OITE - Sports Flashcards
Tunnel malposition, if ACL loose extension and tight in flexion?
Femoral tunnel too anterior
Tunnel malposition, if ACL has blowout potential (ie tight in ext, loose in flexion)?
femoral tunnel too posterior
Tunnel malposition, if ACL has rotational instability?
Femoral tunnel too vertical (in coronal plane)
Where should the tibial tunnel be in line with, for ACL recon?
In line with anterior horn of lateral meniscus
Tunnel malposition, if having notch impingement?
Tibial tunnel too anterior
Tunnel malposition, if having PCL impingement?
Tibial tunnel too posterior
Prevention of ACL injury focuses on what?
- Biomechanics and neuromuscular training.
- Instruct to land more in flexion (rather than in pivot/valgus)
In biomechanical testing, which ACL graft has highest maximum load to failure?
Quadruple semi-T and gracilis tendons (ie hamstring) - 2400 N
What is maximum load to failure of native ACL?
2200 N
What exercise do you avoid in early ACL rehab?
Avoid open kinetic chain knee extension 0-30deg
Acute hemarthrosis in ACL “pop” injury, caused by bleeding from what?
Branches of middle geniculate artery
Pop with effusion in non-contact pivoting, has what likelihood of ACL injury?
> 60-70%
Most common bone bruise pattern in acute ACL tear?
- Lateral fem condyle (middle third)
- Lateral tibial plateau (posterior third)
What would you consider in irreparable cuff tears in young active patients?
Tendon transfers (latissimus) Fat atrophy is a bad sign
Prevalence of asymptomatic uff tears in patients > 60?
30-55% (half partial, half full-thickness)
What item on hx is poor indicator for successful non-op mgt, with cuff tears?
Night pain
What is avg med-to-lateral distance of supraspinatous tendon insertion at its footprint on GT?
14-16 mm
Anterior traumatic shoulder dislocation associated with which MRI finding most commonly?
Antero-inferior labral tear (soft tissue Bankart tear)
Older patient with shoulder dislocation, associated with what other injury?
Rotator cuff tear
Failure to recognize HAGL injury, can lead to what, in shoulder repair?
Recurrent instability
GLAD?
Glenoid labrum articular disruption
ALPSA?
Anterior labral periosteal sleeve avulsion
HAGL?
Humeral avulsion of the glenohumeral ligament
TUBS?
Traumatic anterior shoulder instability
Traumatic Unilateral Dislocations with Bankart lesion requiring Surgery
What is the best view to identify a hill-sachs defect?
- Stryker notch view
- patient supine, arm/elbow flexed toward ceiling, hand placed on top of head
- xray beam directed AP with 10deg cephalic angulation
Xray to pickup a Bony Bankart?
West point view
On OITE, which 2 views (besides stryker notch) are asked for Hill-sachs lesion?
AP and internal rotation
What CVS parameter does dynamic exercise increase? Via which mechanism?
Increased cardiac output via increased SV (stroke volume)
What is iontophoresis (in physical therapy)
Electrical current to drive charged molecules of medicine through skin to deeper tissue
What does isometric exercise mean?
Constant resistance, no change in length
What is isoinertial exercise?
Variable resistance (like free weights)
What is isotonic?
- Constant resistance
- Concentric (shortens)
- Eccentric (lengthens)
Isokinetic exercise?
-Constant velocity (speed)
Plyometric exercise?
Plyometric (power)
-rapid shortening eccentric
What two tests do you use to assess for posterior shoulder instability?
-Jerk test
-Kim test
(97% sensitivity when combined)
What is the light-bulb sign on an AP shoulder xray, suggest?
Posterior shoulder dislocation
Superior baseplate placement in RSA, causes what?
Inferior scapular notching
What must a patient have to be indicated for an RSA?
Adequate deltoid/acromion function
In chronic PCL-PLC injury, what must you correct first?
Alignment (varus)
-obtain long leg alignment films
Dial test with Increased ER at 30 deg knee flexion = ?
isolated PLC injury
Dial test with Increased ER at 30 and 90 deg knee flexion= ?
Combined PLC/PCL injury
What is the relationship of the Popliteus tendon to the LCL (in postero-lateral corner)?
Popliteus is deep (medial), distal, and more anterior
Where does biceps insert relative to LCL on fibular head?
Posterior to LCL
What are contraindications to total shoulder arthroplasty?
- cuff arthropathy
- deltoid dysfunction
- insufficient glenoid stock
- infection, -brachial plexus palsy
With delto-pec open approach, what do you protect in post op period?
Subscap repair
-early PT no active IR , or ER past 30deg
In PCL alignment correction, want to increase or decrease tibial slope?
Increase tibial slope, shift tibia more anterior
Isolated PCL tear, tx with op or non op? Exception?
Non-op (Quad rehab, prone ROM). ALWAYS
Exception: bony avulsion
Suprascapular neuropathy, 2 possible spots?
Suprascapular notch (affects both supra+infraspinatous) Spinoglenoid notch (affects only infraspinatous) -Think Volleyball players (traction injury)
What is the most important bundle in Medial UCL?
-Anterior oblique ligament
-Isometric with ROM
(is most common answer to med UCL questions)
What is little leaguer’s elbow?
- Medial epicondyle stress fx (apophysitis)
- Repetitive Valgus stress and tension overload
Most common meniscal tear?
Medial > lateral
in ACL, lateral more often
On arthroscopy, how can you differentiate between lat and medial meniscus?
- Medial meniscus takes up less SA of tibia than lateral meniscus
- Look at notch, and orientation of ACL
In biceps tendon rupture, what side of distal attachment does a partial tear begin?
- Partial tear beings on radial side
- (tendon must wrap around radius as it attaches to posteriorly situated rad tuberosity)
Most commonly injured nerve in surgical repair of biceps tendon.
Two incision repair: LABCN (more common)
One incision repair: PIN
What structure is most commonly disrupted in acute lateral patellar dislocation
MPFL soft tissue avulsion off medial side
ACute lateral patellar dislocation, which side of patella is bruised most often?
Medial facet of patella
MDI (multi-directional shoulder instability), AMBRI?
AMBRI: atraumatic, multi-directional, rehab, inferior capsular shift sx)
What side effect is more common with creatine
Muscle cramping
Side effects with testosterone?
Testicular atrophy, acne, male pattern baldness, impotence
Patient with inflammatoy arthritis compared with OA of shoulder, what is more likely?
- Medialization of G-H joint line (centralized narrowing of the joint)
- fewer osteophytes
Wilson sign for diagnosis of OCD?
Reproduction of pain with internal rotation of tibia during extension of the knee.
Skeletal immature patient with OCD, initial management?
Conservative, NWB x 6-12 weeks
Most common OCD lesion
Lateral aspect of medial femoral condyle (MFC)
Post op rehab protocol for SLAP repair?
- Sling + Passive ROM only! early
- Advance to closed kinetic chain with scap/cuff strengthening
- (passive, to active assisted, to active)
What nerve roots are involved with long thoracic nerve?
C5, 6, 7
How can you treat medial scapular winging?
Pec transfer
How to treat lateral scapular winging?
Edan Lange - lateralize lavator scapulae and rhomboids
What structures pass through the rotator interval?
CHL, SGHL, biceps
Static stabilizers of the shoulder?
- SGHL (resists anterior translation in adducted arm)
- MGHL (in 45 deg abduction/ER)
- IGHL (in full abduction)
What is sleeper stretch? indicated for?
- Posterior capsular stretch
- GIRD
Repetitive overuse type injury (long distance runner), think what?
Stress fracture
What bones are at right risk for stress fractures?
- tibial shaft
- femoral neck (tension side)
- 5th metatarsal, navicular
Which AROM exercise most appropriate in immediate post-op patellar tendon repair?
- Heel slide (closed chain)
- active flexion (of hamstrings)
- passive extension (gravity for quads)
Tx of type 1 or 2 ACJ separation?
Non-op
Tx for Type IV-VI ACJ sep?
operative
Tx for Type 3 ACJ injury?
Controversial, non-op unless labor/athlete and dominant arm
What is the “PSI” mnemonic for ACJ separation?
For Type 4 to 6 ACJ seps, PSI tire of someone who falls of bike.
4 - posterior
5 - subcutaneous
6 - inferior to coracoid
What is the essential lesion in adhesive capsulitis?
- CHL
- Rotator interval capsule
Treatment for MRSA skin pustule?
Topical mupirocin
What is the most common cause of graft failure following ACL reconstruction
Tunnel malpositioning
