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 daccount dfor d11% dof dall dfractures damong dsnowboarders dand dare dthe dsecond-
most- dcommon dupper-extremity dfracture dafter dradius dfractures d(48%). dSurgical dfixation dis
drecommended dfor dfractures dwith dresidual ddisplacement d>5 dmm, dor d>3 dmm din dactive dpatients
dinvolved din dfrequent doverhead dactivity. dMalunion dcan dresult din da dmechanical dblock dto
dshoulder dabduction dor dexternal drotation dand daltered drotator dcuff dmechanics, dcausing
dweakness. dA drich darterial dnetwork dprovides da dfavorable dhealing denvironment dfor dgreater
dtuberosity dfractures. dConsequently, dnonunion dand dosteonecrosis dare duncommon.
• Recommended dReadings
Bissell dBT, dJohnson dRJ, dShafritz dAB, dChase dDC, dEttlinger dCF. dEpidemiology dand drisk
dfactors dof dhumerus dfractures damong dskiers dand dsnowboarders. dAm dJ dSports dMed. d2008
dOct;36(10):1880-8. dEpub d2008 dJul d1. dPubMed
George dMS. dFractures dof dthe dgreater dtuberosity dof dthe dhumerus. dJ dAm dAcad dOrthop
dSurg. d2007 dOct;15(10):607-13. dFull dtext
Question d3 dof d100
A d23-year-old dstudent dcomplains dof drecurrent dleft dshoulder dinstability. dHe dfirst ddislocated dhis
dshoulder din dhigh dschool dwhile dplaying dlacrosse dand dwas dmanaged dwith dphysical dtherapy. dA
dsecond ddislocation doccurred done dyear dlater dwhile dskiing. dHe dhas dsince dsustained dtwo dmore
ddislocations dand dsays dthat dhis dshoulder dfeels d“loose.” dExamination dreveals dgrade dII danterior
dload dand dshift, dpositive dapprehension dand drelocation dtests, dand dnormal drotator dcuff dstrength.
dAn dMRI darthrogram dis dordered dand dsurgical dtreatment dis drecommended. dWhat dfactor dwould
dmost dstrongly drepresent dan dindication dfor da dprocedure dincluding dbone daugmentation d(e.g.
dLatarjet) drather dthan da dsoft-tissue-only dstabilization d(isolated dlabral drepair/capsulorrhaphy)?
A. Patient’s dintention dto dresume dlacrosse dand dother dcontact dsports dafter dsurgery
B. Presence dof da d270° dlabral dtear
C. 2-cm d“on-track” dHill-Sachs dlesion
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 daccount dfor d11% dof dall dfractures damong dsnowboarders dand dare dthe dsecond-
most- dcommon dupper-extremity dfracture dafter dradius dfractures d(48%). dSurgical dfixation dis
drecommended dfor dfractures dwith dresidual ddisplacement d>5 dmm, dor d>3 dmm din dactive dpatients
dinvolved din dfrequent doverhead dactivity. dMalunion dcan dresult din da dmechanical dblock dto
dshoulder dabduction dor dexternal drotation dand daltered drotator dcuff dmechanics, dcausing
dweakness. dA drich darterial dnetwork dprovides da dfavorable dhealing denvironment dfor dgreater
dtuberosity dfractures. dConsequently, dnonunion dand dosteonecrosis dare duncommon.
• Recommended dReadings
Bissell dBT, dJohnson dRJ, dShafritz dAB, dChase dDC, dEttlinger dCF. dEpidemiology dand drisk
dfactors dof dhumerus dfractures damong dskiers dand dsnowboarders. dAm dJ dSports dMed. d2008
dOct;36(10):1880-8. dEpub d2008 dJul d1. dPubMed
George dMS. dFractures dof dthe dgreater dtuberosity dof dthe dhumerus. dJ dAm dAcad dOrthop
dSurg. d2007 dOct;15(10):607-13. dFull dtext
Question d3 dof d100
A d23-year-old dstudent dcomplains dof drecurrent dleft dshoulder dinstability. dHe dfirst ddislocated dhis
dshoulder din dhigh dschool dwhile dplaying dlacrosse dand dwas dmanaged dwith dphysical dtherapy. dA
dsecond ddislocation doccurred done dyear dlater dwhile dskiing. dHe dhas dsince dsustained dtwo dmore
ddislocations dand dsays dthat dhis dshoulder dfeels d“loose.” dExamination dreveals dgrade dII danterior
dload dand dshift, dpositive dapprehension dand drelocation dtests, dand dnormal drotator dcuff dstrength.
dAn dMRI darthrogram dis dordered dand dsurgical dtreatment dis drecommended. dWhat dfactor dwould
dmost dstrongly drepresent dan dindication dfor da dprocedure dincluding dbone daugmentation d(e.g.
dLatarjet) drather dthan da dsoft-tissue-only dstabilization d(isolated dlabral drepair/capsulorrhaphy)?
A. Patient’s dintention dto dresume dlacrosse dand dother dcontact dsports dafter dsurgery
B. Presence dof da d270° dlabral dtear
C. 2-cm d“on-track” dHill-Sachs dlesion
