OCS Sports Medicine & Athletic Injuries 2 — Questions and Answers
Question 1: A distance runner presents with lateral knee pain that worsens progressively with prolonged running, especially on downhill terrain. The most likely diagnosis is:
- Lateral meniscus tear
- Iliotibial band (ITB) syndrome (Correct answer)
- Lateral collateral ligament sprain
- Biceps femoris tendinopathy
Correct answer: Iliotibial band (ITB) syndrome
ITB syndrome is an overuse injury common in runners characterized by lateral knee pain caused by repetitive friction of the iliotibial band over the lateral femoral epicondyle, worsened by downhill running.
Question 2: A Grade II muscle strain is characterized by which of the following?
- Microscopic tearing with minimal strength loss and no palpable defect
- Partial tearing with moderate strength loss, pain, and possible palpable defect (Correct answer)
- Complete muscle rupture with total loss of function and a visible deformity
- Inflammation without structural damage to muscle fibers
Correct answer: Partial tearing with moderate strength loss, pain, and possible palpable defect
A Grade II strain involves partial tearing of muscle fibers resulting in moderate pain, swelling, strength loss, and often a palpable defect, distinguishing it from the microscopic damage of Grade I and complete rupture of Grade III.
Question 3: A gymnast falls on an outstretched hand and presents with anatomical snuffbox tenderness. Which fracture must be ruled out due to risk of avascular necrosis?
- Colles fracture
- Scaphoid fracture (Correct answer)
- Lunate fracture
- Hook of hamate fracture
Correct answer: Scaphoid fracture
Scaphoid fractures are located in the anatomical snuffbox and have a high risk of avascular necrosis due to the proximal pole's retrograde blood supply; initial X-rays may be negative, requiring MRI or CT confirmation.
Question 4: The 'terrible triad' of the knee classically refers to injury of which three structures?
- ACL, PCL, and medial meniscus
- ACL, MCL, and medial meniscus (Correct answer)
- PCL, LCL, and lateral meniscus
- ACL, LCL, and lateral meniscus
Correct answer: ACL, MCL, and medial meniscus
The terrible triad (O'Donoghue's triad) refers to combined injuries of the ACL, MCL, and medial meniscus, typically caused by a valgus and rotational force to the knee.
Question 5: During the overhead throwing motion, which phase generates the greatest valgus stress on the medial elbow, predisposing the UCL to injury?
- Wind-up phase
- Late cocking and early acceleration phase (Correct answer)
- Follow-through phase
- Deceleration phase
Correct answer: Late cocking and early acceleration phase
The transition from late cocking to early acceleration produces maximum valgus torque at the elbow, stressing the ulnar collateral ligament (UCL) and medial structures.
Question 6: A soccer player reports anterior knee pain that worsens with stair climbing, prolonged sitting, and squatting. Clarke's sign is positive. The most likely diagnosis is:
- Patellar tendinopathy
- Patellofemoral pain syndrome (PFPS) (Correct answer)
- Hoffa's fat pad impingement
- Prepatellar bursitis
Correct answer: Patellofemoral pain syndrome (PFPS)
PFPS presents with peripatellar or retropatellar pain aggravated by activities that increase patellofemoral joint reaction force; Clarke's sign (patellar grind test) is a classic clinical indicator.
Question 7: A football lineman hyperextends his great toe while pushing off on artificial turf. The injury most commonly involves which structure in 'turf toe'?
- Plantar fascia at its calcaneal origin
- First metatarsophalangeal joint plantar plate and capsule (Correct answer)
- Sesamoid bones of the flexor hallucis brevis
- Flexor hallucis longus tendon sheath
Correct answer: First metatarsophalangeal joint plantar plate and capsule
Turf toe is a sprain of the plantar plate and capsuloligamentous complex of the first MTP joint caused by forced hyperextension, most common on hard artificial surfaces.
OCS Sports Medicine & Athletic Injuries 2
A distance runner presents with lateral knee pain that worsens progressively with prolonged running, especially on downhill terrain.
The most likely diagnosis is: