2

3
Sports Injury

High Yield Facts

Tests Positive in
Shoulder:
Neer’s Impingement test Impingement syndrome /
Hawkins-Kennedy test Supraspinatus tendinitis
Empty can test
Drop-arm test Supraspinatus tendon complete rupture
Sulcus sign / test Inferior shoulder instability
Yergason test Bicipital Tendinitis
Speed Test
Popeye sign Biceps tendon rupture
Jobe Relocation Test Recurrent shoulder dislocation
Gerber’s Lift-off Test, Subscapularis tendinitis
Gerber’s Belly Press Test
Elbow:
Cozen’s test Lateral epicondylitis (Tennis elbow)
Mill’s maneuver
Hand:
Finkelstein’s test de Quervain’s Disease
Knee:
McMurray test Meniscal tears
Apley’s grinding test
Thessaly test
The bulge test To test the knee effusion
(when the fluid is less)
Anterior Drawer Test Anterior cruciate ligament tear
Lachman Test
Pivot shift test
The bulge test To test the knee effusion
(when the fluid is less)
Thompson calf muscle squeeze test Achilles tendon rupture
 Chapter 3  |  Sports Injury

Soft Tissue Disorders Frozen Shoulder

93
(Adhesive Capsulitis)
Eponymous Bursae
zz Commonly known as Periarthritis of the shoulder.
zz A self-limiting condition; resolves spontaneously after
18 months
zz Associated with diabetes, hyperthyroidism, cardiac
disease, hemiplegia and trauma.
zz Internal rotation and abduction of shoulder are
restricted.
zz Treated with physical therapy, NSAIDs, intra-articular
steroid injections, distention arthrography, closed ma-
nipulation under anaesthesia.

Olecranon Bursitis
zz Inflammation of bursa between the olecranon process
Fig. 1: Bursa around the knee skin.
zz Also called as student’s elbow, miner’s elbow, drafts-
man’s elbow.

Servant maid’s Knee Prepatellar Bursitis

Clergyman’s knee Infrapatellar bursitis
Pes Anserine bursa Bursa at the insertion of Sartorius,
Gracilis, Semitendinosus
Student’s elbow Olecranon bursitis
Bunion Bursa over 1st MTP in Hallux valgus of
great toe)
Weaver’s bottom Ischial bursitis
Tailor’s bunion Bursa over 5th MTP joint of little toe.
(also known as Bunionette) Fig. 2: Olecranon bursitis
Haglund deformity Retrocalcaneal bursitis (pump bump) zz Repetitive rubbing of the olecranon on hard surfaces
resulting in aseptic distension of the bursa is the most
Sobriquet Elbows common presentation.
zz Other causes are
 Trauma
 Inflammatory – gout, rheumatoid arthritis
 Infectious – pyogenic, tuberculosis.
Student’s elbow Olecranon bursitis
Nursemaid’s elbow Radial head subluxation (pulled elbow) Dupuytren’s Contracture
Little leaguer’s elbow Avulsion of medial epicondyle zz It is a proliferative fibroplasia of the subcutaneous
Javelin thrower’s Avulsion or impingement tip of palmar fascia of the hand.
elbow olecranon zz Presents as painless nodules and cord-like thickening.
ORTHOPEDICS

Golfer’s elbow Medial epicondylitis zz Deformity: irreversible flexion contractures of the

fingers.
Tennis elbow Lateral epicondylitis zz MC in males, between 40-60 years, rare in Asians.
zz MC seen in ring finger and may involve little and
Sobriquet Shoulders middle fingers also.
zz Similar lesions in the plantar fascia of foot, known as
zz Frozen shoulder: Adhesive capsulitis
Ledderhose disease,
zz Sprengel shoulder: Cong. Elevation of scapula
zz About 3% of patients have cord-like induration of the
zz Milwaukee shoulder: Hydroxyapatite Deposition ar-
penis, known as Peyronie’s disease.
thropathy
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94

Fig. 3: Dupuytren’s contracture Fig. 4: Baker’s cyst

Etiology: not known.
zz
Morrant Baker’s Cyst
zz The risk factors are hereditary, alcoholism, epilepsy,
diabetes, smoking, cirrhosis, AIDS and pulmonary zz A herniation of synovial cavity of the knee.
diseases. zz Presents as fluid filled sac at popliteal fossa.
zz Occurs secondary to knee disorders causing synovial ef-
Treatment fusion such as Osteoarthritis and Rheumatoid arthritis.

When contracture is >15° in proximal interphalangeal joint

and >30° in metacarpophalangeal joint needs surgical
intervention.
zz Subcutaneous fasciotomy: In elderly patients who are
not concerned about the deformity.
zz Partial (selective) fasciectomy: Indicated when medial
one or two fingers are involved.
zz Fasciectomy with skin grafting: Indicated for young
people with risk factors such as epilepsy.
Osteitis Pubis
zz An inflammatory condition presenting with pain in the
pubic region.
zz Seen in long distance runners or weight lifters.
zz X-ray: bone resorption at the medial ends of the pubic
bones and widening of the pubic symphysis.
Athletic Pubalgia
Results from repetitive microtrauma at the insertion of the
rectus abdominis and the origin of the hip abductors at the
pubis.
ORTHOPEDICS
Achilles Tendinitis
zz Achilles tendon is the largest and most powerful tendon.
zz It has a zone of relative avascularity 2–6 cm proximal to
its insertion.
zz Overuse of tendon → leads to inadequate vascular supply
→ degeneration and fibrosis → weakness → rupture.
Two Types of Tendinitis
zz Non-insertional tendinitis: Occurs in Achilles tendon at
2–6 cm proximal to the insertion.
zz Insertional tendinitis: Occurs at the site of insertion
(tendon-bone junction) at calcaneus due to overuse. As-
sociated with
 Haglund deformity (“pump bump”): An exostosis
arises from the posterosuperior aspect of the
calcaneal tuberosity.
 Retrocalcaneal bursitis: A subfascial/subcutane-
ous bursitis occurs due to chronic irritation from a
shoe heel counter behind calcaneum.
Achilles Tendon Rupture

zz Most ruptures occur during sports activities.

Ischial Bursitis zz Common in middle-aged athletes.
zz Plantar-flexion of the foot is weak
zz Also known as Weaver’s bottom.
zz A palpable gap is felt at the site of rupture.
zz The bursa lies between the ischial tuberosity and the
zz Thompson’s calf muscle squeeze test (or Simmond’s
gluteus maximus.
test): on squeezing the calf muscles, the ankle moves into
zz Inflammation of this bursa usually is caused by constant
plantar flexion. In Achilles tendon rupture, there is no
irritation in people who have a sedentary occupation.
plantar flexion.
 Chapter 3  |  Sports Injury

95

A B C D

Fig. 5: Thompson test Fig. 8: A. Mitchell’s osteotomy; B. Wilson’s osteotomy;

C. Keller’s operation; D. Arthrodesis

zz O'Brien’s needle test is also useful.

zz MRI is the gold standard for detecting the rupture and zz Lateral deviation of great toe
its extent. zz Bunion: Formation of thick walled bursa over medial
side of MTP joint.
zz Exostosis: prominence at metatarsal head.
Hallux Valgus Deformity zz Osteoarthritis of MTP joint because of malalignment.
zz Overriding of second toe by the great toe.
zz Commonest of the foot deformities zz Normally the intermetatarsal angle is < 9°. The valgus
zz Lateral deviation of the great toe at metatarsophalangeal angle at the MTP joint < 15°. In hallux valgus, the angles
joint. are higher.
zz MC in women.
Caused by pointed shoes (MC), idiopathic, RA etc.
zz
Treatment Methods
Pathological Changes Keller procedure: Combination resection hemiarthroplasty
of the first metatarsophalangeal joint with removal of the
zz Medial deviation of 1st metatarsal (metatarsus primus medial eminence of the first metatarsal head.
varus)

Tendon Ruptures
zz Common in middle-aged and elderly patients.
zz MC cause is overuse of tendons producing repetitive mi-
crotrauma → predisposes the tendons to rupture.
Other predisposing conditions:
zz Rheumatoid arthritis
zz Lupus erythematosus
zz Hyperbetalipoproteinemia (xanthoma)
zz Systemic steroids / local injection of steroids.
Fig. 6: Hallux valgus
Commonly Ruptured Tendons
Tendon rupture Description
Supraspinatus Drop arm sign positive
Abduction of shoulder is weak
ORTHOPEDICS

Biceps Popeye sign positive

MC at long head of biceps
Achilles tendons Thompson squeeze test: squeezing the calf
muscle bring about plantar flexion of ankle.
In Achilles tendon complete rupture when
there is no plantar flexion of the ankle.

Fig. 7: Changes in hallux valgus deformity

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96

Fig. 9: Sites of muscle avulsion in the pelvic girdle

Avulsion Fractures
zz Most commonly seen in adolescent athletes.
zz Due to sudden, forceful muscle contraction during
sports activities.
zz Common avulsion injuries are:
 Avulsed bony part : Involved muscle.
 Anterior Superior Iliac Spine : Sartorius
 Anterior Inferior Iliac Spine : Rectus Femoris Fig. 10: Impingement syndrome
 Ischial Tuberosity : Hamstrings
 Lesser Trochanter : Iliacus zz Osteophytes at acromioclavicular joint
zz Greater tuberosity fracture.
Upper Limb
Treatment Options
The Shoulder zz For small tears in the rotator cuff: Repair by suturing.
Impingement Syndrome zz For large irreparable cuff tears: Tendon transfer (For
younger patients)
Seen with repetitive overhead activities of shoulder → me-
chanical impingement of the rotator cuff and humeral head
against the lateral edge of acromion.
zz Supraspinatus tendon is most susceptible to impinge-
ment and rupture.

Pathogenesis
Repetitive overhead shoulder abduction → Compression
of supraspinatus tendon under acromion → Supraspinatus
tendinitis → Partial rupture of Supraspinatus → Full
thickness tear → Altered shoulder biomechanics → Rotator
ORTHOPEDICS

cuff shoulder arthropathy.

zz In supraspinatus tendinitis: Pain occurs in middle of the
arc of abduction → Painful arc syndrome, pain in 60˚–
120˚ abduction of shoulder.
zz In Complete rupture of supraspinatus tendon: No pain.
Drop arm sign is positive.
Impingement of Supraspinatus is aggravated by
Fig. 11: Painful Arc syndrome
zz Subacromial bursitis
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97

A B

Fig. 12: A. Standard total shoulder arthroplasty; Fig. 14: SLAP lesion

B. Reverse total shoulder arthroplasty
zz For rotator cuff arthropathy: Reverse shoulder arthro-
plasty (for older patients)
 In standard total shoulder arthroplasy, the metal
ball is positioned to replace the head of humerus.
 In reverse total shoulder arthroplasty, the metal ball
is placed in the glenoid.
Subscapularis Injury
The subscapularis muscle is an anteriorly placed rotator cuff
muscle.
Its action is internal (medial) rotation of shoulder joint.
In Subscapularis tears → the Internal rotation of shoulder
is weak.
This weakness of internal rotation is tested by
zz Belly press test: The patient presses the abdomen with
the palm of the hand and attempts to keep the arm in
maximal internal rotation.
In cases of subscapularis ruptures → internal
rotation is weak → the arm falls backward (as it cannot
come forward anteriorly by medial rotation)
zz Lift off test: The patient keeps the dorsum of the hand
on the lower back. Lifting the hand away from the back
is done by internal rotation movement of shoulder joint.
In subsacpularis tear, the patient is unable to lift the
dorsum of the hand off the back.
SLAP Lesions
zz This acronym stands for Superior Labrum Anterior-to-
Posterior)
zz Denotes glenoid labral tear at Superior part which
involves the origin of the long head of biceps muscle.
zz SLAP lesions are seen in throwing athletes.
zz O’brien’s test is positive.
Shoulder Instability
The shoulder joint the most unstable joint; hence most
commonly dislocated joint in the body.
zz Type I Traumatic structural instability
zz Type II Minimally traumatic structural instability
zz Type III Atraumatic non-structural instability

Tests for Shoulder Instability

ORTHOPEDICS

zz Test for inferior shoulder instability:

 The sulcus test.
zz Test for anterior instability:
 The apprehension test,
 The fulcrum test
 The crank test,
 Shoulder relocation test.
A B zz Test for posterior instability:
 The jerk test.
Fig. 13: A. Belly press test; B. Lift Off test
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98

Fig. 15: Causes of shoulder instability

Treatment for Shoulder Instability

It is based on the following simplified classification.
zz TUBS: Traumatic, Unidirectional Bankart Surgery.
This means that traumatic lesions causing recurrent
dislocation needs Bankart’s surgery.
zz AMBRII: Atraumatic, Multidirectional, Bilateral, Reha-
bilitation, Inferior Capsular Shift, Internal Closure.
Fig. 16: Cozen’s test
  This means, recurrent shoulder dislocation caused by
non-traumatic events is usually bilateral, multidirectional
instability; and this is managed by physical therapy and The Wrist and The Hand
rehabilitation.
Rarely, they may need inferior capsular shift and Zones of Flexor Tendons of Hand
closure also.
zz Microtraumatic lesions fall between the extremes of zz Zone I starts just distal to the insertion of the sublimis
macrotraumatic and atraumatic lesions and can overlap tendon.
these extreme lesions. zz Zone II: between the distal palmar crease and the
insertion of the sublimis tendon.
 Both FDS and FDP are present here with supports
of pulleys.
Surgical Procedures for Recurrent Shoulder Dislocation zz Zone III the area of the lumbrical muscles.
zz Bankart’s repair: Detached anterior structure are attached to zz Zone IV: the area covered by transverse carpal ligament
the glenoid rim by sutures. (flexor retinaculum).
zz Putti Platt: Double breasting of subscapularis muscle. zz Zone V is proximal to the transverse carpal ligament.
zz Bristow procedure: Transplantation of coracoids process to zz Zone II is in the critical area of pulleys
anterior rim of the glenoid cavity.  It is called Bunnel's “no man's land” because
injuries in this zone are most difficult to treat
because of risk of formation of adhesions.
The Elbow
Lateral Epicondylitis (Tennis Elbow)
zz Inflammation of common extensor origin at lateral
epicondyle of the humerus.
zz Due to repetitive overuse activities.
zz Extensor carpi radialis brevis (ECRB) is more
commonly and more severely affected.
 Cozen’s test: Resisted dorsiflexion of wrist causes
pain in the lateral epicondyle.
 Mill’s manoeuvre: Passive stretching of wrist
extensors cause pain.
ORTHOPEDICS

zz Treatment: rest, ice, steroid injections, and physical

therapy, counterforce bracing.

Medial Epicondylitis (Golfer’s Elbow)

zz Inflammation of common flexor origin at medial
epicondyle of humerus.
zz Less common.
Fig. 17: Flexor zones of hand
zz Pronator teres and flexor carpi radialis are mainly involved.
 Chapter 3  |  Sports Injury

zz Inflammation at the intersection of tendons of 1st dorsal

compartment and 2nd dorsal compartment. 99
zz 1st compartment tendons: abductor pollicis longus (APL)
and extensor pollicis brevis (EPB)
zz 2nd compartment tendons: extensor carpi radialis longus
(ECRL) and extensor carpi radialis brevis (ECRB)
zz Crossing of these two groups of tendons takes place
about 4–6 cm proximal to the wrist joint.
zz Occurs most commonly in athletes requiring repetitive
wrist flexion - extension
zz Due to friction between the intersecting tendons
resulting in tenosynovitis of the ECRB and ECRL.
Fig. 18: Contents of extensor compartments of wrist
zz Treatment is same as for De Quervain’s disease.

TABLE 1: Contents of Extensor Compartment of Wrist

Trigger Finger
I Extensor pollicis brevis,
zz It is a Stenosing tenosynovitis of flexor tendons leading
Abductor pollicis longus
to inability to extend the flexed digit (“triggering”)
II Extensor carpi radialis brevis and longus zz Common in older than 45 years of age.
III Extensor pollicis longus zz Etiology: unknown.
IV Four tendons of extensor digitorum communis and
zz Risk factors: diabetes and rheumatoid arthritis.
extensor indicis proprius zz Characterized by thickening of the first annular (A1)
pulley of flexor tendon sheath.
V Extensor digiti quinti zz Presents with painful and palpable nodules at the level
VI Extensor carpi ulnaris of MCP joint. Difficulty and triggering like effect on
extension of fingers.
DE Quervain’s Disease
zz Stenosing tenosynovitis at first extensor compartment
of wrist.
zz Abductor pollicis longus and extensor pollicis brevis
(APL and EPB) are involved.
zz Due to repetitive gliding of these two tendons through
the sheath of the first dorsal compartment.
zz Pain is at the radial styloid process.
zz Finkelstein’s Test – flexion of the thumb, followed by
ulnar deviation of the wrist will produce pain. - is positive.
zz Treatment: rest, immobilization in thumb spica, NSAIDs,
corticosteroid injection. Fig. 20: Trigger finger
zz Surgical release of sheath is carried out if conservative
measures fail.

Intersection Syndrome
zz Also known as crossover syndrome.
ORTHOPEDICS

Fig. 19: Finkelstein’s test Fig. 21: Flexor tensons and pulley system of fingers
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100

Fig. 22: Gamekeeper’s thumb Fig. 24: Mallet finger

zz The ring finger, middle finger, are most commonly
involved.
zz Thumb is commonly involved in Congenital Trigger
finger.

Bowler’s Thumb
zz A perineural fibrosis of the ulnar digital nerve of the
thumb
zz Caused by repetitious compression while grasping a
bowling ball.
zz Tingling and hyperesthesia around the pulp will occur.
Fig. 25: Hyperextension splinting for Mallet finger
Gamekeeper’s Thumb (Skier’s Thumb)
zz Ulnar collateral ligament injury of thumb at MCP joint. zz Treated with splinting the DIP joint in hyperextension
zz A forceful radial deviation of thumb at meta- for 6 weeks.
carpophalangeal joint.
zz Most commonly seen in skiers and ball-handling
athletes.
Lower Limb

Jersey Finger The Knee

Avulsion of Flexor digitorum profundus tendon of fingers Bones of the knee:
from distal phalanx. zz Patella
zz Distal femoral condyles
zz Proximal tibial plateaus or condyles.
Mallet Finger The knee is a hinge joint and is stabilized by ligaments.
zz Avulsion central slip of extensor tendon from distal
phalanx.
zz Presents with Flexion deformity at DIP, and difficulty in
extension of DIP joint.
ORTHOPEDICS

Fig. 23: Jersey finger Fig. 26: The Knee joint


Fig. 27: Ligaments of knee
zz Collateral ligaments: Provide sideward (mediolateral)
support.
 Medial collateral ligament (MCL) is the primary
stabilizer of medial side of the knee against valgus
stress.
 Lateral collateral ligament (LCL) is the primary
stabilizer of lateral side of the knee against varus
stress.
zz Cruciate ligaments: Provide antero-posterior support.
 Anterior Cruciate Ligament (ACL): Provides support
to anterior aspect of knee by acting as the primary
restraint to anterior displacement (translation) of
tibia over femur.
 Posterior Cruciate Ligament (PCL): Prevents
posterior displacement (translation) of tibia over
femur.
zz MCL Injuries occur by a direct blow to the lateral side of
the knee. ( i.e a valgus force)
 Tested by Valgus stress test at 30° knee flexion.
 Leg is abducted at knee in 30° flexion.
 In MCL strain: Pain occurs at medial side of the knee.
 In complete MCL tear: The knee opens up on medial
side.
Chapter 3  |  Sports Injury
101
Fig. 28: Varus and valgus stress test
zz LCL injury is rare. Tested by varus stress test at 30° knee
flexion.
Pellegrini-Stieda disease: An valgus (abduction) injury of MCL;
followed by ossification near the femoral attachment of the
ligament.
Anterior Cruciate Ligament Injury
This ligament prevents anterior translation the tibia on the
femur.
ACL injuries are the most common knee ligament
injuries seen in all forms of sporting activities.
Tests for ACL tears:
zz Lachman's test: Most sensitive test. Performed with
knee in 20°–30° flexion. Can be done even in acutely
swollen knee joint.
zz Anterior drawer test: Performed with the knee in 90°
flexion. Excessive anterior movement of more than 6–8
mm is considered positive.
zz Pivot shift test: Done in chronic cases presenting with
anterolateral knee instability.
Treatment for ACL rupture: ACL reconstruction by using one
ORTHOPEDICS
of the following grafts.
zz Patellar tendon
zz Semitendinosus/gracilis hamstring (latest and most
commonly used)
zz Quadriceps tendon.
Segond’s fracture: A posterolateral capsular avulsion from
the tibial condyle.
This is a pathognomonic sign of ACL injury.
 Triple O

Tests for PCL Injuries

102 zz Posterior drawer test: is the most specific test for PCL
injury
zz Posterior sag test: in PCL rupture → gravity causes the
tibia to sag down.
zz Quadriceps Active Test: contract the quadriceps
→ in case of a complete PCL rupture → quadriceps
contraction brings the tibia forward.
zz Reverse pivot shift test
The dial test: also known as tibial external rotation test.
zz Positive in Postero Lateral Corner Injury.

The Meniscus
zz Crescent shaped semilunar cartilages.
zz Peripheral borders are attached, thick and convex.
zz Inner borders are free, thin and concave

Functions
zz Load transmission
zz Shock absorption
zz Proprioception
zz Joint lubrication

Meniscal Injury
Fig. 29: Anterior drawer and Lachman’s test zz Meniscal injury occurs when twisting a partially flexed
knee. During this movement, rotation occurs between
condyles of femur and tibia.
Posterior Cruciate Ligament Injury zz Medial meniscus is larger, semicircular, less mobile
The posterior cruciate ligament (PCL) prevents posterior (because it is attached to MCL).
translation of the tibia on the femur. zz So injuries are more common with medial meniscus.
zz PCL injury: less common than ACL injury. zz Lateral meniscus is smaller, more circular and more
zz Occurs by a posteriorly directed blow to the proximal mobile. Less commonly injured.
tibia.
ORTHOPEDICS

Fig. 30: Tests for PCL injuries

 Chapter 3  |  Sports Injury

zz Vertical longitudinal tear: Displacement of complete

longitudinal tear presents as bucket handle tear which 103
is the commonest type of tear.
zz Clinically: Recurrent episodes of pain and locking of the
knee.

Tests for Meniscal Injury

zz McMurray's test: Patient is supine, fully flex and rotate
the knee gradually. External rotation painful → medial
meniscal tear. Internal rotation painful → lateral
meniscal tear.
zz Apley’s grinding test: pt is prone. Rest is as same as
Fig. 31: Meniscus of knee McMurray's test.
zz Duck walk test (Childress test): Patient walks in a
deep squatting position. While lifting the unaffected
limb, the affected limb will receive the body weight →
this compresses the meniscus of the affected knee →
produces pain.
zz Bounce home test: To specifically detect displaced
bucket handle tear. Pt actively extend the knee as much
as he can → examiner extends the knee little more → if
there is displaced bucket handle tear, the pt perceives
a sharp pain in the joint line. This test is also known as
Passive extension test.
zz Thessaly test: With the affected knee flexed to 20° and
the foot placed flat on the ground, the patient asked to
Fig. 32: Longitudinal and bucket handle tear
twist his body to one side and then to the other side. If
the patient experiences medial or lateral joint line pain
and sense of locking, meniscal tears is suspected.

A B C

ORTHOPEDICS

D E

Fig. 33: A. McMurray’s test; B. Apley’s grinding test; C. Thessaly test; D. Duck walk test; E. Bounce home test
 Triple O
104
Fig. 34: Vascularity of Meniscus
Arthroscopy is the “gold standard” for diagnosing meniscal
disease and intra-articular disorders of the knee.
Blood supply of Meniscus:
zz Red (outer part): well vascularised area.
zz Red-white: borderline vascular area
zz White (inner part): avascular area
The capacity of meniscal healing is determined by the
location of tear.
Treatment Options
Tear in outer zone - red area: treated by Repair (Meni-
scorraphy) (Repair is preferred because this region has rich
blood supply)
Tear in inner zone -white area: treated by Resection
(Meniscectomy) (Meniscus does not heal as this region is
avascular)
[LOCKING: It is of two types: true and pseudolocking.
zz True locking: Rare, occurs when loose body or meniscal
tear interposes between the femoral condyle and tibial
surface and mechanically blocks the knee extension.
zz Pseudolocking: More common, seen in patellar disorders.
Here, the knee extension is difficult because of pain,
not because of mechanical block. Pseudolocking occurs
after prolonged sitting or when coming downstairs, e.g.
chondromalacia of patella.]
Unhappy triad of O'Donoghue: Is combination of injuries of the
following three structures
zz Medial collateral ligament
zz Medial meniscus
ORTHOPEDICS
zz Anterior cruciate ligament
Chondromalacia of Patella
(Patello Femoral Syndrome)
zz It means softening of the patellar cartilage.
zz Common in female adolescents.
zz Pain in the anterior part of the knee, after sitting in one
position for a long time (“movie sign” or “theatre sign”)
and while descending stairs.
Fig. 35: Unhappy triad of O’Donoghue
zz JUMPER'S KNEE: Inflammation of patellar ligament
insertion at the inferior pole of the patella. It is caused
by repetitive traction injury during sports activities.
zz Pes anserinus is the term for the conjoined insertion of
sartorius, gracilis, and semitendinosus muscles at the
proximal medial aspect to the tibia.
zz Ober's test is positive in iliotibial band (ITB) contractures.
Positive in
 Cerebral palsy
 Poliomyelitis
 ITB friction syndrome (ITB Syndrome is due to
friction and contracture of ITB which occurs during
repetitive knee flexion movements)
The Ankle
Lateral collateral ligament complex: Consists of
zz Anterior talofibular ligament
zz Posterior talofibular ligament
zz Calcaneofibular ligament
Medial collateral (deltoid) ligament complex: Consists of
zz Tibionavicular ligament
Tibiocalcaneal ligament
zz
zz Superficial tibiotalar ligament
zz Deep tibiotalar ligament
Among the above ligaments, Anterior talofibular ligament
it the weakest and most often injured.
Deltoid ligaments are strong and rarely injured.
zz About 85% of ankle injury (involve lateral ligaments) is
due to Inversion of foot.
 Chapter 3  |  Sports Injury

Indications for Shoulder Arthroscopy

zz Subacromial bursitis
105
zz Rotator cuff tendonitis
zz Rotator cuff tears
zz Acromioclavicular joint osteoarthritis
zz Removal of loose bodies
zz Chronic synovitis
zz Glenohumeral instability
zz SLAP lesions
zz Adhesive capsulitis (frozen shoulder)

Plantar Fasciitis Indications for Hip Arthroscopy

zz Repair of Labral defects
Presents with pain and tenderness in the sole of the foot.
zz Femoroacetabular impingement syndrome (FAI)
Increase in incidence is associated with sporting activity,
zz Removal of loose bodies
change of footwear, sports shoes or running surface.
zz Debridement for osteoarthritis and osteonecrosis
The pain is worse when first getting up in the morning,
zz Extraction of intra-articular cement
when first getting up from a period of sitting.
zz Excision of impinging ligamentum teres
Enthesopathy of plantar fascia can be associated with zz Lavage for early-stage septic arthritis
zz Gout
Ankylosing spondylitis
zz
zz Reiter’s disease.
Advantages of Arthroscopic Procedures
zz Improved thoroughness of diagnosis.
zz Smaller incisions: less likely to produce disfiguring scars.
zz Possibility of performing surgical procedures that are
Arthroscopy difficult or impossible to perform through open arthrotomy.
Arthroscopic examination and surgery is gaining importance zz A number of surgical procedures are more easily
for various reasons. performed with arthroscopic techniques than through
This technique is used in most of the joints, most open arthrotomy incisions.
commonly knee, shoulder and hip in that order. zz Reduced postoperative morbidity.
When screening of sports related injuries can be zz Less postoperative pain, faster rehabilitation, and faster
carried out by X-ray and MRI, the confirmation and visual return to work.
documentation is done by arthroscopic technique. zz Reduced hospital cost. As most arthroscopic procedures
Arthroscopy can be either diagnostic as well as can be performed on an outpatient basis.
therapeutic. zz Reduced complication rate.

Indications for Knee Arthroscopy Complications

zz Meniscus injuries zz Damage to intra-articular structures is the most common
zz Loose bodies removal intra-operative complication of knee arthroscopy
zz Patellar chondromalacia zz Damage to menisci and fat pad
zz Chronic synovitis zz Damage to cruciate ligaments
zz Knee instability zz Hemarthrosis is the most common postoperative com-
zz Recurrent effusions plication
zz Osteochondral fractures zz Tourniquet palsy
ORTHOPEDICS

zz Instruments breakage within the joint.

 Triple O

Chapter at a Glance
106
Common Injuries of Upper Limb

Common Injuries of the Hand Common Injuries of the Knee

ORTHOPEDICS
 Chapter 3  |  Sports Injury

Image-Based Questions 107

1. Bursa affected in the mechanism shown in the pho- 4.  Injury shown in the photograph
tograph

A. Rolando fracture B. Kaplan lesion

A. Suprapatellar bursa B. Infrapatellar bursa
C. Mallet finger D. Jersey finger
C. Prepatellar bursa D. Pes anserine bursa

2. Identify the abnormality shown in the following 5.  What is the name of this condition?
picture?

A. Hallux valgus B. Hallux varus A. Tennis elbow B. Student’s elbow

C. Rheumatoid nodule D. Subcutaneos nodule C. Panner’s disease D. Prepatellar bursitis

3. Identify the Orthopedic disorder shown in photo- 6. 

Injury which commonly occurs in the sports
graph showing in the picture is

ORTHOPEDICS

A. Trigger finger A. De Quervain’s disease

B. Carpal tunnel syndrome B. Carpal tunnel syndrome
C. Compound palmar ganglion C. Medial epicondylitis
D. Dupuytren’s contracture D. Lateral epicondylitis
 Triple O

7. Name the knee disorder that can result from the 8. Bursa affected by the posture shown in the picture
108 activity shown in the picture is

A. Baker’s cyst
B. Chondromalacia patellae A. Suprapatellar bursa B. Prepatellar bursa
C. Suprapatellar bursitis C. Infrapatellar bursa D. Olecranon bursa
D. Infrapatellar bursitis

Answers of Image-Based Questions

1. C. Prepatellar bursa (Apley’s System of Orthopedics and fractures, 9th Edition, page 578)
•• Housemaid’s Knee: Flexion of knee on crawling position → friction between skin and bone.
Prepatellar bursitis is seen mainly in carpet layers, paving workers, floor cleaners and miners who do not use protective knee
pads.
•• Clergyman’s Knee: The swelling is below the patella and superficial to the patellar ligament, being more distally placed than
prepatellar bursitis. It is seen on those prays in kneeling in more upright position.
2. A. Hallux valgus (Apley’s System of Orthopedics and fractures, 9th Edition, page 604)
•• The picture shows, lateral deviation of great toe.
•• It produces a bunion deformity.
3. D. Dupuytren’s contracture (Apley’s System of Orthopedics and fractures, 9th Edition, page 422)
•• The picture shows a flexion deformity of ring finger with cord like thickening subcutaneously.
•• Produced by nodular hypertrophy and contracture of the superficial palmar fascia (palmar aponeurosis).
•• An autosomal dominant trait, it causes flexion deformities at the MCP and PIP joints.
•• Similar pathology affecting the sole of the foot is known as Ledderhose’s disease.
4. C. Mallet finger (Apley’s System of Orthopedics and fractures, 9th Edition, page 791)
The picture shows rupture of central extensor tendon from distal flexion → flexion deformity at DIP joint.
5. B. Student’s elbow (Apley’s System of Orthopedics and fractures, 9th Edition, page 380)
The picture shows a subcutaneous swelling at the level of olecranon → Olecranon bursitis.
6. D. Lateral epicondylitis
•• Lateral epicondylitis is Tennis elbow. The picture is self-explanatory!
•• Medial epicondylitis is Golfer’s elbow. Do you need any reference?
ORTHOPEDICS

•• Enjoy this: “Right-handed golfers tend to experience medial epicondylitis of the right elbow or lateral epicondylitis of the left
elbow!”
7. B. Chondromalacia patellae (Apley’s System of Orthopedics and Fractures, 9th Ed, page 565)
Symptoms appear on climbing stairs, or when standing up after prolonged sitting in situations like watching movie in cinema
hall. This is known as movie sign or theatre sign.
8. C. Infrapatellar bursa (Apley’s System of Orthopedics and fractures, 9th Edition, page 578)
The position shown in the picture is praying (the clergymen usually do) which rubs the infrapatellar bursa with the floor and
produces infrapatellar bursitis.

Multiple Choice Questions
SOFT TISSUE DISORDERS
1. Prepatellar bursitis is (2015, 2016)
A. Housemaid’s knee B. Clergyman’s knee
C. Tailor’s knee D. Tubercular knee
2. Housemaid’s knee is inflammation of (JIPMER 2009)
A. Prepattellar bursa B. Suprapatellar bursa
C. Infrapatellar bursa D. Anserine bursa
3. Clergyman’s knee is due to involvement of 18. Most commonly involved finger in Dupuytren’s
(JIPMER 2011, 2015)
A. Semimemranous bursa B. Infrapatellar bursa
C. Suprapatellar bursa D. Prepatellar bursa
4. Most common patellar bursitis is? (2016)
A. Prepatellar bursitis B. Supra patellar bursitis
C. Infra patellar bursitis D. Pes anserine bursitis
5. Ischial bursitis is also known as (2013)
A. Clergyman’s knee B. Housemaid’s knee
C. Weaver’s bottom D. Student’s elbow
6. Olecranon bursitis (Recent Pattern 2016)
A. Tennis elbow B. Golfer’s elbow
C. Student’s elbow D. Little Leaguer’s elbow
7. Bunion is commonly seen at (Recent Pattern 2015)
A. Great toe MTP joint B. Medial malleolus
C. Lateral malleolus D. Shin of tibia
8. Keller’s operation is done for? (Recent Pattern 2016)
A. Hallax valgus B. Hallux varus
C. Genu varus D. CTEV
9. In Hallux valgus, all are true EXCEPT (PGI 2003)
A. A bunion
B. Exostosis on head of 1st metatarsal
C. Over riding of second two by third toe
D. OA of MTP joint of great toe
10. Ruptured tendon is most commonly seen in:(AIPG 2000)
A. Stab injury B. Soft tissue tumor
C. Over use D. Congenital defect
11. What is the commonest cause of non insertional
tendinitis of Achilles tendon? (AIIMS Nov 2008)
A. Overuse B. Improper shoes
C. Steroid injection D. Running / jumping
12. The most common cause of Achilles tendinitis is D. Venous engorgement
(Recent Pattern 2014)
A. Improper shoes B. Overuse
C. Running and jumping D. Corticosteroids
13. Finkelstein test is used for diagnosis of? 
A. Thoracic outlet syndrome (Recent Pattern 2013)
B. Carpal tunnel syndrome
C. Tarsal tunnel syndrome
D. De Quervain’s tenosynovitis
14. The muscle affected in Athletic Pubalgia is (AIPG 2009)
A. Abdominal muscles B. Rectus femoris
C. Gluteus medius D. Hamstrings
15. Dupuytren’s contracture can be caused by B. Frozen shoulder
 (Recent Pattern 2013)
A. Eptoin B. Alcoholism
C. Diabetes D. All of the above
Chapter 3  |  Sports Injury
109
16. Dupuytren’s contracture occurs in (PGI 2008)
A. Diabetes B. Alcoholism
C. Epilepsy D. Rheumatoid arthritis
E. Chronic pulmonary disease
17. Dupuytren’s contracture is fibrosis of
 (Recent Pattern 2016)
A. Palmar fascia B. Forearm muscles
C. Sartorius fascia D. None of the above
contracture is (Recent Pattern 2005, 2006, 2007)
A. Ring finger B. Middle finger
C. Little finger D. Thumb
19. A diabetic and alcoholic patient present with 15 deg
flexion deformity of little finger. What is the appropriate
management? (AIIMS Nov 2011)
A. Observation
B. Subtotal fasciectomy
C. Percutaneous fasciectomy
D. Total fasciectomy
20. True about Frozen shoulder (PGI Nov 2013)
A. May occur after myocardial infarction
B. Seen following Colle’s fracture
C. Less commonly seen in diabetes
D. Improves after intraarticular steroid injection
21. True about Dupuytren’s contracture (PGI Nov 2010)
A. Associated with Peyronie’s disease
B. First affect index finger
C. Nodule formation and thickening of palmar fascia
D. Amputation may be required
22. Fractured iliac spine on X-ray is diagnostic of avulsion
injury of which muscle? (TNPG 2000, 2012)
A. Gluteus minimus B. Iliacus
C. Rectus femoris D. Adductor
UPPER LIMB
23. Impingement syndrome refers to (Recent Pattern 2016)
A. Nerve entrapped in closed space
B. Soft tissues entrapment
C. Arterial injury
24. Most common muscle damaged in rotator cuff
 (Recent Pattern 2016)
A. Supraspinatus B. Subscapularis
C. Infraspinatus D. Teres minor
25. Painful arc syndrome is caused by impingement of
(Recent Pattern 2015)
ORTHOPEDICS
A. Sub acromial bursa B. Sub deltoid bursa
C. Rotator cuff tendon D. Biceps tendon
26. Injury to supraspinatus muscle can lead to
 (Recent Pattern 2014)
A. Winging of scapula
C. Inability to abduct
D. Inability to abduct beyond 90 deg.
 Triple O

27. Painful arc syndrome is due to: (JIPMER 2004) 38. Golfer s elbow is (Recent Pattern July 2015)
110 A. Subacromial bursitis A. Medial epicondylitis
B. Fracture of greater tubercle B. Lateral epicondylitis
C. Chronic supraspinatus tendinitis C. Posterior elbow dislocation
D. All of the above D. Lateral collateral ligament injury
28. Painful arc syndrome is seen in all except: (AIIMS 2001) 39. de Quervain’s disease involves
A. Complete tear of supraspinatus tendon  (AIIMS 2005, Recent Pattern 2015)
B. Greater tuberosity fracture A. Abductor pollicis longus and extensor pollicis brevis
C. Subacromial bursitis B. Adductor pollicis brevis and Extensor pollicis longus
D. Supraspinatus tendinitis C. Abductor pollicis brevis and Extensor pollicis longus
29. Posterior glenohumeral instability can be tested by: D. Adductor pollicis longus and extensor pollicis brevis
(AIIMS 2009) 40. True about de Quervain’s disease is/are (PGI 2008)
A. Jerk test B. Sulcus test A. May present as painful swelling
C. Fulcrum test D. Crank test B. Involves Abductor pollicis longus
30. A person is able to abduct his arm, internally rotate it, C. Involves Extensor pollicis brevis
place the back of hand on the lumbosacral joint, but is D. Straining the thumb may produce pain
not able to lift it from the back. What is the etiology? E. Steroid injection is used to relieve pain.
(AIIMS May 2012) 41. Finkelstein’s test used for (AIPG 1992, Recent Pattern
A. Subscapularis tendon tear  2013, Recent Pattern 2012, Recent Pattern 2015)
B. Teres major tendon tear A. CDH
C. Long head of biceps tendon tear B. de Quervain’s tenosynovitis
D. Acromioclavicular joint dislocation C. Trigger finger
31. Lift-Off test is done to assess the function of (AIPG 2010) D. Tennis elbow
A. Supraspinatus B. Infraspinatus 42. In hand surgery which area is called ‘no man’s land’?
C. Teres Minor D. Subscapularis A. Proximal phalanx (AIIMS 2000)
32. Pulled elbow is (Recent Pattern 2015) B. Distal phalanx
A. Radial head subluxation C. Between distal phalanx crease and proximal phalanx
B. Elbow dislocation D. Wrist
C. Avulsion fracture of olecranon 43. Gamekeeper’s thumb is (Recent Pattern 2013)
D. Osteochondritis dessicans A. Ulnar collateral ligament injury of MCP joint of thumb
33. A child is presenting with pronated forearm. X-ray of B. Radial collateral ligament injury of MCP joint of thumb
elbow is normal. What is the diagnosis? C. Ulnar collateral ligament injury of IP joint of thumb
D. Radial collateral ligament injury of IP joint of thumb
 (Recent Pattern 2011)
44. Most common cause of trigger finger
A. Supracondylar fracture
 (Recent Pattern 2012)
B. Elbow dislocation
A. Trauma B. Alcohol
C. Lateral condyle fracture
C. Smoking D. Drug abuse
D. Pulled elbow
45. Kanavel’s sign is seen in: (TNPG 2001, JIPMER 2013)
34. Tennis elbow is characterized by (Recent Pattern 2015)
A. Flexor tendon sheath infectious inflammation in hand
A. Tendinitis at common extensor origin
B. Mid palmar space abscess
B. Tendinitis at common flexor origin
C. Ulnar bursitis D. Web space involvement
C. Painful elbow flexion
46. A cricket player complaining of pain while catching the
D. Painful elbow extension
ball, which structure is involved? (AIIMS 2011)
35. Tennis elbow is (AIPG 2007)
A. Abductor pollicis
A. Myositis ossificans B. Extensor pollicis
B. Olecranon bursitis C. Extensor carpi radialis longus
C. Pain over medial epicondyle D. Ulnar collateral ligament
D. Pain over lateral epicondyle 47. Mallet finger is (JIPMER 2014)
36. True about Tennis elbow: (PGI May 2012) A. Facture of proximal phalanx
ORTHOPEDICS

A. Seen on lateral epicondyle B. Avulsion of extensor tendon

B. Seen on medial epicondyle C. Rupture of flexor tendon
C. Tendinitis of Extensor carpi radialis brevis origin D. Capsular rupture of PIP joint
D. Tendinitis of Extensor carpi radialis brevis insertion 48. True regarding mallet finger.
37. Cozen test is done for (Recent Pattern 2011) (AIIMS Nov 2000, PGI Dec 2001)
A. Frozen shoulder A. Tendon avulsion at the base of middle phalanx
B. Little leaguers elbow B. Extensor tendon avulsion at the base of distal phalanx
C. Tennis elbow C. Fracture of distal phalanx
D. Golfers elbow D. Fracture of middle phalanx

49. Jersey finger is caused by rupture of: (AIIMS May 2015)
A. Flexor digitorum profundus
B. Extensor digiti minimi
C. Flexor digitorum superficialis
D. Extensor indicis
50. Mallet finger treated by (AIIMS Nov 2015)
A. Observation B. Surgery
C. Splinting D. Drugs
51. A 30-yr-old man involved in fist cuff, injured his middle
finger. He noticed slight flexion of DIP joint. Best
management is (AIIMS 2004, AIIMS Nov 2012)
A. Ignore
B. Splint the finger with hyperextension
C. Surgical repair of the flexor tendon
D. Buddy strapping
52. Trigger finger refers to (Recent Pattern 2000, 2004, 2005)
A. Stenosis and tenovaginitis of flexor tendon sheath
B. Injury to finger by friction from using pistols
C. Sensation loss as in carpal tunnel syndrome
D. All of the above
53. Pulley involved in trigger finger: (AIIMS 1993)
A. A1 B. A2
C. A3 D. A4
54. In trigger finger, the level of tendon sheath constriction
is found at the level of: (AIIMS 2005)
A. Middle phalanx
B. Proximal interphalangeal joint
C. Proximal phalanx
D. Metacarpo-phalangeal joint.
55. Distal interphalangeal joint involvement occur in: C. Antero- medial bundle of ACL
(PGI Nov 2014)
A. Boutonniere deformity B. Swan neck deformity
C. Mallet finger D. Trigger finger
E. Dupuytren’s contracture
56. Flexion of distal interphalangeal joint with fixing of
proximal interphalangeal joint tests the action of:
A. Palmaris longus (TNPG 2000)
B. Flexor digitorum superficialis
C. Flexor digitorum profundus
D. All of the above
57. Stenosing tenosynovitis produces: (TNPG 2012)
A. Trigger finger B. Mallet finger
C. Jersey finger D. Swan neck deformity
58. Putti-platt operation is done for cases of: (TNPG 2002)
A. Recurrent shoulder dislocation
B. Posterior dislocation of hip
C. Congenital hip dislocation
D. Inferior dislocation of shoulder
59. No Man’s land in hand injury: (TNPG 2012)
A. Zone 1 B. Zone 2
C. Zone 3 D. None
60. Regarding lumbricals true statement: (TNPG 2012)
A. Arise from Flexor Digitorum Superficalis
B. Extensor of MCP joint
C. 1st and 2nd lumbricals are supplied by median nerve.
D. Flexor of inter-phalangeal joints
Chapter 3  |  Sports Injury
LOWER LIMB
61. Structural integrity of collateral ligaments are tested by
111
A. Valgus/varus stress test in full flexion (JIPMER 2002)
B. Valgus/varus stress test in full extension
C. Valgus/varus stress test in 30 deg flexion
D. Valgus/varus test in 90 deg flexion
62. Injury from lateral side of knee causes damage to
(Recent Pattern 2012)
A. MCL B. LCL
C. ACL D. PCL
63. Injury from lateral side of knee with fracture in the
intercondylar area, which structure is injured?
A. ACL B. PCL (AIPG 2012)
C. MCL D. LCL
64. What would be the most reliable (safest) test for an
acutely injured knee?
 (AIPG 2001, 2008, JIPMER 2008, Recent Pattern 2013)
A. Apley’s grinding test B. McMurray test
C. Lachman test D. Pivot shift test.
65. Lachman test is used for injury to (Recent Pattern 2015
A. Lateral collateral ligament
B. Medial collateral ligament
C. Anterior Cruciate ligament
D. Posterior cruciate ligament
66. A 22 year old young male suffered a left knee injury while
playing football. On examination, there was anterior
laxity in full extension but it was normal at 90° flexion.
Which of the following is the most likely injured part?
A. Posterior cruciate ligament (AIIMS Nov 2013)
B. Anterior horn of medial meniscus
D. Postero-lateral bundle of ACL
67. Pivot shift test is done for injury to: (AIIMS 2000)
A. Anterior Cruciate ligament
B. Posterior cruciate ligament
C. Medial meniscus D. Lateral meniscus
68. A football player presenting with history of twisting
injury shows positive for Anterior drawer test and
Lachman test. His X-ray is normal. What is the
diagnosis? (Recent Pattern 2015)
A. Medial meniscus tear B. Lateral meniscus tear
C. ACL tear D. PCL tear
69. Which of the following prevents the posterior gliding of
tibia on femur? (Recent Pattern 2015)
A. Lateral collateral ligament
B. Medial collateral ligament
C. Anterior cruciate ligament
D. Posterior cruciate ligament
70. Posterior cruciate ligament – true statement is
A. Attached to lateral femoral condyle (AIPG 2007)
ORTHOPEDICS
B. Intrasynovial
C. Prevents posterior dislocation of tibia
D. Relaxed in full extension
71. After road traffic accident, a patient complains of knee
pain. Clinically, dial test is positive. Diagnosis?
(AIIMS 2010, 2012)
A. MCL injury B. Meniscal injury
C. ACL injury
D. Posterolateral corner injury
 Triple O

72. All are true about menisci of knee joint EXCEPT: 83. In O’Donoghue triad, which of the following structures
112 (Recent Pattern 2013) are involved? (PGI Nov 2015)
A. Lateral meniscus covers more articular surface of tibia A. Medial meniscus
B. Lateral meniscus is more mobile B. Medial collateral ligament
C. Lateral meniscus is more prone to injury C. Anterior cruciate ligament
D. Lateral meniscus is semicircular D. Posterior cruciate ligament
73. Meniscal injury occurs during: (JIPMER 2013)
E. Lateral collateral ligament
A. Flexion B. Rotation
84. Pellagrini-Steida disease is avulsion of:
C. Extension D. Flexion and Rotation
(Recent Pattern 2012, Recent Pattern 2012)
74. Which type of movement causes damage to meniscal
A. Femoral attachment of MCL
cartilages? (AIPG 1996)
B. Tibial attachment of MCL
A. Flexion and extension of knee
B. Rotation on a flexed knee C. Femoral attachment of LCL
C. Rotation of an extended knee D. Tibial attachment of LCL
D. Squatting position 85. A pedestrian is hit by a moving vehicle on the lateral
75. History of twisting strain and locking of knee joint aspect of the knee. On X-ray a fracture line is seen
occurs due to: (JIPMER) running through the intercondylar eminence. Which of
A. Tear of Anterior cruciate ligament the following structures will most likely be injured?
B. Tear of Medial cruciate ligament A. Medial collateral ligament (AIIMS Nov 2012)
C. Meniscal tear B. Lateral collateral ligament
D. Patellar fractures C. Medial meniscus
76. McMurray’s test is positive in injury of: (PGI 2002) D. Anterior cruciate ligament
A. ACL B. PCL 86. The MC ligament injured around the ankle joint.
C. Medial meniscus D. Lateral Meniscus (AIPG1998, Recent Pattern 2012, 2013, 2015)
E. Bakers cyst A. Deltoid ligament
77. Which of the following is the most common type of B. Anterior talo fibular ligament
meniscal injury? (JIPMER 2002) C. Posterior talo fibular ligament
A. Anterior horn tear of lateral meniscus D. Spring ligament
B. Anterior horn tear of medial meniscus 87. If the foot is suddenly inverted while in plantar flexed
C. Bucket handle tear of lateral meniscus position, which of the following ligament will be
D. Bucket handle tear of medial meniscus injured? (Recent Pattern 2012, AIIMS Nov 2012)
78. ln which of the following meniscal tears will meni- A. Anterior talofibular ligament
scectomy be a more suitable option than meniscal B. Posterior talofibular ligament
repair? (AIPG 2008) C. Calcaneo cuboid ligament
A. Tears in the outer zone D. Calcaneofibular ligament
B. Tears in the middle zone
88. An athletic teenage girl complains of anterior knee pain
C. Tears in the inner zone
on climbing stairs and on getting up after prolonged
D. Associated with collateral ligament.
sitting. Which of the following is the most likely
79. Locking of knee is due to: (Recent Pattern 2012)
diagnosis? (AIPG 2011)
A. Menisci B. Loose bodies
A. Chondramalacia patellae
C. Both D. None
80. Locking of knee is caused by: (PGI Dec 2005) B. Plica syndrome
A. Loose bodies B. TB of knee C. Bipartite patella
C. Meniscal tear D. Patellofemoral osteoarthritis
D. Osgood Schlatter disease 89. Which of the following test is/are done to assess the
81. A footballer complains of sudden giving away of knee, meniscus injury of the knee joint? (PGI Nov 2016)
which could be due to? (JIPMER 2008) A. Apley’s test
A. Medial collateral ligament tear B. Lachman test
ORTHOPEDICS

B. Anterior cruciate ligament tear C. McMurray’s test

C. Medial meniscal tear D. Thessaly test
D. Posterior cruciate ligament tear E. Hamilton ruler test
82. The Unhappy triad of O’Donoghue does NOT include 90. Locking sensation in knee following injury is commonly
injury to: (Recent Pattern 2014, 2015) due to: (TNPG 2016)
A. Medial meniscus A. ACL tear
B. Medial collateral ligament B. Meniscal tear
C. Anterior Cruciate ligament C. Osteophyte loose bodies
D. Posterior cruciate ligament D. Osteochondral fracture

Answers with Explanations
SOFT TISSUE DISORDERS
1. A. Housemaid’s knee •• It is overriding of second toe by the great toe.
(Apley’s System of Orthopedics and fractures,
9th Edition, page 578)
Traumatic prepatellar bursitis can be caused by
•• An acute injury (fall directly on the patella)
•• Recurrent minor injuries (housemaid's knee)
ƒƒ Both types are treated by conservative method.
ƒƒ If fibrosis or synovial thickening with painful nodules
fails to respond → excision of the bursa is indicated.
2. A. Prepatellar bursa (See above)
3. B. Infrapatellar bursa (Apley’s System of Orthopedics and
 fractures, 9th Edition, page 578)
•• A small, deep, subpatellar or infrapatellar bursa is
located between the tuberosity of the tibia and the
patellar tendon.
•• Presents as a swelling is below the patella and superficial
to the patellar ligament.
•• It is more distally located than prepatellar bursitis.
•• Caused by friction while praying in kneeling position
more uprightly.
4. A. Prepatellar bursitis (see above)
5. C. Weaver’s bottom (Maheswari’s Essential Orthopedics,
5th Edition, page 301)
Ischial Bursitis
•• The ischial bursa lies between the tuberosity of the
ischium and the gluteus maximus.
•• Inflammation of this bursa usually is caused by constant
irritation.
•• Most commonly occurs in those who have a sedentary
occupation with less amounts of subcutaneous tissue in
the buttock region.
6. C. Student’s elbow (Maheswari’s Essential Orthopedics,
5th Edition, page 301)
Olecranon Bursitis
Two olecranon bursae present at elbow region.
•• One deep bursa lies between the triceps tendon and the
olecranon.
•• Other, superficial bursa lies between the olecranon and
the skin. More commonly inflamed.
Olecranon bursitis may be associated with Rheumatoid
arthritis.
7. A. Great toe MTP joint (Apley’s System of Orthopedics and
fractures, 9th Edition, page 603)
The lateral deviation and rotation of the big toe with a
prominence of the medial side of the head of the first
metatarsal is known as bunion.
8. A. Hallux valgus
 (Maheswari’s Essential Orthopedics, 5th Edition, page 327)
Keller operation is Excision of the base of the proximal
phalanx.
Chapter 3  |  Sports Injury
113
9. C. Over riding of second two by third toe (Apley’s System
 of Orthopedics and fractures, 9th Edition, page 603)
ƒƒ Prominence of the first metatarsal head is due to
subluxation of the MTP joint.
ƒƒ Increasing pressure on the medial side leads →
overlying bursa and soft tissues thickening.
ƒƒ The medial prominence of metatarsal had appears as
exostosis.
ƒƒ In old cases the MTP joint show osteoarthritic
changes and osteophytes may appear.
10. C. Overuse (Maheswari’s Essential Orthopedics, 5th
 Edition, page 6)
Rupture occurs if the tendon becomes weak due to
degeneration or wear and tear.
11. D. Running/jumping (Apley and Solomon’s Concise
 System of Orthopedics and Trauma, page 302)
Overuse (repetitive activity) or overload (sudden increase
in activity) commonly causes tendinitis. Rupture occurs
only if the tendon is degenerate.
12. C. Running and jumping (Apley and Solomon’s Concise
 System of Orthopedics and Trauma, page 302)
Athletes, joggers and hikers develop Achilles tendinitis,
caused by push off movements.
13. D. De Quervain’s tenosynovitis (Apley’s System of
 Orthopedics and fractures, 9th Edition, page 406)
Finkelstein’s Test
Ulnar deviation with the thumb held close to the palm and
the pull on the thumb tendons causes intense pain.
14. A. Abdominal muscles (Namdari Orthopdic Secrets,
4th Ed, page 349)
Athletic pubalgia is also known as sports hernia (it is not
a true hernia).
This involves strain of the muscles in the abdominal
wall or adductors - internal oblique, rectus abdominus and
adductor longus.
More commonly seen in soccer and hockey players.
15. D. All of the above (Apley’s System of Orthopedics and
fractures, 9th Edition, page 421)
Dupuytren’s Contracture
It is more common in males than females; the prevalence
increases with age.
There is a high incidence in epileptics receiving phenyt-
ORTHOPEDICS
oin therapy; associations with diabetes, smoking, alcohol-
ic cirrhosis, AIDS and pulmonary tuberculosis have also
been described.
16. A. Diabetes, B. Alcoholism, C. Epilepsy, E. Chronic
pulmonary disease
(Maheswari’s Essential Orthopedics, 5th Edition, page 302)
The cause is unknown, but a hereditary predisposition has
been established.
 Triple O
17. A. Palmar fascia (Maheswari’s Essential Orthopedics,
114 5th Edition, page 302)
Dupuytren’s Contracture is flexion deformity of one or
more fingers due to thickening and shortening of palmar
fascia.
Thickening of penile fascia is called as Peyronie’s
disease.
18. A. Ring finger (Maheswari’s Essential Orthopedics,
5th Edition, page 302)
Ring finger is most commonly affected.
The contracture is usually limited to the medial three
fingers.
19. A. Observation (Apley’s System of Orthopedics and fractures,
9th Edition, page 423)
Surgery does not cure the disease, it only partially corrects
the deformity, and recurrence or extension is common.
Lesser degree deformity can be observed.
20. A. May occur after myocardial infarction, B. Seen
following Colle’s fracture, D. Improves after intraa-
rticular steroid injection (Maheswari’s Essential
 Orthopedics, 5th Edition, page 304)
•• Frozen shoulder is more common in diabetics.
21. A. Associated with Peyronie’s disease, C. Nodule formation
and thickening of palmar fascia, D. Amputation may be
required (Apley’s System of Orthopedics and fractures,
9th Edition, page 423)
Amputation in Dupuytren’s Disease
•• Amputation is rarely necessary.
•• It is indicated in severe flexion contracture of PIP joint
in the little finger and when the contracture cannot be
corrected enough to make the finger useful.
22. C. Rectus femoris (Apley’s System of Orthopedics and
 fractures, 9th Edition, page 832)
“A piece of bone is pulled off by violent muscle contraction;
this is usually seen in sportsmen and athletes. The sartorius
may pull off the anterior superior iliac spine, the rectus
femoris the anterior inferior iliac spine, the adductor
longus a piece of the pubis, and the hamstrings part of the
ischium. All are essentially muscle injuries, needing only
rest for a few days and reassurance.”
UPPER LIMB
23. B. Soft tissues entrapment (Apley’s System of Orthopedics
and fractures, 9th Edition, page 341)
ORTHOPEDICS
Rotator cuff impingement syndrome is thought to arise
from repetitive compression of supraspinatus under the
coracoacromial arch.
The critical area of diminished vascularity in the
supraspinatus tendon about 1 cm proximal to its insertion
into the greater tuberosity.
24. A. Supraspinatus (See above)
25. C. Rotator cuff tendon (Apley’s System of Orthopedics and
fractures, 9th Edition, page 343)
It is due to impingement of supraspinatus producing
subacute tendinitis → painful arc syndrome.
26. C. Inability to abduct
•• Supraspinatus is the initiator of shoulder abduction.
27. D. All of the above (Apley’s System of Orthopedics and
fractures, 9th Edition, page 343)
Painful arc syndrome: is pain in the shoulder during the
mid range of abduction.
The common causes are:
•• Minor tears of supraspinatous tendon
•• Supraspinatous tendinitis
•• Subacromial bursitis
•• Fracture of greater tuberosity.
28. A. Complete tear of supraspinatus tendon (Apley’s
System of Orthopedics and fractures, 9th Edition, page 345)
•• Complete rupture is painless. Drop arm sign is positive.
•• The ‘abduction paradox’ and ‘drop arm sign’ are helpful
in the diagnosis of a complete rupture of the cuff.
29. A. Jerk test (Reider, Orthopedic Physical Examination,
 page 58)
The Jerk and circumduction tests are two provocative tests
to reproduce symptoms of posterior shoulder instability.
30. A. Subscapularis tendon tear (Apley’s System of
Orthopedics and fractures, 9th Edition, page 345)
•• The description of the test in the question is Lift off test.
31. D. Subscapularis (Apley’s System of Orthopedics and
fractures, 9th Edition, page 345)
•• Lift-Off test and Belly press test are positive in
subscapularis tendinitis.
32. A. Radial head subluxation (Apley’s System of Orthopedics
and fractures, 9th Edition, page 372)
•• The radial head can be pulled out of the cuff of the
annular ligament when the forearm is forcibly pronated.
33. D. Pulled elbow (See above)
34. A. Tendinitis at common extensor origin (Apley’s System
 of Orthopedics and fractures, 9th Edition, page 378)
Tennis Elbow
Pain and tenderness over the lateral epicondyle (the bony
origin of the common extensor tendon) is a common
complaint among tennis players – but even more common
in non-players who perform similar activities involving
forceful repetitive wrist extension.
35. D. Pain over lateral epicondyle (See above)
36. A. Seen on lateral epicondyle and C. Tendinitis of
Extensor carpi radialis brevis origin (see above)
37. C. Tennis elbow (Apley’s System of Orthopedics and
 fractures, 9th Edition, page 379)
Pain at the lateral epicondyle is reproduced by
•• Passively stretching the wrist extensors (Mills test)
•• Actively by having the patient extend the wrist against
resistance (Cozen test)

38. A. Medial epicondylitis (Apley’s System of Orthopedics
and fractures, 9th Edition, page 379)
Golfer s elbow: similar to tennis elbow, but less common.
In this case it is the pronator origin that is affected.
39. A. Abductor pollicis longus and extensor pollicis brevis
(Apley’s System of Orthopedics and fractures,
9th Edition, page 406)
•• Thickening of the sheath around the extensor pollicis
brevis and abductor pollicis longus tendons within the
first extensor compartment.
•• Caused by overuse, but can also occurs spontaneously.
•• More common in middle-aged women.
40. All (Apley’s System of Orthopedics and fractures,
9th Edition, page 406)
•• Straining the thumb may produce pain – Finklestein’s
test
41. B. de Quervain’s tenosynovitis (See above)
42. C. Between distal phalanx crease and proximal phalanx 49. A. Flexor digitorum profundus
(Apley’s System of Orthopedics and fractures,
9th Edition, page 798)
Flexor tendon repair is challenging, particularly in the
region (Zone II) between the distal palmar crease and the
flexor crease of the proximal interphalangeal joint where
both FDS and FDP tendons run together in a tight sheath.
•• Zone II is known as ‘no man’s land’ because injuries in
this zone are the most dangerous.
43. A. Ulnar collateral ligament injury of MCP joint of
thumb (Apley’s System of Orthopedics and fractures,
9th Edition, page 795)
•• Rupture of the ulnar collateral ligament of the thumb
metacarpo-phalangeal joint.
•• This injury is seen in skiers (Skier’s, thumb) who fall
onto the extended thumb, forcing it into hyperabduction.
44. None (Apley’s System of Orthopedics and fractures,
9th Edition, page 795)
The underlying cause is unknown but the condition is
certainly more common in patients with diabetes. People
with rheumatoid disease may develop synovial thickening
or intratendinous nodules which can also cause triggering.
45. A. Flexor tendon sheath infectious inflammation in
hand  (Apley’s System of Orthopedics and fractures,
9th Edition, page 433)
Kanavel's Four Cardinal Signs: for diagnosing acute
suppurative tenosynovitis of flexor tendons.
•• Intense pain: accompanies any attempt to extend partly
flexed finger
•• Flexion posture: finger is held in flexion for comfort.
•• Uniform swelling: involving entire finger in contrast to
localized swelling in local inflammation
•• Percussion tenderness: along the course of the tendon
sheath.
46. D. Ulnar collateral ligament (Apley’s System of Orthopedics
and fractures, 9th Edition, page 795)
•• It is gamekeeper's thumb.
Chapter 3  |  Sports Injury
47. B. Avulsion of extensor tendon (Apley’s System of
 Orthopedics and fractures, 9th Edition, page 791) 115
After a sudden stubbing of the fingertip at the terminal
phalanx, the tip of finger droops and cannot be straightened
actively.
It may be an
•• Avulsion of the most distal part of the extensor tendon.
•• Avulsion of a small flake of bone from the base of the
terminal phalanx.
Treated with immobilization of DIP joint in slight hyper-
extension.
For tendinous avulsions: the splinting constantly for 8
weeks, then at night only for 4 weeks.
For bone avulsions: splinting for 6 weeks is enough
(bone heals quicker than tendon)
48. B. Extensor tendon avulsion at the base of distal
phalanx (see above)
(Apley’s System of
Orthopedics and Fractures, 9th Edition, page 793)
Avulsion of the flexor tendon is caused by sudden
hyperextension of the distal joint, typically when a game
player catches his finger on an opponent’s shirt.
The ring finger is most commonly affected. The flexor
digitorum profundus tendon is avulsed, either rupturing
the tendon itself or taking a fragment of bone with it.
50. C. Splinting (Apley’s System of Orthopedics and Fractures,
9th Edition, page 792)
The DIP joint should be immobilized in slight
hyperextension, using a special mallet-finger splint which
fixes the distal joint but leaves the proximal joints free.
51. B. Splint the finger with hyperextension (See above)
52. A. Stenosis and tenovaginitis of flexor tendon sheath
(Apley’s System of Orthopedics and Fractures,
9th Edition, page 423)
Trigger finger is digital tenovaginosis.
A flexor tendon may become trapped by thickening at
the entrance to its sheath; on forced extension it passes the
constriction with a snap (‘triggering’).
53. A. A1
A1 pulley is at the level of MCP joint.
54. D. Metacarpo-phalangeal joint
Pain, tenderness and nodular thickening are present at
MCP joint.
55. A. Boutonniere deformity, B. Swan neck deformity,
C. Mallet finger.
ORTHOPEDICS
56. C. Flexor digitorum profundus (Apley’s System of
Orthopedics and fractures, 9th Edition, page 416)
FDS: flexes the PIP
FDP: flexes the DIP
ED: extends the MCP
Interossei and Lumbricals: flex the MCP and extend the IP
joints.
 Triple O
116
LOWER LIMB
Flexor digitorum superficialis is inserted into the palmar
surfaces the middle phalanges of individual fingers. And it
is a flexor of all the joints over which it passes, i.e. proximal
interphalangeal, metacarpophalangeal and wrist joints.
Flexor digitorum profundus is inserted on the palmar
surfaces of the bases of the distal phalanges. It is also
capable of flexing all of the joints over which it passes.
And it is the only muscle capable of flexing the distal
interphalangeal joints.
Palmaris longus is a phylogenetically degenerate meta-
carpophalangeal joint flexor. Its main function appears to
be as an anchor for the skin and fascia of the hand.
57. A. Trigger finger
TRIGGER FINGER or stenosing tenosynovitis is d/t nodule
or thickening of flexor tendon in A1 pulley (MCP) when
the finger is actively flexed.
•• Most common finger: ring, middle finger > thumb
•• Most common sex: female
•• Causes: Local trauma, RA, DM, gout, overuse in
unaccustomed activity
•• Eastwood classification
•• Rest, analgesics, splinting, steroid injection, surgical
release of A1 pulley. Never release A2 pulley
•• In RA treatment is synovectomy
58. A. Recurrent shoulder dislocation
 (Maheswari, Essential Orthopedics 4th Edition, page 88)
Putti platt surgery is Double breasting of the subscapularis
muscle.
It is performed in order to prevent external rotation
and abduction, thereby preventing recurrence of shoulder
dislocation.
59. B. Zone 2 (Apley’s System of Orthopedics and fractures,
9th Edition, page 798)
ORTHOPEDICS
Zones of the Palmar Aspect of Hand: Five Zones
•• Zone I extends from just distal to the insertion of the
sublimis tendon to the site of insertion of the profundus
tendon.
•• Zone II is in the critical area of pulleys (Bunnell's “no
man's land”) between the distal palmar crease and the
insertion of the sublimis tendon.
•• Zone III comprises the area of the lumbrical origin
between the distal margin of the transverse carpal
ligament and the beginning of the critical area of pulleys
or first anulus.
•• Zone IV is the zone covered by the transverse carpal
ligament.
•• Zone V is the zone proximal to the transverse carpal
ligament and includes the forearm.
60. C. 1st and 2nd lumbricals are supplied by median
nerve. (Apley’s System of Orthopedics and fractures,
9th Edition, page 437)
Lumbical muscles arise from flexor digitorum profundus
tendons.
61. C. Valgus/varus stress test in 30 deg flexion
(Apley’s System of Orthopedics and fractures,
9th Edition, page 550)
•• In isolated MCL tear: the stress test is done in 30deg
flexion.
•• Because, at full extension of knee: ACL and posterior
capsule become taut. MCL cannot be tested.
•• At 30 degrees of flexion, the MCL is the primary stabilizer.
62. A. MCL (look at the pic below) (Apley’s System of
Orthopedics and fractures, 9th Edition, page 876)
A solitary MCL injury is caused on the medial side when the
joint is flexed to 30 degrees and a valgus stress is applied.
63. A. ACL (Apley’s System of Orthopedics and fractures,
9th Edition, page 884)
If there is an associated fracture at intercondylar area (area
of ACL attachment), the ACL rupture is suspected.
64. C. Lachman test (Apley’s System of Orthopedics
and fractures, 9th Edition, page 878)
To perform this test, only 15-20 deg flexion of knee is
adequate. That is why this is useful in acute injuries, where
patients won’t allow flexion to 90 deg to perform anterior
drawer test.
Lachman test is the most sensitive test to detect ACL
tear.

65. C. Anterior Cruciate ligament (See above)
66. D. Postero-lateral bundle of ACL (Apley’s System of
Orthopedics and fractures, 9th Edition, page 876, Fig 30.2)
In the question, there is anterior laxity; means the ACL is
affected.
The ACL is made up of two bundles
•• Anteromedial (AM) bundle: stabilizes the knee in
flexion.
•• Posterolateral (PL) bundle stabilizes in extension.
As the patient has laxity in extension → postero lateral
bundle of ACL injury is suspected.
67. A. Anterior Cruciate ligament (Apley’s System of
Orthopedics and fractures, 9th Edition, page 879)
A positive pivot shift test indicates anterolateral rotatory
instability.
In anterolateral rotatory instability: ACL, the lateral
capsule and LCL are torn. Here, in addition to the positive
anterior drawer test, pivot shift test also will be positive.
Pivot shift phenomenon: the lateral tibial condyle
can be made to subluxate forwards as the tibia rotates
abnormally around an axis through the medial condyles.
68. C. ACL tear (Apley’s System of Orthopedics and fractures,
9th Edition, page 878)
•• Anterior drawer test, Lachaman test are positive in ACL
tear.
69. D. Posterior cruciate ligament (Apley’s System of
Orthopedics and fractures, 9th Edition, page 879)
PCL function is to prevent posterior translation
(displacement or gliding) of tibia from femur.
A positive posterior tibial sag and drawer sign means
that the posterior cruciate ligament is torn.
70. C. Prevents posterior dislocation of tibia (Apley’s System
 of Orthopedics and fractures, 9th Edition, page 876)
Posterior displacement is prevented by the posterior
cruciate ligament (PCL), specifically by the anterolateral
bundle when the knee is in near 90 degree flexion and by
the posteromedial bundle when the knee is straight.
71. D. Posterolateral corner injury (Apley’s System of
Orthopedics and fractures, 9th Edition, page 881)
Dial test is positive in Postero lateral corner (PLC) injury.
How to do: The leg is dangled over the edge of the couch.
The examiner steadies the distal femur with one hand and
holds the heel firmly in the other. The knee is flexed at 30
degrees. External rotation is applied through the heel and
the position of the tibial tuberosity is noted. If external
rotation is greater by 15 degrees as compared to the other
side, a posterolateral corner injury is suspected.
72. C. Lateral meniscus is more prone to injury (Apley’s
 System of Orthopedics and fractures, 9th Edition, page 558)
Lateral meniscus is nearly circular, covering up to two
thirds of the articular surface of the underlying tibial
plateau, much more than that of medial meniscus.
The popliteus tendon separates the lateral meniscus
from the joint capsule and the fibular (lateral) collateral
Chapter 3  |  Sports Injury
ligament. It is NOT attached to LCL; so more mobile; less
commonly injured. 117
Medial meniscus is larger, semicircular, less mobile and
more commonly injured.
73. D. Flexion and Rotation (Apley’s System of Orthopedics
and fractures, 9th Edition, page 559)
Meniscal Injury occurs during twisting of the knee in
semi-flexed position.
74. B. Rotation on a flexed knee (Apley’s System of
Orthopedics and fractures, 9th Edition, page 559)
The meniscus is usually torn by a twisting force with the
knee bent and taking weight.
75. C. Meniscal tear (Apley’s System of Orthopedics and
fractures, 9th Edition, page 559)
The presenting complaints of meniscal tears are
•• Recurrent episodes of pain, effusion and
•• Locking of the knee.
Meniscal tears happen because of twisting movement.
76. C. Medial meniscus, D. Lateral Meniscus (Apley’s System
of Orthopedics and fractures, 9th Edition, page 552)
McMurray’s test: flex the knee as far as possible, with one
hand steady the knee and with the other hand rotates the
leg medially and laterally while the knee is slowly extended.
With the knee stressed in valgus or varus, a palpable
click is felt.
To test the medial meniscus: external rotation and varus
stress is applied.
To test the lateral meniscus: internal rotation and valgus
stress is applied.
77. D. Bucket handle tear of medial meniscus (Apley’s System
of Orthopedics and fractures, 9th Edition, page 559)
“In 75 per cent of cases the split is vertical in the length of
the meniscus. If the separated fragment remains attached
front and back, the lesion is called a bucket-handle tear.”
78. C. Tears in the inner zone (Apley’s System of Orthopedics
and fractures, 9th Edition, page 560)
Peripheral (outer) zone is well vascularized, while their
inner regions are avascular.
Tears of the menisci in the avascular inner zones are best
treated by resection.
Peripheral tears in the vascular zone have the capacity to
heal which makes repair a possibility.
Inner zone: Resection
ORTHOPEDICS
zz
zz Outer zone: Repair
Total meniscectomy leads to instability and predisposes to
secondary osteoarthritis.
79. C. Both (Apley’s System of Orthopedics and fractures,
9th Edition, page 548)
Any loose bodies can mechanically block the knee
extension and cause locking of knee.
 Triple O
80. A. Loose bodies, C. Meniscal tears (Apley’s System
118 of Orthopedics and fractures, 9th Edition, page 548)
Locking happens when a torn meniscus or loose body is
caught between the articular surfaces.
81. C. Medial meniscal tear (Apley’s System of Orthopedics
and fractures, 9th Edition, page 548, 558)
Giving way (a feeling of instability) in the knee indicates a
mechanical injury to
•• Ligaments
•• Meniscus or
•• Capsule
Giving way during climbing up or down stairs indicates
patello-femoral instability.
Meniscal tear is usually caused by a rotational force,
when the knee is flexed and twisted while taking weight (it
happens more commonly in footballers.)
82. D. Posterior cruciate ligament (Apley’s System of
Orthopedics and fractures, 9th Edition, page 876)
The medial structures are most often affected but if the
injury involves a twist in addition to a valgus force, the ACL
also may be damaged.
This twisting force in a weight bearing knee often tears
the medial meniscus.
•• Causing the triad of O’Donoghue → Injury to 1. MCL 2.
ACL 3. Medial meniscus.
83. A. Medial meniscus, B. Medial collateral ligament, C.
Anterior Cruciate ligament (See above)
84. A. Femoral attachment of MCL (Apley’s System
of Orthopedics and fractures, 9th Edition, page 879)
•• When the avulsed MCL gets calcified after some years of
injury, it is known as Pellegirini- Steida lesion.
85. D. Anterior cruciate ligament (Apley’s System of
Orthopedics and fractures, 9th Edition, page 883)
Severe valgus or varus stress, (or twisting injuries) may
damage the knee ligaments and fracture the tibial spine
including part of the intercondylar eminence. This is a type
of traction injury producing a cruciate ligament tear.
ORTHOPEDICS
86. B. Anterior talo fibular ligament (Apley’s System of
Orthopedics and Fractures, 9th Ed, page 908)
The anterior talofibular ligament (ATFL) runs almost
horizontally from the anterior edge of the lateral malleolus
to the neck of the talus.
It is relaxed in dorsiflexion and tense in plantar flexion.
So, in plantarflexion the ligament is tense, stretched and is
most vulnerable to injury.
That is why, the ATFL injury is commonly seen with the
plantar flexion and inversion of foot.
•• In more than 75 per cent of cases it is the lateral ligament
complex that is injured, caused by inversion force.
87. A. Anterior talofibular ligament (See above)
88. A. Chondramalacia patellae (Apley’s System of
Orthopedics and Fractures, 9th Ed, page 565)
“In chondromalacia of patella, the symptoms are
aggravated by activity or climbing stairs, or when standing
up after prolonged sitting.”
89. A. Apley’s test; C. McMurray’s test; D. Thessaly test
 (Apley’s System of Orthopedics and Fractures,
9th Ed, page 552)
•• Lachman test: most sensitive test for ACL injury
•• Hamilton ruler test: done for shoulder dislocation
90. B. Meniscal tear (Apley’s System of Orthopedics and
Fractures, 9th Ed, page 547)
Locking of knee is defined as inability to obtain full
extension of knee joint motion.
True locking: Due to mechanical block of movement by
the presence of displaced fragments of torn menisci (MC,
intra-articular structure, loose bodies etc.
Pseudo-locking: seen in patients with patella femoral
disorders such as chondromalacia of patellae.
Here, the knee extension is difficult because of pain, not
because of mechanical block.