sun sign

Answer

Winner sign

Question 8

Which of the following shoulder movements is/ are weak in patients of supraspinatus tear?

Accepted Answer

Abduction

Answer

Adduction

Answer

External rotation

Answer

Internal rotation

Question 9

Which of the following statements about impingement syndrome is incorrect?

Accepted Answer

Surgical decompression of the subacromial space is frequently indicated

Answer

Supraspinatus tendon is most often involved

Answer

Shoulder abduction in the arc of 60 - 120 degrees is particularly painful

Answer

It is the tendinitis caused by inflammation of the rotator cuff tendons

Question 10

Which of the following statements is NOT true regarding ACL injury?

Accepted Answer

ACL is intrasynovial

Answer

Lachman test is the most sensitive test for ACL injury.

Answer

ACL contributes to proprioceptive function but is not primarily responsible for it.

Answer

It is a component of the O'Donoghue triad

Sports Medicine — MCQs

Sports Medicine — MCQs

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