Sports Medicine Practice Questions

Q: Which bone is commonly associated with a 'runner's fracture'?

Fibula. **Explanation:** A **Runner’s Fracture** refers specifically to a stress fracture of the **distal third of the fibula**, typically occurring 3–5 cm above the lateral malleolus. While the tibia bears the majority of the body's weight, the fibula acts as a site for muscle attachment and helps in dissipating torsional forces. In long-distance runners, repetitive rhythmic stress leads to bone resorption outpacing bone formation, resulting in a micro-fracture. **Analysis of Options:** * **A. Fibula (Correct):** The distal fibula is the classic site for this eponym. It is caused by repetitive muscle pull (specifically the flexors and peroneals) and repetitive ankle loading during the gait cycle. * **B. Femur (Incorrect):** While stress fractures can occur in the femoral neck or shaft (often seen in military recruits or athletes), they are not termed "runner’s fracture." * **C. Tibia (Incorrect):** The tibia is actually the *most common* site for stress fractures in athletes overall (often presenting as "shin splints" progressing to cortical breaks), but the specific clinical eponym "runner’s fracture" is reserved for the fibula. * **D. All of the above (Incorrect):** The term is specific to the fibular site. **High-Yield Clinical Pearls for NEET-PG:** 1. **March Fracture:** A stress fracture of the shaft of the **2nd or 3rd metatarsal**, commonly seen in military recruits. 2. **Dancer’s Fracture:** An avulsion fracture of the base of the **5th metatarsal** (insertion of Peroneus brevis). 3. **Jones Fracture:** A fracture at the **meta-diaphyseal junction** of the 5th metatarsal (Zone 2), notorious for high rates of non-union. 4. **Investigation of Choice:** While X-rays may be negative in the first 2–3 weeks, **MRI** is the most sensitive gold standard for early detection of stress fractures (showing marrow edema).

Q: Which test is used to evaluate posteroinferior instability of the glenohumeral joint?

Jerk test. **Explanation:** The **Jerk Test** is the specific clinical maneuver used to evaluate **posteroinferior instability** of the glenohumeral joint. To perform this test, the patient's arm is placed in 90° of abduction and internal rotation. As the examiner applies a longitudinal axial load to the humerus while moving the arm into horizontal adduction, a sudden "jerk" or "clunk" is felt as the humeral head subluxates posteriorly over the glenoid rim. A second jerk may be felt when the arm is returned to the starting position (reduction). **Analysis of Incorrect Options:** * **Crank Test:** Used to evaluate **SLAP lesions** (Superior Labrum Anterior to Posterior). It involves axial loading and rotation of the humerus in an elevated position to "crank" the labrum. * **Fulcrum Test:** Used to assess **Anterior instability**. While the patient is supine, the examiner’s hand acts as a fulcrum under the shoulder while the arm is abducted and externally rotated. (Note: Also used in femoral stress fracture assessment). * **Sulcus Test:** Used to evaluate **Inferior/Multidirectional instability**. A downward traction is applied to the humerus; a visible "sulcus" or dip appearing below the acromion indicates laxity of the superior glenohumeral ligament. **Clinical Pearls for NEET-PG:** * **Kim Test:** Often paired with the Jerk test; it is highly sensitive for **posteroinferior labral tears**. * **Apprehension & Relocation Tests:** Gold standard for **Anterior instability**. * **Bankart Lesion:** Most common cause of recurrent anterior dislocation (avulsion of the anteroinferior labrum).

Q: A patient injured his knee while playing hockey 3 months ago. On examination, his knee was unstable during extension but was stable at 90 degrees of flexion. He is most likely suffering from which of the following?

ACL posterolateral fiber tear. ### Explanation The **Anterior Cruciate Ligament (ACL)** consists of two distinct functional bundles named according to their tibial insertion sites: the **Anteromedial (AM) bundle** and the **Posterolateral (PL) bundle**. **1. Why Option B is Correct:** The stability of these bundles varies with the knee's position: * **PL Bundle:** It is tightest when the knee is in **extension**. It provides stability against anterior translation and rotatory loads at low flexion angles. Therefore, if the knee is unstable in extension but stable at 90° flexion, the PL bundle is likely torn. * **AM Bundle:** It is tightest when the knee is in **flexion** (90°). If the knee is stable at 90° flexion, the AM bundle is intact. **2. Why Other Options are Incorrect:** * **Option A:** An AM bundle tear would result in instability (increased anterior drawer) specifically when the knee is flexed at 90°. * **Option B:** PCL tears typically present with a "posterior sag" sign and instability during flexion, not extension. * **Option D:** Meniscal tears usually present with mechanical symptoms (locking, clicking) and joint line tenderness rather than gross ligamentous instability in specific degrees of extension. **3. Clinical Pearls for NEET-PG:** * **Lachman Test:** The most sensitive clinical test for ACL injury; it primarily evaluates the **PL bundle** (performed at 20-30° flexion). * **Anterior Drawer Test:** Primarily evaluates the **AM bundle** (performed at 90° flexion). * **Pivot Shift Test:** Highly specific for ACL tears; it specifically assesses the rotatory instability caused by a **PL bundle** deficiency. * **Blood Supply:** The middle genicular artery is the primary blood supply to the ACL.

Q: Tennis elbow is characterized by?

Tendinitis of the common extensor origin. **Explanation:** **Tennis Elbow (Lateral Epicondylitis)** is a clinical condition caused by repetitive overuse leading to microtrauma and degenerative changes (angiofibroblastic hyperplasia) at the **common extensor origin** of the forearm. 1. **Why Option B is Correct:** The common extensor origin is located at the **lateral epicondyle** of the humerus. The muscle most frequently involved is the **Extensor Carpi Radialis Brevis (ECRB)**. Repetitive wrist extension and supination lead to inflammation and chronic degeneration at this site, resulting in pain over the lateral aspect of the elbow. 2. **Why Other Options are Incorrect:** * **Option A & C:** Tenderness over the **medial epicondyle** and tendinitis of the **common flexor origin** (specifically the Pronator teres and Flexor carpi radialis) characterize **Golfer’s Elbow** (Medial Epicondylitis). * **Option D:** While movement can be painful, the hallmark of the condition is localized tenderness over the lateral epicondyle and pain specifically during **resisted wrist extension** with the elbow extended, rather than general flexion/extension. **High-Yield Clinical Pearls for NEET-PG:** * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Clinical Tests:** * **Cozen’s Test:** Pain on resisted wrist extension. * **Mill’s Test:** Pain when the clinician passively flexes the wrist while the elbow is extended and forearm pronated. * **Maudsley’s Test:** Pain on resisted extension of the middle finger. * **Treatment:** Conservative management (Rest, NSAIDs, bracing) is the first line. Refractory cases may require corticosteroid or PRP injections, or surgical release of the ECRB origin (Nirschl procedure).

Q: Unhappy triad doesn't include injury to which of the following structures?

LCL. The **Unhappy Triad** (also known as O'Donoghue's Triad) is a classic sports medicine injury involving three specific structures of the knee joint. It typically occurs due to a powerful lateral blow to the knee while the foot is fixed on the ground, resulting in a combination of **valgus stress, flexion, and external rotation.** ### Explanation of Options: * **Correct Answer (C) LCL:** The Lateral Collateral Ligament (LCL) is located on the outer side of the knee. It is generally spared in this injury pattern because the mechanism involves a **valgus** (inward) force, which puts tension on the medial structures and compression on the lateral side. * **Option (A) ACL:** The Anterior Cruciate Ligament is almost always torn in this triad due to the rotational force and anterior translation of the tibia. * **Option (B) MCL:** The Medial Collateral Ligament is the first structure to fail when a valgus stress is applied to the knee. * **Option (D) Medial Meniscus:** Classically, O'Donoghue described the medial meniscus as the third component. However, modern sports medicine (MRI studies) suggests that **lateral meniscus** tears are actually more common in acute ACL injuries. Despite this, for the purpose of exams like NEET-PG, the "classic" triad still consists of the **ACL, MCL, and Medial Meniscus.** ### High-Yield Clinical Pearls for NEET-PG: * **Mechanism of Injury:** Valgus stress + External rotation + Fixed foot (e.g., a "clipped" tackle in football). * **Pivot Shift Test:** The most specific clinical test for an ACL tear. * **Lachman Test:** The most sensitive clinical test for an ACL tear. * **McMurray Test:** Used to identify meniscal tears. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Q: Which of the following characterizes 'Tennis elbow'?

Tendinitis of the common extensor origin. **Explanation:** **Tennis Elbow (Lateral Epicondylitis)** is a clinical condition characterized by pain and tenderness over the lateral epicondyle of the humerus. It is caused by repetitive stress or overuse leading to micro-tears and degenerative changes (angiofibroblastic hyperplasia) at the **common extensor origin**. 1. **Why Option B is Correct:** The common extensor origin attaches to the lateral epicondyle. The muscle most frequently involved is the **Extensor Carpi Radialis Brevis (ECRB)**. Repetitive wrist extension and supination lead to inflammation and tendinosis at this site, making "tendinitis of the common extensor origin" the definitive pathological description. 2. **Why Other Options are Incorrect:** * **Option A & C:** Tenderness over the **medial epicondyle** and tendinitis of the **common flexor origin** (specifically the Pronator teres and Flexor carpi radialis) characterize **Golfer’s Elbow** (Medial Epicondylitis), not Tennis elbow. * **Option D:** While movement may be painful, the hallmark of the condition is pain during **resisted wrist extension** and gripping, rather than simple passive flexion and extension of the elbow joint itself. **High-Yield Clinical Pearls for NEET-PG:** * **Cozen’s Test:** Pain at the lateral epicondyle when the patient resists wrist extension with the elbow flexed. * **Mill’s Test:** Pain elicited by passive wrist flexion and forearm pronation while extending the elbow. * **Maudsley’s Test:** Pain on resisted extension of the middle finger (due to ECRB involvement). * **Management:** Primarily conservative (NSAIDs, activity modification, eccentric exercises). Refractory cases may require corticosteroid or PRP injections, or surgical release of the ECRB origin (Nirschl procedure).

Q: Jumper's knee is primarily caused by:

Patellar tendonosis. **Explanation:** **Jumper’s Knee**, clinically known as **Patellar Tendonitis/Tendonosis**, is a common overuse injury characterized by pain at the inferior pole of the patella. It is caused by repetitive stress on the extensor mechanism of the knee, typically seen in athletes involved in sports requiring frequent jumping and landing (e.g., basketball, volleyball). * **Why Patellar Tendonosis is Correct:** The pathology involves micro-tears and mucoid degeneration of the patellar tendon, most commonly at its origin at the **inferior pole of the patella**. While initially inflammatory (tendonitis), chronic cases show a lack of inflammatory cells and are more accurately termed "tendonosis." * **Why Incorrect Options are Wrong:** * **Sacral, Tibial, and Fibular Fractures:** These are acute traumatic bony injuries. While a tibial tuberosity avulsion can occur in adolescents (Osgood-Schlatter disease), Jumper's knee specifically refers to the soft tissue pathology of the tendon itself, not a fracture. **Clinical Pearls for NEET-PG:** 1. **Blazina Classification:** Used to grade the severity of Jumper’s Knee based on whether pain occurs before, during, or after activity. 2. **Physical Exam:** Tenderness is localized to the inferior pole of the patella; pain is elicited by resisted knee extension. 3. **Imaging:** MRI is the gold standard, showing tendon thickening and increased signal intensity. 4. **Management:** Primarily conservative (eccentric strengthening exercises). Surgery is reserved for refractory cases. 5. **Differential Diagnosis:** Must be distinguished from **Sinding-Larsen-Johansson syndrome**, which is traction apophysitis at the inferior patellar pole in children.

Q: Which of the following is NOT a component of O'Donoghue's unhappy triad?

Fibular collateral ligament (FCL) injury. **Explanation:** The **O'Donoghue’s Unhappy Triad** (also known as the "blown knee") is a classic knee injury pattern typically resulting from a high-impact lateral blow to the knee while the foot is fixed on the ground (valgus stress with external rotation). **1. Why Option D is correct:** The **Fibular Collateral Ligament (FCL)**, also known as the Lateral Collateral Ligament (LCL), is located on the lateral aspect of the knee. The Unhappy Triad specifically involves structures on the **medial** side of the knee due to the valgus mechanism of injury. Therefore, an FCL injury is not part of this triad. **2. Why the other options are incorrect:** The classic triad consists of the following three structures: * **Anterior Cruciate Ligament (ACL) injury (Option A):** This is the most common ligamentous component of the triad, resulting from the rotational force. * **Medial Meniscus injury (Option B):** In O'Donoghue’s original description, the medial meniscus was included. However, modern sports medicine studies (using MRI) suggest that **lateral meniscus** tears are actually more common in acute ACL injuries, though the "classic" definition for exams remains the medial meniscus. * **Medial Collateral Ligament (MCL) injury (Option C):** The valgus stress directly stretches and tears the MCL on the medial side. **Clinical Pearls for NEET-PG:** * **Mechanism:** Valgus stress + External rotation + Fixed foot. * **Clinical Sign:** Positive Lachman’s test (for ACL) and opening of the medial joint line on valgus stress (for MCL). * **Modern Update:** While the "Classic Triad" includes the Medial Meniscus, the "Modern Triad" often cites the **Lateral Meniscus** as being more frequently injured in acute cases. Always follow the classic definition (Medial Meniscus) unless the question specifically asks for modern epidemiological findings.

Question 1

Which bone is commonly associated with a 'runner's fracture'?

Accepted Answer

Fibula

Answer

Femur

Answer

Tibia

Answer

All of the above

Question 2

Which test is used to evaluate posteroinferior instability of the glenohumeral joint?

Accepted Answer

Jerk test

Answer

Crank test

Answer

Fulcrum test

Answer

Sulcus test

Question 3

A patient injured his knee while playing hockey 3 months ago. On examination, his knee was unstable during extension but was stable at 90 degrees of flexion. He is most likely suffering from which of the following?

Accepted Answer

ACL posterolateral fiber tear

Answer

ACL anteromedial fiber tear

Answer

PCL tear

Answer

Anterior portion of medial meniscus tear

Question 4

Tennis elbow is characterized by?

Accepted Answer

Tendinitis of the common extensor origin

Answer

Tenderness over the medial epicondyle

Answer

Tendinitis of the common flexor origin

Answer

Painful flexion and extension

Question 5

Unhappy triad doesn't include injury to which of the following structures?

Accepted Answer

LCL

Answer

ACL

Answer

MCL

Answer

Medial meniscus

Question 6

Which of the following characterizes 'Tennis elbow'?

Accepted Answer

Tendinitis of the common extensor origin

Answer

Tenderness over the medial epicondyle

Answer

Tendonitis of the common flexor origin

Answer

Painful flexion and extension

Question 7

Jumper's knee is primarily caused by:

Accepted Answer

Patellar tendonosis

Answer

Sacral fracture

Answer

Tibial fracture

Answer

Fibular fracture

Question 8

The Female Athlete Triad consists of all EXCEPT:

Accepted Answer

Absence of secondary sexual characteristics

Answer

Disordered eating

Answer

Amenorrhea

Answer

Osteoporosis

Question 9

Which of the following is NOT a component of O'Donoghue's unhappy triad?

Accepted Answer

Fibular collateral ligament (FCL) injury

Answer

Anterior cruciate ligament (ACL) injury

Answer

Medial meniscus injury

Answer

Medial collateral ligament (MCL) injury

Question 10

A 17-year-old athletic girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. What is the likely diagnosis?

Accepted Answer

Chondromalacia patella

Answer

Blount's disease

Answer

Nail-patella syndrome

Answer

Bursitis

Sports Medicine — MCQs

Sports Medicine — MCQs

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