Sports Medicine Practice Questions

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: 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.

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.

Question 1

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 2

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 3

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 4

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

Question 5

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 6

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 7

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 8

Most common affected tendon in the Swimmer's shoulder?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Teres minor

Answer

Teres major

Question 9

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 10

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

Sports Medicine — MCQs

Sports Medicine — MCQs

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