Sports Medicine Practice Questions

Q: In meniscus injury, 'Locking'-that is sudden inability to extend the knee fully is a feature of:

Bucket handle tear. ***Bucket handle tear*** - A **bucket handle tear** is a specific type of **longitudinal tear** where a large segment of the meniscus is displaced into the intercondylar notch, physically blocking knee extension and leading to **locking**. - This tear typically affects the **medial meniscus** and is a classic cause of **mechanical locking** where the knee cannot be fully straightened. *Anterior horn tear* - Tears of the **anterior horn** are less common than posterior horn tears and rarely cause **locking** unless they are extensive and displace significantly. - While they can cause pain and instability, they are not the primary cause of acute, complete mechanical **locking**. *Horizontal tears* - **Horizontal tears** separate the meniscus into superior and inferior halves and are often degenerative. - They typically cause pain and swelling but are less likely to cause a distinct mechanical **locking** sensation compared to displaced bucket handle tears. *Posterior horn tear* - **Posterior horn tears** are the most common type of meniscus injury and can cause pain, swelling, and sometimes catching. - While they can impede movement, they usually do not cause the complete, irreversible **locking** characteristic of a displaced bucket handle fragment.

Q: Which of the following tests is not done for anterior cruciate ligament injury?

Dial test. ***Dial test*** - The **dial test** is used to assess **posterolateral rotatory instability** of the knee and evaluates the integrity of the **posterior cruciate ligament (PCL)** and **posterolateral corner structures**, not the ACL. - It involves assessing the amount of external rotation of the tibia relative to the femur at different degrees of knee flexion. *Anterior drawer test* - The **anterior drawer test** evaluates the integrity of the **anterior cruciate ligament (ACL)** by attempting to move the tibia anteriorly on the femur. - Excessive anterior translation of the tibia indicates a possible ACL tear. *Lachman's test* - **Lachman's test** is considered one of the most sensitive tests for **ACL injury**, especially acute injuries. - It involves stabilizing the femur and gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees; excessive anterior excursion or a soft end-point indicates a tear. *Pivot shift test* - The **pivot shift test** is highly specific for a torn **ACL** and simulates the subluxation and reduction of the tibia that occurs during dynamic activity. - It involves applying a valgus stress and internal rotation to the knee while moving it from extension to flexion; a palpable or visible "clunk" indicates a positive test.

Q: Pivot shift test is positive with

Anterior cruciate ligament tear. **Anterior cruciate ligament tear** - The **pivot shift test** is a specific clinical examination maneuver used to detect **rotary knee instability** caused by an **ACL tear**. - It demonstrates the feeling of the tibia subluxing anteriorly on the femur during knee extension and then reducing with flexion, indicative of ACL insufficiency. *Posterior cruciate ligament tear* - PCL tears are primarily assessed using the **posterior drawer test** or **posterior sag sign**. - The pivot shift test is not designed to evaluate the stability provided by the PCL. *Medial meniscus injury* - Meniscal injuries are typically assessed with tests like **McMurray's test** or **Apley's compression test**, which elicit pain or clicking. - While meniscal tears can contribute to knee instability, the pivot shift test specifically targets rotatory instability associated with ACL deficiency. *Lateral meniscus injury* - Similar to medial meniscus injuries, lateral meniscal tears are identified through specific maneuvers like McMurray's test, focusing on pain and clicking during rotation and flexion/extension. - The pivot shift test is not a primary diagnostic tool for isolated meniscal pathology.

Q: Most common affected tendon in the Swimmer's shoulder?

Supraspinatus. ***Supraspinatus*** - The **supraspinatus tendon** is most commonly affected in **swimmer's shoulder** due to its vulnerable position beneath the **acromion** and its significant involvement in **overhead arm movements**. - Repetitive abduction and external rotation of the arm, typical in swimming strokes, can lead to **impingement** and **tendinopathy** of this tendon. *Infraspinatus* - While the infraspinatus can be involved in rotator cuff pathologies, it is less frequently the primary tendon affected in swimmer's shoulder compared to the supraspinatus. - Its primary actions are **external rotation** and **horizontal abduction**, which are less prominent in causing impingement seen in swimmers. *Teres minor* - The **teres minor** is also a rotator cuff muscle involved in **external rotation**, but it is relatively protected from impingement injuries that commonly affect the supraspinatus. - Injuries to the teres minor are generally less common in overhead athletes compared to the supraspinatus. *Teres major* - The **teres major** is not part of the **rotator cuff** and primarily functions in **adduction**, **internal rotation**, and **extension of the humerus**. - It is located inferiorly and is not typically involved in the impingement syndrome characteristic of swimmer's shoulder.

Q: Which of the following tests is used to test anterior instability of shoulder?

Apprehension Test (crank test). ***Apprehension Test (crank test)*** - The **apprehension test** assesses for anterior shoulder instability by passively abducting and externally rotating the arm, which is the position of potential anterior dislocation. - A positive test is indicated by the patient's **apprehension** or fear of dislocation, often accompanied by muscle guarding, as the head of the humerus is forced anteriorly. *Push-pull test* - The push-pull test is used to assess for **posterior shoulder stability**, specifically for **posterior labral tears** or instability. - It involves applying axial compression while simultaneously pulling the humerus posteriorly, looking for pain or a clunk. *Posterior drawer test* - The posterior drawer test is primarily used to evaluate **posterior glenohumeral instability**. - It involves stabilizing the scapula and applying a posterior force to the humerus while the arm is flexed, abducted, and internally rotated. *Jerk test* - The jerk test is used to identify **posterior-inferior glenohumeral instability** or a **posterior labral tear**, particularly a reverse Bankart lesion. - It involves axially loading the arm while moving it from an abducted and externally rotated position to an adducted and internally rotated position, looking for a sudden "jerk" or clunk.

Q: An athletic teenage girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. Which of the following is the most likely diagnosis?

Chondromalacia Patellae. ***Chondromalacia Patellae*** - This condition involves the **softening and breakdown of cartilage** on the underside of the patella, leading to pain exacerbated by activities that increase **patellofemoral joint compression**, such as climbing stairs or prolonged sitting. - It is particularly common in **athletic adolescents and young adults**, especially females, due to repetitive stress and potential alignment issues. *Patellofemoral osteoarthritis* - While it also affects the patellofemoral joint, **osteoarthritis** typically occurs in older individuals and involves **degenerative changes** of the cartilage, which are less likely in a teenage girl without significant prior trauma or predisposing conditions. - The pain is usually more persistent and can be associated with **crepitus** and **swelling**, which are not specified here. *Plica Syndrome* - **Plica syndrome** involves irritation or inflammation of a synovial fold (plica) in the knee, which can cause snapping, clicking, or pain. - Although it can cause anterior knee pain, the pain is often more localized to the **medial side of the patella** and may not be as directly correlated with activities that load the patellofemoral joint broadly. *Bipartite Patella* - A **bipartite patella** is a congenital condition where the kneecap is made of two separate bones, usually fused by adolescence. It is often asymptomatic. - When symptomatic, it typically presents with pain localized to the **superolateral aspect of the patella** and may be acutely aggravated by direct trauma or overuse, not necessarily generalized patellofemoral loading.

Q: Manoeuvre carried out for diagnosing medial meniscus injury is:

McMurray's test. ***McMurray's test*** - This test is specifically designed to assess for meniscal tears, particularly the **medial meniscus**. - A positive test involves eliciting a **click or pain** when extending the knee from a fully flexed position while internally and externally rotating the tibia. *Valgus stress test* - This test evaluates the integrity of the **medial collateral ligament (MCL)**. - It involves applying a valgus (outward) force to the knee while stabilizing the thigh, looking for increased gapping or pain. *Lachmann's test* - This is the most sensitive test for assessing the integrity of the **anterior cruciate ligament (ACL)**. - It involves gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees, looking for excessive anterior translation. *Varus stress test* - This test assesses the integrity of the **lateral collateral ligament (LCL)**. - It involves applying a varus (inward) force to the knee while stabilizing the thigh, looking for increased gapping or pain.

Q: An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:

Stress fracture. ***Stress fracture*** - A **stress fracture** is highly likely in a recruit undergoing rigorous training, as repetitive stress on bones, especially in the legs, can lead to micro-fractures. - The symptoms of **localized pain** at the posteromedial aspect of both legs, acute point tenderness, and pain aggravated by physical activity are classic for stress fractures. *Gout* - **Gout** typically presents with sudden, severe pain and inflammation in a single joint, most commonly the big toe; it is less likely to cause bilateral, activity-related leg pain. - While smoking is a risk factor for gout, the clinical presentation does not align with a **gout flare-up**. *Buerger's disease* - **Buerger's disease** (thromboangiitis obliterans) is a rare inflammatory disease of the small and medium-sized arteries and veins, mainly affecting the hands and feet of heavy smokers. - It causes pain, numbness, and tingling due to **ischemia**, often leading to gangrene; it does not manifest as point tenderness and activity-aggravated pain along the posteromedial aspect of the legs. *Lumbar canal stenosis* - **Lumbar canal stenosis** typically causes neurogenic claudication, characterized by radiating pain, numbness, or weakness in the legs that is exacerbated by standing or walking and relieved by sitting or leaning forward. - The symptoms described, including **acute point tenderness** and posteromedial leg pain, are not characteristic of spinal canal narrowing.

Q: Drawer sign is seen in:

Cruciate ligament injury. ***Cruciate ligament injury*** - The **drawer test** specifically assesses the integrity of the **anterior and posterior cruciate ligaments** in the knee. - A positive drawer sign indicates excessive forward or backward translation of the tibia relative to the femur, signifying a **ligamentous tear**. *Hyperparathyroidism* - This condition involves **excessive parathyroid hormone**, leading to calcium and phosphate imbalances. - Symptoms are primarily related to **bone demineralization**, kidney stones, and neuromuscular issues, not ligament instability. *Perthes' disease* - An **avascular necrosis of the femoral head** in children, causing hip pain and limping. - It affects the **hip joint**, not the knee, and there is no associated drawer sign. *Scurvy* - Caused by a **deficiency of vitamin C**, which is essential for collagen synthesis. - Manifestations include **bleeding gums**, poor wound healing, and musculoskeletal pain, but not specific ligamentous instability of the knee.

Q: Cozen test is positive in :-

Tennis elbow. ***Tennis elbow*** - The **Cozen test** is a specific diagnostic maneuver used to assess for **lateral epicondylitis**, commonly known as tennis elbow. - A positive test indicates pain over the **lateral epicondyle** with resisted wrist extension, confirming inflammation or degeneration of the common extensor tendons. *Skiers thumb* - This condition involves injury to the **ulnar collateral ligament of the thumb**, typically due to hyperextension and abduction forces. - The Cozen test is **irrelevant** for diagnosing thumb ligament injuries. *Golfer's elbow* - Also known as **medial epicondylitis**, this involves inflammation of the **flexor-pronator tendons** at the medial epicondyle. - The Cozen test specifically evaluates the extensor tendons, and a comparable test for golfer's elbow would involve resisted wrist flexion. *Pulled elbow* - This refers to **radial head subluxation**, a common injury in children where the radius slips out of the annular ligament. - It is an injury related to joint displacement, not tendon pathology, and therefore the Cozen test is not applicable.

Question 1

In meniscus injury, 'Locking'-that is sudden inability to extend the knee fully is a feature of:

Accepted Answer

Bucket handle tear

Answer

Anterior horn tear

Answer

Horizontal tears

Answer

Posterior horn tear

Question 2

Which of the following tests is not done for anterior cruciate ligament injury?

Accepted Answer

Dial test

Answer

Anterior drawer test

Answer

Lachman's test

Answer

Pivot shift test

Question 3

Pivot shift test is positive with

Accepted Answer

Anterior cruciate ligament tear

Answer

Posterior cruciate ligament tear

Answer

Medial meniscus injury

Answer

Lateral meniscus injury

Question 4

Most common affected tendon in the Swimmer's shoulder?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Teres minor

Answer

Teres major

Question 5

Which of the following tests is used to test anterior instability of shoulder?

Accepted Answer

Apprehension Test (crank test)

Answer

Push-pull test

Answer

Posterior drawer test

Answer

Jerk test

Question 6

An athletic teenage girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. Which of the following is the most likely diagnosis?

Accepted Answer

Chondromalacia Patellae

Answer

Patellofemoral osteoarthritis

Answer

Plica Syndrome

Answer

Bipartite Patella

Question 7

Manoeuvre carried out for diagnosing medial meniscus injury is:

Accepted Answer

McMurray's test

Answer

Valgus stress test

Answer

Lachmann's test

Answer

Varus stress test

Question 8

An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:

Accepted Answer

Stress fracture

Answer

Gout

Answer

Buerger's disease

Answer

Lumbar canal stenosis

Question 9

Drawer sign is seen in:

Accepted Answer

Cruciate ligament injury

Answer

Hyperparathyroidism

Answer

Perthes' disease

Answer

Scurvy

Question 10

Cozen test is positive in :-

Accepted Answer

Tennis elbow

Answer

Skiers thumb

Answer

Golfer's elbow

Answer

Pulled elbow

Sports Medicine — MCQs

Sports Medicine — MCQs

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