Sports Medicine Practice Questions

Q: An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:

Stress fracture. ***Stress fracture*** - A **stress fracture** is highly likely in a recruit undergoing rigorous training, as repetitive stress on bones, especially in the legs, can lead to micro-fractures. - The symptoms of **localized pain** at the posteromedial aspect of both legs, acute point tenderness, and pain aggravated by physical activity are classic for stress fractures. *Gout* - **Gout** typically presents with sudden, severe pain and inflammation in a single joint, most commonly the big toe; it is less likely to cause bilateral, activity-related leg pain. - While smoking is a risk factor for gout, the clinical presentation does not align with a **gout flare-up**. *Buerger's disease* - **Buerger's disease** (thromboangiitis obliterans) is a rare inflammatory disease of the small and medium-sized arteries and veins, mainly affecting the hands and feet of heavy smokers. - It causes pain, numbness, and tingling due to **ischemia**, often leading to gangrene; it does not manifest as point tenderness and activity-aggravated pain along the posteromedial aspect of the legs. *Lumbar canal stenosis* - **Lumbar canal stenosis** typically causes neurogenic claudication, characterized by radiating pain, numbness, or weakness in the legs that is exacerbated by standing or walking and relieved by sitting or leaning forward. - The symptoms described, including **acute point tenderness** and posteromedial leg pain, are not characteristic of spinal canal narrowing.

Q: Drawer sign is seen in:

Cruciate ligament injury. ***Cruciate ligament injury*** - The **drawer test** specifically assesses the integrity of the **anterior and posterior cruciate ligaments** in the knee. - A positive drawer sign indicates excessive forward or backward translation of the tibia relative to the femur, signifying a **ligamentous tear**. *Hyperparathyroidism* - This condition involves **excessive parathyroid hormone**, leading to calcium and phosphate imbalances. - Symptoms are primarily related to **bone demineralization**, kidney stones, and neuromuscular issues, not ligament instability. *Perthes' disease* - An **avascular necrosis of the femoral head** in children, causing hip pain and limping. - It affects the **hip joint**, not the knee, and there is no associated drawer sign. *Scurvy* - Caused by a **deficiency of vitamin C**, which is essential for collagen synthesis. - Manifestations include **bleeding gums**, poor wound healing, and musculoskeletal pain, but not specific ligamentous instability of the knee.

Q: Cozen test is positive in :-

Tennis elbow. ***Tennis elbow*** - The **Cozen test** is a specific diagnostic maneuver used to assess for **lateral epicondylitis**, commonly known as tennis elbow. - A positive test indicates pain over the **lateral epicondyle** with resisted wrist extension, confirming inflammation or degeneration of the common extensor tendons. *Skiers thumb* - This condition involves injury to the **ulnar collateral ligament of the thumb**, typically due to hyperextension and abduction forces. - The Cozen test is **irrelevant** for diagnosing thumb ligament injuries. *Golfer's elbow* - Also known as **medial epicondylitis**, this involves inflammation of the **flexor-pronator tendons** at the medial epicondyle. - The Cozen test specifically evaluates the extensor tendons, and a comparable test for golfer's elbow would involve resisted wrist flexion. *Pulled elbow* - This refers to **radial head subluxation**, a common injury in children where the radius slips out of the annular ligament. - It is an injury related to joint displacement, not tendon pathology, and therefore the Cozen test is not applicable.

Q: Which of the rotator cuff muscles was not given its due importance and was called the forgotten muscle of the rotator cuff?

Subscapularis. ***Subscapularis*** - The **subscapularis** was historically considered less important than other rotator cuff muscles in clinical assessment and treatment, earning it the moniker **"the forgotten muscle"** - However, its critical role in **internal rotation** and dynamic anterior stability of the glenohumeral joint is now well-recognized - Located on the anterior surface of the scapula, it was often overlooked in clinical examinations and its tears were under-diagnosed before advanced imaging techniques *Teres minor* - The teres minor is part of the rotator cuff and is crucial for **external rotation** and stabilization of the shoulder joint - While clinically important, it has not been specifically singled out as "the forgotten muscle" in the same way the subscapularis was - It is the smallest of the rotator cuff muscles and works synergistically with infraspinatus *Infraspinatus* - The infraspinatus is a primary **external rotator** of the humerus and plays a significant role in shoulder stability - Its function has always been well understood and is commonly assessed in rotator cuff examinations - It is easily palpable posteriorly and readily evaluated clinically *Supraspinatus* - The supraspinatus is often considered the **most commonly injured** rotator cuff muscle due to its location and function in initiating **abduction** - It has never been "forgotten" and is consistently emphasized in clinical evaluations of shoulder pain and dysfunction - It is the most frequently assessed muscle in rotator cuff pathology

Q: While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?

Tear of the medial meniscus. **Tear of the medial meniscus** - A **twisting injury** to the knee, especially when tackled from the lateral side (which can force the leg into valgus stress), commonly causes a **tear of the medial meniscus**. - The **medial meniscus** is less mobile and more firmly attached than the lateral meniscus, making it more susceptible to injury during twisting forces. *Ruptured fibular collateral ligament* - A rupture of the **fibular collateral ligament (FCL)**, also known as the **lateral collateral ligament (LCL)**, typically results from a **varus stress** (a blow to the medial side of the knee), which is contrary to a tackle from the lateral side. - While twisting can contribute to knee injuries, isolate FCL tears from a lateral-side tackle are less likely than meniscal damage. *Tenderness on pressure along the fibular collateral ligament* - Tenderness along the **fibular collateral ligament** would indicate an injury to this structure, but a twisting injury from the lateral side is less likely to directly damage the FCL compared to the medial structures. - This symptom alone does not fully explain the mechanism of injury and the common resulting pathology in this scenario. *Injured posterior cruciate ligament* - The **posterior cruciate ligament (PCL)** is most commonly injured by a direct blow to the anterior tibia when the knee is flexed (a **dashboard injury**) or by a hyperflexion injury. - A twisting injury from the lateral side is a less common mechanism for isolated PCL injury.

Q: A 30-year-old woman is on her first ski trip. While skiing, she fell and twisted her left leg. She cannot stand on her left leg because of pain. On examination, the left knee is swollen and tender. With the patient sitting on the stretcher with her knee flexed, the doctor on duty performed a test which came out to be positive. What is the most likely injured structure?

Option B. ***Option B*** - The scenario describes a **skiing injury** with twisting of the leg, acute pain preventing weight-bearing, and knee swelling. A positive test with the knee flexed suggests a **cruciate ligament injury**. - The **anterior cruciate ligament (ACL)** is commonly injured in skiing accidents due to sudden twisting movements or hyperextension, and its integrity is assessed by tests like the **Lachman test** or **anterior drawer test**, which are performed with the knee flexed. *Option A* - While injuries to the **menisci** can occur from twisting forces, they less commonly present with immediate inability to bear weight and significant swelling as the primary complaint in the absence of a distinct test revealing meniscal damage. - Meniscal tears often manifest with **locking** or **catching sensations** in the knee. *Option C* - Injury to the **medial collateral ligament (MCL)** typically results from a **valgus stress** (force to the outside of the knee). - Although MCL injuries cause pain and instability, the described mechanism and a generic "positive test" in knee flexion are not as specifically indicative of MCL tears as they are for cruciate ligaments. *Option D* - The **patellar tendon** connects the patella to the tibia and is primarily involved in knee extension. - While patellar tendon ruptures can occur with powerful quadriceps contraction or direct trauma, the twisting mechanism described is less typical for a patellar tendon injury.

Q: Most common type of meniscal injury is

Bucket handle type tear of Medial meniscus. ***Bucket handle type tear of Medial meniscus*** - The **medial meniscus** is more prone to injury than the lateral meniscus due to its **firm attachment** to the joint capsule, making it less mobile. - A **bucket handle tear** is a longitudinal tear where the inner portion of the meniscus displaces into the intercondylar notch, often leading to **locking** of the knee. *Anterior horn tear of Medial meniscus* - While medial meniscus tears are common, tears of the **anterior horn** are less frequent than posterior horn or bucket-handle tears. - This typically occurs with **hyperextension injuries** and is not the most common type of meniscal injury overall. *Posterior horn tear of Medial meniscus* - Tears of the **posterior horn** of the medial meniscus are common, especially in older individuals due to degeneration. - However, the **bucket handle tear** more frequently causes mechanical symptoms like locking and is often considered the most common significant meniscal injury requiring surgical intervention. *Bucket handle type tear of Lateral meniscus* - The **lateral meniscus** is more mobile and less frequently injured than the medial meniscus. - While bucket handle tears can occur in the lateral meniscus, they are **less common** compared to those in the medial meniscus.

Q: A 40-year-old man was repairing his wooden shed on Sunday morning. By afternoon, he felt that the hammer was becoming heavier and heavier. He felt pain in the lateral side of the elbow and also found that squeezing water out of sponge hurt his elbow. Which of the muscles are most likely involved-

Extensor carpi radialis longus and brevis. ***Extensor carpi radialis longus and brevis*** - The symptoms described, such as **lateral elbow pain** and pain with actions like hammering and squeezing, are classic for **lateral epicondylitis**, also known as **tennis elbow**. - **Extensor carpi radialis longus** and **brevis** are the primary muscles that originate from the **lateral epicondyle**, and their tendons are commonly affected in this condition. *Triceps brachii and anconeus* - The **triceps brachii** is responsible for elbow extension; injury to this muscle or the anconeus would typically cause pain in the **posterior aspect of the elbow**. - Pain specifically localized to the **lateral elbow** with gripping and wrist extension activities is not characteristic of triceps or anconeus involvement. *Biceps brachii and supinator* - The **biceps brachii** is a primary supinator and elbow flexor, while the **supinator** muscle also aids in supination; involvement of these would typically cause pain in the **anterior elbow** or with supination against resistance. - These muscles are generally not associated with pain in the **lateral epicondyle** with wrist extension and gripping activities. *Flexor digitorum superficialis* - The **flexor digitorum superficialis** is involved in flexing the fingers and wrist and originates from the **medial epicondyle** of the humerus. - Injury to this muscle would cause pain on the **medial side of the elbow** (golfer's elbow), not the lateral side, and is typically exacerbated by repetitive wrist flexion.

Q: Lachmann's test is used for -

ACL injury. ***ACL injury*** - **Lachman's test** is considered the most sensitive clinical test for diagnosing an **anterior cruciate ligament (ACL) rupture**. - It assesses the amount of **anterior tibial translation** relative to the femur while the knee is in slight flexion (20-30 degrees), indicating laxity if the ACL is torn. *LCL injury* - **LCL (lateral collateral ligament)** injuries are typically assessed using the **varus stress test**, not Lachman's test. - The varus stress test evaluates the integrity of the LCL by applying a **varus force** to the knee. *PCL injury* - **PCL (posterior cruciate ligament)** injuries are primarily evaluated using the **posterior sag sign** or the **posterior drawer test**. - These tests look for **posterior displacement** of the tibia on the femur, which is opposite to what Lachman's test assesses. *MCL injury* - **MCL (medial collateral ligament)** injuries are assessed using the **valgus stress test**, not Lachman's test. - The valgus stress test checks for laxity by applying a **valgus force** to the knee joint.

Q: Anterior Drawer Test is used to diagnose tear of

Anterior Cruciate Ligament. ***Anterior Cruciate Ligament*** - The **Anterior Drawer Test** assesses the integrity of the **Anterior Cruciate Ligament (ACL)** by evaluating anterior translation of the tibia relative to the femur. - A positive test (excessive anterior movement) indicates a tear or injury to the **ACL**, which is a common knee injury often seen in athletes. *Medial meniscus* - Tears of the **medial meniscus** are typically diagnosed using tests like the **McMurray test** or **Apley grind test**, which stress the meniscus. - While meniscal tears can cause knee pain and instability, they do not directly manifest as excessive anterior tibial translation in the **Anterior Drawer Test**. *Lateral meniscus* - Similar to the medial meniscus, tears of the **lateral meniscus** are evaluated with tests such as the **McMurray test** (internal rotation) or **Apley grind test**. - The **Anterior Drawer Test** is specific for ligamentous instability and is not a primary diagnostic tool for meniscal injuries. *Posterior Cruciate Ligament* - The integrity of the **Posterior Cruciate Ligament (PCL)** is assessed by the **Posterior Drawer Test**, which checks for posterior translation of the tibia. - A positive **Posterior Drawer Test** indicates a PCL tear, whereas the **Anterior Drawer Test** specifically evaluates the **ACL**.

Question 1

An army recruit, smoker and 6 months into training started complaining of pain at posteromedial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is:

Accepted Answer

Stress fracture

Answer

Gout

Answer

Buerger's disease

Answer

Lumbar canal stenosis

Question 2

Drawer sign is seen in:

Accepted Answer

Cruciate ligament injury

Answer

Hyperparathyroidism

Answer

Perthes' disease

Answer

Scurvy

Question 3

Cozen test is positive in :-

Accepted Answer

Tennis elbow

Answer

Skiers thumb

Answer

Golfer's elbow

Answer

Pulled elbow

Question 4

Which of the rotator cuff muscles was not given its due importance and was called the forgotten muscle of the rotator cuff?

Accepted Answer

Subscapularis

Answer

Teres minor

Answer

Infraspinatus

Answer

Supraspinatus

Question 5

While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?

Accepted Answer

Tear of the medial meniscus

Answer

Ruptured fibular collateral ligament

Answer

Tenderness on pressure along the fibular collateral ligament

Answer

Injured posterior cruciate ligament

Question 6

A 30-year-old woman is on her first ski trip. While skiing, she fell and twisted her left leg. She cannot stand on her left leg because of pain. On examination, the left knee is swollen and tender. With the patient sitting on the stretcher with her knee flexed, the doctor on duty performed a test which came out to be positive. What is the most likely injured structure?

Accepted Answer

Option B

Answer

Option D

Answer

Option C

Answer

Option A

Question 7

Most common type of meniscal injury is

Accepted Answer

Bucket handle type tear of Medial meniscus

Answer

Anterior horn tear of Medial meniscus

Answer

Posterior horn tear of Medial meniscus

Answer

Bucket handle type tear of Lateral meniscus

Question 8

A 40-year-old man was repairing his wooden shed on Sunday morning. By afternoon, he felt that the hammer was becoming heavier and heavier. He felt pain in the lateral side of the elbow and also found that squeezing water out of sponge hurt his elbow. Which of the muscles are most likely involved-

Accepted Answer

Extensor carpi radialis longus and brevis

Answer

Triceps brachii and anconeous

Answer

Biceps brachii and supinator

Answer

Flexor digitorum superficialis

Question 9

Lachmann's test is used for -

Accepted Answer

ACL injury

Answer

LCL injury

Answer

PCL injury

Answer

MCL injury

Question 10

Anterior Drawer Test is used to diagnose tear of

Accepted Answer

Anterior Cruciate Ligament

Answer

Medial meniscus

Answer

Lateral meniscus

Answer

Posterior Cruciate Ligament

Sports Medicine — MCQs

Sports Medicine — MCQs

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