Sports Medicine Practice Questions

Q: In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Lachman's test. **Explanation:** The **Lachman’s test** is the most sensitive clinical test for diagnosing an acute Anterior Cruciate Ligament (ACL) injury. In the acute phase, knee injuries are often accompanied by significant swelling (hemarthrosis) and protective muscle spasms (hamstring guarding). * **Why Lachman’s is the correct answer:** The test is performed at **20–30° of flexion**. At this angle, the bony geometry of the femoral condyles does not stabilize the tibia, and the hamstrings are relatively relaxed, minimizing the effect of muscle spasms. This allows for the detection of even subtle anterior translation and the assessment of the "endpoint" (firm vs. soft). * **Why other options are incorrect:** * **Anterior Drawer Test:** Performed at 90° of flexion. In acute injuries, the hamstrings go into spasm at this angle, preventing anterior translation and leading to high false-negative rates. Additionally, the posterior horn of the medial meniscus can "wedge" against the femoral condyle, blocking movement. * **Pivot Shift Test:** While it is the most **specific** test for ACL insufficiency (indicating rotatory instability), it is very difficult to perform in an acute setting because it is painful and requires complete muscle relaxation. It is often only reliable under anesthesia. * **Apley’s Grinding Test:** This test is used to evaluate **meniscal injuries**, not ligamentous laxity. **Clinical Pearls for NEET-PG:** * **Most Sensitive Test (Overall & Acute):** Lachman’s Test. * **Most Specific Test:** Pivot Shift Test. * **Gold Standard Investigation:** MRI Knee. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Q: Painful arc syndrome is characterized by pain during which movement?

Mid-range abduction. **Explanation:** **Painful Arc Syndrome** is a clinical sign typically associated with **Subacromial Impingement Syndrome**. It occurs when the structures within the subacromial space (most commonly the Supraspinatus tendon or the subacromial bursa) become compressed between the greater tuberosity of the humerus and the acromion process. 1. **Why Mid-range Abduction is Correct:** During abduction, the subacromial space is at its narrowest between **60° and 120°**. In this range, the inflamed or degenerated tendon is pinched against the acromial arch, eliciting sharp pain. This is the "mid-range" of motion. 2. **Analysis of Incorrect Options:** * **Initial Abduction (0°–15°):** Pain here usually indicates a complete Supraspinatus tear (inability to initiate) or severe tendonitis, but the subacromial space is not yet maximally compromised. * **Terminal Abduction (120°–180°):** Pain at the very end of abduction is characteristic of **Acromioclavicular (AC) joint arthritis**, not impingement. * **Full Range:** Pain throughout the entire range is more suggestive of adhesive capsulitis (Frozen Shoulder) or acute calcific tendonitis rather than a classic "arc." **Clinical Pearls for NEET-PG:** * **Neer’s Test and Hawkins-Kennedy Test:** These are the specific clinical provocative tests used to confirm subacromial impingement. * **The "Critical Zone":** The area of the Supraspinatus tendon roughly 1 cm proximal to its insertion is relatively avascular and is the most common site for pathology in this syndrome. * **Management:** Initial treatment is conservative (NSAIDs, PT, subacromial steroid injection). Surgical decompression (Acromioplasty) is reserved for refractory cases.

Q: McMurray's test is a useful clinical test to assess injury to which structure?

Meniscus. **Explanation:** **McMurray’s Test** is a classic clinical maneuver used to diagnose tears in the **menisci** (fibrocartilaginous structures) of the knee. The test works by trapping a torn meniscal fragment between the femoral condyles and the tibial plateau. When the knee is rotated and extended, the displaced fragment causes a palpable or audible **"thud" or "click,"** often accompanied by pain. * **Medial Meniscus:** Tested by externally rotating the foot and applying valgus stress while extending the knee. * **Lateral Meniscus:** Tested by internally rotating the foot and applying varus stress while extending the knee. **Why other options are incorrect:** * **Collateral Ligaments (A & B):** These are assessed using the **Valgus Stress Test** (for Medial Collateral Ligament) and **Varus Stress Test** (for Lateral Collateral Ligament) at 0° and 30° of knee flexion. * **Cruciate Ligaments (D):** The Anterior Cruciate Ligament (ACL) is assessed via the **Lachman test** (most sensitive), Anterior Drawer test, and Pivot Shift test. The Posterior Cruciate Ligament (PCL) is assessed via the **Posterior Drawer test** and the Sag sign. **High-Yield Clinical Pearls for NEET-PG:** 1. **Apley’s Grinding Test:** Another specific test for meniscal injuries (Distraction helps differentiate ligamentous from meniscal pain). 2. **Thessaly Test:** Performed by having the patient stand on one leg and rotate; it is considered more sensitive than McMurray’s in some clinical settings. 3. **Triad of O'Donoghue:** Includes injury to the ACL, MCL, and Medial Meniscus. 4. **Gold Standard Diagnosis:** While McMurray’s is a high-yield clinical test, **MRI** is the investigation of choice for meniscal tears.

Q: Which of the following bones is not typically involved in a stress fracture?

Metacarpals. **Explanation:** Stress fractures occur due to repetitive submaximal loading on a bone, where the rate of bone resorption by osteoclasts exceeds the rate of bone formation by osteoblasts. This typically occurs in **weight-bearing bones** of the lower limb. **Why Metacarpals are the correct answer:** Metacarpals are non-weight-bearing bones. While they can sustain traumatic fractures (e.g., Boxer’s fracture), they are rarely subjected to the repetitive, rhythmic loading required to cause a stress fracture. Stress fractures in the upper limb are rare and usually limited to specific athletes (e.g., olecranon in throwers or ribs in rowers). **Analysis of Incorrect Options:** * **Metatarsals:** The **2nd and 3rd metatarsals** are the most common sites for stress fractures (known as **March Fractures**), frequently seen in military recruits and long-distance runners. * **Tibia:** The tibia is the **most common overall site** for stress fractures in athletes, typically occurring at the junction of the middle and distal thirds. * **Calcaneus:** This is a common site for stress fractures in military trainees and runners, often presenting as heel pain that is reproducible by medial-lateral compression of the calcaneal body (Squeeze test). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** **MRI** is the most sensitive and specific investigation (shows marrow edema). * **X-ray finding:** Often negative in the first 2–3 weeks; later shows a "dreaded black line" or periosteal reaction/callus. * **Female Athlete Triad:** Amenorrhea, disordered eating, and osteoporosis significantly increase the risk of stress fractures. * **Commonest site:** Tibia. * **Commonest tarsal bone:** Navicular.

Question 1

In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Accepted Answer

Lachman's test

Answer

Pivot shift test

Answer

Apley's grinding test

Answer

Anterior drawer test

Question 2

Painful arc syndrome is characterized by pain during which movement?

Accepted Answer

Mid-range abduction

Answer

Initial abduction

Answer

Terminal abduction

Answer

Full range of abduction

Question 3

McMurray's test is a useful clinical test to assess injury to which structure?

Accepted Answer

Meniscus

Answer

Medial collateral ligament

Answer

Lateral collateral ligament

Answer

Cruciate ligament

Question 4

Which of the following bones is not typically involved in a stress fracture?

Accepted Answer

Metacarpals

Answer

Metatarsals

Answer

Tibia

Answer

Calcaneus

Question 5

What is the primary pathology in Athletic Pubalgia?

Accepted Answer

Abdominal muscle strain

Answer

Rectus femoris strain

Answer

Gluteus medius strain

Answer

Hamstring strain

Sports Medicine — MCQs

Sports Medicine — MCQs

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