Sports Medicine Scored and Recorded Self-Assessment Examination 2019
1. Based on the injury shown on the axial MRI scan of the shoulder in Figure 1, what other
pathology should be closely examined for during surgery?
a. Subscapularis tear
b. Supraspinatus tear
c. Superior labral anterior-posterior (SLAP) tear
d. Bankart tear
Preffered Answer : 1
The axial MRI scan reveals a subluxated biceps tendon. In the study by Koh and associates, 85%
of patients with a biceps subluxation on MRI were found to have a subscapularis tear at the time
of arthroscopy. These are not always obvious on the MRI, and close inspection of the leading
edge/upper border of the subscapularis tendon at the time of arthroscopy is necessary. Although
supraspinatus tears, SLAP tears, and Bankart tears can all occur in conjunction with a biceps
subluxation, none have been shown to be strongly correlated with this pathology, nor as specific
to this pathology.
2. Figure 1 is the radiograph of a 31-year-old man who had left shoulder pain after a fall during a
snowboarding jump. Residual displacement of 5 mm after closed reduction is most likely to result
in
Figure 1
a. nonunion.
b. osteonecrosis.
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
,Sports Medicine Scored and Recorded Self-Assessment Examination 2019
c. altered rotator cuff mechanics.
d. normal shoulder function.
Preffered Answer 3
Humerus fractures account for 11% of all fractures among snowboarders and are the second-
most-common upper-extremity fracture after radius fractures (48%). Surgical fixation is
recommended for fractures with residual displacement >5 mm, or >3 mm in active patients
involved in frequent overhead activity. Malunion can result in a mechanical block to shoulder
abduction or external rotation and altered rotator cuff mechanics, causing weakness. A rich
arterial network provides a favorable healing environment for greater tuberosity fractures.
Consequently, nonunion and osteonecrosis are uncommon.
3. A 23-year-old student complains of recurrent left shoulder instability. He first dislocated his
shoulder in high school while playing lacrosse and was managed with physical therapy. A second
dislocation occurred one year later while skiing. He has since sustained two more dislocations
and says that his shoulder feels ―loose.‖ Examination reveals grade II anterior load and shift,
positive apprehension and relocation tests, and normal rotator cuff strength. An MRI arthrogram
is ordered and surgical treatment is recommended. What factor would most strongly represent an
indication for a procedure including bone augmentation (e.g. Latarjet) rather than a soft-tissue-
only stabilization (isolated labral repair/capsulorrhaphy)?
a. Patient’s intention to resume lacrosse and other contact sports after surgery
b. Presence of a 270° labral tear
c. 2-cm ―on-track‖ Hill-Sachs lesion
d. Anterior bony loss measuring 30% of inferior glenoid width
Preffered Answer: 4
There is much debate in the literature regarding optimal techniques for treatment of shoulder
instability. Barring other factors or concomitant pathology, however, there is no persuasive
literature to suggest routine use of bone augmentation for contact athletes. Extensive labral
involvement (here specifically implying posterior labral involvement, as well) will require a more
extensive repair but does not, in and of itself, suggest the necessity for glenoid bone
augmentation. A large Hill-Sachs lesion may be an indication for glenoid augmentation, primarily
if it is in a location/orientation that engages the anterior glenoid rim. These are referred to as ―off-
track‖ lesions. Of these choices, the strongest indication for a Latarjet coracoid transfer or similar
bone augmentation (other options include iliac crest autograft or distal tibial allograft) is high-
grade glenoid bone loss. Classically, this is performed through an open approach, although
arthroscopic techniques are increasing in popularity. Although the critical amount of bone loss is
debated, most surgeons and studies suggest a cut-off of approximately 20% to 25%, above
which isolated soft-tissue stabilization alone is less likely to be successful in the long-term.
4. A 32-year-old volleyball player has dull posterior shoulder pain. An examination reveals
moderate external rotation weakness with his arm at his side but normal strength on
supraspinatus isolation. Deltoid and supraspinatus bulk appear normal, although there appears
to be mild infraspinatus atrophy. Sensation is normal throughout the shoulder and shoulder
girdle. What is the most likely diagnosis?
a. Calcified transverse scapular ligament
b. Parsonage-Turner syndrome
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
,Sports Medicine Scored and Recorded Self-Assessment Examination 2019
c. Spinoglenoid notch cyst
d. Quadrilateral space syndrome
Preffered Answer: 3
This clinical scenario describes a patient with an isolated injury affecting the infraspinatus muscle.
The anatomic location of such a lesion would be at the spinoglenoid notch, at which the
suprascapular nerve may be compressed distal to its innervation of the supraspinatus but
proximal to the infraspinatus innervation. A calcified transverse scapular ligament would also
affect the suprascapular nerve but is proximal to the innervation of both muscles. Quadrilateral
space syndrome would affect innervation of the deltoid (and teres minor). Parsonage-Turner
syndrome is a more diffuse, and often severely painful, brachial plexus neuropathy.
5. Figure 1 is an MRI scan of the right hip of a 19-year-old woman with a 6-month history of right
groin pain. She was diagnosed with a stress fracture and was treated with 3 months of limited
weight bearing. Figure 2 is a repeat MRI scan in which the edema pattern changed minimally but
the pain worsened. Ibuprofen alleviates most of her pain. What is the best next step?
Figure 1 Figure 2
a. Hip arthroscopy with labrum repair
b. MRI arthrogram
c. Percutaneous screw fixation
d. CT scan with fine cuts
Preffered Answer: 4
An osteoid osteoma is a benign bone tumor. Osteoid osteomas tend to be small—typically <1.5
cm. Regardless of their size, they cause a large amount of reactive bone to form around them,
and they make a new type of abnormal bone material called osteoid bone. This osteoid bone,
along with the tumor cells, forms the nidus of the tumor, which is easily identified on CT scans.
6. When reconstructing the anterior cruciate ligament (ACL) with autograft, what is the most
common source of surgical failure?
a. Graft choice
b. Tunnel position
c. Tibial fixation
d. Femoral fixation
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
, Sports Medicine Scored and Recorded Self-Assessment Examination 2019
Preffered Answer: 3
Technical failure is the most common reason for ACL reconstruction failure. Tunnel position is
the most frequent cause for technical failure. Malpositioning of the tunnel affects the length of the
graft, causing either decreased range of motion or increased graft laxity. Although graft choice is
an important factor when planning an ACL reconstruction, overall outcomes with autograft
tissues are fairly similar. Fixation of the graft at the femoral or tibial end is not as important as
tunnel position.
7. An otherwise healthy 31-year-old man has had right knee pain for the past 9 months. His former
physician administered a cortisone injection and ordered 6 months of physical therapy. The
patient later had an arthroscopy with debridement of the right knee by another physician and
completed another course of physical therapy. The patient received minimal relief from these
treatments and still is not able to walk longer distances or go on hikes. On examination, he is a
healthy appearing male with a body mass index of 24 kg/m2. He has a small effusion, minimal
quadriceps atrophy, no tenderness about the knee, full range of motion, stable to varus and
valgus stress at 30° of flexion, a grade 1 Lachman test, and a normal posterior drawer. Figures 1
through 4 are his arthroscopic views, radiograph and MRI scan from his prior surgical procedure.
What is the next most appropriate step in treatment?
Figure 1 Figure 2
Figure 3 Figure 4
a. Bracing with physical therapy focusing on quadriceps/vastus medialis obliquus (VMO) and
hamstring strengthening
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
1. Based on the injury shown on the axial MRI scan of the shoulder in Figure 1, what other
pathology should be closely examined for during surgery?
a. Subscapularis tear
b. Supraspinatus tear
c. Superior labral anterior-posterior (SLAP) tear
d. Bankart tear
Preffered Answer : 1
The axial MRI scan reveals a subluxated biceps tendon. In the study by Koh and associates, 85%
of patients with a biceps subluxation on MRI were found to have a subscapularis tear at the time
of arthroscopy. These are not always obvious on the MRI, and close inspection of the leading
edge/upper border of the subscapularis tendon at the time of arthroscopy is necessary. Although
supraspinatus tears, SLAP tears, and Bankart tears can all occur in conjunction with a biceps
subluxation, none have been shown to be strongly correlated with this pathology, nor as specific
to this pathology.
2. Figure 1 is the radiograph of a 31-year-old man who had left shoulder pain after a fall during a
snowboarding jump. Residual displacement of 5 mm after closed reduction is most likely to result
in
Figure 1
a. nonunion.
b. osteonecrosis.
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
,Sports Medicine Scored and Recorded Self-Assessment Examination 2019
c. altered rotator cuff mechanics.
d. normal shoulder function.
Preffered Answer 3
Humerus fractures account for 11% of all fractures among snowboarders and are the second-
most-common upper-extremity fracture after radius fractures (48%). Surgical fixation is
recommended for fractures with residual displacement >5 mm, or >3 mm in active patients
involved in frequent overhead activity. Malunion can result in a mechanical block to shoulder
abduction or external rotation and altered rotator cuff mechanics, causing weakness. A rich
arterial network provides a favorable healing environment for greater tuberosity fractures.
Consequently, nonunion and osteonecrosis are uncommon.
3. A 23-year-old student complains of recurrent left shoulder instability. He first dislocated his
shoulder in high school while playing lacrosse and was managed with physical therapy. A second
dislocation occurred one year later while skiing. He has since sustained two more dislocations
and says that his shoulder feels ―loose.‖ Examination reveals grade II anterior load and shift,
positive apprehension and relocation tests, and normal rotator cuff strength. An MRI arthrogram
is ordered and surgical treatment is recommended. What factor would most strongly represent an
indication for a procedure including bone augmentation (e.g. Latarjet) rather than a soft-tissue-
only stabilization (isolated labral repair/capsulorrhaphy)?
a. Patient’s intention to resume lacrosse and other contact sports after surgery
b. Presence of a 270° labral tear
c. 2-cm ―on-track‖ Hill-Sachs lesion
d. Anterior bony loss measuring 30% of inferior glenoid width
Preffered Answer: 4
There is much debate in the literature regarding optimal techniques for treatment of shoulder
instability. Barring other factors or concomitant pathology, however, there is no persuasive
literature to suggest routine use of bone augmentation for contact athletes. Extensive labral
involvement (here specifically implying posterior labral involvement, as well) will require a more
extensive repair but does not, in and of itself, suggest the necessity for glenoid bone
augmentation. A large Hill-Sachs lesion may be an indication for glenoid augmentation, primarily
if it is in a location/orientation that engages the anterior glenoid rim. These are referred to as ―off-
track‖ lesions. Of these choices, the strongest indication for a Latarjet coracoid transfer or similar
bone augmentation (other options include iliac crest autograft or distal tibial allograft) is high-
grade glenoid bone loss. Classically, this is performed through an open approach, although
arthroscopic techniques are increasing in popularity. Although the critical amount of bone loss is
debated, most surgeons and studies suggest a cut-off of approximately 20% to 25%, above
which isolated soft-tissue stabilization alone is less likely to be successful in the long-term.
4. A 32-year-old volleyball player has dull posterior shoulder pain. An examination reveals
moderate external rotation weakness with his arm at his side but normal strength on
supraspinatus isolation. Deltoid and supraspinatus bulk appear normal, although there appears
to be mild infraspinatus atrophy. Sensation is normal throughout the shoulder and shoulder
girdle. What is the most likely diagnosis?
a. Calcified transverse scapular ligament
b. Parsonage-Turner syndrome
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
,Sports Medicine Scored and Recorded Self-Assessment Examination 2019
c. Spinoglenoid notch cyst
d. Quadrilateral space syndrome
Preffered Answer: 3
This clinical scenario describes a patient with an isolated injury affecting the infraspinatus muscle.
The anatomic location of such a lesion would be at the spinoglenoid notch, at which the
suprascapular nerve may be compressed distal to its innervation of the supraspinatus but
proximal to the infraspinatus innervation. A calcified transverse scapular ligament would also
affect the suprascapular nerve but is proximal to the innervation of both muscles. Quadrilateral
space syndrome would affect innervation of the deltoid (and teres minor). Parsonage-Turner
syndrome is a more diffuse, and often severely painful, brachial plexus neuropathy.
5. Figure 1 is an MRI scan of the right hip of a 19-year-old woman with a 6-month history of right
groin pain. She was diagnosed with a stress fracture and was treated with 3 months of limited
weight bearing. Figure 2 is a repeat MRI scan in which the edema pattern changed minimally but
the pain worsened. Ibuprofen alleviates most of her pain. What is the best next step?
Figure 1 Figure 2
a. Hip arthroscopy with labrum repair
b. MRI arthrogram
c. Percutaneous screw fixation
d. CT scan with fine cuts
Preffered Answer: 4
An osteoid osteoma is a benign bone tumor. Osteoid osteomas tend to be small—typically <1.5
cm. Regardless of their size, they cause a large amount of reactive bone to form around them,
and they make a new type of abnormal bone material called osteoid bone. This osteoid bone,
along with the tumor cells, forms the nidus of the tumor, which is easily identified on CT scans.
6. When reconstructing the anterior cruciate ligament (ACL) with autograft, what is the most
common source of surgical failure?
a. Graft choice
b. Tunnel position
c. Tibial fixation
d. Femoral fixation
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
, Sports Medicine Scored and Recorded Self-Assessment Examination 2019
Preffered Answer: 3
Technical failure is the most common reason for ACL reconstruction failure. Tunnel position is
the most frequent cause for technical failure. Malpositioning of the tunnel affects the length of the
graft, causing either decreased range of motion or increased graft laxity. Although graft choice is
an important factor when planning an ACL reconstruction, overall outcomes with autograft
tissues are fairly similar. Fixation of the graft at the femoral or tibial end is not as important as
tunnel position.
7. An otherwise healthy 31-year-old man has had right knee pain for the past 9 months. His former
physician administered a cortisone injection and ordered 6 months of physical therapy. The
patient later had an arthroscopy with debridement of the right knee by another physician and
completed another course of physical therapy. The patient received minimal relief from these
treatments and still is not able to walk longer distances or go on hikes. On examination, he is a
healthy appearing male with a body mass index of 24 kg/m2. He has a small effusion, minimal
quadriceps atrophy, no tenderness about the knee, full range of motion, stable to varus and
valgus stress at 30° of flexion, a grade 1 Lachman test, and a normal posterior drawer. Figures 1
through 4 are his arthroscopic views, radiograph and MRI scan from his prior surgical procedure.
What is the next most appropriate step in treatment?
Figure 1 Figure 2
Figure 3 Figure 4
a. Bracing with physical therapy focusing on quadriceps/vastus medialis obliquus (VMO) and
hamstring strengthening
UI // UNAIR // UNPAD // UNHAS // UNS // UGM // UB // UNUD // USU
