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Sports > Miller's Sports Review > Flashcards

Miller's Sports Review Flashcards

Ortho sports review

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1
Q

What causes os acromiale?

A

Failure to fuse the meso and meta-acromion during development

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2
Q

Name the structures within the rotator interval

A

SGHL, CHL and LHBT

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3
Q

What is the rotator cable?

A

Thickening of the CHL from just posterior to the LHBT to inferior infraspinatus

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4
Q

Difference between Kim and Jerk tests

A

Kim = direct posterior load with pain and/or click. Jerk = posterior subluxation with posterior load that reduces with abduction.

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5
Q

Biceps pathology testing more sensitive or more specific?

A

Sensitive, all have poor specificity

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6
Q

What x-rays are these and what are they looking for?

A

Top = West Point view looking for bony Bankart. Bottom = Stryker notch looking for Hill=Sachs.

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7
Q

What’s your diagnosis and treatment?

A

HAGL. Open > arthroscopic repair.

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8
Q

Indication for early surgical intervention in a first time dislocator?

A

High risk patient, young, male, contact sports and/or military

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9
Q

% of people with asymptomatic rotator cuff tears that become symptomatic?

A

51% at 3 years, 50% with partial tears progress to full thickness tears. There is a direct correlation with symptoms and tear progression.

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10
Q

Supraspinatus M-L footprint size

A

12-14mm

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11
Q

Critical shoulder angle

A

If >35, higher shear forces across shoulder and correlated with rotator cuff tears. If <30, there are increased compressive forces across the joint and higher risk for osteoarthritis.

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12
Q

Cuff tear classification

A

Small <1cm, medium 1-3cm, large 3-5cm, massive >5cm

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13
Q

Goutallier classification

A

0 = normal, 1= streaking, 2= muscle > fat, 3= fat = muscle, 4 = fat > muscle

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14
Q

Effectiveness of PT in cuff tears

A

Up to 75% will improve enough to not need surgery. Biggest predictor of failing PT was patient expectations.

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15
Q

Benefit of arthroscopic cuff repair vs open

A

Equivalent outcomes with less pain, better visualization and lower risk

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16
Q

Single vs double row rotator cuff repair

A

Equivalent outcomes, double row may be better in large tears. Double row failure associated with type II retears at the musculotendinous junction

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17
Q

Indications for SCR

A

No arthrosis, intact or repairable posterior cuff, intac subscap, young and active.

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18
Q

Management of calcific tendinitis

A

Needle lavage under fluoroscopy. If associated with cuff tear then arthroscopic debridement +/- cuff repair.

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19
Q

Native humeral head height

A

8mm proximal to top of greater tuberosity

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20
Q

Walsch classification

A

A1 = minor erosion, A2 = deeper erosion. B1 = posterior wear. B2= biconcave wear. B3= retroverted from wear. C = >25 deg retroversion

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21
Q

Normal acromiohumeral interval

A

8-10mm

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22
Q

Hamada classification

A

I) AHI >6, II) AHI <5, III) acetabularization of acromion, IVa) GHJ narrowing w/o acetabularization, IVb) GHJ narrowing w/acetabularization, V) humeral head collapse

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23
Q

Position of shoulder fusion

A

20 abd, 30 FF and 40 IR

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24
Q

Indications for shoulder arthrodesis

A

Young person w/severe OA, paralysis, recurrent dislocator (Ehlers-Danlos)

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25
Q

Most common TSA complications

A

1) Glenoid loosening, 2) cuff failure, others: stiffness, infection (worry if you see humeral loosening), nerve injury and instability

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26
Q

Treatment of failed subscap in anatomic TSA

A

If acute (<2 weeks) re-repair. If > 4-6 weeks, convert to RSA

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27
Q

Pseudoparesis vs pseudoparalysis?

A

Pseudoparesis: supraspinatous weakness limiting FF to 90 degrees until humerus hits acromion. Pseudoparalysis = anterior superior escape due to additional subscap tear

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28
Q

What post RSA scapular spine fractures are operative

A

Type 3 scapular base fractures treated with ORIF

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29
Q

Thrower’s shoulder with pain in late cocking/early acceleration?

A

SLAP tears and internal impingement

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30
Q

Thrower’s shoulder with pain in deceleration

A

Rotator cuff

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31
Q

Pathophysiology of internal impingement in throwers shoulder

A

In late cocking/early acceleration the posterior superior rotator cuff and labrum are entrapped between the humerus and acromion causing partial articular sided cuff tears at junction of SS and IS and peel-back SLAP tears

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32
Q

PT modalities for thrower’s shoulder and internal impingement

A

Sleeper stretching, pec minor stretching and scapular mechanics

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33
Q

What causes this?

A

This is a Bennett lesion, it’s a posterior glenoid exostosis caused by internal impingement vs posterior capsule traction

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34
Q

Batter’s shoulder

A

Posterior subluxation of the humerus on the glenoid at the end of the swing, treatment is a posterior stabilization procedure on the labrum

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35
Q

Function of and nerve at risk in proximal anteromedial portal in elbow arthroscopy

A

Common viewing portal for the anterior joint, MABCN, ulnar nerve and median nerve at risk

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36
Q

Elbow arthroscopy portals that put the radial nerve at risk

A

Anterolateral > proximal anterolateral portal. These are typically your working portals

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37
Q

Physical exam maneuvers testing the anterior band of the MCL?

A

Valgus stress test. The milking maneuver tests the posterior band.

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38
Q

Conservative treatment of MUCL injuries

A

No throwing for 12 weeks, PRP, therapy and then graduated throwing

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39
Q

Indications for operative management of MUCL injury

A

Acute complete rupture or partial attritional rupture that has failed conservative management

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40
Q

Indications for surgery in triceps tears

A

Complete or >50% rupture

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41
Q

Treatment of elbow capitellum OCD

A

Arthroscopic debridement, microfracture vs allograft or autograft OATS

42
Q

Snyder SLAP classification

A

I) Degeneration/fraying II) Detached from anchor III) Bucket handle w/attached biceps IV) tear propagates into biceps anchor

43
Q

Indications for SLAP repair

A

Unstable traumatic type II tear in a younger overhead throwing athlete with normal biceps and mostly posterior shoulder pain.

44
Q

Acromial morphology types

A

I = flat. 2 = curved, 3 = hooked

45
Q

Position of arm in subcoracoid impingement

A

Flexion and internal rotation

46
Q

Normal coracohumeral interval

A

8.7mm with arm adducted, 6.8mm with arm flexed

47
Q

Anatomic structure most commonly involved in adhesive capsulitis

A

CHL

48
Q

Collagen formed in adhesive capsulitis

A

Type III

49
Q

AC ligaments that contribute greatest to A/P stability?

A

Superior > posterior

50
Q

Most important structure for stability in the SC joint

A

Posterior capsule

51
Q

Most common head injured in pec major rupture

A

Sternal head

52
Q

Long thoracic nerve palsy winging

A

Medial scapular winging

53
Q

Spinal accessory nerve (CN XI) palsy winging

A

Lateral scapular winging.

54
Q

Return to play after this infection

A

Herpes infection, treat with acyclovir and return to play 120 hours later as long as no lesions within last 48 hours or less than 72 hours of antibiotics, lesions shoulde be dry

55
Q

Return to play after this infection

A

Impetigo from beta-hemolytic strep or staph. RTP when crusting is gone, no new lesions for 48 hours and on antibiotics for at least 72 hours

56
Q

Return to play after this infection

A

Community acquired MRSA. Return to play when no new lesions for 48 hours and 72 hours after abx treatment started

57
Q

How do steroids increase muscle mass

A

Increase muscle mRNA

58
Q

Side effects of steroid use

A

LVH, HLD, HTN, acne, premature physeal closure, VTE

59
Q

Isotonic muscle contraction

A

Constant resistance, muscle shortens or lengthens (concentric vs eccentric). Bench press.

60
Q

Isokinetic

A

Constant contraction speed

61
Q

Isometric

A

Constant muscle length

62
Q

Mononucleosis triad

A

Pharyngitis, fever, lymphadenopathy

63
Q

Return to play after mononucleosis

A

3-4 weeks due to splenomegaly

64
Q

Return to play in patients with spear tackler spine

A

Never. Diagnosed on x-rays with stenosis, loss of normal lordosis of the c-spine

65
Q

Causes of sudden cardiac death in athletes

A

HCM, comotio cordis and CAD

66
Q

Female athlete triad

A

Osteopenia, abnormal menses and disordered eating

67
Q

Labs to test for asthma

A

Increased FEV1

68
Q

Reason to leave helmet and shoulder pads on after on field c-spine injury

A

Limits cervical lordosis

69
Q

Solid organ most commonly injured in sports

A

Kidney

70
Q

Nerves at risk in portals made during hip arthroscopy

A

AL – SGN. PL – sciatic nerve (higher risk with external rotation). Anterior – LFCN. MAP = safter.

71
Q

Normal alpha angle in hip FAI evaluation

A

<50

72
Q

X-ray measurement that defines hip dysplasia

A

LCEA < 20

73
Q

How much femoral neck can you resect without increasing fracture risk in FAI?

A

30%

74
Q

Pathophysiology of ischiofemoral impingement

A

Pain w/passive hip extension and adduction from the quadratus femoris muscle impinging between the ischium and lesser trochanter

75
Q

Indications for operative management in hip avulsion injuries in adolescents

A

2-3cm displaced

76
Q

Where is the nutrient artery to the tibia?

A

Just below the PCL insertion

77
Q

Intra-articular innervation of the knee

A

Posterior tibial nerve articular branch

78
Q

Where is the saphenous nerve in relation to the hamstrings

A

Posterior border of sartorius, superficial to gracilis and anterior to semi-tendinosis with the knee flexed

79
Q

Blood supply from middle geniculate goes to what structures

A

Cruciates and posterior horns of both menisci

80
Q

In single bundle PCL reconstruction, which bundle do you reconstruct?

A

Anterolateral bundle because it restores stability in flexion

81
Q

LCL is tightest in

A

Extension

82
Q

Medial layers of the knee

A

1) Sartorius 2) sMCL, POL, SM 3) dMCL, capsule. Semitendinosus, gracilis and saphenous nerve are between layers 1 & 2

83
Q

Lateral layers of the knee

A

Superficial: biceps and iliotibial band. Deep = LCL, popliteus and popliteofibular ligament

84
Q

Function of the popliteus

A

Internally rotates the tibia, this unlocks it from its screw home mechanism when extended

85
Q

In what range of motion is the MPFL most effective

A

0-20 degrees of flexion

86
Q

What is a Pellegrini Stieda lesion

A

Calcification of the origin of the MCL at the femoral epicondyle

87
Q

Contraindications to meniscus allograft transplant

A

Flattening of condyles, age > 50, BMI > 30, <2mm joint space on WB views, ligamentous instability, RA

88
Q

Classification of discoid meniscus

A

I) Incomplete II) Complete = bow tie on 3 consecutive 4-5mm MRI slices III) Wrisberg variant = no peripheral attachments

89
Q

Most common location for knee osteochondritis dessicans

A

Lateral aspect of MFC

90
Q

Consequence of femoral ACL tunnel too anterior

A

Tight in flexion, lax in extension.

91
Q

Consequence of tibial ACL tunnel too anterior

A

Tight in flexion, limits full extension due to roof impingment

92
Q

Consequence of tibial ACL tunnel too posterior

A

PCL impingment, laxity in flexion and extension

93
Q

Consequence of femoral ACL tunnel too posterior

A

Tight in extension, lax in flexion

94
Q

Tibial slope concerning for ACL failure

A

12 degrees

95
Q

Only population where ACL bracing prevents ACL tears

A

Skiiers

96
Q

How do you tension the PCL graft

A

90 degrees of flexion. If doing posteromedial two bundle graft, that one is tensioned in 30 degrees of flexion.

97
Q

Goal MAD in HTO

A

62%

98
Q

ACL reconstruction if <9 years old

A

Extra-physeal

99
Q

ACL reconstruction if 9-11 years old

A

All epiphyseal

100
Q

ACL reconstruction if 12+ years old

A

Epiphyseal femur, trans-physeal tibia

101
Q

Position of tibia in pivot shift and reverse pivot shift.

A

Pivot shift = subluxed tibia in extension, reduced with flexion

102
Q

CECS pressure thresholds

A

Resting >15, >30 one minute of exercise and >20 five minutes after exercise

Sports (1 decks)

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