CCSP Sports Injury Diagnosis 5 — Questions and Answers
Question 1: A gymnast reports chronic low back pain with pain that worsens with lumbar extension and is relieved by flexion. Single-leg hyperextension reproduces pain on the ipsilateral side. The most likely diagnosis is:
- Lumbar disc herniation
- Spondylolysis (Correct answer)
- Sacroiliac joint dysfunction
- Piriformis syndrome
Correct answer: Spondylolysis
Spondylolysis (pars interarticularis stress fracture) classically presents in young athletes with extension-based sports and is reproduced by the single-leg hyperextension (stork) test.
Question 2: A tennis player presents with lateral elbow pain reproducible with resisted wrist extension and gripping. The extensor carpi radialis brevis is implicated. This is best described as:
- Medial epicondylitis
- Radial tunnel syndrome
- Lateral epicondylitis (Correct answer)
- Posterior interosseous nerve entrapment
Correct answer: Lateral epicondylitis
Lateral epicondylitis (tennis elbow) is a tendinopathy of the extensor carpi radialis brevis origin, reproduced by resisted wrist extension.
Question 3: A hockey player develops acute groin pain during a rapid change of direction. Resisted hip adduction against gravity reproduces the pain. The most likely structure injured is:
- Iliopsoas muscle
- Rectus femoris
- Adductor longus (Correct answer)
- Sartorius
Correct answer: Adductor longus
Adductor longus strain is the most common groin injury in hockey players and is reproduced by resisted hip adduction.
Question 4: A college basketball player sustains a hyperextension mechanism of the knee without contact and immediately cannot bear weight. MRI confirms a posterior cruciate ligament tear. Which physical finding confirms the diagnosis?
- Positive Lachman test
- Positive posterior drawer sign (Correct answer)
- Positive valgus stress test at 30°
- Positive McMurray test
Correct answer: Positive posterior drawer sign
The posterior drawer test, where the tibia sags or can be pushed posteriorly relative to the femur at 90° knee flexion, is the hallmark sign of PCL rupture.
Question 5: A sprinter presents with acute posterior thigh pain during acceleration. Ecchymosis appears distally 24-48 hours later. The most commonly strained hamstring muscle is:
- Biceps femoris long head (Correct answer)
- Semimembranosus
- Biceps femoris short head
- Semitendinosus
Correct answer: Biceps femoris long head
The biceps femoris long head is the most commonly injured hamstring muscle in sprinters due to its biarticular nature and high eccentric load at terminal swing phase.
Question 6: A wrestler has a subacute shoulder injury with weakness in external rotation and a positive drop arm test. Which rotator cuff muscle is most likely torn?
- Subscapularis
- Infraspinatus
- Supraspinatus (Correct answer)
- Teres minor
Correct answer: Supraspinatus
Supraspinatus tears are the most common rotator cuff injuries and produce a positive drop arm test due to loss of abduction strength in the mid-range.
Question 7: A distance runner with a recent training mileage increase presents with localized tenderness over the femoral neck on the compression side. FABER test is negative but hip internal rotation is painful. The priority concern is:
- Iliopsoas bursitis
- Femoral neck stress fracture on the tension side (Correct answer)
- Femoral neck stress fracture on the compression side
- Avascular necrosis of the femoral head
Correct answer: Femoral neck stress fracture on the tension side
Tension-side (superior) femoral neck stress fractures carry the highest risk of displacement and require urgent non-weight-bearing and possible surgical fixation, making them the priority concern regardless of which side is tender.
CCSP Sports Injury Diagnosis 5
A gymnast reports chronic low back pain with pain that worsens with lumbar extension and is relieved by flexion.
Single-leg hyperextension reproduces pain on the ipsilateral side.
The most likely diagnosis is: