Sports Medicine Practice Questions

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: 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.

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: Identify the clinical sign being tested in the image:

Hawkins test. ***Hawkins test*** - The image depicts the **Hawkins-Kennedy test**, a specific orthopedic maneuver used to assess **shoulder impingement syndrome**. - The test involves **shoulder flexion to 90°**, **elbow flexion to 90°**, followed by **forceful internal rotation**, which reproduces pain if subacromial impingement is present. *Neer test* - The **Neer impingement test** involves **passive forward flexion** of the arm while stabilizing the scapula, not the position shown in the image. - This test compresses the **supraspinatus tendon** against the anterior acromion, causing pain in impingement syndrome. *Sag sign* - The **posterior sag sign** is used to test for **posterior cruciate ligament (PCL) injury** in the knee joint. - It involves observing for **posterior displacement** or "sag" of the tibia relative to the femur when the knee is flexed to 90°. *Capener sign* - The **Capener sign** is associated with **scaphoid fractures** in the wrist and refers to a specific **radiographic finding**. - It indicates **displacement of a scaphoid fracture fragment** seen on X-rays, not a physical examination maneuver.

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: A 16-year-old competitive swimmer presents with recurrent shoulder dislocation. MRI shows a Bankart lesion and significant bone loss. His coach wants him to return to competition quickly, his parents are concerned about long-term function, and the patient wants to continue swimming. Evaluate the management approach that best addresses all stakeholder concerns.

Latarjet procedure for bone loss with extended recovery. ***Latarjet procedure for bone loss with extended recovery*** - The **Latarjet procedure** addresses both the **Bankart lesion** and significant **bone loss** on the glenoid, which is crucial for preventing future dislocations in a high-risk athlete. - While it requires an **extended recovery** (typically 4-6 months), this approach offers the best long-term stability, satisfying the parents' concern for long-term function and ultimately allowing the patient to return to competitive swimming. - This procedure transfers the coracoid process to the glenoid, providing both a bony buttress and dynamic sling effect from the conjoint tendon. *Temporary activity restriction with delayed surgical decision* - This approach fails to address the underlying **structural instability** and significant bone loss, making future dislocations highly probable, especially in a competitive swimmer. - Delaying surgery prolongs the patient's time away from sport and does not adequately address the goal of a definitive, long-term solution. *Conservative management with physical therapy* - In a young, athletic individual with **recurrent dislocations**, a Bankart lesion, and **significant bone loss**, conservative management is highly unlikely to provide adequate stability to prevent recurrence. - This would not allow the patient to safely return to high-demand activities like competitive swimming. *Open Bankart repair with 4-6 month recovery period* - While an **open Bankart repair** addresses the labral lesion, it does not adequately manage the **significant bone loss**, which is a major risk factor for re-dislocation in this patient population. - The risk of recurrent instability remains high with failure rates of 20-30% in athletes with bone loss, making this a less durable solution for a competitive swimmer.

Question 1

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 2

Ruptured tendon is most commonly seen in which of the following conditions?

Accepted Answer

Overuse

Answer

Stab injury

Answer

Soft tissue tumor

Answer

Congenital defect

Question 3

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 4

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 5

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 6

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

Question 7

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 8

Identify the clinical sign being tested in the image:

Accepted Answer

Hawkins test

Answer

Sag sign

Answer

Capener sign

Answer

Neer test

Question 9

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 10

A 16-year-old competitive swimmer presents with recurrent shoulder dislocation. MRI shows a Bankart lesion and significant bone loss. His coach wants him to return to competition quickly, his parents are concerned about long-term function, and the patient wants to continue swimming. Evaluate the management approach that best addresses all stakeholder concerns.

Accepted Answer

Latarjet procedure for bone loss with extended recovery

Answer

Temporary activity restriction with delayed surgical decision

Answer

Conservative management with physical therapy

Answer

Open Bankart repair with 4-6 month recovery period

Sports Medicine — MCQs

Sports Medicine — MCQs

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