Sports Medicine

Question 1

Older golfer falls onto butt walking on the green and has lower back pain. Common type of injury?

What to do if this was a young patient?

Answer 1

Lower thoracic spine compression fracture

If this is a young patient, do metabolic bone workup as this should only happen in older patients

Question 2

Most common cause?

Answer 2

Anterior-inferior glenohumeral ligament tear

(Shoulder dislocation = 80-90% anterior due to AIGHL tear)

Question 3

Presentation in adult?

Kid?

Answer 3

Adult = lower back pain + neuro sx (pain down leg)

Kids = pain in thigh/hamstring area OR back pain

(This is a ruptured lumbar disc)

Question 4

This test is positive in a patient who would experience worsening pain when?

Answer 4

At night

(Drop arm test = supraspinatus tear)

Question 5

What would you expect to see on imaging of young male weight lifter complaining of lower back pain without neuro sx?

Answer 5

Stres fracture or pars in lumbar spine

Question 6

This Xray of 60 yo male. What additional PE should you do?

Answer 6

Rotator cuff tests

(Elderly pt with shoulder dislocation is at risk for rotator cuff tear)

Question 7

This type of injury most commonly occurs at what level?

Answer 7

C5

(Stinger’s syndrome = traction injury = brachial plexus stretched away from side of tingling/warmth)

Question 8

How would you fix this?

Answer 8

Extend to get it back in place

(PIP joint dislocation)

Question 9

This pt who underwent this surgery is most likely what kind of athlete?

Answer 9

Overhead athlete (baseball player, tennis, track/field)

(This is repair of the biceps tendon ripped from the glenoid labrum = SLAP tear)

Question 10

Such a fracture would be expected in a young patient if:

Answer 10

Caused by strong sartorius contraction during sports

(Pelvic avulsion fracture of ASIS)

Question 11

This lesion predisposes to:

Answer 11

Arthritis of the hip because it wears on cartilage with hip flexion

(Pincer lesion - note bony mass on os coxae adjacent to acetabulum)

Question 12

What PE finding?

Answer 12

Limited elbow flexion and forearm supination

(Distal biceps tendon rupture)

Question 13

How did this pt jack himself up?

Answer 13

Fell on tip of shoulder

(AC joint separation)

Question 14

How would this present?

Answer 14

Pain at base of 4th metatarsal

(Pseudo-Jones fracture = base of 5th metatarsal)

Question 15

If this test is positive, what would you expect to see on CT?

Answer 15

Bone bruises (LFC, LTP)

(This is a positive pivot test = ACL tear)

Question 16

Sx?

Answer 16

Popping/locking of knee + edema

(OCD of knee)

Question 17

Demographic?

Answer 17

10-15 yo boy gymnast or weight lifter

(OCD capitellum)

Question 18

Demographic?

Answer 18

20-30 yo

(Achilles tendon rupture)

Question 19

Young drunk pt punches wall and complains of pain in his hand. What do you expect to see on Xray?

Answer 19

Boxer’s fracture (4th/5th digit)

Question 20

This type of injury commonly occurs at what level?

Answer 20

C5-6

(C spine subluxation)

Question 21

A young soccer player presents with this finding. Cause?

Answer 21

Strong rectus femoris contraction causing fracture of AIIS

(Pelvic avulsion fracture)

Question 22

Typical patient who will present with this finding?

Answer 22

Football player who uses head for tackling

(This is spear tackler’s spine - note loss of cervical lordosis compared to this normal cervical spine)

Question 23

Most likely cause?

Answer 23

Jam finger (like on basketball)

(Mallet finger; unable to extend)

Question 24

What precipitated this lesion?

Answer 24

Change in activity ~3 weeks prior

(Dreaded black line = tibial stress fracture)

Question 25

Tx?

Answer 25

Immobilize and Xray in 3 weeks due to risk of secondary arthritis (Scaphoid fracture)

Question 26

Dx?

Answer 26

PIP joint dislocation

Question 27

Dx?

Answer 27

Stress fracture of pars | (Lumbar spine)

Question 28

5 yo falls from a tree with outstretched arm and has this finding. What would you counsel the parents about?

Answer 28

Pt needs immediate PT to avoid stiffening of elbow (Elbow dislocation)

Question 29

5 yo falls from a tree with outstretched arm and has this finding on Xray. You should counsel the parents about what?

Answer 29

Pt is at increased risk of recurrence (Shoulder dislocation in young pt = increased risk of recurrence)

Question 30

Complication?

Answer 30

Popliteal artery and/or peroneal nerve injury = must treat immediately (Knee dislocation = 3+ ligaments torn)

Question 31

This lesion results in what PE findings?

Answer 31

Inability to flex the DIP joint, pain in flexor tendon (Jersey finger)

Question 32

Cause?

Answer 32

Fall on flexed knee or direct tibial blow (dashboard injury)

Question 33

This patient presents with pain in the indicated area. Xray is normal. First step in management?

Answer 33

Immobilize (Snuff box pain + normal Xray = scaphoid fracture; you will Xray in 3 weeks to make sure it's healed; risk of secondary arthritis)

Question 34

Dx?

Answer 34

Lisfranc injury (Injury at tarsal-metatarsal junction)

Question 35

Dx?

Answer 35

IT fracture in kid from strong hamstrings contraction (Pelvic avulsion fracture)

Question 36

Tx?

Answer 36

None if older pt - mostly cosmetic (Proximal biceps tendon rupture)

Question 37

This type of movement might cause what injury?

Answer 37

Low ankle sprain = lateral ligament injury

Question 38

Commonly seen in what kind of athletes?

Answer 38

Runners and baseball players (Tibial stress fracture)

Question 39

This movement could cause what type of injury?

Answer 39

Turf toe (Extreme dorsiflexion of big toe)

Question 40

Dx?

Answer 40

Psuedoparalysis of rotator cuff

Question 41

Dx?

Answer 41

Posterior shoulder dislocation (Light bulb sign)

Question 42

Most sensitive test for ACL tear?

Answer 42

Lachman test

Question 43

What type of athletes commonly present with this upon physical exam?

Answer 43

Swimmers, javelin throwers, pitchers (Positive empty can test = supraspinatus tear)

Question 44

Tx?

Answer 44

Figure 8 harness (Clavicular harness)

Question 45

Dx?

Answer 45

Type III AC joint separation (Full AC ligament and coracoclavicular ligament tears = complete separation of acromion and clavicle)

Question 46

Dx?

Answer 46

Common sports metacarpal fracture (3rd digit)

Question 47

Inability to extend DIP joint

Answer 47

Mallet finger

Question 48

Inability to flex DIP joint

Answer 48

Jersey finger

Question 49

Dx?

Answer 49

Cam lesion (Bony mass on femoral neck; type of femoroacetabulur impingement)

Question 50

Management?

Answer 50

Fix immediately because it won't fix by itself (Patellar tendon rupture = notice displaced patella)

Question 51

Dx?

Answer 51

ACL tear

Question 52

Dx?

Answer 52

Jones fracture (Metaphyseal of 5th metatarsal)

Question 53

Dx?

Answer 53

Lisfranc injury (Injury at tarsal-metatarsal junction)