Sports Medicine Practice Questions

Q: What is the most important physical sign for the diagnosis of anterior instability of the glenohumeral joint?

Apprehension sign. The **Apprehension Test** is the most specific and important clinical sign for diagnosing chronic anterior shoulder instability. ### **Why Apprehension Sign is Correct** Anterior instability usually results from a Bankart lesion (avulsion of the anterior-inferior labrum). When the arm is placed in **abduction and external rotation** (the position of provocation), the humeral head stresses the deficient anterior capsule. The patient experiences a sudden sense of impending dislocation and resists further movement. This subjective feeling of "giving way" or "coming out" is the hallmark of instability. ### **Analysis of Incorrect Options** * **B. Impingement sign (e.g., Neer’s or Hawkins-Kennedy):** These tests are used to diagnose **Rotator Cuff pathology** or subacromial bursitis, where the tendons are pinched under the acromial arch. * **C. Resisted straight arm raising sign (Speed’s Test):** This is used to identify **Bicipital Tendonitis** or SLAP lesions. * **D. Resisted forearm supination sign (Yergason’s Test):** This specifically tests the stability and integrity of the **Long Head of the Biceps** tendon in the bicipital groove. ### **High-Yield Clinical Pearls for NEET-PG** * **Relocation Test (Jobe’s Test):** If a posterior force is applied to the humerus during a positive apprehension test, the pain/apprehension disappears. This confirms the diagnosis of anterior instability. * **Bankart Lesion:** The most common cause of recurrent anterior dislocation (detachment of the anteroinferior labrum). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head, often seen on X-ray (Stryker notch view). * **Most common type of shoulder dislocation:** Anterior (95%). * **Nerve most commonly injured:** Axillary nerve (Regimental badge sign).

Q: A twisting injury of the knee in a flexed position would result in injury to all of the following structures EXCEPT:

Fibular collateral ligament. **Explanation:** The mechanism of injury described—**twisting of the knee in a flexed position**—is the classic mechanism for injuries to the internal structures of the knee. When the knee is flexed, the ligaments and capsule are under specific stresses that predispose them to injury. **Why Fibular Collateral Ligament (FCL/LCL) is the correct answer:** The **Fibular Collateral Ligament** is a cord-like structure on the lateral aspect of the knee. Crucially, the LCL becomes **relaxed (lax) during flexion** and is only taut in full extension. Because it is slack when the knee is flexed, a twisting force in this position is unlikely to cause it to tear. In contrast, the LCL is typically injured by a varus stress applied to an extended knee. **Analysis of Incorrect Options:** * **Meniscal tear:** Rotation (twisting) while weight-bearing on a flexed knee is the most common cause of meniscal injuries, as the meniscus gets trapped between the femoral condyles and the tibial plateau. * **Anterior Cruciate Ligament (ACL):** The ACL is frequently injured during a "pivot-shift" mechanism (sudden deceleration + twisting in slight flexion). It is the primary stabilizer against rotational stress. * **Capsular tear:** The joint capsule is intimately attached to the menisci and the coronary ligaments; rotational forces that tear the meniscus or ligaments often involve concomitant capsular disruption. **NEET-PG High-Yield Pearls:** * **O’Donoghue’s Unhappy Triad:** Consists of injuries to the **ACL, MCL, and Medial Meniscus** (though recent studies suggest the Lateral Meniscus is more commonly injured in acute ACL tears). * **MCL vs. LCL:** The MCL is more commonly injured than the LCL. The MCL is attached to the medial meniscus, whereas the LCL is **not** attached to the lateral meniscus (separated by the popliteus tendon). * **Most common meniscus injured:** Medial meniscus (due to its fixity to the capsule and MCL).

Q: Which tendon is affected in lateral epicondylitis?

Extensor Carpi Radialis Brevis. **Explanation:** **Lateral Epicondylitis**, commonly known as **Tennis Elbow**, is a clinical condition characterized by pain and tenderness over the lateral epicondyle of the humerus. It is caused by repetitive microtrauma and overuse, leading to angiofibroblastic hyperplasia (degenerative changes) rather than true inflammation. 1. **Why Option A is Correct:** The **Extensor Carpi Radialis Brevis (ECRB)** is the most commonly involved tendon. It originates from the lateral epicondyle. Because of its anatomical position, the underside of the ECRB tendon rubs against the lateral capitellum during elbow extension and forearm pronation, making it highly susceptible to wear, tear, and microscopic failure. 2. **Why Other Options are Incorrect:** * **Extensor Carpi Radialis Longus (ECRL):** While it originates near the lateral epicondyle (supracondylar ridge), it is rarely the primary site of pathology in tennis elbow. * **Flexor Pollicis Longus:** This is a deep muscle of the anterior (flexor) compartment of the forearm. It is unrelated to lateral epicondylar pathology. * **Supinator:** Although the supinator lies deep in the lateral elbow, it is not the primary tendon involved. However, the **posterior interosseous nerve** passes through the supinator (Arcade of Frohse), which is a differential diagnosis for lateral elbow pain (Radial Tunnel Syndrome). **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Test:** **Cozen’s Test** (pain on resisted wrist extension with elbow extended) and **Mill’s Test** (pain on passive wrist flexion with elbow extended). * **Medial Epicondylitis (Golfer’s Elbow):** Involves the common flexor origin, most commonly the **Pronator Teres** and **Flexor Carpi Radialis (FCR)**. * **Treatment:** Primarily conservative (NSAIDs, eccentric exercises, bracing). Surgery (Nirschl debrisment) is reserved for refractory cases.

Q: Injury to which of the following structures would MOST likely account for the increased anterior translation of the tibia in reference to the femur?

Anterior cruciate ligament. **Explanation:** The **Anterior Cruciate Ligament (ACL)** is the primary intra-articular stabilizer of the knee joint. Its fundamental biomechanical function is to prevent **anterior translation of the tibia** relative to the femur. It also provides secondary stability against internal rotation and valgus/varus stress. When the ACL is torn, the tibia can be pulled or pushed forward excessively, which is the hallmark of ACL deficiency. **Analysis of Options:** * **Anterior Cruciate Ligament (Correct):** Injury leads to a positive **Lachman test** (most sensitive) and **Anterior Drawer test**, both of which demonstrate increased anterior tibial translation. * **Lateral Collateral Ligament (LCL):** Primarily resists **varus** (outward) stress at the knee. Injury leads to lateral joint line opening, not anterior translation. * **Medial Collateral Ligament (MCL):** The most commonly injured knee ligament; it resists **valgus** (inward) stress. * **Patellar Ligament:** Part of the extensor mechanism. Rupture results in an inability to actively extend the knee and a high-riding patella (patella alta), but it does not control anterior-posterior translation. **Clinical Pearls for NEET-PG:** * **Mechanism of Injury:** Most commonly a non-contact pivoting injury (sudden deceleration/change of direction). * **Classic Triad (O'Donoghue’s):** Injury involving the **ACL, MCL, and Medial Meniscus** (though recent studies suggest Lateral Meniscus is more common in acute ACL tears). * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Gold Standard Investigation:** MRI. * **Gold Standard Treatment:** Arthroscopic reconstruction (usually using Bone-Patellar Tendon-Bone or Hamstring graft).

Q: A footballer sustained a blow on the lateral side of the knee. X-ray showed no bony injuries. On examination, the Drawer tests were negative and McMurray's test was positive. Which structure is most likely injured?

Lateral meniscus. ### Explanation The correct answer is **Lateral meniscus**. **1. Why the Correct Answer is Right:** The diagnosis is based on the clinical examination findings. **McMurray’s test** is a specific provocative maneuver used to identify meniscal tears. A positive result (a palpable or audible click/clunk) indicates a tear of either the medial or lateral meniscus. In this scenario, a blow to the **lateral side** of the knee (valgus stress) often compresses the lateral compartment, leading to a lateral meniscus injury. Since the Drawer tests are negative, a ligamentous rupture is unlikely, pointing directly to the meniscus. **2. Why the Incorrect Options are Wrong:** * **Anterior Cruciate Ligament (ACL):** Injury to the ACL would result in a positive **Anterior Drawer test** or Lachman test. * **Posterior Cruciate Ligament (PCL):** Injury to the PCL would result in a positive **Posterior Drawer test** or Posterior Sag sign. * **Lateral Collateral Ligament (LCL):** An LCL injury is typically caused by a blow to the *medial* side of the knee (varus stress). It is assessed using the **Varus Stress Test**, not McMurray’s. **3. Clinical Pearls for NEET-PG:** * **McMurray’s Test:** Internal rotation of the tibia tests the **Lateral Meniscus**; External rotation tests the **Medial Meniscus**. * **O’Donoghue’s Triad (Unhappy Triad):** Involves injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest Lateral Meniscus is more common in acute ACL tears). * **Gold Standard Investigation:** MRI is the investigation of choice for soft tissue injuries of the knee, but **Diagnostic Arthroscopy** remains the "Gold Standard." * **Lachman Test:** The most sensitive clinical test for an acute ACL tear.

Q: A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?

Meniscal tear. **Explanation:** The clinical presentation of a **twisting injury** followed by **locking** of the knee is a classic hallmark of a **Meniscal Tear**. 1. **Why Meniscal Tear is correct:** The menisci are C-shaped fibrocartilage structures that act as shock absorbers. A rotational (twisting) force on a weight-bearing, flexed knee can cause a tear. "True locking" occurs when a detached fragment (commonly a **bucket-handle tear**) gets displaced into the joint space, mechanically obstructing full extension. This is the most specific diagnostic sign for meniscal pathology. 2. **Why other options are incorrect:** * **Avulsion of tibial tubercle:** Typically seen in adolescents (Osgood-Schlatter disease or acute trauma). It presents with localized pain and swelling over the tubercle, not joint locking. * **Lateral Collateral Ligament (LCL) tear:** Caused by a varus stress. It presents with lateral joint line pain and instability, but not locking. * **Anterior Cruciate Ligament (ACL) tear:** Usually presents with a "pop" sound, immediate profuse swelling (hemarthrosis), and a feeling of "giving way" (instability). While an ACL tear can coexist with a meniscal tear, isolated ACL tears do not cause mechanical locking. **High-Yield Clinical Pearls for NEET-PG:** * **McMurray’s Test:** The most specific clinical test for meniscal tears. * **Apley’s Grinding Test:** Positive for meniscal tears; **Apley’s Distraction Test** helps differentiate ligamentous from meniscal injuries. * **Triad of O'Donoghue:** Injury involving the ACL, MCL, and Medial Meniscus. * **Investigation of Choice:** MRI is the gold standard for diagnosis. * **Management:** Peripheral tears (vascular zone) may be repaired; central tears (avascular zone) often require partial meniscectomy.

Q: What is the medical term for Golfer's elbow?

Medial epicondylitis. **Explanation:** **Golfer’s Elbow (Medial Epicondylitis)** is a clinical condition characterized by pain and inflammation at the medial epicondyle of the humerus. It is caused by repetitive stress or overuse of the **common flexor tendon**, primarily involving the **Pronator teres** and **Flexor carpi radialis** muscles. This occurs due to forceful wrist flexion and forearm pronation, common in the "trailing arm" during a golf swing. **Analysis of Options:** * **A. Medial epicondylitis (Correct):** This is the anatomical site where the common flexor origin attaches. Inflammation here leads to pain on the inner side of the elbow. * **B. Lateral epicondylitis:** Known as **Tennis Elbow**, this involves the common extensor origin (specifically the **Extensor Carpi Radialis Brevis - ECRB**). It is more common than Golfer's elbow. * **C. Posterior elbow dislocation:** This is an acute traumatic injury, usually resulting from a fall on an outstretched hand (FOOSH). It is the most common type of elbow dislocation but is not an overuse syndrome. * **D. Lateral collateral ligament injury:** This typically results in posterolateral rotatory instability and is not associated with the repetitive gripping/flexion seen in Golfer's elbow. **NEET-PG High-Yield Pearls:** * **Common Flexor Origin:** Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris. * **Clinical Test:** Pain is elicited by **resisted wrist flexion** and resisted forearm pronation. * **Differential Diagnosis:** Always rule out **Ulnar neuropathy**, as the ulnar nerve runs in the cubital tunnel posterior to the medial epicondyle. * **Management:** Primarily conservative (Rest, Ice, NSAIDs, and eccentric strengthening). Surgery is rarely required.

Q: Painful arc syndrome is most commonly caused by a tear of which of the following rotator cuff muscles?

Supraspinatus. **Explanation:** **Painful Arc Syndrome** (also known as Subacromial Impingement Syndrome) is characterized by shoulder pain during the middle range of abduction, typically between **60° and 120°**. **Why Supraspinatus is correct:** The Supraspinatus muscle is the most frequently injured component of the rotator cuff. It passes through the narrow subacromial space, beneath the acromion process and the coracoacromial ligament. During abduction, the tendon is compressed against the acromion. If the tendon is inflamed, degenerated, or torn, this compression causes sharp pain specifically in the 60°–120° range. Below 60°, the tendon hasn't yet contacted the acromion; above 120°, the greater tuberosity rotates away, relieving the pressure. **Why other options are incorrect:** * **Deltoid:** While the deltoid is the primary abductor of the arm (after the first 15°), it is a superficial muscle and not part of the rotator cuff. It is rarely the primary cause of impingement. * **Trapezius:** This muscle acts on the scapula (rotation and elevation) rather than the glenohumeral joint directly. * **Pectoralis Major:** This is a powerful adductor and internal rotator of the humerus; it does not contribute to the rotator cuff or the painful arc mechanism. **NEET-PG High-Yield Pearls:** * **Rotator Cuff Muscles (SITS):** Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. * **Initiation of Abduction:** Supraspinatus initiates the first 0–15°. * **Nerve Supply:** Supraspinatus is supplied by the **Suprascapular nerve (C5, C6)**. * **Neer’s Test and Hawkins-Kennedy Test:** Clinical exams used to identify subacromial impingement. * **Critical Zone:** The area of the supraspinatus tendon with poor blood supply (Codman’s point), making it prone to degenerative tears.

Q: A 45-year-old man has shoulder pain after a motorcycle fall. Radiographs are negative for fracture and dislocation. On examination, a positive lift-off test is noted. What is the most likely diagnosis?

Subscapularis tear. **Explanation:** The clinical presentation of shoulder pain following trauma with negative radiographs and a **positive lift-off test** is pathognomonic for a **subscapularis tear**. **1. Why Subscapularis is correct:** The subscapularis is the only rotator cuff muscle responsible for **internal rotation** of the humerus. The **Gerber’s Lift-off Test** specifically isolates this muscle. It is performed by placing the patient's hand behind their back (lumbar region) and asking them to lift the hand away from the back against resistance. Inability to do so indicates a tear or weakness of the subscapularis. **2. Why other options are incorrect:** * **Supraspinatus (B):** The most commonly injured rotator cuff muscle. It is responsible for the first 15° of abduction. Clinical tests include the **Empty Can (Jobe’s) test** and the **Drop Arm test**. * **Infraspinatus (C):** Responsible for **external rotation** with the arm at the side. It is tested using resisted external rotation. * **Teres Minor (D):** Also an external rotator. It is specifically tested using the **Hornblower’s sign** (resisted external rotation with the arm in 90° abduction). **Clinical Pearls for NEET-PG:** * **Rotator Cuff Muscles (SITS):** Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. * **Belly Press Test:** An alternative test for subscapularis if the patient cannot internally rotate enough to place the hand behind the back. * **Imaging Gold Standard:** While X-rays rule out fractures/dislocations, **MRI** is the investigation of choice for soft tissue/rotator cuff tears. * **Subscapularis Insertion:** It is the only SITS muscle that inserts into the **lesser tuberosity** of the humerus; the others insert into the greater tuberosity.

Question 1

What is the most important physical sign for the diagnosis of anterior instability of the glenohumeral joint?

Accepted Answer

Apprehension sign

Answer

Impingement sign

Answer

Resisted straight arm raising sign

Answer

Resisted forearm supination sign

Question 2

A twisting injury of the knee in a flexed position would result in injury to all of the following structures EXCEPT:

Accepted Answer

Fibular collateral ligament

Answer

Meniscal tear

Answer

Capsular tear

Answer

Anterior cruciate ligament

Question 3

Which tendon is affected in lateral epicondylitis?

Accepted Answer

Extensor Carpi Radialis Brevis

Answer

Extensor Carpi Radialis Longus

Answer

Flexor Pollicis Longus

Answer

Supinator

Question 4

Injury to which of the following structures would MOST likely account for the increased anterior translation of the tibia in reference to the femur?

Accepted Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Answer

Medial collateral ligament

Answer

Patellar ligament

Question 5

A footballer sustained a blow on the lateral side of the knee. X-ray showed no bony injuries. On examination, the Drawer tests were negative and McMurray's test was positive. Which structure is most likely injured?

Accepted Answer

Lateral meniscus

Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Answer

Posterior cruciate ligament

Question 6

A patient presents with a history of twisting strain and locking of the knee joint. What is the most likely diagnosis?

Accepted Answer

Meniscal tear

Answer

Avulsion of tibial tubercle

Answer

Tearing of lateral collateral ligament

Answer

Tear of anterior cruciate ligament

Question 7

What is the medical term for Golfer's elbow?

Accepted Answer

Medial epicondylitis

Answer

Lateral epicondylitis

Answer

Posterior elbow dislocation

Answer

Lateral collateral ligament injury

Question 8

A 25-year-old man experiences pain in the right knee following a fall. His knee is swollen and he cannot bear full weight or fully extend his leg. There is tenderness over the medial joint line. X-ray findings were normal, and the range of motion (ROM) is stable to varus and valgus stress. The straight-leg raise is unrestricted. Which is the most likely type of injury?

Accepted Answer

Medial meniscus

Answer

Anterior cruciate ligament

Answer

Tibial tuberosity

Answer

Transverse genicular ligament

Question 9

Painful arc syndrome is most commonly caused by a tear of which of the following rotator cuff muscles?

Accepted Answer

Supraspinatus

Answer

Deltoid

Answer

Trapezius

Answer

Pectoralis major

Question 10

A 45-year-old man has shoulder pain after a motorcycle fall. Radiographs are negative for fracture and dislocation. On examination, a positive lift-off test is noted. What is the most likely diagnosis?

Accepted Answer

Subscapularis tear

Answer

Supraspinatus tear

Answer

Infraspinatus tear

Answer

Teres minor tear

Sports Medicine — MCQs

Sports Medicine — MCQs

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