Questions

Question 1

Name 2 ways to decrease scapular notching with RTSA

Answer 1

inferior placement and inferior tilt of the glenoid component

Question 2

where does the COR move with RTSA and what does this do?

Answer 2

Medial and inferior which tensions the deltoid
- true medial would be medial to the GH joint -lateral placement would be between the GH joint and the COR of the humeral head; this helps to tension the rotator cuff more but doesn’t tension the deltoid as much

Question 3

with ER lag and teres minor dysfunction, what must the patient have to consider a latissmus dorsi transfer?

Answer 3

subscapularis function

Question 4

what nerves are at risk with LD transfer for massive irreparable cuff tears?

Answer 4

radial nerve runs along the anterior surface just 2.3 cm medial to the inferior aspect of the humeral insertion; the axillary and lower subscapular nerve are more proximal and medial and at risk with muscle belly mobilization

Question 5

what are the post operative limitations with TEA?

Answer 5

-lifetime weightbearing restriction of 5 lbs or less; no immediate triceps strengthening

Question 6

what is the most common complication of interscalene blocks?

Answer 6

-temporary paresthesias to the affected arm

Question 7

Glenohumeral arthrodesis is a good operation for someone with a ____ shoulder but intact ____ and ____

Answer 7

• flail
• elbow and wrist
• **the goal of fusion is to have the shoulder in a position that the hand can still reach the mouth

Question 8

what is released with a rotator interval release? what must be seen superiorly to know that you are fully released?

Answer 8

• SGHL and CHL

- CAL

Question 9

what are 2 situations where you wouldn’t want to use a unstrained compared to a semiconstrained total elbow?

Answer 9

1. ligamentous instability

2. rheumatoid arthritis

Question 10

what is the most common complication of arthroscopic capsular release for adhesive capsulitis? how is this prevented?

Answer 10

• recurrent stiffness

- immediate ROM and PT

Question 11

in patients with OA, what is a PE finding that is a clue that wear is more posterior than just central?

Answer 11

loss of external rotation

Question 12

list 4 predictors of humeral head ischemia in order from greatest to least for proximal humerus fractures

Answer 12

1. calcar length less than 8 mm
2. disrupted medial hinge
3. humeral head angulation greater than 45 degrees
4. head split fracture

Question 13

what happens to intra-capsular volume on MRI with adhesive capsulitis?

Answer 13

decreased

Question 14

what are the 3 components of the medial elbow ligamentous complex? what are the bundles of the anterior band and when are they tight? does the posterior band subdivide?

Answer 14

• anterior, posterior, transverse
• anterior bundle, posterior bundle, oblique
  (anterior bundle is isometric while the posterior bundle of the anterior band tightens during flexion)
• no

Question 15

what nerve is most at risk during a laterjet and why is this? what nerve is at risk during graft fixation?

Answer 15

• musculotaneous, as you put retractors around the conjoined tendon
• axillary

Question 16

where do partial distal bicep tears occur?

Answer 16

radial

Question 17

what is the order of injuries with terrible triads as far as soft tissues: anterior capsule, MCL, LUCL?

Answer 17

• LUCL, anterior capsule, MCL

Question 18

with a pec transfer for subscapularis insurrficiency, where is the transfer relative to the conjoint tendon and what nerve can this tether?

Answer 18

• deep

- musculotaneous

Question 19

what is the position for shoulder fusion?

Answer 19

• 20 abduction 30 FF 40 IR

Question 20

shoulder hemiarthroplasty indications

Answer 20

• OA in young patient with preserved glenoid
• AVN
• PH fracture in young patient

Question 21

what is the rate of RCT’s with primary shoulder OA undergoing arthroplasty? what group of patients is this much higher?

Answer 21

• < 10%

- RA

Question 22

with adhesive capsulitis, what is the MRI finding on the coronal sequences?

Answer 22

• loss of the normal axillary recess

Question 23

what is the mclaughlin procedure? who might benefit from this?

Answer 23

• transfer of the LT and subscapularis into the reverse hill sachs defect from someone that had a posterior shoulder dislocation
• posterior shoulder dislocation (electric shock or seizure)

Question 24

what is the cutoff for glenoid retroversion that can be safely eccentrically reamed?

Answer 24

15 degrees

Question 25

what has more complications, RTSA for cuff tears and cuff arthropathy or converting an ATSA to RTSA?

Answer 25

• ATSA to RTSA

Question 26

what is the distance from the upper border of the pectoralis major insertion to the top of the humeral head?

Answer 26

• 56 mm