Sports Medicine Practice Questions

Q: Tennis elbow is -

Lateral Epicondylitis. ***Lateral Epicondylitis*** - **Tennis elbow** is the common term for **lateral epicondylitis**, an overuse injury causing pain on the **outer side of the elbow**. - It is typically caused by repetitive wrist extension and supination movements, leading to **tendinopathy** of the **extensor carpi radialis brevis** muscle origin. *Radial head subluxation* - This condition, commonly known as **nursemaid's elbow**, involves the displacement of the **radial head** from the annular ligament. - It is usually caused by a sudden pull on an outstretched arm, typically in young children, and presents with immediate pain and refusal to move the arm. *Ulnar collateral ligament injury* - An injury to the **ulnar collateral ligament (UCL)**, often seen in overhead throwing athletes, is sometimes called **"Tommy John injury"**. - It involves damage to the ligament on the **inner side of the elbow** and can lead to instability and pain during throwing motions. *Medial Epicondylitis* - This condition, known as **golfer's elbow**, involves pain on the **inner side of the elbow**. - It is caused by overuse of the forearm flexor muscles that originate from the **medial epicondyle**, due to repetitive wrist flexion and pronation.

Q: Circumduction test is used for:

Posterior shoulder instability. ***Posterior shoulder instability*** - The **circumduction test** involves circumducting the arm while applying a **posteriorly directed force** to the humeral head. - A positive test, indicated by a **clunk** or patient apprehension, suggests **posterior glenohumeral instability**. *Inferior shoulder instability* - Inferior instability is often tested using the **sulcus sign**, which assesses for a gap between the acromion and the humeral head when traction is applied. - The circumduction test primarily focuses on posterior translation, not inferior laxity. *Anterior shoulder instability* - **Anterior instability** is typically evaluated by tests like the **apprehension test** or **relocation test**, where the arm is abducted and externally rotated. - These tests provoke a sense of apprehension or pain in patients with anterior instability, which differs from the mechanism of the circumduction test. *Either of above* - Each type of shoulder instability (anterior, posterior, inferior) has specific physical examination maneuvers designed to identify it. - The circumduction test has a particular diagnostic utility for **posterior instability** and is not broadly applicable to all forms of instability.

Q: A patient complains to a physician of chronic pain and tingling of the buttocks. The pain is exacerbated when the buttocks are compressed by sitting on a toilet seat or chair for long periods. No lumbar pain is noted. Pain is elicited when the physician performs Freiberg's maneuver. Most likely diagnosis?

Piriformis syndrome. ***Piriformis syndrome*** - The symptoms of **chronic pain and tingling in the buttocks**, exacerbated by sitting, and the positive finding on **Freiberg's maneuver** (passive internal rotation of the hip) are hallmark signs. - This condition involves **entrapment or irritation of the sciatic nerve by the piriformis muscle**, which is located deep in the buttock. *Disk compression of the sciatic nerve* - While it can cause similar symptoms, the absence of **lumbar pain** makes a primary disc issue less likely. - **Freiberg's maneuver** is specific to piriformis irritation, not typically for disk compression. *Fibromyalgia* - Fibromyalgia presents with **widespread musculoskeletal pain** and tenderness, not typically localized to the buttocks with specific positional exacerbation. - It does not involve nerve entrapment or specific orthopedic maneuvers like Freiberg's maneuver. *Popliteus tendinitis* - Popliteus tendinitis causes pain in the **posterolateral aspect of the knee**, not the buttocks. - It is typically associated with activities involving downhill running or pivoting of the knee.

Q: Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?

Subscapularis tear. ***Subscapularis tear*** - The patient can perform **internal rotation** but has difficulty lifting the arm *off* the lumbosacral spine, indicating weakness in **subscapularis function**. - The **lift-off test** is a specific clinical test for subscapularis integrity, where the inability to lift the hand off the back suggests a tear. *Teres major tear* - A tear in the **teres major** would primarily affect **adduction** and **internal rotation** of the arm. - The patient's ability to internal rotate and abduct the arm makes a primary teres major tear less likely. *Acromioclavicular joint dislocation* - This condition presents with **pain** and **tenderness** over the AC joint, and a visible deformity ("step-off"). - While it can cause shoulder pain and limit movement, it does not typically present with the specific internal rotation and lift-off deficits described. *Long head of biceps tear* - A tear of the **long head of the biceps** usually presents with a "Popeye" deformity and pain with **supination** and **flexion of the elbow**. - The symptoms described (difficulty with lift-off, intact internal rotation) are not characteristic of a biceps tear.

Q: All are true about Rotator cuff syndrome except:

Fracture. ***Fracture*** - Rotator cuff syndrome primarily involves the **tendons and muscles** of the rotator cuff, not the bony structures. - A fracture refers to a **break in the bone**, which is a distinct injury from rotator cuff pathologies. *Rupture* - A **rotator cuff tear** or rupture is a common and severe form of rotator cuff syndrome. - This involves a tear in one or more of the **four rotator cuff tendons**, leading to pain and weakness. *Weakness* - Weakness, particularly in **shoulder abduction** and external rotation, is a hallmark symptom of rotator cuff syndrome, especially with tears. - The compromised integrity of the rotator cuff muscles and tendons directly impairs their ability to generate **force and control movement**. *Tendinitis* - **Rotator cuff tendinitis** (or tendinopathy) is a common cause of shoulder pain and is often the initial stage of rotator cuff syndrome. - It involves **inflammation and degenerative changes** within the rotator cuff tendons, leading to pain with movement.

Q: Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?

Walk downhill. ***Walk downhill*** - An **anterior cruciate ligament (ACL) deficient knee** experiences anterior tibial translation, especially when the muscles can't compensate, leading to instability. - Walking downhill places higher **anterior shear forces** on the knee joint and often involves knee extension or hyperextension, which dramatically increases the risk of the tibia translating anteriorly relative to the femur. *Getting up from a sitting position* - This activity primarily involves **quadriceps muscle contraction** and a concentric movement of the knee, which stabilizes the joint. - It does not typically place significant **anterior shear stress** on the ACL, even in a deficient knee. *Walk uphill* - Walking uphill often involves knee flexion and places the knee in a more protected position against **anterior tibial translation**. - The quadriceps and hamstrings work synergistically to **stabilize the joint** during this motion, reducing stress on the ACL. *Sitting cross-legged* - This position primarily involves **hip and knee flexion and external rotation**, but it is generally a static and non-weight-bearing position. - It does not impose significant **dynamic loads** or shear forces that would cause instability in an ACL-deficient knee.

Q: Yergason's supination sign is seen in lesion of which muscle?

Biceps. ***Biceps*** - **Yergason's test** assesses the stability of the **long head of the biceps tendon** within the bicipital groove. - A positive test, indicated by pain or palpable snapping, suggests **tenosynovitis** or **subluxation** of the biceps tendon. *Brachioradialis* - The **brachioradialis** is primarily a forearm flexor and pronator/supinator to neutral, not directly involved in the bicipital groove. - Its pathology is not assessed by **Yergason's maneuver**. *Triceps* - The **triceps** is the primary extensor of the elbow and has no direct connection to the shoulder joint structures assessed by Yergason's. - Its function is typically evaluated by tests of **elbow extension strength**. *Supinator* - The **supinator muscle** is responsible for **forearm supination**, but its integrity is not directly evaluated by Yergason's test, which focuses on the biceps tendon. - Damage to the supinator typically presents with weakness in active supination, rather than pain in the bicipital groove.

Q: A 17-year-old boy from Calcutta was playing football when he was tackled by another player. The opponent hit the lateral aspect of his knee. He presented to a hospital 1 week after the injury, complaining of swelling and pain in his right knee. On physical examination of his right knee, there is a large effusion. There is increased laxity (as compared to his uninjured knee) of his knee when his knee is passively placed in a valgus (abducted) position. In addition, there is significant anterior translation of his tibia with respect to his femur when his knee is tested at ninety degrees of flexion. Injury to which of the following structures most likely accounts for the increased laxity of his knee when his knee is passively placed in a valgus position?

Medial collateral ligament. **Medial collateral ligament** - **Valgus stress** on the knee, which involves an abduction force on the tibia, primarily tests the integrity of the **medial collateral ligament (MCL)**. Increased laxity in this position indicates an MCL injury. - The MCL resists forces that push the knee inward (valgus forces) and is commonly injured by direct blows to the lateral aspect of the knee. *Patellar ligament* - The **patellar ligament** connects the patella to the tibia and is crucial for knee extension. - Injury to the patellar ligament would affect the ability to straighten the knee and would be tested by examining extensor mechanism integrity, not valgus laxity. *Anterior cruciate ligament* - The **anterior cruciate ligament (ACL)** primarily prevents anterior translation of the tibia relative to the femur and resists rotational forces. - While the patient has significant anterior translation, the question specifically asks about laxity in a valgus position, which is an MCL test. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** resists **varus stress** (adduction force) on the knee, preventing the knee from bowing outward. - An injury to the LCL would manifest as increased laxity when the knee is passively placed in a varus, not valgus, position.

Q: Best initial treatment for acute calcific tendinitis of shoulder?

NSAIDs and Physical Therapy. ***NSAIDs and Physical Therapy*** - **NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)** are the first-line treatment for acute pain and inflammation associated with calcific tendinitis. - **Physical therapy** helps maintain joint mobility, reduce stiffness, and strengthen surrounding muscles, preventing chronic issues. *Surgical Removal* - **Surgical removal** of calcium deposits is typically reserved for cases that are refractory to conservative treatments after several months or for severe, disabling symptoms. - It is an **invasive procedure** and not the initial approach for acute presentation. *Steroid Injection* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation, but they do not address the underlying calcium deposits. - Repeated injections can have adverse effects on tendon health and are generally considered after **NSAIDs** have failed. *Ultrasound Therapy* - **Ultrasound therapy** may be used as an adjunct treatment to help break down calcium deposits or to reduce inflammation, but it is not typically the sole initial treatment. - Its effectiveness is **variable**, and it is often combined with other modalities like NSAIDs and physical therapy.

Question 1

A 26-year-old male power lifter visits the outpatient clinic with a painful shoulder. Radiographic examination reveals tendinopathy of the long head of the biceps. Which of the following conditions will most likely be present during physical examination?

Accepted Answer

Pain is felt in the anterior shoulder during forced contraction.

Answer

Pain is felt during abduction and flexion of the shoulder joint.

Answer

Pain is felt in the lateral shoulder during forced contraction.

Answer

Pain is felt during extension and adduction of the shoulder joint.

Question 2

Tennis elbow is -

Accepted Answer

Lateral Epicondylitis

Answer

Radial head subluxation

Answer

Ulnar collateral ligament injury

Answer

Medial Epicondylitis

Question 3

Circumduction test is used for:

Accepted Answer

Posterior shoulder instability

Answer

Inferior shoulder instability

Answer

Anterior shoulder instability

Answer

Either of above

Question 4

A patient complains to a physician of chronic pain and tingling of the buttocks. The pain is exacerbated when the buttocks are compressed by sitting on a toilet seat or chair for long periods. No lumbar pain is noted. Pain is elicited when the physician performs Freiberg's maneuver. Most likely diagnosis?

Accepted Answer

Piriformis syndrome

Answer

Disk compression of the sciatic nerve

Answer

Fibromyalgia

Answer

Popliteus tendinitis

Question 5

Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?

Accepted Answer

Subscapularis tear

Answer

Teres major tear

Answer

Acromioclavicular joint dislocation

Answer

Long head of biceps tear

Question 6

All are true about Rotator cuff syndrome except:

Accepted Answer

Fracture

Answer

Rupture

Answer

Weakness

Answer

Tendinitis

Question 7

Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?

Accepted Answer

Walk downhill

Answer

Getting up from a sitting position

Answer

Walk uphill

Answer

Sitting cross-legged

Question 8

Yergason's supination sign is seen in lesion of which muscle?

Accepted Answer

Biceps

Answer

Brachioradialis

Answer

Triceps

Answer

Supinator

Question 9

A 17-year-old boy from Calcutta was playing football when he was tackled by another player. The opponent hit the lateral aspect of his knee. He presented to a hospital 1 week after the injury, complaining of swelling and pain in his right knee. On physical examination of his right knee, there is a large effusion. There is increased laxity (as compared to his uninjured knee) of his knee when his knee is passively placed in a valgus (abducted) position. In addition, there is significant anterior translation of his tibia with respect to his femur when his knee is tested at ninety degrees of flexion. Injury to which of the following structures most likely accounts for the increased laxity of his knee when his knee is passively placed in a valgus position?

Accepted Answer

Medial collateral ligament

Answer

Patellar ligament

Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Question 10

Best initial treatment for acute calcific tendinitis of shoulder?

Accepted Answer

NSAIDs and Physical Therapy

Answer

Surgical Removal

Answer

Steroid Injection

Answer

Ultrasound Therapy

Sports Medicine — MCQs

Sports Medicine — MCQs

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