Sports Medicine Practice Questions

Q: Jumper's knee is primarily caused by:

Patellar tendonosis. **Explanation:** **Jumper’s Knee**, clinically known as **Patellar Tendonitis/Tendonosis**, is a common overuse injury characterized by pain at the inferior pole of the patella. It is caused by repetitive stress on the extensor mechanism of the knee, typically seen in athletes involved in sports requiring frequent jumping and landing (e.g., basketball, volleyball). * **Why Patellar Tendonosis is Correct:** The pathology involves micro-tears and mucoid degeneration of the patellar tendon, most commonly at its origin at the **inferior pole of the patella**. While initially inflammatory (tendonitis), chronic cases show a lack of inflammatory cells and are more accurately termed "tendonosis." * **Why Incorrect Options are Wrong:** * **Sacral, Tibial, and Fibular Fractures:** These are acute traumatic bony injuries. While a tibial tuberosity avulsion can occur in adolescents (Osgood-Schlatter disease), Jumper's knee specifically refers to the soft tissue pathology of the tendon itself, not a fracture. **Clinical Pearls for NEET-PG:** 1. **Blazina Classification:** Used to grade the severity of Jumper’s Knee based on whether pain occurs before, during, or after activity. 2. **Physical Exam:** Tenderness is localized to the inferior pole of the patella; pain is elicited by resisted knee extension. 3. **Imaging:** MRI is the gold standard, showing tendon thickening and increased signal intensity. 4. **Management:** Primarily conservative (eccentric strengthening exercises). Surgery is reserved for refractory cases. 5. **Differential Diagnosis:** Must be distinguished from **Sinding-Larsen-Johansson syndrome**, which is traction apophysitis at the inferior patellar pole in children.

Q: Which of the following statements about nerve entrapment syndromes is FALSE?

Cheiralgia paresthetica involves the femoral nerve.. **Explanation:** The correct answer is **C** because **Cheiralgia paresthetica** involves the **superficial branch of the radial nerve**, not the femoral nerve. It is a sensory neuropathy characterized by pain or numbness over the dorsal-radial aspect of the wrist and hand, often caused by tight watchbands, handcuffs, or repetitive trauma. In contrast, entrapment of the lateral femoral cutaneous nerve is known as *Meralgia paresthetica*. **Analysis of other options:** * **Option A (Guyon’s Canal Syndrome):** This is a true statement. It involves compression of the **ulnar nerve** as it passes through the fibro-osseous tunnel (Guyon’s canal) at the wrist, often seen in long-distance cyclists. * **Option B (Cubital Tunnel Syndrome):** This is a true statement. It is the second most common compression neuropathy, involving the **ulnar nerve** at the elbow (medial epicondyle). * **Option D (Tarsal Tunnel Syndrome):** This is a true statement. It involves compression of the **posterior tibial nerve** (or its branches) as it passes behind the medial malleolus. **High-Yield Clinical Pearls for NEET-PG:** * **Wartenberg’s Syndrome:** Another name for Cheiralgia paresthetica (radial nerve). * **Meralgia Paresthetica:** Involves the **Lateral Femoral Cutaneous Nerve** (L2-L3); common in obesity or those wearing tight belts. * **Double Crush Syndrome:** When a nerve is compressed at two different levels (e.g., cervical radiculopathy and Carpal Tunnel). * **Froment’s Sign:** Positive in Ulnar nerve palsy (Cubital/Guyon’s canal) due to adductor pollicis weakness.

Q: All of the following features in the knee are recognized to be consistent with a torn medial meniscus, except?

Excessive forward glide. **Explanation:** The correct answer is **A. Excessive forward glide**. **1. Why "Excessive forward glide" is the correct (except) option:** Excessive forward glide of the tibia on the femur is the hallmark of an **Anterior Cruciate Ligament (ACL) injury**, not a meniscal tear. This clinical finding is elicited through the **Anterior Drawer Test** or the **Lachman Test** (the most sensitive test for ACL deficiency). While meniscal tears often coexist with ACL injuries (the "unhappy triad"), the glide itself indicates ligamentous laxity rather than a meniscal lesion. **2. Analysis of incorrect options (Features of Medial Meniscus Tear):** * **Giving way (Option B):** This occurs due to reflex inhibition of the quadriceps when the torn meniscal fragment gets momentarily caught between the articular surfaces, causing the knee to "buckle." * **Locking (Option C):** A classic mechanical symptom, especially in "bucket-handle" tears. The displaced fragment becomes wedged in the joint space, physically preventing full extension of the knee. * **McMurray’s sign (Option D):** This is a specific provocative test for meniscal injuries. For a medial meniscus tear, the clinician externally rotates the foot and applies valgus stress while extending the knee from a flexed position; a palpable/audible "thud" or "click" indicates a positive result. **Clinical Pearls for NEET-PG:** * **Most common meniscus injured:** Medial meniscus (due to its firm attachment to the deep medial collateral ligament, making it less mobile than the lateral meniscus). * **Gold Standard Diagnosis:** MRI is the investigation of choice; however, **Arthroscopy** remains the "Gold Standard" for both diagnosis and treatment. * **Red Zone vs. White Zone:** Tears in the peripheral vascular "Red Zone" have healing potential and can be repaired, whereas "White Zone" tears (avascular) usually require partial meniscectomy.

Q: Painful arc syndrome is seen in all of the following conditions except?

Complete tear of supraspinatus. **Explanation:** The **Painful Arc Syndrome** refers to shoulder pain that occurs during mid-range abduction (typically between **60° and 120°**). This occurs because the subacromial space is narrowest in this range, causing the sensitive structures (supraspinatus tendon or subacromial bursa) to be compressed against the acromion process. **Why "Complete tear of supraspinatus" is the correct answer:** In a **complete (full-thickness) tear** of the supraspinatus, the patient is unable to initiate or maintain abduction effectively. Since the muscle cannot contract to pull the humerus into the subacromial space, the "impingement" mechanism does not occur in the same way. More importantly, the patient typically presents with a "Drop Arm Sign" rather than a painful arc, as they cannot control the limb through the 60°-120° range. **Analysis of Incorrect Options:** * **Supraspinatus tendinitis:** This is the most common cause. The inflamed, thickened tendon gets pinched during the middle arc of motion. * **Subacromial bursitis:** Inflammation of the bursa reduces the subacromial clearance, leading to classic impingement pain during abduction. * **Fracture of the greater tuberosity:** The supraspinatus inserts here. A fracture or malunion alters the anatomy of the subacromial space, leading to mechanical impingement and a painful arc. **NEET-PG High-Yield Pearls:** * **Range of Pain:** 60°–120° (Subacromial impingement); 120°–180° (Acromioclavicular joint pathology). * **Neer’s Test & Hawkins-Kennedy Test:** Clinical maneuvers used to elicit pain in impingement syndrome. * **Initiation of Abduction (0-15°):** Performed by the Supraspinatus. * **Main Abductor (15-90°):** Performed by the Deltoid. * **Overhead Abduction (>90°):** Involves scapular rotation by the Serratus Anterior and Trapezius.

Q: A Baker's cyst is a type of:

Pulsion diverticulum of the knee joint. **Explanation:** A **Baker’s cyst** (also known as a popliteal cyst) is a fluid-filled sac located in the popliteal fossa. It is considered a **pulsion diverticulum** because it represents a herniation of the synovial membrane through the posterior capsule of the knee joint, typically between the medial head of the gastrocnemius and the semimembranosus muscle. **Why Option A is correct:** The cyst is formed when intra-articular pressure increases (often due to underlying pathology like osteoarthritis or a meniscal tear). This pressure "pushes" (pulsion) the synovium through a point of least resistance in the joint capsule, creating a diverticulum. It often communicates with the joint via a valve-like mechanism. **Why other options are incorrect:** * **Retention cyst:** These occur due to the obstruction of a gland's duct (e.g., a sebaceous cyst). A Baker’s cyst is a synovial herniation, not a glandular obstruction. * **Bursitis:** While a Baker’s cyst often involves the gastrocnemio-semimembranosus bursa, it is specifically a herniation/communication with the joint space rather than simple primary inflammation of a bursa. * **Benign tumor:** A Baker’s cyst is a reactive, fluid-filled structure, not a neoplastic growth of cells. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most commonly found between the **medial head of gastrocnemius and semimembranosus**. * **Associated Pathology:** In adults, it is usually secondary to **osteoarthritis** or **meniscal tears**. In children, it is often primary and idiopathic. * **Foucher’s Sign:** The cyst becomes firm on knee extension and soft on flexion. * **Complication:** Rupture of the cyst can mimic **Deep Vein Thrombosis (DVT)**, presenting with sudden calf pain and a positive Homan’s sign (Pseudothrombophlebitis).

Q: Lift-off test is used for assessing the strength of which of the following muscles?

Subscapularis. **Explanation:** The **Lift-off test** (Gerber’s test) is the clinical gold standard for assessing the integrity and strength of the **Subscapularis** muscle. **1. Why Subscapularis is correct:** The subscapularis is the primary **internal rotator** of the shoulder. To perform the test, the patient places the dorsum of their hand against their mid-lumbar spine (internal rotation) and attempts to lift the hand away from the back against resistance. An inability to lift the hand or significant weakness indicates a subscapularis tear or dysfunction. If the patient cannot reach the small of their back, the **Belly-press test** is used as an alternative. **2. Why other options are incorrect:** * **Supraspinatus:** Assessed using the **Jobe’s test (Empty Can test)**. It is primarily responsible for the first 15° of abduction. * **Infraspinatus:** Along with the Teres minor, it is an **external rotator**. It is assessed using the External Rotation Lag Sign or resistance to external rotation with the arm at the side. * **Biceps brachii:** Assessed using **Speed’s test** or **Yergason’s test**, which evaluate for long head of biceps tendonitis or SLAP lesions. **Clinical Pearls for NEET-PG:** * **Rotator Cuff Muscles (SITS):** Supraspinatus (Abduction), Infraspinatus (External rotation), Teres minor (External rotation), Subscapularis (Internal rotation). * **Subscapularis** is the only rotator cuff muscle that inserts into the **Lesser Tuberosity** of the humerus; the other three insert into the Greater Tuberosity. * **Bear-hug test** is another highly sensitive test for subscapularis tears.

Q: The image displays a clinical maneuver. Which ligament's integrity is being assessed by this test?

Anterior cruciate ligament. ***Anterior cruciate ligament*** - The image demonstrates the **Anterior Drawer Test**, a clinical maneuver used to assess the integrity of the **Anterior Cruciate Ligament (ACL)**. - During this test, the examiner pulls the tibia anteriorly; excessive forward movement of the tibia relative to the femur indicates a positive test, suggesting an **ACL tear**. *Posterior cruciate ligament* - The **Posterior Cruciate Ligament (PCL)** is assessed with the **Posterior Drawer Test**, which involves pushing the tibia posteriorly, the opposite motion of what is shown. - The PCL prevents the posterior translation of the tibia, and its rupture is often associated with a **dashboard injury** or a direct blow to the anterior tibia. *Medial collateral ligament* - The **Medial Collateral Ligament (MCL)** is tested using the **Valgus Stress Test**, where a force is applied to the lateral side of the knee to test for medial joint space opening. - This maneuver is performed with the knee in slight flexion (20-30 degrees) and full extension, a different position and action than depicted. *Lateral collateral ligament* - The **Lateral Collateral Ligament (LCL)** is evaluated with the **Varus Stress Test**, where a force is applied to the medial side of the knee to check for lateral joint space opening. - This test, like the valgus stress test, is performed at different degrees of flexion and is distinct from the drawer test shown in the image.

Question 1

Jumper's knee is primarily caused by:

Accepted Answer

Patellar tendonosis

Answer

Sacral fracture

Answer

Tibial fracture

Answer

Fibular fracture

Question 2

The Female Athlete Triad consists of all EXCEPT:

Accepted Answer

Absence of secondary sexual characteristics

Answer

Disordered eating

Answer

Amenorrhea

Answer

Osteoporosis

Question 3

A 17-year-old athletic girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. What is the likely diagnosis?

Accepted Answer

Chondromalacia patella

Answer

Blount's disease

Answer

Nail-patella syndrome

Answer

Bursitis

Question 4

Which of the following statements about nerve entrapment syndromes is FALSE?

Accepted Answer

Cheiralgia paresthetica involves the femoral nerve.

Answer

Guyon's canal syndrome involves the ulnar nerve.

Answer

Cubital tunnel syndrome involves the ulnar nerve.

Answer

Tarsal tunnel syndrome involves the posterior tibial nerve.

Question 5

All of the following features in the knee are recognized to be consistent with a torn medial meniscus, except?

Accepted Answer

Excessive forward glide

Answer

Giving way

Answer

Locking

Answer

McMurray's sign

Question 6

A spontaneous rupture of the Achilles tendon occurs in an 18-year-old male. This is most likely due to excess stress beyond which of the following?

Accepted Answer

Tendon strength

Answer

Bone strength

Answer

Muscle strength

Answer

Musculotendinous junction strength

Question 7

Painful arc syndrome is seen in all of the following conditions except?

Accepted Answer

Complete tear of supraspinatus

Answer

Fracture of the greater tuberosity

Answer

Subacromial bursitis

Answer

Supraspinatus tendinitis

Question 8

A Baker's cyst is a type of:

Accepted Answer

Pulsion diverticulum of the knee joint

Answer

Retention cyst

Answer

Bursitis

Answer

Benign tumor

Question 9

Lift-off test is used for assessing the strength of which of the following muscles?

Accepted Answer

Subscapularis

Answer

Supraspinatus

Answer

Infraspinatus

Answer

Biceps brachii

Question 10

The image displays a clinical maneuver. Which ligament's integrity is being assessed by this test?

Accepted Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Posterior cruciate ligament

Answer

Lateral collateral ligament

Sports Medicine — MCQs

Sports Medicine — MCQs

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