2025
Sports Medicine Scored and Recorded Self-Assessment Examination 2025
,Question 1 of 100
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?
Figure 1
A. Subscapularis tear
B. Supraspinatus tear
C. Superior labral anterior-posterior (SLAP) tear
D. Bankart tear
Correct answer: A
• Discussion
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.
• Recommended Readings
,Shi LL, Mullen MG, Freehill MT, Lin A, Warner JJ, Higgins LD. Accuracy of long head of the
biceps subluxation as a predictor for subscapularis tears. Arthroscopy. 2015 Apr;31(4):615-9.
doi: 10.1016/j.arthro.2014.11.034. Epub 2015 Jan 28. PubMed
Koh KH, Kim SC, Yoo JC. Arthroscopic Evaluation of Subluxation of the Long Head of the
Biceps Tendon and Its Relationship with Subscapularis Tears. Clin Orthop Surg. 2017
Sep;9(3):332-339. doi: 10.4055/cios.2017.9.3.332. Epub 2017 Aug 4. PubMed
Question 2 of 100
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.
C. altered rotator cuff mechanics.
D. normal shoulder function.
, Correct answer: C
• Discussion
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.
• Recommended Readings
Bissell BT, Johnson RJ, Shafritz AB, Chase DC, Ettlinger CF. Epidemiology and risk factors of
humerus fractures among skiers and snowboarders. Am J Sports Med. 2008 Oct;36(10):1880-8.
Epub 2008 Jul 1. PubMed
George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg. 2007
Oct;15(10):607-13. Full text
Question 3 of 100
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
Sports Medicine Scored and Recorded Self-Assessment Examination 2025
,Question 1 of 100
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?
Figure 1
A. Subscapularis tear
B. Supraspinatus tear
C. Superior labral anterior-posterior (SLAP) tear
D. Bankart tear
Correct answer: A
• Discussion
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.
• Recommended Readings
,Shi LL, Mullen MG, Freehill MT, Lin A, Warner JJ, Higgins LD. Accuracy of long head of the
biceps subluxation as a predictor for subscapularis tears. Arthroscopy. 2015 Apr;31(4):615-9.
doi: 10.1016/j.arthro.2014.11.034. Epub 2015 Jan 28. PubMed
Koh KH, Kim SC, Yoo JC. Arthroscopic Evaluation of Subluxation of the Long Head of the
Biceps Tendon and Its Relationship with Subscapularis Tears. Clin Orthop Surg. 2017
Sep;9(3):332-339. doi: 10.4055/cios.2017.9.3.332. Epub 2017 Aug 4. PubMed
Question 2 of 100
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.
C. altered rotator cuff mechanics.
D. normal shoulder function.
, Correct answer: C
• Discussion
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.
• Recommended Readings
Bissell BT, Johnson RJ, Shafritz AB, Chase DC, Ettlinger CF. Epidemiology and risk factors of
humerus fractures among skiers and snowboarders. Am J Sports Med. 2008 Oct;36(10):1880-8.
Epub 2008 Jul 1. PubMed
George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg. 2007
Oct;15(10):607-13. Full text
Question 3 of 100
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
