Sports Medicine — MCQs

Sports Medicine Indian Medical PG Practice Questions and MCQs

Question 81: A 35-year-old patient with recurrent shoulder dislocations has an MRI showing an anteroinferior labral tear and glenoid bone loss. What is the next best management?

A. Physical therapy
B. Arthroscopic Bankart repair
C. Latarjet procedure (Correct Answer)
D. Rotator cuff repair

Explanation: ***Latarjet procedure*** - The presence of recurrent shoulder dislocations, an **anteroinferior labral tear**, and significant **glenoid bone loss** indicates insufficient glenoid concavity and soft tissue damage that is unlikely to be adequately addressed by a simple soft-tissue repair. - The Latarjet procedure involves transferring the **coracoid process** and its attached tendons to the anterior glenoid, augmenting bone stock and creating a "sling effect" to prevent further dislocation. It is the preferred treatment for recurrent instability with significant bone loss. *Physical therapy* - While physical therapy is crucial for rehabilitation post-surgery and for managing mild instability, it is unlikely to prevent recurrent dislocations in the presence of a **significant labral tear** and **glenoid bone loss**. - It would primarily focus on strengthening the **rotator cuff** and **scapular stabilizers**, which alone cannot overcome structural instability. *Arthroscopic Bankart repair* - An arthroscopic Bankart repair addresses the soft tissue injury (**labral tear**) by reattaching the labrum to the glenoid rim. - However, in cases with **significant glenoid bone loss** (typically >20-25%), a Bankart repair alone often has a high failure rate because it does not restore the lost bone integrity. *Rotator cuff repair* - A rotator cuff repair addresses tears in the **rotator cuff tendons**, which are important for shoulder movement and stability. - While rotator cuff tears can sometimes co-exist with instability, the primary pathology described here is recurrent dislocation and a labral tear with glenoid bone loss, not a primary rotator cuff injury.

Question 82: What is the recommended first-line treatment approach for a patient with a rotator cuff tear that is causing shoulder weakness and pain?

A. Joint replacement
B. Subacromial injection
C. Physiotherapy only (Correct Answer)
D. Arthroscopic repair

Explanation: ***Physiotherapy only*** - **Physiotherapy** is the recommended **first-line treatment** for most rotator cuff tears, especially in cases of shoulder weakness and pain, as it helps improve strength and range of motion. - Early conservative management focuses on **pain control**, **restoration of motion**, and progressive **strengthening exercises** to improve shoulder function and reduce the need for surgery. *Joint replacement* - **Joint replacement** (arthroplasty) is typically reserved for severe, **irreparable rotator cuff tears** causing significant pain and loss of function, especially in older patients. - It is an **invasive surgical procedure** that is not considered a first-line treatment for a rotator cuff tear. *Subacromial injection* - **Subacromial injections**, often with corticosteroids, can provide **temporary pain relief** for rotator cuff tears or tendinitis by reducing inflammation. - However, they do not address the underlying **structural weakness** or tear, and repeated injections carry risks and can potentially weaken tendons. *Arthroscopic repair* - **Arthroscopic repair** is a surgical option considered when conservative management fails, or for **acute, full-thickness tears** in younger, active individuals. - It involves surgically repairing the torn tendon and is not the **initial approach** for most patients with rotator cuff tears.

Question 83: A patient presents with a painful, swollen knee following a twisting injury during soccer. What is the most likely diagnosis?

A. Meniscal tear (Correct Answer)
B. Ligament sprain
C. Patellar dislocation
D. Osteoarthritis exacerbation

Explanation: ***Meniscal tear*** - A **twisting injury** followed by a painful, swollen knee is highly suggestive of a meniscal tear, as the menisci are particularly vulnerable to rotational forces. - Patients often report **locking, catching, or giving way** of the knee and experience pain with squatting or pivoting. *Ligament sprain* - While a ligament sprain can occur with a twisting injury and cause pain and swelling, a meniscal tear is more specifically associated with the described mechanism of injury and often presents with more pronounced mechanical symptoms like **locking**. - **Ligamentous injury** might present with instability or specific pain on stress testing of the affected ligament, which is not highlighted here. *Patellar dislocation* - Patellar dislocation usually involves a feeling of the **kneecap moving out of place** with visible deformity and extreme pain, which is not mentioned in the patient's presentation. - It often occurs during **sudden changes in direction** or direct trauma to the kneecap. *Osteoarthritis exacerbation* - Osteoarthritis typically causes **chronic, progressive knee pain** that worsens with activity and improves with rest, rather than an acute onset due to a specific twisting injury. - While an acute injury can exacerbate existing OA, the primary cause of acute, significant pain and swelling following a distinct twisting incident points to an acute structural injury like a meniscal tear.

Question 84: A patient complains of pain during the abduction of the shoulder. Which muscle is likely involved?

A. Pectoralis major
B. Supraspinatus (Correct Answer)
C. Infraspinatus
D. Trapezius

Explanation: ***Supraspinatus*** - The **supraspinatus muscle** is crucial for **initiating shoulder abduction**, particularly the first 15-20 degrees. - Pain during abduction strongly suggests involvement or injury to the supraspinatus due to its primary role in this movement. *Pectoralis major* - The **pectoralis major** is primarily responsible for **adduction, medial rotation, and flexion of the humerus**, not abduction. - Pain related to this muscle would typically manifest during activities involving pushing or chest movements. *Infraspinatus* - The **infraspinatus muscle** primarily functions in **external (lateral) rotation of the humerus**. - While it is part of the rotator cuff, its main role is not shoulder abduction. *Trapezius* - The **trapezius muscle** primarily **elevates, retracts, and rotates the scapula**, and assists in neck movements. - Its role in shoulder abduction is indirect, primarily by stabilizing the scapula, and it is not a direct force generator for the movement.

Question 85: Ankle sprain due to forced inversion of a plantar flexed foot is due to injury to

A. Anterior talofibular ligament (Correct Answer)
B. Posterior talofibular ligament
C. Calcaneofibular ligament
D. Posterior fibres of deltoid

Explanation: ***Anterior talofibular ligament*** - The **anterior talofibular ligament** is the most commonly injured ligament in **ankle sprains** caused by **forced inversion** of a **plantar-flexed foot**. - Its anatomical position makes it vulnerable as it is taut during plantarflexion and inversion. *Posterior talofibular ligament* - This ligament is usually injured in cases of **severe ankle sprains**, often involving - It provides significant stability against **posterior displacement** of the talus but is less frequently damaged in isolated inversion injuries. *Calcaneofibular ligament* - The **calcaneofibular ligament** is also commonly injured in **inversion sprains**, but typically after or in conjunction with the anterior talofibular ligament. - Its orientation makes it more resistant to injury during plantarflexion compared to the ATFL. *Posterior fibers of deltoid* - The **deltoid ligament** is located on the **medial side** of the ankle and resists **eversion** forces. - Injury to the deltoid ligament would occur with forced eversion, not inversion, making it an unlikely injury in this scenario.

Question 86: What is Jumper's knee and what condition does it refer to?

A. Apophysitis of the patellar tendon at its insertion in the patella. (Correct Answer)
B. Apophysitis of the patellar tendon at its insertion in the tibia.
C. Apophysitis of the hamstring tendon at its insertion in the tibia.
D. Apophysitis of the quadriceps tendon at its insertion in the patella.

Explanation: ***Apophysitis of the patellar tendon at its insertion in the patella.*** - **Jumper's knee**, or **patellar tendinopathy**, refers to inflammation and micro-tears at the **proximal patellar tendon insertion** on the inferior pole of the patella. - This condition is often seen in athletes involved in sports requiring repetitive jumping and landing, leading to overuse of the **extensor mechanism of the knee**. *Apophysitis of the patellar tendon at its insertion in the tibia.* - Apophysitis at the patellar tendon's insertion on the tibia is known as **Osgood-Schlatter disease**, which affects the **tibial tuberosity** in adolescents. - While both involve the patellar tendon, **Jumper's knee** specifically concerns the patella's attachment, not the tibia. *Apophysitis of the hamstring tendon at its insertion in the tibia.* - Apophysitis of the hamstring tendon at its tibial insertion is not a commonly recognized specific condition like **Jumper's knee** or **Osgood-Schlatter disease**. - Hamstring issues typically involve strains or tendinopathy at their origin or belly, not primarily apophysitis at the tibial insertion in the context of "Jumper's knee." *Apophysitis of the quadriceps tendon at its insertion in the patella.* - Apophysitis of the quadriceps tendon at its insertion into the patella is known as **Sinding-Larsen-Johansson syndrome**, which affects the superior pole of the patella. - While similar in mechanism (overuse at the patella), **Jumper's knee** specifically involves the **patellar tendon** at the inferior pole, distinguishing it from quadriceps tendinopathy.

Question 87: Which of the following shoulder movements is/ are weak in patients of supraspinatus tear?

A. Abduction (Correct Answer)
B. Adduction
C. External rotation
D. Internal rotation

Explanation: ***Abduction*** - The **supraspinatus muscle** initiates the first 15 degrees of **shoulder abduction** and is active throughout the range of abduction. - A tear in the supraspinatus would therefore significantly impair the ability to **abduct the arm**, especially against resistance. *Adduction* - **Adduction** is primarily performed by the **pectoralis major**, **latissimus dorsi**, and **teres major** muscles. - The supraspinatus muscle plays no direct role in shoulder adduction. *External rotation* - **External rotation** of the shoulder is mainly performed by the **infraspinatus** and **teres minor** muscles. - While the rotator cuff muscles work together, the supraspinatus is not the primary external rotator. *Internal rotation* - **Internal rotation** is primarily carried out by the **subscapularis**, **pectoralis major**, **latissimus dorsi**, and **teres major** muscles. - The supraspinatus muscle does not contribute to internal rotation of the shoulder.

Question 88: Which of the following statements is NOT true regarding ACL injury?

A. ACL is intrasynovial (Correct Answer)
B. Lachman test is the most sensitive test for ACL injury.
C. ACL contributes to proprioceptive function but is not primarily responsible for it.
D. It is a component of the O'Donoghue triad

Explanation: ***ACL is intrasynovial*** - The **ACL** is located within the joint capsule but is **extrasynovial**, meaning it is surrounded by a synovial membrane, but not bathed directly by synovial fluid. - This anatomical distinction is crucial for understanding its limited healing capacity and specific surgical repair considerations. *Lachman test is the most sensitive test for ACL injury.* - The **Lachman test** is indeed considered the **most sensitive and specific clinical test** for diagnosing an acute ACL injury. - It assesses anterior tibial translation with the knee in slight flexion (around 20-30 degrees), which minimizes hamstring muscular guarding. *ACL contributes to proprioceptive function but is not primarily responsible for it.* - The **ACL contains mechanoreceptors** that contribute to **proprioception** (the sense of joint position and movement). - While it plays a role, proprioceptive function is a complex process involving multiple structures, including muscle spindles, Golgi tendon organs, and other joint mechanoreceptors. *It is a component of the O'Donoghue triad* - The **O'Donoghue triad** (also known as the "unhappy triad") classically involves injury to the **ACL**, the **medial collateral ligament (MCL)**, and the **medial meniscus**. - This common injury pattern often results from a valgus stress with rotation on a partially flexed knee.

Question 89: Which of the following statements about impingement syndrome is incorrect?

A. Supraspinatus tendon is most often involved
B. Shoulder abduction in the arc of 60 - 120 degrees is particularly painful
C. It is the tendinitis caused by inflammation of the rotator cuff tendons
D. Surgical decompression of the subacromial space is frequently indicated (Correct Answer)

Explanation: ***Surgical decompression of the subacromial space is frequently indicated*** - **Surgical decompression** for impingement syndrome is reserved for cases that fail conservative treatment after several months (typically 6-12 months) and is not "frequently indicated" as a primary or early intervention. - Initial management for impingement syndrome focuses on **conservative treatments** such as rest, NSAIDs, physical therapy, and corticosteroid injections. *It is the tendinitis caused by inflammation of the rotator cuff tendons* - **Impingement syndrome** is indeed a form of tendinitis, often caused by the compression and friction of the rotator cuff tendons, particularly the supraspinatus, as they pass under the **acromion**. - This compression leads to **inflammation** and degeneration of the affected tendons. *Supraspinatus tendon is most often involved* - The **supraspinatus tendon** is the most commonly affected rotator cuff tendon in impingement syndrome due to its anatomical position, which makes it particularly susceptible to compression in the subacromial space. - Its location directly beneath the **acromion** makes it vulnerable during overhead activities. *Shoulder abduction in the arc of 60 - 120 degrees is particularly painful* - The "painful arc" of **abduction** between 60 and 120 degrees is a classic **clinical sign** of shoulder impingement syndrome. - This symptom occurs because during this specific range of motion, the **rotator cuff tendons** are maximally compressed against the acromion.

Question 90: Cozen's test is used for the diagnosis of ?

A. Tennis elbow (Correct Answer)
B. Carpal tunnel syndrome
C. Olecranon bursitis
D. Medial epicondylitis (Golfer's elbow)

Explanation: ***Tennis elbow*** - Cozen's test is a specific orthopedic test used to assess for **lateral epicondylitis**, also known as **tennis elbow**. - It involves extending the patient's elbow, pronating the forearm, and resisting wrist extension, which elicits pain at the **lateral epicondyle** in positive cases. *Medial epicondylitis (Golfer's elbow)* - Medial epicondylitis is tested by forcefully **flexing the wrist** against resistance, which would reproduce pain at the **medial epicondyle**. - While an elbow condition, it involves the tendinous origin of the **flexor-pronator mass**, distinct from the extensors involved in tennis elbow. *Olecranon bursitis* - Olecranon bursitis typically presents with **swelling and tenderness** directly over the **olecranon bursa** at the posterior aspect of the elbow. - Diagnosis is usually made by physical examination, observing the characteristic swelling, and does not involve specific provocative tests like Cozen's. *Carpal tunnel syndrome* - Carpal tunnel syndrome involves compression of the **median nerve** at the wrist, causing **numbness, tingling, and weakness** in the hand. - Diagnostic tests include **Phalen's maneuver** and **Tinel's sign** at the wrist, which are unrelated to elbow pain or Cozen's test.

Practice by Chapter

Sports Injuries: Epidemiology and Prevention

Practice Questions

Knee Ligament Injuries

Practice Questions

Meniscal Injuries

Practice Questions

Shoulder Instability

Practice Questions

Rotator Cuff Pathology

Practice Questions

Tendinopathies

Practice Questions

Muscle Strains and Contusions

Practice Questions

Ankle Sprains and Instability

Practice Questions

Overuse Injuries

Practice Questions

Return to Play Criteria

Practice Questions

Sports-Specific Conditioning

Practice Questions

Performance Enhancement

Practice Questions

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