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 faccount ffor f11% fof fall ffractures famong fsnowboarders fand fare fthe fsecond-
most- fcommon fupper-extremity ffracture fafter fradius ffractures f(48%). fSurgical ffixation fis
frecommended ffor ffractures fwith fresidual fdisplacement f>5 fmm, for f>3 fmm fin factive fpatients
finvolved fin ffrequent foverhead factivity. fMalunion fcan fresult fin fa fmechanical fblock fto fshoulder
fabduction for fexternal frotation fand faltered frotator fcuff fmechanics, fcausing fweakness. fA frich
farterial fnetwork fprovides fa ffavorable fhealing fenvironment ffor fgreater ftuberosity ffractures.
fConsequently, fnonunion fand fosteonecrosis fare funcommon.
• Recommended fReadings
Bissell fBT, fJohnson fRJ, fShafritz fAB, fChase fDC, fEttlinger fCF. fEpidemiology fand frisk
ffactors fof fhumerus ffractures famong fskiers fand fsnowboarders. fAm fJ fSports fMed. f2008
fOct;36(10):1880-8. fEpub f2008 fJul f1. fPubMed
George fMS. fFractures fof fthe fgreater ftuberosity fof fthe fhumerus. fJ fAm fAcad fOrthop fSurg.
f2007 fOct;15(10):607-13. fFull ftext
Question f3 fof f100
A f23-year-old fstudent fcomplains fof frecurrent fleft fshoulder finstability. fHe ffirst fdislocated fhis
fshoulder fin fhigh fschool fwhile fplaying flacrosse fand fwas fmanaged fwith fphysical ftherapy. fA fsecond
fdislocation foccurred fone fyear flater fwhile fskiing. fHe fhas fsince fsustained ftwo fmore fdislocations
fand fsays fthat fhis fshoulder ffeels f“loose.” fExamination freveals fgrade fII fanterior fload fand fshift,
fpositive fapprehension fand frelocation ftests, fand fnormal frotator fcuff fstrength. fAn fMRI farthrogram
fis fordered fand fsurgical ftreatment fis frecommended. fWhat ffactor fwould fmost fstrongly frepresent fan
findication ffor fa fprocedure fincluding fbone faugmentation f(e.g. fLatarjet) frather fthan fa fsoft-tissue-
only fstabilization f(isolated flabral frepair/capsulorrhaphy)?
A. Patient’s fintention fto fresume flacrosse fand fother fcontact fsports fafter fsurgery
B. Presence fof fa f270° flabral ftear
C. 2-cm f“on-track” fHill-Sachs flesion
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 faccount ffor f11% fof fall ffractures famong fsnowboarders fand fare fthe fsecond-
most- fcommon fupper-extremity ffracture fafter fradius ffractures f(48%). fSurgical ffixation fis
frecommended ffor ffractures fwith fresidual fdisplacement f>5 fmm, for f>3 fmm fin factive fpatients
finvolved fin ffrequent foverhead factivity. fMalunion fcan fresult fin fa fmechanical fblock fto fshoulder
fabduction for fexternal frotation fand faltered frotator fcuff fmechanics, fcausing fweakness. fA frich
farterial fnetwork fprovides fa ffavorable fhealing fenvironment ffor fgreater ftuberosity ffractures.
fConsequently, fnonunion fand fosteonecrosis fare funcommon.
• Recommended fReadings
Bissell fBT, fJohnson fRJ, fShafritz fAB, fChase fDC, fEttlinger fCF. fEpidemiology fand frisk
ffactors fof fhumerus ffractures famong fskiers fand fsnowboarders. fAm fJ fSports fMed. f2008
fOct;36(10):1880-8. fEpub f2008 fJul f1. fPubMed
George fMS. fFractures fof fthe fgreater ftuberosity fof fthe fhumerus. fJ fAm fAcad fOrthop fSurg.
f2007 fOct;15(10):607-13. fFull ftext
Question f3 fof f100
A f23-year-old fstudent fcomplains fof frecurrent fleft fshoulder finstability. fHe ffirst fdislocated fhis
fshoulder fin fhigh fschool fwhile fplaying flacrosse fand fwas fmanaged fwith fphysical ftherapy. fA fsecond
fdislocation foccurred fone fyear flater fwhile fskiing. fHe fhas fsince fsustained ftwo fmore fdislocations
fand fsays fthat fhis fshoulder ffeels f“loose.” fExamination freveals fgrade fII fanterior fload fand fshift,
fpositive fapprehension fand frelocation ftests, fand fnormal frotator fcuff fstrength. fAn fMRI farthrogram
fis fordered fand fsurgical ftreatment fis frecommended. fWhat ffactor fwould fmost fstrongly frepresent fan
findication ffor fa fprocedure fincluding fbone faugmentation f(e.g. fLatarjet) frather fthan fa fsoft-tissue-
only fstabilization f(isolated flabral frepair/capsulorrhaphy)?
A. Patient’s fintention fto fresume flacrosse fand fother fcontact fsports fafter fsurgery
B. Presence fof fa f270° flabral ftear
C. 2-cm f“on-track” fHill-Sachs flesion
