Sports Medicine — MCQs

A 25-year-old man experiences pain in the right knee following a fall. His knee is swollen and he cannot bear full weight or fully extend his leg. There is tenderness over the medial joint line. X-ray findings were normal, and the range of motion (ROM) is stable to varus and valgus stress. The straight-leg raise is unrestricted. Which is the most likely type of injury?

Q15Easy

McMurray's test is positive in injury of which structure?

Q16Medium

A 21-year-old javelin thrower is diagnosed with a full-thickness ulnar collateral ligament (UCL) tear. On presentation, he complains of numbness and tingling in the ring and small fingers. Which muscle group would he be most likely to have motor weakness?

Q17Medium

A 22-year-old male basketball player presents with a swollen, painful left knee. He was on a fast break and as he began to jump for an alley-oop, he felt his knee give out and he collapsed to the floor. What is the most likely diagnosis?

Q18Easy

Cozen test is used to diagnose which condition?

Q19Medium

Tennis elbow is characterized by?

Q20Easy

Unhappy triad doesn't include injury to which of the following structures?

Sports Medicine Indian Medical PG Practice Questions and MCQs

Question 11: What is the medical term for Golfer's elbow?

A. Medial epicondylitis (Correct Answer)
B. Lateral epicondylitis
C. Posterior elbow dislocation
D. Lateral collateral ligament injury

Explanation: **Explanation:** **Golfer’s Elbow (Medial Epicondylitis)** is a clinical condition characterized by pain and inflammation at the medial epicondyle of the humerus. It is caused by repetitive stress or overuse of the **common flexor tendon**, primarily involving the **Pronator teres** and **Flexor carpi radialis** muscles. This occurs due to forceful wrist flexion and forearm pronation, common in the "trailing arm" during a golf swing. **Analysis of Options:** * **A. Medial epicondylitis (Correct):** This is the anatomical site where the common flexor origin attaches. Inflammation here leads to pain on the inner side of the elbow. * **B. Lateral epicondylitis:** Known as **Tennis Elbow**, this involves the common extensor origin (specifically the **Extensor Carpi Radialis Brevis - ECRB**). It is more common than Golfer's elbow. * **C. Posterior elbow dislocation:** This is an acute traumatic injury, usually resulting from a fall on an outstretched hand (FOOSH). It is the most common type of elbow dislocation but is not an overuse syndrome. * **D. Lateral collateral ligament injury:** This typically results in posterolateral rotatory instability and is not associated with the repetitive gripping/flexion seen in Golfer's elbow. **NEET-PG High-Yield Pearls:** * **Common Flexor Origin:** Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris. * **Clinical Test:** Pain is elicited by **resisted wrist flexion** and resisted forearm pronation. * **Differential Diagnosis:** Always rule out **Ulnar neuropathy**, as the ulnar nerve runs in the cubital tunnel posterior to the medial epicondyle. * **Management:** Primarily conservative (Rest, Ice, NSAIDs, and eccentric strengthening). Surgery is rarely required.

Question 12: Which is the investigation of choice for a suspected injury of the knee?

A. Ultrasonography
B. Plain radiography
C. Arthrography
D. Arthroscopy (Correct Answer)

Explanation: **Explanation:** The investigation of choice for a suspected internal derangement of the knee (IDK), such as meniscal or cruciate ligament injuries, is **Arthroscopy**. **Why Arthroscopy is the Correct Answer:** Arthroscopy is considered the **Gold Standard** because it serves a dual purpose: it is both diagnostic and therapeutic. It allows for direct visualization of intra-articular structures (menisci, ACL, PCL, and articular cartilage) with 100% accuracy. While MRI is the investigation of choice for *screening* (non-invasive), Arthroscopy remains the definitive investigation of choice for *confirmation* and immediate management. **Analysis of Incorrect Options:** * **Ultrasonography (USG):** While useful for superficial soft tissue pathologies like Baker’s cysts or patellar tendonitis, it has very low sensitivity for deep intra-articular structures like the cruciate ligaments. * **Plain Radiography:** This is the *initial* investigation to rule out fractures or bony avulsions (e.g., Segond fracture), but it cannot visualize soft tissue injuries, which comprise the majority of sports-related knee trauma. * **Arthrography:** This invasive procedure involving dye injection was used historically to detect meniscal tears but has been entirely superseded by MRI and Arthroscopy due to lower accuracy and high complication rates. **Clinical Pearls for NEET-PG:** * **Investigation of Choice (Non-invasive/Screening):** MRI. * **Gold Standard/Definitive Investigation:** Arthroscopy. * **Initial Investigation:** X-ray (AP and Lateral views). * **Unhappy Triad (O'Donoghue):** Injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest Lateral Meniscus involvement is more common in acute phases).

Question 13: The PIVOT test is used to assess which of the following?

A. Medial meniscus
B. Lateral meniscus
C. Anterior cruciate ligament (Correct Answer)
D. Posterior cruciate ligament

Explanation: **Explanation:** The **Pivot Shift Test** is the most specific clinical test for diagnosing an **Anterior Cruciate Ligament (ACL) injury**. While the Lachman test is the most sensitive, the Pivot Shift test confirms functional instability (anterolateral rotatory instability) of the knee. **Underlying Concept:** In an ACL-deficient knee, the tibia is subluxed anteriorly relative to the femur when the knee is in extension. As the knee is moved from extension into flexion (while applying a **valgus stress** and **internal rotation**), the **Iliotibial (IT) band** transitions from being an extensor to a flexor. At approximately 20–30° of flexion, the IT band pulls the tibia back into its normal position, causing a palpable "clunk" or "shift." This reduction signifies a positive test. **Analysis of Incorrect Options:** * **Options A & B (Menisci):** Meniscal injuries are assessed using tests like **McMurray’s test**, Apley’s Grind test, and Steinman’s test. These focus on joint line tenderness and mechanical locking rather than rotatory instability. * **Option D (PCL):** Posterior Cruciate Ligament injuries are evaluated using the **Posterior Drawer test**, the **Sag sign** (Godfrey’s test), and the Dial test (for posterolateral corner involvement). **Clinical Pearls for NEET-PG:** * **Gold Standard Clinical Test for ACL:** Lachman Test (Highest sensitivity). * **Most Specific Test for ACL:** Pivot Shift Test. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Terrible Triad (O'Donoghue):** Injury involving the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the lateral meniscus is more commonly injured in acute cases).

Question 14: A 25-year-old man experiences pain in the right knee following a fall. His knee is swollen and he cannot bear full weight or fully extend his leg. There is tenderness over the medial joint line. X-ray findings were normal, and the range of motion (ROM) is stable to varus and valgus stress. The straight-leg raise is unrestricted. Which is the most likely type of injury?

A. Anterior cruciate ligament
B. Tibial tuberosity
C. Transverse genicular ligament
D. Medial meniscus (Correct Answer)

Explanation: ### Explanation The clinical presentation points toward a **Medial Meniscus Injury**, specifically a "Bucket-handle tear." **1. Why Medial Meniscus is Correct:** * **Mechanism & Symptoms:** Meniscal tears often occur due to twisting injuries. The hallmark signs in this case are **medial joint line tenderness** and **mechanical locking** (inability to fully extend the leg). * **Joint Line Tenderness:** This is the most sensitive physical exam finding for meniscal pathology. * **Locking:** When a fragment of the meniscus (like a bucket-handle tear) becomes displaced into the intercondylar notch, it physically blocks the terminal extension of the knee. * **Stability:** The fact that the knee is stable to varus/valgus stress rules out collateral ligament ruptures. **2. Why Incorrect Options are Wrong:** * **Anterior Cruciate Ligament (ACL):** While ACL tears cause swelling (hemarthrosis) and instability, they typically do not cause a mechanical block to extension unless associated with a "locked" meniscus (O'Donoghue's Triad). The question emphasizes joint line tenderness over instability. * **Tibial Tuberosity:** Injuries here (like avulsion fractures) would show localized bony tenderness, pain on resisted extension, and abnormalities on X-ray. * **Transverse Genicular Ligament:** This ligament connects the anterior horns of the menisci; isolated injury is extremely rare and does not present with joint locking or significant joint line tenderness. **3. High-Yield Clinical Pearls for NEET-PG:** * **McMurray Test:** The most specific clinical test for meniscal tears. * **The "Unhappy Triad" (O'Donoghue):** Injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus. * **Gold Standard Investigation:** MRI is the investigation of choice; Arthroscopy is the gold standard for diagnosis and treatment. * **Vascularity:** The outer 1/3 (Red zone) has a good blood supply and can heal; the inner 2/3 (White zone) is avascular and usually requires excision (meniscectomy).

Question 15: McMurray's test is positive in injury of which structure?

A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial meniscus (Correct Answer)
D. All of the above

Explanation: **Explanation:** **McMurray’s test** is a clinical provocative maneuver used specifically to diagnose **meniscal tears**. The test works by trapping the torn fragment of the meniscus between the femoral condyles and the tibial plateau. When the knee is rotated and extended, the displacement of this fragment produces a palpable or audible **"thud" or "click,"** often accompanied by pain. * **Why Medial Meniscus is correct:** To test the medial meniscus, the clinician applies **valgus stress** (to open the joint) and **external rotation** of the tibia while extending the knee from a fully flexed position. This maneuver compresses the posterior horn of the medial meniscus, eliciting a positive sign if a tear is present. * **Why A & B are incorrect:** The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) are stabilized using tests that assess translation (sliding) of the tibia, such as the **Lachman test** (most sensitive for ACL), **Anterior Drawer test**, and **Posterior Drawer/Sag sign** (for PCL). * **Why D is incorrect:** McMurray’s is specific to meniscal pathology and does not assess ligamentous stability. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mnemonic for McMurray's:** **M**edial meniscus = **E**xternal rotation (**ME**); **L**ateral meniscus = **I**nternal rotation (**LI**). 2. **The "Unhappy Triad" (O'Donoghue’s):** Simultaneous injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly injured in acute ACL tears). 3. **Apley’s Grinding Test:** Another specific test for meniscal injuries; **Distraction** helps differentiate ligamentous pain from meniscal pain (compression). 4. **Thessaly Test:** Performed by rotating the patient on a single flexed leg; it is considered more clinically sensitive than McMurray’s.

Question 16: A 21-year-old javelin thrower is diagnosed with a full-thickness ulnar collateral ligament (UCL) tear. On presentation, he complains of numbness and tingling in the ring and small fingers. Which muscle group would he be most likely to have motor weakness?

A. Brachioradialis
B. Extensor carpi ulnaris
C. Abductor digiti minimi (Correct Answer)
D. Palmaris longus

Explanation: **Explanation:** The clinical presentation describes a **Uinar Collateral Ligament (UCL) injury** (common in overhead athletes like javelin throwers) associated with **Ulnar Nerve neuropathy**. The ulnar nerve runs in close proximity to the UCL within the cubital tunnel at the medial elbow. Chronic valgus stress or acute UCL tears can lead to ulnar nerve irritation or entrapment, manifesting as sensory loss in the ring and small fingers and motor weakness in ulnar-innervated muscles. **Why Abductor Digiti Minimi (ADM) is correct:** The **Abductor Digiti Minimi** is an intrinsic muscle of the hand (hypothenar eminence) supplied by the **deep branch of the ulnar nerve (C8, T1)**. In ulnar nerve palsy at the elbow, the intrinsic muscles of the hand are the most sensitive indicators of motor weakness. **Analysis of Incorrect Options:** * **Brachioradialis:** Supplied by the **Radial nerve**. It is a flexor of the forearm in the mid-prone position and is unaffected by ulnar nerve pathology. * **Extensor Carpi Ulnaris (ECU):** Despite the name "ulnaris," this muscle is located in the posterior compartment of the forearm and is supplied by the **Posterior Interosseous Nerve (a branch of the Radial nerve)**. * **Palmaris Longus:** A superficial flexor of the forearm supplied by the **Median nerve**. **NEET-PG High-Yield Pearls:** * **Tommy John Surgery:** The eponym for UCL reconstruction, typically using the Palmaris Longus tendon autograft. * **Mannerfelt-Stack Syndrome:** Rupture of the FPL tendon in rheumatoid arthritis (not to be confused with ulnar nerve issues). * **Froment’s Sign:** Tests for ulnar nerve palsy; specifically assesses the **Adductor Pollicis** muscle. * **Wartenberg’s Sign:** Inability to adduct the small finger due to weakness of the third palmar interosseous muscle (ulnar nerve).

Question 17: A 22-year-old male basketball player presents with a swollen, painful left knee. He was on a fast break and as he began to jump for an alley-oop, he felt his knee give out and he collapsed to the floor. What is the most likely diagnosis?

A. Patello-femoral dislocation
B. Anterior cruciate ligament injury (Correct Answer)
C. Medial collateral ligament injury
D. Posterior cruciate ligament injury

Explanation: **Explanation:** The clinical presentation describes a classic non-contact deceleration injury involving a sudden change in direction and vertical loading (jumping), which is the hallmark mechanism for an **Anterior Cruciate Ligament (ACL) injury**. 1. **Why ACL is correct:** The ACL is the primary stabilizer against anterior tibial translation. In basketball, "giving way" (instability) followed by immediate swelling (hemarthrosis) after a landing or pivoting maneuver is highly suggestive of an ACL tear. Patients often report a "pop" sound at the time of injury. 2. **Why other options are incorrect:** * **Patello-femoral dislocation:** Usually occurs due to a forceful contraction of the quadriceps with the knee in slight flexion and valgus. While it causes swelling, the patella is often visibly displaced laterally or there is exquisite tenderness over the medial patellofemoral ligament (MPFL). * **Medial Collateral Ligament (MCL) injury:** Typically results from a **valgus stress** (a blow to the lateral side of the knee). While common, it rarely causes the knee to "give out" as dramatically as an ACL tear unless associated with other injuries. * **Posterior Cruciate Ligament (PCL) injury:** Usually occurs due to a **"dashboard injury"** (direct blow to the proximal tibia with a flexed knee) or extreme hyperextension. It is much less common in non-contact jumping scenarios. **High-Yield Clinical Pearls for NEET-PG:** * **Lachman Test:** The most sensitive clinical test for acute ACL injury. * **Pivot Shift Test:** The most specific test for ACL deficiency. * **Segond Fracture:** A small avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Golden Period:** The first 1–2 hours after injury before significant swelling (hemarthrosis) occurs, making clinical examination easier.

Question 18: Cozen test is used to diagnose which condition?

A. Golfer's elbow
B. Tennis elbow (Correct Answer)
C. Little leaguer's elbow
D. Frozen shoulder

Explanation: **Explanation:** The **Cozen test** is a clinical provocative test used to diagnose **Lateral Epicondylitis (Tennis Elbow)**. **1. Why Option B is Correct:** Tennis elbow involves inflammation or micro-tearing at the common extensor origin, primarily affecting the **Extensor Carpi Radialis Brevis (ECRB)** muscle. To perform the Cozen test, the patient’s elbow is stabilized, the forearm is pronated, and the wrist is extended against resistance while the clinician palpates the lateral epicondyle. A positive test is indicated by **sudden, sharp pain at the lateral epicondyle**, as the resisted contraction of the ECRB puts stress on its inflamed attachment. **2. Why Other Options are Incorrect:** * **A. Golfer’s Elbow (Medial Epicondylitis):** This involves the common flexor origin. It is diagnosed using the **Mill’s test (medial version)** or by resisted wrist flexion. * **C. Little Leaguer’s Elbow:** This is a medial elbow injury (apophysitis) seen in adolescent pitchers due to repetitive valgus stress, not typically diagnosed by the Cozen test. * **D. Frozen Shoulder (Adhesive Capsulitis):** This is characterized by a global, painful loss of passive and active range of motion (especially external rotation) of the glenohumeral joint. **Clinical Pearls for NEET-PG:** * **Mill’s Test:** Another common test for Tennis Elbow involving passive wrist flexion and forearm pronation while the elbow is extended. * **Maudsley’s Test:** Resisted extension of the **middle finger** (stresses ECRB); also used for Tennis Elbow. * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Management:** Primarily conservative (RICE, NSAIDs, eccentric exercises). Refractory cases may require Nirschl’s surgical release.

Question 19: Tennis elbow is characterized by?

A. Tenderness over the medial epicondyle
B. Tendinitis of the common extensor origin (Correct Answer)
C. Tendinitis of the common flexor origin
D. Painful flexion and extension

Explanation: **Explanation:** **Tennis Elbow (Lateral Epicondylitis)** is a clinical condition caused by repetitive overuse leading to microtrauma and degenerative changes (angiofibroblastic hyperplasia) at the **common extensor origin** of the forearm. 1. **Why Option B is Correct:** The common extensor origin is located at the **lateral epicondyle** of the humerus. The muscle most frequently involved is the **Extensor Carpi Radialis Brevis (ECRB)**. Repetitive wrist extension and supination lead to inflammation and chronic degeneration at this site, resulting in pain over the lateral aspect of the elbow. 2. **Why Other Options are Incorrect:** * **Option A & C:** Tenderness over the **medial epicondyle** and tendinitis of the **common flexor origin** (specifically the Pronator teres and Flexor carpi radialis) characterize **Golfer’s Elbow** (Medial Epicondylitis). * **Option D:** While movement can be painful, the hallmark of the condition is localized tenderness over the lateral epicondyle and pain specifically during **resisted wrist extension** with the elbow extended, rather than general flexion/extension. **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. * **Mill’s Test:** Pain when the clinician passively flexes the wrist while the elbow is extended and forearm pronated. * **Maudsley’s Test:** Pain on resisted extension of the middle finger. * **Treatment:** Conservative management (Rest, NSAIDs, bracing) is the first line. Refractory cases may require corticosteroid or PRP injections, or surgical release of the ECRB origin (Nirschl procedure).

Question 20: Unhappy triad doesn't include injury to which of the following structures?

A. ACL
B. MCL
C. LCL (Correct Answer)
D. Medial meniscus

Explanation: The **Unhappy Triad** (also known as O'Donoghue's Triad) is a classic sports medicine injury involving three specific structures of the knee joint. It typically occurs due to a powerful lateral blow to the knee while the foot is fixed on the ground, resulting in a combination of **valgus stress, flexion, and external rotation.** ### Explanation of Options: * **Correct Answer (C) LCL:** The Lateral Collateral Ligament (LCL) is located on the outer side of the knee. It is generally spared in this injury pattern because the mechanism involves a **valgus** (inward) force, which puts tension on the medial structures and compression on the lateral side. * **Option (A) ACL:** The Anterior Cruciate Ligament is almost always torn in this triad due to the rotational force and anterior translation of the tibia. * **Option (B) MCL:** The Medial Collateral Ligament is the first structure to fail when a valgus stress is applied to the knee. * **Option (D) Medial Meniscus:** Classically, O'Donoghue described the medial meniscus as the third component. However, modern sports medicine (MRI studies) suggests that **lateral meniscus** tears are actually more common in acute ACL injuries. Despite this, for the purpose of exams like NEET-PG, the "classic" triad still consists of the **ACL, MCL, and Medial Meniscus.** ### High-Yield Clinical Pearls for NEET-PG: * **Mechanism of Injury:** Valgus stress + External rotation + Fixed foot (e.g., a "clipped" tackle in football). * **Pivot Shift Test:** The most specific clinical test for an ACL tear. * **Lachman Test:** The most sensitive clinical test for an ACL tear. * **McMurray Test:** Used to identify meniscal tears. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Practice by Chapter

Sports Injuries: Epidemiology and Prevention

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Knee Ligament Injuries

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Meniscal Injuries

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Shoulder Instability

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Rotator Cuff Pathology

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Tendinopathies

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Muscle Strains and Contusions

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Ankle Sprains and Instability

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Overuse Injuries

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Return to Play Criteria

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Sports-Specific Conditioning

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Performance Enhancement

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