Shoulder

Question 1

Adult >40 with shoulder dislocation has high rate of:

Answer 1

rotator cuff tear

Question 2

Which phase of throwing has highest tensile strain on the cuff?

Answer 2

deceleration phase

Question 3

Size of supraspinatus footprint

Answer 3

12.7mm on anterosuperior greater tuberostiy. Thus a 50% tear is 6mm long.

Question 4

Most rotator cuffs occur on this side of the cuff:

Answer 4

articular side. Because articular side is 50% tensile strength of the bursal side.

Question 5

Which cuff side is most vascular?

Answer 5

Bursal side, therefore more likely to heal

Question 6

Contents of the rotator interval

Answer 6

SGHL, CHL, capsule

Question 7

The Rotator Cable

Answer 7

fibers from the CHL, perpendicular to the Supraspinatus,

Question 8

see a subscap tear and think…

Answer 8

subcoracoid impingement

Question 9

Massive rotator cuff tear definition

Answer 9

> 5cm, t ypically involving more than 1 tendon

Question 10

Ellman Classification of Partial Cuff Tears

Answer 10

1: <3mm/<25%
2: 3-6mm/25-50%
3. >6mm/>50%
subclassified as A (articular) B (bursal) or I (intradentinous)

Question 11

Goutallier Classification

Answer 11

Cuff Atrophy

1. Normal tissue
2. some fatty streaks
3. more muscle than fat
4. more fat than muscle

Question 12

Night pain in a rotator cuff tear suggests:

Answer 12

worse non-operative otucomes

Question 13

Medial biceps tendon subluxation suggest:

Answer 13

Subscapularis tear

Question 14

Tangent sign:

Answer 14

supraspinatus atrophy. Does not cross a line between the scapular spine and the coracoid on the sagittal MRI

Question 15

What %age of asymptomatic patients >60 have a RCT?

Answer 15

55%

Question 16

What size bursal sided cuff tear needs repair?

Answer 16

> 25%

msut be treated more aggressively than articular sided tears

Question 17

What size aritcular sided cuff tear needs repair?

Answer 17

> 50% (PASTA lesion)

if less than this and failing PT, can do a selective subacromial decompression and debridement. Has a 5% failure rate

Question 18

Best treatment for irreparable posterosuperior tears with intact subscap?

Answer 18

latissimus dorsi transfer

best in a young laborer

Question 19

most common cause of RCR failure is:

Answer 19

failure to heal, causing suture pullout from the repaired tissue

Question 20

Does early vs delayed motion affect outcomes of Rotator cuff repair?

Answer 20

no difference in clinical outcomes or healing with early vs delayed motion protocols. PT and guided early ROM exercises do not reduce stiffness one-year post-operatively

Question 21

TUBS Means:

Answer 21

traumatic unilateral dislocations with a Bankart requiring surgery.

one of the most common shoulder injuries

Question 22

Shoulder instability recurrence rates related to age:

Answer 22

90% chance of recurrence in patients <25 years old

Question 23

Avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid

Answer 23

Bankart lesion

Question 24

HAGL Lesions:

Answer 24

occurs in patients slightly older than those with Bankart lesions, but much less common than Bankart

treatment = open repair

Question 25

Anterior labral periosteal sleeve avulsion (ALPSA)

Answer 25

issue is the labrum can heal medially along the medial glenoid neck

Question 26

Hill-Sachs defect

Answer 26

chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim

• seen in 80% of traumatic dislocations and 25% of trumatic subluxations
• clinically significant if it engages the glenoid

Question 27

% Glenoid bone loss considerations for surgical management of instability:

Answer 27

<20% glenoid bone loss can be managed with arthroscopic Bankart repair
>20% bone loss requires glenoid augmentation such as open coracoid transfer

Question 28

Failure risks for arthroscopic bankart repair:

Answer 28

• inverted pear shape glenoid
• engaging Hill-Sachs lesion

67% recurrence in all, 89% recurrence in athletes… therefore contact athletes require open surgery and bone-block reconstruction (Burkhart 2000)

Question 29

Open vs Arthroscopic Bankart Repairs?

Answer 29

scopes have slightly better post op ROM, slightly higher recurrence rates. Slightly lower return to sport and return to work rates

Question 30

Recurrence rate for bankart repairs that have concomitant glenoid defects?

Answer 30

at least 60% with glenoid defects of 20-30%

Question 31

What is Remplissage procedure?

Answer 31

advancement of the infraspinatus into the engaging Hill-Sachs defect.
- for >25% humeral head deficiency

Question 32

IF shoulder has crepitus in the 90/90 position, think

Answer 32

engaging Hill-Sachs lesion

Question 33

Anatomic structures involved in Bankart tear:

Answer 33

• anteroinferior glenoid labrum
• MGHL
• IGHL

Question 34

Anatomic area affected by Hill-Sachs lesion?

Answer 34

Posterosuperior humeral head

Question 35

In a HAGL lesion, what is torn?

Answer 35

the anterior band of the IGHL

Question 36

Pec transfer for subscap deficiency - results?

Answer 36

better for anterior instability than for arthroplasty

Question 37

Best xray for viewing a Hill-Sachs

Answer 37

Stryker Notch View

• arm flexed up, hand resting on head
• A-P xray with 10 deg cephalad angulation

Question 38

SH-III proximal humerus fractures in the adolescent: known copmlication?

Answer 38

AVN
- with observation they tend to revascularize and do well without long-term issues
(JDZ 1997)

Question 39

Anterior Labroligamentous Periosteal Sleeve Avulsion Injuries: Treatment

Answer 39

the “ALPSA” lesion

- needs periosteal mobilization and fixation to the anterior glenoid neck in order to obtain glenohumeral stability

Question 40

How do you treat a HAGL lesion?

Answer 40

Open capsular repair.

No scope!