Sports injuries, ligament and spine disorders

43 NEET-PG practice questions on Sports injuries, ligament and spine disorders, part of Orthopaedics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   A posterolateral prolapse of the L4-L5 intervertebral disc most often compresses which nerve root?

   1. AL5
   2. BL4
   3. CS1
   4. DL3

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   Answer: A · L5

   A posterolateral disc prolapse, the commonest type, misses the root exiting above at that level and presses on the root traversing down to the next foramen. At L4-L5 the traversing root is L5, which gives pain down the lateral leg to the dorsum of the foot, weak extensor hallucis longus and numbness of the first web space. L4-L5 and L5-S1 together account for most lumbar disc prolapses. Key point: Posterolateral lumbar disc compresses the traversing (lower) root: L4-L5 disc hits L5, L5-S1 disc hits S1.

   • B: L4 is the exiting root at L4-L5 and is hit only by a far lateral (foraminal) prolapse.
   • C: S1 is compressed by a posterolateral L5-S1 disc.
   • D: L3 is the root affected by a far lateral L3-L4 or a posterolateral L2-L3 disc.

2. Question 2 · Medium

   MRI tonight shows a massive central L4-L5 disc extrusion filling the canal in a bank clerk who has had 18 hours of bilateral sciatica and perineal numbness. Before taking consent for emergency decompression, the spine surgeon classifies the syndrome so that he can counsel the family about the likely bladder outcome. Which finding would mark it as cauda equina syndrome with retention (CES-R), the stage with the poorest outlook?

   1. APainless urinary retention with overflow
   2. BReduced bladder sensation, voiding kept
   3. CUnilateral saddle numbness
   4. DBilateral loss of the ankle jerks

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   Answer: A · Painless urinary retention with overflow

   Cauda equina syndrome is staged as incomplete (CES-I), with altered urinary sensation, loss of the desire to void or a poor stream but preserved voluntary control, and with retention (CES-R), in which the bladder becomes painless and retains urine with overflow incontinence. CES-R means the sacral roots are already severely damaged, and bladder recovery is much less likely even after decompression. Both stages need emergency surgery; operating at the CES-I stage gives the best results. Key point: Painless retention with overflow defines CES-R, which carries the worst sphincter outcome; operate before CES-I progresses.

   • B: Reduced sensation with preserved voiding is CES-I, which has a better prognosis.
   • C: Unilateral saddle numbness is an early or incomplete sign.
   • D: Lost ankle jerks show S1 root involvement but do not define the bladder stage.

3. Question 3 · Medium

   Deep pain and clicking in the right shoulder during the cocking phase of bowling trouble a fast bowler. With the arm flexed forward to 90 degrees, adducted 10 degrees and internally rotated (thumb down), resisted downward pressure causes deep pain, which is relieved when the test is repeated with the palm up. Which lesion is suspected?

   1. AAcromioclavicular joint arthritis
   2. BBankart lesion of the anteroinferior labrum
   3. CSLAP tear of the superior labrum
   4. DFull-thickness supraspinatus tear

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   Answer: C · SLAP tear of the superior labrum

   This is a positive O'Brien (active compression) test with deep pain, suggesting a superior labrum anterior-to-posterior (SLAP) tear at the biceps anchor, common in overhead throwers from repeated peel-back forces. Pain felt on top of the shoulder in the same test points instead to the acromioclavicular joint. MR arthrography confirms it. Key point: Deep shoulder pain in throwers on the O'Brien test, relieved with palm up: SLAP lesion of the superior labrum.

   • A: AC arthritis gives pain on top of the shoulder, not deep pain.
   • B: A Bankart lesion follows anterior dislocation and causes anterior instability with apprehension.
   • D: A supraspinatus tear gives weak abduction and a positive empty-can test.

4. Question 4 · Medium

   As the orthopaedic surgeon, you review a bank manager in his fifties whose MRI 3 months ago showed a complete ACL tear. He walks and climbs stairs without giving way and plays no sport. The Lachman test is positive, the menisci are intact, and quadriceps strength has recovered with exercises. He asks whether he needs an operation. Which advice is most appropriate?

   1. ALifelong hinged brace for all activities
   2. BTotal knee replacement
   3. CUrgent ACL reconstruction to prevent arthritis
   4. DRehabilitation; reconstruct if unstable

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   Answer: D · Rehabilitation; reconstruct if unstable

   Treatment of ACL tears depends on symptoms and demands, not on the MRI alone. A low-demand patient without giving way can do well with structured rehabilitation focused on quadriceps and hamstring strength and proprioception; reconstruction is offered if functional instability appears or he wishes to return to pivoting activity. Reconstruction has not been shown to prevent osteoarthritis. Key point: Low-demand patients without instability after an ACL tear are treated with rehabilitation; reconstruct for instability or pivoting sport.

   • A: A brace for all activities is unnecessary in a stable, low-demand knee.
   • B: Knee replacement is for end-stage arthritis, not a ligament tear.
   • C: Reconstruction does not reliably prevent osteoarthritis and is not urgent here.

5. Question 5 · Medium

   Snapping and clunking of the left knee on bending, painless, has been noticed by the parents of a schoolgirl of 8 for a year. There was no injury. MRI shows a lateral meniscus that covers the whole lateral tibial plateau, seen as a continuous band on three consecutive sagittal slices. What is the diagnosis?

   1. ABucket-handle tear of the lateral meniscus
   2. BOsgood-Schlatter disease
   3. CDiscoid lateral meniscus
   4. DOsteochondritis dissecans

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   Answer: C · Discoid lateral meniscus

   A discoid meniscus is a congenital, thickened, disc-shaped meniscus, almost always the lateral one, that covers more of the tibial plateau than normal. It typically presents in childhood as a 'snapping knee', with a clunk on flexion and extension, and on MRI the meniscus appears continuous across three or more 5-mm sagittal slices. Asymptomatic ones are observed; symptomatic or torn ones are saucerised arthroscopically. Key point: Snapping knee in a child with a lateral meniscus seen on three or more sagittal slices: discoid lateral meniscus.

   • A: A bucket-handle tear follows injury and causes locking, not painless snapping since childhood.
   • B: Osgood-Schlatter causes pain and swelling over the tibial tuberosity.
   • D: Osteochondritis dissecans affects the femoral condyle, usually in adolescents, with pain and effusion.

6. Question 6 · Medium

   Neurogenic claudication has troubled a retired schoolteacher from Kottayam for a year: after about 200 m both thighs and legs ache and feel heavy, and she must sit or bend forward for relief; she walks further leaning on a supermarket trolley. Pedal pulses are normal. A standing lateral X-ray shows a forward slip of L4 on L5 of about 20%, with intact pars interarticularis and marked facet joint arthritis. Which type of spondylolisthesis is this?

   1. ADysplastic
   2. BDegenerative
   3. CIsthmic
   4. DTraumatic

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7. Question 7 · Hard

   Thrown from his bicycle, a schoolboy of 11 has a tense haemarthrosis of the left knee and cannot straighten it fully. X-rays show a fragment of the tibial intercondylar eminence completely lifted off its bed and rotated, with no bony contact (Meyers-McKeever type III). The growth plates are wide open. MRI shows the ACL intact and attached to the fragment, with the anterior horn of the medial meniscus trapped under it. Which is the best treatment?

   1. AAspiration and early mobilisation
   2. BACL reconstruction with a hamstring graft
   3. CCylinder cast in full extension for 6 weeks
   4. DArthroscopic reduction and fixation

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8. Question 8 · Medium

   Examination of a footballer tackled from the outer side of his left knee: valgus stress at 30 degrees of flexion opens the medial joint by about 7 mm more than the other knee, with a firm end point; in full extension the knee is stable. The Lachman test is negative and there is tenderness over the medial femoral epicondyle. Which management is most appropriate?

   1. AHinged brace, early rehabilitation
   2. BCylinder cast for 8 weeks
   3. CArthroscopic ACL reconstruction
   4. DPrimary surgical repair of the ligament

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9. Question 9 · Medium

   On the menisci of the knee: 1. The medial meniscus is injured more often, partly because it is fixed to the deep medial collateral ligament. 2. The lateral meniscus is the more C-shaped of the two. 3. Only the peripheral part of each meniscus has a good blood supply. 4. Total meniscectomy has no long-term effect on the joint. Which statements are correct?

   1. A1 and 3 only
   2. B2 and 4 only
   3. C1, 3 and 4 only
   4. D1, 2 and 3 only

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10. Question 10 · Hard

    At a cricket academy in Pune, a 16-year-old fast bowler has had six weeks of left-sided low back pain that is worst as he arches backwards at the moment of delivery. Standing on the left leg and extending the spine reproduces it; forward bending is free and the neurological examination is normal. Plain X-rays, including oblique views, are normal. MRI shows bone-marrow oedema in the left L5 pars interarticularis without a fracture line or any slip. His coach wants him fit for a tournament in a month. What is the best management?

    1. AKeep bowling with a lumbar belt
    2. BStop bowling; rest and graded physiotherapy
    3. CL5-S1 posterolateral fusion
    4. DDirect surgical repair of the pars

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11. Question 11 · Medium

    A powerlifter has pain at the back of the left shoulder during bench pressing. In the jerk test, an axial load applied to the adducted, flexed and internally rotated arm causes a painful clunk as the arm is moved across the body. MRI shows a tear of the posteroinferior labrum. What is this lesion called?

    1. ASLAP lesion
    2. BHill-Sachs lesion
    3. CReverse Bankart lesion
    4. DBankart lesion

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12. Question 12 · Hard

    Leg pain in both calves after walking about 300 m troubles a retired railway guard who smokes and has diabetes. MRI shows L4-L5 canal stenosis with a degenerative slip, and his dorsalis pedis pulses are faint. Before spinal surgery is planned, the team must decide whether his claudication is neurogenic or vascular. Which finding most strongly favours a neurogenic cause?

    1. AAnkle-brachial pressure index of 0.6
    2. BPain settles within minutes of standing still
    3. CThe claudication distance is the same daily
    4. DHe can cycle for 30 minutes without pain

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13. Question 13 · Medium

    Arthroscopy report from a 42-year-old clerk with mechanical medial knee pain: 'Ligaments intact. Small radial flap tear of the inner third (white-white zone) of the posterior horn of the medial meniscus; the flap is unstable and catches between the condyles. Articular cartilage normal.' What is the appropriate procedure?

    1. APartial meniscectomy of the unstable flap
    2. BTotal medial meniscectomy
    3. CSuture repair of the flap
    4. DLeave it and immobilise for 6 weeks

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14. Question 14 · Easy

    The flexed knee of a scooter rider hit the road on its front, pushing the tibia backward. With both hips and knees flexed to 90 degrees, the injured tibia sags backward compared with the other side. Which ligament is torn?

    1. APatellar tendon
    2. BPosterior cruciate ligament
    3. CMedial collateral ligament
    4. DAnterior cruciate ligament

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15. Question 15 · Easy

    Which clinical test is the most sensitive for an acute tear of the anterior cruciate ligament?

    1. APosterior sag test
    2. BMcMurray test
    3. CAnterior drawer test at 90 degrees
    4. DLachman test

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16. Question 16 · Medium

    On a neurosurgery ward round, the resident is asked to localise the lesion in a man with leg weakness, saddle sensory loss and urinary symptoms whose MRI has not yet been done. The registrar says the pattern points to the cauda equina rather than the conus medullaris. Which finding best supports her view?

    1. ASudden onset with little pain
    2. BSymmetric saddle anaesthesia
    3. CSevere, asymmetric radicular leg pain
    4. DEarly and prominent bladder and bowel loss

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17. Question 17 · Medium

    At 11 p.m. in the emergency department, a construction worker with two years of on-and-off sciatica says that since morning both legs ache, his bottom 'feels numb on the toilet seat' and he has not passed urine for ten hours, with only mild fullness. Perianal pinprick sensation is reduced and anal tone is lax. A bladder scan shows 800 mL. After a catheter is passed, what should be done next?

    1. AAdmit for bed rest, MRI on the routine list
    2. BEmergency MRI of the lumbosacral spine tonight
    3. CUrodynamic study before any imaging
    4. DEpidural steroid injection with analgesia

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18. Question 18 · Easy

    While squatting to lift a sack, a porter felt a twist and sharp pain on the inner side of his right knee; the knee swelled slowly over the next day. Now there is medial joint-line tenderness, and flexing the knee fully, then extending it with the leg externally rotated, gives a painful click on the medial side. Which structure is most likely torn?

    1. AAnterior cruciate ligament
    2. BLateral meniscus
    3. CMedial collateral ligament
    4. DMedial meniscus

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19. Question 19 · Hard

    MRI of the right knee 2 days after a non-contact injury in a footballer who landed and turned sharply: bone marrow oedema in the middle of the lateral femoral condyle near the terminal sulcus and in the posterior part of the lateral tibial plateau. The medial patellar facet and the front of the lateral condyle are normal, and there is no fracture on the plain films. He felt a pop and could not continue playing. A large effusion is present; the radiologist has not yet commented on the ligaments. Which injury does this bone bruise pattern most strongly imply?

    1. AACL tear from a pivot-shift mechanism
    2. BLateral dislocation of the patella
    3. CMCL tear from a direct valgus blow
    4. DPCL tear from a dashboard blow

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20. Question 20 · Easy

    In suspected cauda equina syndrome, which investigation should be done as an emergency?

    1. AMRI of the lumbosacral spine
    2. BX-ray of the lumbosacral spine
    3. CNerve conduction studies
    4. DUrodynamic study

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21. Question 21 · Medium

    Aspiration of the knee of a kabaddi player, done 3 hours after he planted his foot, twisted, felt a pop and could not continue: 60 mL of uniformly blood-stained fluid without fat droplets. X-rays show no fracture. He had a full range of movement before the injury. Which structure is most likely injured?

    1. AMedial collateral ligament
    2. BAnterior cruciate ligament
    3. CMedial meniscus
    4. DPatellar tendon

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22. Question 22 · Medium

    Sciatica for ten days troubles a schoolteacher in Kollam: she bent to lift a bucket, felt sudden low back pain, and the next day pain spread down the right leg to the dorsum of the foot. She has numbness of the first web space and straight leg raising positive at 50 degrees, but full power, normal reflexes, normal bladder and bowel function, and no fever, weight loss or history of cancer. What is the most appropriate management now?

    1. AUrgent MRI of the lumbosacral spine today
    2. BMicrodiscectomy at the L4-L5 level
    3. CAnalgesia, stay active, review in 6 weeks
    4. DStrict bed rest for three weeks

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23. Question 23 · Medium

    Shoulder instability is often grouped as TUBS or AMBRI. On the TUBS group: 1. It usually follows a definite traumatic dislocation. 2. A Bankart lesion is commonly present. 3. Surgery is often needed in young athletes. 4. Generalised ligamentous laxity is the typical background. Which statements are correct?

    1. A2, 3 and 4 only
    2. B1, 2 and 3 only
    3. C1, 2, 3 and 4
    4. D1 and 4 only

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24. Question 24 · Medium

    MRI confirms a large central L5-S1 disc extrusion compressing the cauda equina in a homemaker who developed perineal numbness, bilateral leg pain and urinary hesitancy about 20 hours ago; she can still pass urine with straining. Her blood counts and clotting are normal, and she has no other illness. What is the definitive treatment?

    1. ALumbar traction and a corset
    2. BIV methylprednisolone and review
    3. CUrgent surgical decompression
    4. DCaudal epidural steroid injection

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25. Question 25 · Hard

    MRI report: 'Extraforaminal (far lateral) disc herniation at L4-L5 on the right; central canal and lateral recesses clear; no other level involved.' The patient is a tailor from Kannur who has had severe right-sided pain over the front of the thigh and the inner side of the leg for a month, worse on standing. On examination the right knee jerk is reduced, knee extension is weak (MRC grade 4), the femoral stretch test is positive and straight leg raising is negative. Ankle jerks and great toe extension are normal. Which nerve root is being compressed?

    1. AS1
    2. BL3
    3. CL4
    4. DL5

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