Sports Medicine Practice Questions

Q: Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?

Subscapularis tear. ***Subscapularis tear*** - The patient can perform **internal rotation** but has difficulty lifting the arm *off* the lumbosacral spine, indicating weakness in **subscapularis function**. - The **lift-off test** is a specific clinical test for subscapularis integrity, where the inability to lift the hand off the back suggests a tear. *Teres major tear* - A tear in the **teres major** would primarily affect **adduction** and **internal rotation** of the arm. - The patient's ability to internal rotate and abduct the arm makes a primary teres major tear less likely. *Acromioclavicular joint dislocation* - This condition presents with **pain** and **tenderness** over the AC joint, and a visible deformity ("step-off"). - While it can cause shoulder pain and limit movement, it does not typically present with the specific internal rotation and lift-off deficits described. *Long head of biceps tear* - A tear of the **long head of the biceps** usually presents with a "Popeye" deformity and pain with **supination** and **flexion of the elbow**. - The symptoms described (difficulty with lift-off, intact internal rotation) are not characteristic of a biceps tear.

Q: All are true about Rotator cuff syndrome except:

Fracture. ***Fracture*** - Rotator cuff syndrome primarily involves the **tendons and muscles** of the rotator cuff, not the bony structures. - A fracture refers to a **break in the bone**, which is a distinct injury from rotator cuff pathologies. *Rupture* - A **rotator cuff tear** or rupture is a common and severe form of rotator cuff syndrome. - This involves a tear in one or more of the **four rotator cuff tendons**, leading to pain and weakness. *Weakness* - Weakness, particularly in **shoulder abduction** and external rotation, is a hallmark symptom of rotator cuff syndrome, especially with tears. - The compromised integrity of the rotator cuff muscles and tendons directly impairs their ability to generate **force and control movement**. *Tendinitis* - **Rotator cuff tendinitis** (or tendinopathy) is a common cause of shoulder pain and is often the initial stage of rotator cuff syndrome. - It involves **inflammation and degenerative changes** within the rotator cuff tendons, leading to pain with movement.

Q: Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?

Walk downhill. ***Walk downhill*** - An **anterior cruciate ligament (ACL) deficient knee** experiences anterior tibial translation, especially when the muscles can't compensate, leading to instability. - Walking downhill places higher **anterior shear forces** on the knee joint and often involves knee extension or hyperextension, which dramatically increases the risk of the tibia translating anteriorly relative to the femur. *Getting up from a sitting position* - This activity primarily involves **quadriceps muscle contraction** and a concentric movement of the knee, which stabilizes the joint. - It does not typically place significant **anterior shear stress** on the ACL, even in a deficient knee. *Walk uphill* - Walking uphill often involves knee flexion and places the knee in a more protected position against **anterior tibial translation**. - The quadriceps and hamstrings work synergistically to **stabilize the joint** during this motion, reducing stress on the ACL. *Sitting cross-legged* - This position primarily involves **hip and knee flexion and external rotation**, but it is generally a static and non-weight-bearing position. - It does not impose significant **dynamic loads** or shear forces that would cause instability in an ACL-deficient knee.

Q: Yergason's supination sign is seen in lesion of which muscle?

Biceps. ***Biceps*** - **Yergason's test** assesses the stability of the **long head of the biceps tendon** within the bicipital groove. - A positive test, indicated by pain or palpable snapping, suggests **tenosynovitis** or **subluxation** of the biceps tendon. *Brachioradialis* - The **brachioradialis** is primarily a forearm flexor and pronator/supinator to neutral, not directly involved in the bicipital groove. - Its pathology is not assessed by **Yergason's maneuver**. *Triceps* - The **triceps** is the primary extensor of the elbow and has no direct connection to the shoulder joint structures assessed by Yergason's. - Its function is typically evaluated by tests of **elbow extension strength**. *Supinator* - The **supinator muscle** is responsible for **forearm supination**, but its integrity is not directly evaluated by Yergason's test, which focuses on the biceps tendon. - Damage to the supinator typically presents with weakness in active supination, rather than pain in the bicipital groove.

Q: A 17-year-old boy from Calcutta was playing football when he was tackled by another player. The opponent hit the lateral aspect of his knee. He presented to a hospital 1 week after the injury, complaining of swelling and pain in his right knee. On physical examination of his right knee, there is a large effusion. There is increased laxity (as compared to his uninjured knee) of his knee when his knee is passively placed in a valgus (abducted) position. In addition, there is significant anterior translation of his tibia with respect to his femur when his knee is tested at ninety degrees of flexion. Injury to which of the following structures most likely accounts for the increased laxity of his knee when his knee is passively placed in a valgus position?

Medial collateral ligament. **Medial collateral ligament** - **Valgus stress** on the knee, which involves an abduction force on the tibia, primarily tests the integrity of the **medial collateral ligament (MCL)**. Increased laxity in this position indicates an MCL injury. - The MCL resists forces that push the knee inward (valgus forces) and is commonly injured by direct blows to the lateral aspect of the knee. *Patellar ligament* - The **patellar ligament** connects the patella to the tibia and is crucial for knee extension. - Injury to the patellar ligament would affect the ability to straighten the knee and would be tested by examining extensor mechanism integrity, not valgus laxity. *Anterior cruciate ligament* - The **anterior cruciate ligament (ACL)** primarily prevents anterior translation of the tibia relative to the femur and resists rotational forces. - While the patient has significant anterior translation, the question specifically asks about laxity in a valgus position, which is an MCL test. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** resists **varus stress** (adduction force) on the knee, preventing the knee from bowing outward. - An injury to the LCL would manifest as increased laxity when the knee is passively placed in a varus, not valgus, position.

Q: Best initial treatment for acute calcific tendinitis of shoulder?

NSAIDs and Physical Therapy. ***NSAIDs and Physical Therapy*** - **NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)** are the first-line treatment for acute pain and inflammation associated with calcific tendinitis. - **Physical therapy** helps maintain joint mobility, reduce stiffness, and strengthen surrounding muscles, preventing chronic issues. *Surgical Removal* - **Surgical removal** of calcium deposits is typically reserved for cases that are refractory to conservative treatments after several months or for severe, disabling symptoms. - It is an **invasive procedure** and not the initial approach for acute presentation. *Steroid Injection* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation, but they do not address the underlying calcium deposits. - Repeated injections can have adverse effects on tendon health and are generally considered after **NSAIDs** have failed. *Ultrasound Therapy* - **Ultrasound therapy** may be used as an adjunct treatment to help break down calcium deposits or to reduce inflammation, but it is not typically the sole initial treatment. - Its effectiveness is **variable**, and it is often combined with other modalities like NSAIDs and physical therapy.

Q: An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?

Anterior Cruciate Ligament. ***Anterior Cruciate Ligament*** - The **Lachman test** is the most sensitive clinical test for diagnosing an **ACL tear**, indicating anterior tibial translation. - **Pivoting injuries** and **hemarthrosis** (blood in the joint) are classic signs of a severe ACL injury, often involving bone bruising. *Posterior Cruciate Ligament* - PCL injuries are less common and typically result from a direct blow to the **anterior tibia** while the knee is flexed or a hyperextension injury. - The primary test for PCL integrity is the **posterior drawer test**, which assesses posterior tibial translation. *Lateral Collateral Ligament* - LCL injuries usually result from a **varus stress** to the knee, often in contact sports, and can cause pain on the lateral aspect of the knee. - The **varus stress test** is used to assess LCL integrity, but it does not cause hemarthrosis as frequently as an ACL tear. *Medial Collateral Ligament* - MCL injuries are common and result from a **valgus stress** to the knee (a blow to the outside of the knee). - The **valgus stress test** assesses MCL integrity, causing pain on the medial aspect of the knee and typically not resulting in acute hemarthrosis unless other structures are also injured.

Q: Which of the following ligaments is injured in an ankle inversion injury?

Anterior talofibular ligament. ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the most commonly injured ligament in an **ankle inversion sprain** due to its position and weaker structure. - It connects the **fibula** to the **talus** anteriorly, and when the foot inverts, this ligament is stretched and often torn first. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is also an important lateral ankle ligament that can be injured in **severe inversion sprains**. - It is often damaged in conjunction with the ATFL, but typically only after the ATFL has already been compromised through an ankle inversion injury. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the **lateral collateral ligaments** and is rarely injured in isolation. - Injury to the PTFL usually occurs in cases of **severe, high-grade ankle dislocations** or very forceful inversion injuries, often involving other ligaments. *Deltoid ligament* - The **deltoid ligament** is a strong, fan-shaped ligament located on the **medial side of the ankle**. - It resists **eversion** of the ankle, meaning it is more commonly injured in **eversion sprains**, not inversion sprains.

Q: Which muscle is tested using the empty can test in shoulder injuries?

Supraspinatus. **Supraspinatus** - The **empty can test** (also known as the Jobe test) specifically assesses the integrity and strength of the **supraspinatus muscle** and tendon. - The test involves abducting the arm to 90 degrees, internally rotating it ("empty can" position), and then asking the patient to resist a downward force, which elicits pain or weakness if the supraspinatus is injured. *Infraspinatus* - The **infraspinatus muscle** is primarily responsible for external rotation of the shoulder. - It is typically tested with specific **external rotation resistance tests**, not the empty can test. *Subscapularis* - The **subscapularis muscle** is the primary internal rotator of the shoulder. - It is evaluated using specific tests like the **Gerber Lift-off test** or the **belly-press test**. *Biceps brachii* - The **biceps brachii** muscle is involved in shoulder flexion and elbow flexion and supination. - Its integrity is assessed with tests like **Speed's test** or **Yergason's test**, which evaluate the long head of the biceps tendon.

Q: A 35-year-old athlete has persistent groin pain and a clicking sound during hip movements. MRI reveals labral tears and femoral acetabular impingement. What is the best intervention?

Arthroscopic labral repair. ***Arthroscopic labral repair*** - A 35-year-old athlete with **persistent groin pain**, **clicking during hip movements**, **labral tears**, and **femoral acetabular impingement (FAI)** is best treated with arthroscopic labral repair. - This procedure directly addresses both the **torn labrum** and the **FAI** morphology, which is crucial for pain relief and preventing further joint damage. *Physiotherapy* - While physiotherapy can help with **muscle strengthening** and **pain management** in the short term, it generally does not resolve structural issues such as a **torn labrum** or **FAI** that are likely causing persistent mechanical symptoms in an active individual. - It's often used as an adjunct to surgery or for mild cases without significant structural pathology. *Hip resurfacing* - This procedure is typically reserved for younger, active patients with **severe, diffuse osteoarthritis** of the hip, which is not indicated by the current presentation of isolated labral tears and FAI. - It involves reshaping the femoral head and placing a metal cap, a more extensive intervention than needed for labral pathology. *Core decompression* - **Core decompression** is a surgical procedure used to treat **avascular necrosis (AVN)** of the femoral head, aiming to improve blood flow and prevent collapse. - The patient's symptoms and MRI findings of labral tears and FAI do not suggest AVN as the primary pathology.

Question 1

Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?

Accepted Answer

Subscapularis tear

Answer

Teres major tear

Answer

Acromioclavicular joint dislocation

Answer

Long head of biceps tear

Question 2

All are true about Rotator cuff syndrome except:

Accepted Answer

Fracture

Answer

Rupture

Answer

Weakness

Answer

Tendinitis

Question 3

Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?

Accepted Answer

Walk downhill

Answer

Getting up from a sitting position

Answer

Walk uphill

Answer

Sitting cross-legged

Question 4

Yergason's supination sign is seen in lesion of which muscle?

Accepted Answer

Biceps

Answer

Brachioradialis

Answer

Triceps

Answer

Supinator

Question 5

A 17-year-old boy from Calcutta was playing football when he was tackled by another player. The opponent hit the lateral aspect of his knee. He presented to a hospital 1 week after the injury, complaining of swelling and pain in his right knee. On physical examination of his right knee, there is a large effusion. There is increased laxity (as compared to his uninjured knee) of his knee when his knee is passively placed in a valgus (abducted) position. In addition, there is significant anterior translation of his tibia with respect to his femur when his knee is tested at ninety degrees of flexion. Injury to which of the following structures most likely accounts for the increased laxity of his knee when his knee is passively placed in a valgus position?

Accepted Answer

Medial collateral ligament

Answer

Patellar ligament

Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Question 6

Best initial treatment for acute calcific tendinitis of shoulder?

Accepted Answer

NSAIDs and Physical Therapy

Answer

Surgical Removal

Answer

Steroid Injection

Answer

Ultrasound Therapy

Question 7

An 18-year-old athlete presents with acute knee pain and hemarthrosis after pivoting. The Lachman test is positive. Which ligament is most likely injured?

Accepted Answer

Anterior Cruciate Ligament

Answer

Posterior Cruciate Ligament

Answer

Lateral Collateral Ligament

Answer

Medial Collateral Ligament

Question 8

Which of the following ligaments is injured in an ankle inversion injury?

Accepted Answer

Anterior talofibular ligament

Answer

Calcaneofibular ligament

Answer

Posterior talofibular ligament

Answer

Deltoid ligament

Question 9

Which muscle is tested using the empty can test in shoulder injuries?

Accepted Answer

Supraspinatus

Answer

Infraspinatus

Answer

Subscapularis

Answer

Biceps brachii

Question 10

A 35-year-old athlete has persistent groin pain and a clicking sound during hip movements. MRI reveals labral tears and femoral acetabular impingement. What is the best intervention?

Accepted Answer

Arthroscopic labral repair

Answer

Physiotherapy

Answer

Hip resurfacing

Answer

Core decompression

Sports Medicine — MCQs

Sports Medicine — MCQs

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