Sports Medicine Practice Questions

Q: 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?

Latarjet procedure. ***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.

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

Physiotherapy only. ***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.

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

Meniscal tear. ***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.

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

Supraspinatus. ***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.

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

Anterior talofibular ligament. ***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.

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

Abduction. ***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.

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

ACL is intrasynovial. ***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.

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

Tennis elbow. ***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.

Question 1

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?

Accepted Answer

Latarjet procedure

Answer

Physical therapy

Answer

Arthroscopic Bankart repair

Answer

Rotator cuff repair

Question 2

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

Accepted Answer

Physiotherapy only

Answer

Joint replacement

Answer

Subacromial injection

Answer

Arthroscopic repair

Question 3

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

Accepted Answer

Meniscal tear

Answer

Ligament sprain

Answer

Patellar dislocation

Answer

Osteoarthritis exacerbation

Question 4

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

Accepted Answer

Supraspinatus

Answer

Pectoralis major

Answer

Infraspinatus

Answer

Trapezius

Question 5

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

Accepted Answer

Anterior talofibular ligament

Answer

Posterior talofibular ligament

Answer

Calcaneofibular ligament

Answer

Posterior fibres of deltoid

Question 6

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

Accepted Answer

Apophysitis of the patellar tendon at its insertion in the patella.

Answer

Apophysitis of the patellar tendon at its insertion in the tibia.

Answer

Apophysitis of the hamstring tendon at its insertion in the tibia.

Answer

Apophysitis of the quadriceps tendon at its insertion in the patella.

Question 7

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

Accepted Answer

Abduction

Answer

Adduction

Answer

External rotation

Answer

Internal rotation

Question 8

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

Accepted Answer

ACL is intrasynovial

Answer

Lachman test is the most sensitive test for ACL injury.

Answer

ACL contributes to proprioceptive function but is not primarily responsible for it.

Answer

It is a component of the O'Donoghue triad

Question 9

Which of the following statements about impingement syndrome is incorrect?

Accepted Answer

Surgical decompression of the subacromial space is frequently indicated

Answer

Supraspinatus tendon is most often involved

Answer

Shoulder abduction in the arc of 60 - 120 degrees is particularly painful

Answer

It is the tendinitis caused by inflammation of the rotator cuff tendons

Question 10

Cozen's test is used for the diagnosis of ?

Accepted Answer

Tennis elbow

Answer

Carpal tunnel syndrome

Answer

Olecranon bursitis

Answer

Medial epicondylitis (Golfer's elbow)

Sports Medicine — MCQs

Sports Medicine — MCQs

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