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Miller's Sports Review Flashcards

Ortho sports review

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
Most common TSA complications
1) Glenoid loosening, 2) cuff failure, others: stiffness, infection (worry if you see humeral loosening), nerve injury and instability
26
Treatment of failed subscap in anatomic TSA
If acute (<2 weeks) re-repair. If > 4-6 weeks, convert to RSA
27
Pseudoparesis vs pseudoparalysis?
Pseudoparesis: supraspinatous weakness limiting FF to 90 degrees until humerus hits acromion. Pseudoparalysis = anterior superior escape due to additional subscap tear
28
What post RSA scapular spine fractures are operative
Type 3 scapular base fractures treated with ORIF
29
Thrower’s shoulder with pain in late cocking/early acceleration?
SLAP tears and internal impingement
30
Thrower’s shoulder with pain in deceleration
Rotator cuff
31
Pathophysiology of internal impingement in throwers shoulder
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
32
PT modalities for thrower’s shoulder and internal impingement
Sleeper stretching, pec minor stretching and scapular mechanics
33
What causes this?
This is a Bennett lesion, it’s a posterior glenoid exostosis caused by internal impingement vs posterior capsule traction
34
Batter’s shoulder
Posterior subluxation of the humerus on the glenoid at the end of the swing, treatment is a posterior stabilization procedure on the labrum
35
Function of and nerve at risk in proximal anteromedial portal in elbow arthroscopy
Common viewing portal for the anterior joint, MABCN, ulnar nerve and median nerve at risk
36
Elbow arthroscopy portals that put the radial nerve at risk
Anterolateral > proximal anterolateral portal. These are typically your working portals
37
Physical exam maneuvers testing the anterior band of the MCL?
Valgus stress test. The milking maneuver tests the posterior band.
38
Conservative treatment of MUCL injuries
No throwing for 12 weeks, PRP, therapy and then graduated throwing
39
Indications for operative management of MUCL injury
Acute complete rupture or partial attritional rupture that has failed conservative management
40
Indications for surgery in triceps tears
Complete or >50% rupture
41
Treatment of elbow capitellum OCD
Arthroscopic debridement, microfracture vs allograft or autograft OATS
42
Snyder SLAP classification
I) Degeneration/fraying II) Detached from anchor III) Bucket handle w/attached biceps IV) tear propagates into biceps anchor
43
Indications for SLAP repair
Unstable traumatic type II tear in a younger overhead throwing athlete with normal biceps and mostly posterior shoulder pain.
44
Acromial morphology types
I = flat. 2 = curved, 3 = hooked
45
Position of arm in subcoracoid impingement
Flexion and internal rotation
46
Normal coracohumeral interval
8.7mm with arm adducted, 6.8mm with arm flexed
47
Anatomic structure most commonly involved in adhesive capsulitis
CHL
48
Collagen formed in adhesive capsulitis
Type III
49
AC ligaments that contribute greatest to A/P stability?
Superior > posterior
50
Most important structure for stability in the SC joint
Posterior capsule
51
Most common head injured in pec major rupture
Sternal head
52
Long thoracic nerve palsy winging
Medial scapular winging
53
Spinal accessory nerve (CN XI) palsy winging
Lateral scapular winging.
54
Return to play after this infection
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
Return to play after this infection
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
Return to play after this infection
Community acquired MRSA. Return to play when no new lesions for 48 hours and 72 hours after abx treatment started
57
How do steroids increase muscle mass
Increase muscle mRNA
58
Side effects of steroid use
LVH, HLD, HTN, acne, premature physeal closure, VTE
59
Isotonic muscle contraction
Constant resistance, muscle shortens or lengthens (concentric vs eccentric). Bench press.
60
Isokinetic
Constant contraction speed
61
Isometric
Constant muscle length
62
Mononucleosis triad
Pharyngitis, fever, lymphadenopathy
63
Return to play after mononucleosis
3-4 weeks due to splenomegaly
64
Return to play in patients with spear tackler spine
Never. Diagnosed on x-rays with stenosis, loss of normal lordosis of the c-spine
65
Causes of sudden cardiac death in athletes
HCM, comotio cordis and CAD
66
Female athlete triad
Osteopenia, abnormal menses and disordered eating
67
Labs to test for asthma
Increased FEV1
68
Reason to leave helmet and shoulder pads on after on field c-spine injury
Limits cervical lordosis
69
Solid organ most commonly injured in sports
Kidney
70
Nerves at risk in portals made during hip arthroscopy
AL – SGN. PL – sciatic nerve (higher risk with external rotation). Anterior – LFCN. MAP = safter.
71
Normal alpha angle in hip FAI evaluation
<50
72
X-ray measurement that defines hip dysplasia
LCEA < 20
73
How much femoral neck can you resect without increasing fracture risk in FAI?
30%
74
Pathophysiology of ischiofemoral impingement
Pain w/passive hip extension and adduction from the quadratus femoris muscle impinging between the ischium and lesser trochanter
75
Indications for operative management in hip avulsion injuries in adolescents
2-3cm displaced
76
Where is the nutrient artery to the tibia?
Just below the PCL insertion
77
Intra-articular innervation of the knee
Posterior tibial nerve articular branch
78
Where is the saphenous nerve in relation to the hamstrings
Posterior border of sartorius, superficial to gracilis and anterior to semi-tendinosis with the knee flexed
79
Blood supply from middle geniculate goes to what structures
Cruciates and posterior horns of both menisci
80
In single bundle PCL reconstruction, which bundle do you reconstruct?
Anterolateral bundle because it restores stability in flexion
81
LCL is tightest in
Extension
82
Medial layers of the knee
1) Sartorius 2) sMCL, POL, SM 3) dMCL, capsule. Semitendinosus, gracilis and saphenous nerve are between layers 1 & 2
83
Lateral layers of the knee
Superficial: biceps and iliotibial band. Deep = LCL, popliteus and popliteofibular ligament
84
Function of the popliteus
Internally rotates the tibia, this unlocks it from its screw home mechanism when extended
85
In what range of motion is the MPFL most effective
0-20 degrees of flexion
86
What is a Pellegrini Stieda lesion
Calcification of the origin of the MCL at the femoral epicondyle
87
Contraindications to meniscus allograft transplant
Flattening of condyles, age > 50, BMI > 30, <2mm joint space on WB views, ligamentous instability, RA
88
Classification of discoid meniscus
I) Incomplete II) Complete = bow tie on 3 consecutive 4-5mm MRI slices III) Wrisberg variant = no peripheral attachments
89
Most common location for knee osteochondritis dessicans
Lateral aspect of MFC
90
Consequence of femoral ACL tunnel too anterior
Tight in flexion, lax in extension.
91
Consequence of tibial ACL tunnel too anterior
Tight in flexion, limits full extension due to roof impingment
92
Consequence of tibial ACL tunnel too posterior
PCL impingment, laxity in flexion and extension
93
Consequence of femoral ACL tunnel too posterior
Tight in extension, lax in flexion
94
Tibial slope concerning for ACL failure
12 degrees
95
Only population where ACL bracing prevents ACL tears
Skiiers
96
How do you tension the PCL graft
90 degrees of flexion. If doing posteromedial two bundle graft, that one is tensioned in 30 degrees of flexion.
97
Goal MAD in HTO
62%
98
ACL reconstruction if <9 years old
Extra-physeal
99
ACL reconstruction if 9-11 years old
All epiphyseal
100
ACL reconstruction if 12+ years old
Epiphyseal femur, trans-physeal tibia
101
Position of tibia in pivot shift and reverse pivot shift.
Pivot shift = subluxed tibia in extension, reduced with flexion
102
CECS pressure thresholds
Resting >15, >30 one minute of exercise and >20 five minutes after exercise

Sports (1 decks)

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