Sports Medicine Practice Questions

Q: A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Housemaid's knee. ***Housemaid's knee*** - This condition, also known as **prepatellar bursitis**, involves inflammation and fluid accumulation in the bursa located directly in front of the patella, matching the MRI findings and the patient's clinical presentation. - It is frequently associated with occupations that require prolonged kneeling, such as being a laborer, leading to chronic irritation and swelling in this specific location. *Subdermal abscess* - A subdermal abscess would typically present with more pronounced signs of infection, such as significant warmth, **erythema** (redness), and systemic symptoms like fever, which are not mentioned in this case. - On MRI, an abscess often shows a more complex fluid collection with **rim enhancement** after contrast administration, distinguishing it from the simple bursal fluid seen here. *Gout* - Gout is an **intra-articular** arthritis caused by **urate crystal** deposition, which would cause swelling within the knee joint itself, not a localized collection in front of the patella. - The classic presentation is an acute, intensely painful, and red joint, most commonly the first **metatarsophalangeal joint** (podagra), which differs from this patient's presentation. *Rheumatoid arthritis* - Rheumatoid arthritis is a systemic inflammatory condition that typically causes **symmetric polyarthritis** of small joints in the hands and feet. - While it can affect the knee, it causes an **intra-articular** effusion (swelling within the joint space) and synovitis, not isolated prepatellar bursitis.

Q: A 28-year-old male cricketer presents to the emergency department with severe knee pain and swelling after a twisting injury while batting. On examination, there is a large effusion, and the patient is unable to fully extend the knee. McMurray's test is positive with a click on the medial side during external rotation of the tibia. MRI shows a vertical tear in the posterior horn. What is the most appropriate initial management?

Arthroscopic repair of the tear. ***Immediate arthroscopic surgery*** - The patient presents with classic signs of a **locked knee** (inability to fully extend) due to a displaced meniscal fragment, highly suggested by the severe pain, large effusion, and the positive medial **McMurray's test**. - A displaced vertical tear (often a **bucket-handle tear**) causes a mechanical block that requires urgent surgical intervention (*arthroscopy*) for reduction or fixation to relieve locking and prevent chronic articular cartilage damage. *RICE (Rest, Ice, Compression, Elevation) and NSAIDs* - While RICE and NSAIDs are appropriate first aid for most acute knee injuries, they are insufficient as the definitive initial management for a knee that is mechanically **locked** and cannot be extended. - This treatment is reserved for stable, non-displaced meniscal tears or low-grade ligament sprains where there is no mechanical block. *Non-weight-bearing and physical therapy (Rehabilitation)* - Physical therapy and rehabilitation are crucial *after* the mechanical symptoms (locking) have been resolved, either through manipulative reduction or surgery, but should not be the initial treatment for an acutely locked joint. - Non-weight-bearing *is* appropriate initially, but it does not address the underlying displaced tear creating the mechanical block. *Aspiration of the knee effusion* - Aspiration is helpful for significant effusions, especially if they are symptomatic or if there is concern for **hemarthrosis** (a possible complication in acute injury), but it is generally a palliative measure. - Removing the fluid reduces pain and tension but does not resolve the critical pathology: the displaced meniscal fragment blocking extension of the knee joint.

Q: The following test is done to evaluate for Achilles tendon rupture. The test is known as?

Thompson test. ***Thompson test*** - The **Thompson test** assesses for an **Achilles tendon rupture** by observing plantarflexion of the foot upon squeezing the calf muscle. - A **positive test** (absence of plantarflexion) indicates a complete rupture of the Achilles tendon. *Thomas test* - The **Thomas test** is used to evaluate for **hip flexor contracture** or tightness. - It involves assessing the ability of the thigh to remain flat on the examination table while the opposite hip is flexed. *Single leg heel raise test* - The **single leg heel raise test** evaluates the strength and endurance of the **calf muscles**, primarily the gastrocnemius and soleus. - Inability to perform this test can be due to weakness, pain, or an Achilles tendon rupture, but it's not a definitive diagnostic test on its own. *Gordon test* - The **Gordon test** is a neurological test used to elicit an abnormal plantar reflex, indicative of an **upper motor neuron lesion**. - It involves squeezing the calf muscles and observing for an extensor plantar response (dorsiflexion of the great toe and fanning of other toes).

Q: A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?

Anterior cruciate ligament tear. ***Anterior cruciate ligament tear*** - The image depicts the **Lachman test**, a highly sensitive and specific clinical test for **ACL integrity**. - A positive Lachman test, characterized by *increased anterior tibial translation* and a *soft or absent endpoint*, confirms an **ACL tear**. *Posterior cruciate ligament tear* - A PCL tear is identified by tests like the **posterior drawer test** or **posterior sag sign**, which show *posterior tibial translation*. - The test shown in the image specifically assesses **anterior stability**, not posterior. *Medial meniscus tear* - Medial meniscus tears are typically diagnosed with tests like **McMurray's test** or **Apley's grind test**, which involve *rotation* and *compression* of the knee. - While a crucial knee structure, the meniscus does not primarily contribute to **anterior-posterior stability** in the way the ACL does. *Medial collateral ligament tear* - An MCL tear is detected by applying a **valgus stress** to the knee at various degrees of flexion. - This tear presents with *medial joint line pain* and *instability to valgus stress*, which is not assessed by the depicted test.

Q: The deformity shown below is seen in:

Rheumatoid arthritis. ***Rheumatoid arthritis*** - The image exhibits classic features of **rheumatoid arthritis**, including **ulnar deviation** of the fingers and swelling of the **metacarpophalangeal (MCP) joints**. - **Swan neck** and **boutonnière deformities** are also characteristic, though less distinctly visible here, while prominent MCP joint swelling points strongly to this diagnosis. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton**, leading to spinal stiffness and sacroiliitis, rather than peripheral joint deformities seen in the image. - While peripheral arthritis can occur in ankylosing spondylitis, the **classic hand deformities** shown are not typical. *Osteoarthritis* - **Osteoarthritis** typically causes **Heberden's** and **Bouchard's nodes** (affecting distal and proximal interphalangeal joints, respectively) and tends to spare the MCP joints. - The type of joint swelling and deviation seen in the image is not characteristic of osteoarthritis, which also lacks the **inflammatory component** of rheumatoid arthritis. *Reiter's syndrome* - Also known as **reactive arthritis**, Reiter's syndrome is characterized by a triad of arthritis, urethritis, and conjunctivitis, often triggered by an infection. - While it can cause inflammatory arthritis, the specific hand deformities of **ulnar deviation** and prominent MCP swelling are not typical; arthritis tends to be asymmetric and involves larger joints or enthesitis.

Q: A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?

Lachman. ***Lachman*** - The image shows the examiner holding the distal thigh and proximal tibia, with the knee flexed at a **20-30 degree angle**, applying an **anterior translational force** to the tibia. This specific maneuver is characteristic of the Lachman test. - The Lachman test is highly sensitive for detecting **anterior cruciate ligament (ACL) tears**, particularly in acute injuries, due to the reduced hamstring spasm compared to the anterior drawer test. *Posterior drawer for PCL* - The posterior drawer test involves flexing the knee to **90 degrees** and applying a **posterior force** to the tibia to assess the integrity of the **posterior cruciate ligament (PCL)**. - The position of the knee in the image (flexed at a shallower angle) and the direction of the applied force (anteriorly towards the femur) do not match the technique for a posterior drawer test. *McMurray* - The McMurray test is performed to evaluate **meniscal tears** by flexing, extending, and rotating the knee while applying a varus or valgus stress. - The maneuver in the image, involving direct anterior translation of the tibia with the knee in slight flexion, is not consistent with the McMurray test. *Anterior drawer for ACL* - While also testing the **ACL**, the anterior drawer test typically involves flexing the knee to **90 degrees** and sitting on the foot, then pulling the tibia anteriorly. - The knee flexion angle in the image is much shallower than 90 degrees, making it inconsistent with the standard anterior drawer test.

Q: Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Game keepers thumb. ***Gamekeeper's thumb*** - A **Gamekeeper's thumb**, or **skier's thumb**, is an injury to the **ulnar collateral ligament (UCL)** of the thumb's metacarpophalangeal (MCP) joint. - This injury commonly occurs due to a **forceful abduction** and hyperextension of the thumb. *Kaplan lesion* - A **Kaplan lesion** refers to an avulsion fracture of the radial styloid process, usually associated with scaphoid fractures. - This lesion is typically related to wrist injuries, not primarily thumb abduction. *Bennett fracture* - A **Bennett fracture** is an intra-articular fracture at the base of the first metacarpal bone. - It usually results from an axial load applied to a partially flexed thumb, rather than pure abduction. *Mallet finger* - A **mallet finger** is an injury to the **extensor tendon** of the finger, causing the fingertip to remain in a flexed position. - This injury typically affects the distal interphalangeal (DIP) joint of any finger and is not directly related to thumb abduction.

Q: Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Medial meniscus. ***Medial meniscus*** - The **medial meniscus** is commonly injured in conjunction with the **medial collateral ligament** due to their anatomical proximity and shared role in knee stability. - The MCL is a primary restraint to **valgus stress**, and strong valgus forces that injure the MCL can also transmit stress to the medial meniscus, leading to tears. *Lateral meniscus* - The **lateral meniscus** is less frequently injured alongside the MCL because it is typically more mobile and not directly attached to the MCL. - Injuries to the lateral meniscus are more often associated with **anterior cruciate ligament (ACL) tears** or significant *rotational forces*. *Anterior cruciate ligament* - The **anterior cruciate ligament** is primarily injured by **non-contact pivoting** or **hyperextension injuries**, and while it can be part of the "unhappy triad" (along with MCL and medial meniscus tears), an isolated MCL injury does not most commonly implicate it. - ACL tears lead to **anterior instability** of the tibia relative to the femur, which is a different biomechanical mechanism than an isolated MCL injury. *Posterior Cruciate Ligament* - The **posterior cruciate ligament** is injured by a direct blow to the anterior tibia while the knee is flexed or during a dashboard injury, leading to **posterior instability**. - Its injury mechanism is distinct from that of the MCL, which is primarily due to **valgus stress**.

Q: Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Recurrent shoulder dislocation. ***Recurrent shoulder dislocation*** - The ability to **spontaneously reduce** a shoulder dislocation, and the history of it happening "again and again" strongly indicate **recurrent shoulder dislocation**. - This condition often results from **ligamentous laxity** or damage to the **labrum** (Bankart lesion) that fails to stabilize the shoulder joint after an initial dislocation. *Inferior shoulder dislocation* - This is a **specific type of shoulder dislocation** (luxatio erecta) where the humeral head is displaced inferiorly, but "inferior" alone does not explain the recurrent nature. - While possible in an individual, the key element here is the **recurrence** and self-reduction, not just the direction of a single dislocation. *Fracture upper end humerus* - A fracture of the upper end of the humerus is a **bony injury** and would typically present with severe pain, swelling, and inability to move the arm, not spontaneous reduction. - This injury would usually **prevent** the patient from repeatedly dislocating and reducing their shoulder. *Acute shoulder dislocation* - An acute shoulder dislocation refers to a **single, recent episode** of dislocation. - The patient's repeated ability to self-reduce the shoulder indicates a chronic problem rather than an initial, isolated event.

Q: A 18-year-old boy was playing football when he suddenly twisted his knee and fell down. He got up after 10 minutes and resumed playing. The next day, he experienced knee swelling and difficulty moving it. What is the most probable cause?

Medial meniscus injury. ***Medial meniscus injury*** - A **twisting injury** in a weight-bearing knee (like during football) combined with delayed swelling points toward a meniscal tear. - The ability to resume playing after initial pain, followed by later swelling and restricted movement, suggests a **meniscal lesion** rather than an immediate, severe ligament rupture. *Posterior cruciate ligament injury* - This typically results from a **direct blow to the anterior tibia** with the knee flexed, not a twisting mechanism. - It often presents with less acute swelling and more **posterior sag** of the tibia. *Anterior cruciate ligament injury* - An **ACL tear** often causes immediate, severe pain and **rapid hemarthrosis** (within hours) due to significant bleeding, making it unlikely for the patient to resume playing quickly. - Often associated with an audible **"pop"** at the time of injury. *Medial collateral ligament injury* - An **MCL injury** usually results from a **valgus stress** (force from the outside of the knee) and typically presents with pain on the medial side of the knee. - While it can cause swelling, a twisting mechanism is less characteristic, and **instability during valgus stress** would be a primary finding.

Question 1

A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?

Accepted Answer

Housemaid's knee

Answer

Rheumatoid arthritis

Answer

Gout

Answer

Subdermal abscess

Question 2

A 28-year-old male cricketer presents to the emergency department with severe knee pain and swelling after a twisting injury while batting. On examination, there is a large effusion, and the patient is unable to fully extend the knee. McMurray's test is positive with a click on the medial side during external rotation of the tibia. MRI shows a vertical tear in the posterior horn. What is the most appropriate initial management?

Accepted Answer

Arthroscopic repair of the tear

Answer

Partial meniscectomy

Answer

Total meniscectomy

Answer

Conservative management with physiotherapy

Question 3

The following test is done to evaluate for Achilles tendon rupture. The test is known as?

Accepted Answer

Thompson test

Answer

Thomas test

Answer

Single leg heel raise test

Answer

Gordon test

Question 4

A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?

Accepted Answer

Anterior cruciate ligament tear

Answer

Posterior cruciate ligament tear

Answer

Medial meniscus tear

Answer

Medial collateral ligament tear

Question 5

The deformity shown below is seen in:

Accepted Answer

Rheumatoid arthritis

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Reiter's syndrome

Question 6

A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?

Accepted Answer

Lachman

Answer

Posterior drawer for PCL

Answer

McMurray

Answer

Anterior drawer for ACL

Question 7

Patient had an injury to thumb causing thumb abduction. Which of the following can happen?

Accepted Answer

Game keepers thumb

Answer

Kaplan lesion

Answer

Mallet finger

Answer

Bennett fracture

Question 8

Football player with knee injury diagnosed as medial collateral ligament injury. Which structure is most commonly associated with this type of injury?

Accepted Answer

Medial meniscus

Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Posterior Cruciate Ligament

Question 9

Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?

Accepted Answer

Recurrent shoulder dislocation

Answer

Inferior shoulder dislocation

Answer

Fracture upper end humerus

Answer

Acute shoulder dislocation

Question 10

A 18-year-old boy was playing football when he suddenly twisted his knee and fell down. He got up after 10 minutes and resumed playing. The next day, he experienced knee swelling and difficulty moving it. What is the most probable cause?

Accepted Answer

Medial meniscus injury

Answer

Posterior cruciate ligament injury

Answer

Anterior cruciate ligament injury

Answer

Medial collateral ligament injury

Sports Medicine — MCQs

Sports Medicine — MCQs

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