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OITE Review Book > Sports > Flashcards

Sports Flashcards

1
Q

The highest risk to tensile failure of the rotator cuff during throwing is during….

A

deceleration due to the eccentric contraction of the cuff to decelerate the arm.

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2
Q

Second impact syndrome occurs due to….

A

disruption of cerebral autoregulation leading to cerebral vascular congestion, edema and death.

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3
Q

The Immediate Post-Concussion and Cognitive Testing Battery (ImPACT) evaluates an athletes…

A

attention, memory and processing speed.

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4
Q

A player with a stinger can return to play when…

A

they are asymptomatic with painless neck ROM.

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5
Q

The posterior approach to the shoulder (Judet) utilizes the plane between…

A

the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve).

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6
Q

Athletic pubalgia (sports hernia) is due to…

A

repetitive thigh extension and abduction leading to strain of the adductors (specifically adductor longus).

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7
Q

Osteitis pubis

A

repetitive trauma leads to pain and osteolysis/erosion oft the pubic symphysis.

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8
Q

Piriformis syndrome

A

compression of the sciatic nerve (usually runs anterior to the piriformis and posterior to the SERs)

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9
Q

Treatment for a quadriceps contusion

A

immobilization with knee flexion for first 24 hours, then PT

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10
Q

Effect of steroids on cholesterol levels

A

increases LDL and decreases HDL

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11
Q

An os acromiale is usually between…

A

meso and meta acromion.

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12
Q

Calcific tendonitis is deposition of…

A

calcium hydroxyapaptite usually in the supraspinatus tendon. Associated with diabetes.

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13
Q

The initial tear location of a degenerative RC tear is…

A

15 mm posterior to the biceps tendon near the supraspinatus/infraspinatus junction.

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14
Q

RC Tears that should be converted to full thickness and repaired:

A
  1. bursal sided RCT > 3 mm

2. articular sided RCT > 6 mm

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15
Q

What are the landmarks for upper border subscapularis repair?

A

SGHL and CHL

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16
Q

Treatment of irreparable subscapularis tear

A

pectoralis major tendon transfer (puts the musculocutaneous nerve at risk)

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17
Q

The supraspinatus tendon medial to lateral width is normally…

A

12.1-12.7 mm.

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18
Q

The greatest risk factor for nonhealing after RCR is…

A

age > 65 years.

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19
Q

Treatment of irreparable supraspinatus/infraspinatus tear

A

Young, laborer: latissimus dorsi transfer (radial nerve at risk during harvest)

Elder: rTSA

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20
Q

An interscalene block gives risk for…

A

tension PTX (distended neck veins, distant heart sounds, hypotension). Treat with emergent needle decompression in 2nd intercostal space.

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21
Q

What nerve is at risk with inferior placement of the posterior shoulder portal?

A

axillary nerve

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22
Q

Anterosuperior humeral head migration occurs when…

A

both cuff and CA ligament are deficient.

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23
Q

SLAP tear is associated with…

A

GIRD and spinoglenoid cyst.

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24
Q

What nerve is at risk with arthroscopic repair of a SLAP tear?

A

suprascapular nerve (especially when there is medial perforation of the glenoid neck).

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25
Q

During a SLAP repair, if there is fraying of biceps or instability then…

A

perform tenodesis.

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26
Q

Maximum shoulder ABD and ER causes significant tension on…

A

the posteroinferior capsule which can lead to mineralization/exostosis of the posteroinferior glenoid (traction spur or Bennett lesion).

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27
Q

What direction does the humeral head shift during late cocking/early acceleration in a GIRD shoulder?

A

posterosuperior

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28
Q

The long head of the biceps predominantly attaches on the…

A

posterior aspect of the glenoid.

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29
Q

What movement should be avoided after biceps tenodesis?

A

seated active forearm supination with elbow flexed to 90

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30
Q

Little Leaguer’s shoulder

A
  • proximal humerus SHI physeal injury (thru the hypertrophic zone)
  • stop pitching and start PT (progressive throwing program eventually)
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31
Q

Adhesive capsulitis is….

A

contracture of the rotator interval and CHL –> decreased intracapsular volume and loss of the axillary recess

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32
Q

Surgical releases for adhesive capsulitis

A

Release of rotator interval (anterior superior capsule) will increase ER w/ arm by side (which is the most limited ROM typically).

Release of the posterior capsule will increase IR.

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33
Q

What does histology of adhesive capsulitis show?

A

fibroblastic proliferation

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34
Q

Initial workup of adhesive capsulitis should inlcude…

A

HbA1c and TSH levels.

associated with DM (poor prognosis) and hypothyroidism

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35
Q

Medial scpaular winging

A

long thoracic nerve palsy (weak serratus anterior)

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36
Q

Lateral scapular winging

A

spinal accessory nerve palsy (weak trapezius)

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37
Q

Distal clavicle osteolysis is a..

A

stress reaction seen from repetitive trauma (hyperemic response, localized bone resorption, cyst formation).

Typically seen in weightlifters and laborers.

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38
Q

Treatment of distal clavicle osteolysis

A

distal clavicle resection

**refractory to non-operative treatment

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39
Q

Anatomy of the suprascapular notch

A

suprascapular artery runs above the suprascapular ligament, suprascapular nerve runs below

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40
Q

Pec major rupture often involves…

A

a tendinous avulsion off bone during eccentric contraction (downward deceleration during bench press).

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41
Q

The pec major inserts…

A

on the humeral shaft lateral to the bicipital groove (adduction and IR of arm). Innervated by medial and lateral pectoral nerves.

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42
Q

What position should the arm be in for MRI of distal biceps tendon rupture?

A

Elbow flexed, shoulder abducted, and forearm supinated

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43
Q

Within the antecubital fossa, the bicep tendon travels…

A

lateral to the median nerve and posterior to the recurrent radial artery.

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44
Q

A partial distal biceps tendon tear typically occurs on…

A

the radial side of the bicipital tuberosity. If it fails non-op tx, then complete the tear and repair it.

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45
Q

Non-operative tx of a distal biceps tendon tear will result in…

A

30% loss of elbow flexion strength and 40% loss of supination strength.

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46
Q

Single incision distal biceps repair risk

A

LABCN injury (branch of musculocutaneous) and can also injure the raidal nerve/PIN/superficial sensory radial nerve

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47
Q

Dual incision distal biceps repair risk

A

HO

**however, more anatomic placement of the repair

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48
Q

Little Leaguer’s Elbow

A

medial elbow pain 2/2 UCL injury/medial epicondyle stress fx/strain of flexor-pronator muscle group

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49
Q

X-rays of Little Leaguer’s Elbow will show…

A

widening of the medial epicondylar apophysis

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50
Q

A little league pitcher can also develop…

A

an olecranon stress fx which will demonstrate posteromedial elbow pain and widening of the olecranon apophysis. Treat non-op but if fails, then ORIF w/ compression screw.

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51
Q

In pitcher’s elbow (valgus extension overload), there will be…

A

osteophytes developing in the posteromedial tip of the olecranon.

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52
Q

If pitcher’s elbow non-op managment fails, then…

A

treat with arthroscopic excision. The most common reason for repeat surgery is valgus instability (avoid overresection of the olecranon).

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53
Q

The anterior oblique bundle of the MUCL is the…

A

primary stabilizer to valgus stress (moving stress test).

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54
Q

The anterior band of the AOL of the MUCL is…

A

tight in extension and shows isometric strain through elbow ROM.

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55
Q

The posterior oblique band of the AOL of the MUCL is…

A

tight in flexion.

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56
Q

The posterior oblique bundle of the MUCL demonstrates the greatest change in…

A

tension from flexion (tight) to extension.

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57
Q

The UCL is typically reconstructed with…

A

the palmaris longus autograft.

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58
Q

The most common complication of UCL reconstruction is…

A

ulnar neuritis.

59
Q

The docking technique of UCL reconstruction provides…

A

higher rate of return to play and lower complication rate compared to the Jobe and modified Jobe techniques.

60
Q

Posterolateral rotatory instability of the elbow is…

A

LUCL injury from elbow dislocation or iatrogenic injury during debridement of lateral epicondylitis.

Demonstrates instability with chair rise.

61
Q

During lateral elbow dissection, debridement should be kept…

A

anterior to the equator of the capitellum/radial head to avoid injury to the LUCL.

62
Q

Lateral pivot shift

A

forearm supination and valgus stress while bringing the elbow from extension to flexion –> extension dislocates and flexion reduces the radiocapitellar joint

63
Q

LUCL is typically reconstructed with…

A

palmaris longus autograft.

64
Q

Lateral epicondylitis

A

tendinitis at the origin of ECRB which inserts on the base of the 3rd MC.

65
Q

Steroid injection in lateral epicondylitis does…

A

not affect outcomes.

66
Q

Histology of lateral epicondylitis

A

angiofibroblastic hyperplasia/proliferation

67
Q

Medial epicondylitis

A

tendinitis of the flexor pronator mass.

68
Q

Most common coexisting pathology of medial epicondylitis is…

A

ulnar neuropathy.

69
Q

Internal snapping hip (coxa saltans)

A

iliopsoas tendon sliding over the iliopectineal eminence or femoral head.

Provocative test: reproduces popping when the hip is moved from FABER to neutral position

70
Q

Treatment of internal snapping hip

A

cortisone injection, psoas tendon release

71
Q

During hip arthroscopy, the zona orbicularis is the landmark for…

A

the iliopsoas tendon.

72
Q

External snapping hip

A

IT band sliding over the GT

+Ober test (limited hip adduction w/ hip extended)

73
Q

Labral tear w/ FAI is usually…

A

anterosuperior.

74
Q

Anterior impingement in FAI can result in…

A

contra-coup chondral injury on the posteroinferior acetabulum.

75
Q

CAM FAI is typically seen in…

A

athletic male, femoral neck retroversion, alpha angle > 42

76
Q

Pincer FAI is typically seen in…

A

middle-aged females, acetabular retroversion and crossover sign

77
Q

If open surgical hip dislocation is required for FAI, perform a…

A

trochanteric flip osteotomy to protect the MCFA.

78
Q

After open FAI tx, adolescent athletes can return to sport at…

A

7 months.

79
Q

In hip arthroscopy, the most common traction neuropraxia is…

A

pudendal nerve.

80
Q

Hip scope anterolateral portal danger

A

superior gluteal nerve

81
Q

Hip scope posterolateral portal danger

A

sciatic nerve, especially if hip is ER when establishing the portal

82
Q

Hip scope anterior portal danger

A

LFCN, femoral NV bundle

83
Q

Hamstring tear usually occurs at…

A

the myotendinous junction during sprinting (eccentric contraction when hip is flexed and knee extended).

84
Q

Which cells are involved in muscle regeneration after injury?

A

satellite cells

85
Q

During an acute muscle injury, which cells are first to appear?

A

neutrophils

86
Q

In muscle injury, TGF-beta stimulates….

A

myofibroblast proliferation –> increased fibrosis.

87
Q

Which meniscus is more commonly discoid?

A

lateral

20% bilateral

88
Q

X-rays of discoid meniscus show…

A

squaring of the lateral femoral condyle

89
Q

Why is medial meniscus more prone to injury than lateral?

A

it is less mobile (especially posterior horn).

**exception is lateral meniscus injury more common with ACL tear

90
Q

What artery supplies the periphery of the menisci?

A

medial and lateral inferior genicular arteries

91
Q

A smaller meniscal rim width (distance from the tear to the periphery) is associated with…

A

better healing potential due to better blood supply.

92
Q

What is the most sensitive exam finding for meniscus injury?

A

joint line tenderness

93
Q

A baker cyst occurs between…

A

the semimembranosus and medial head of the gastroc.

94
Q

The strongest predictor of outcome after meniscectomy is…

A

the degree of OA.

95
Q

The gold standard for meniscus surgery is…

A

inside-out technique with vertical mattress sutures.

96
Q

Approach for lateral meniscus injury

A

between posterolateral joint capsule (posterior to LCL) and lateral head of gastroc

97
Q

Approach to medial meniscus tear

A

between posteromedial joint capsule (posterior to MCL) and medial head of gastroc

98
Q

What is an absolute contraindication to meniscal transplantation?

A

inflammatory arthritis

99
Q

ACL receives blood supply from the middle genicular artery which arises from…

A

the popliteal artery.

100
Q

What polymorphism is associated with lower risk for ACL rupture in women?

A

COL5A1

101
Q

Bone bruises on MRI in ACL tear is a predictor of…

A

motion deficit following ACL reconstruction.

102
Q

Where are bone bruises in ACL tear?

A

middle 1/3 of lateral femoral condyle and posterior 1/3 of lateral tibial plateau

103
Q

Which autograft has the most tensile stiffness?

A

BTB

104
Q

With hamstring graft, what is the smallest diameter that can minimize risk for rerupture?

A

8.5 mm

105
Q

The bifurcate ridge separates…

A

the femoral attachment sites of anteromedial and posterolateral bundles.

106
Q

Pivot shift test

A

when knee is extended and IR/valgus force is applied, as knee is flexed, lateral plateau slides posteriorly and reduces, producing a clunk

107
Q

Drilling the femoral tunnel via the anteromedial portal allows…

A

more anatomic graft placement compared to transtibial drilling.

108
Q

Resident’s ridge is known as…

A

the lateral intercondylar ridge

109
Q

The most common error in ACL tunnel placement is…

A

anterior femoral tunnel placement which leads to loss of knee flexion as the graft will be tight in flexion

110
Q

Vertical femoral tunnel placement leads to…

A

rotational instability (failure to reconstruct the posterolateral bundle) and impingement agains teh PCL.

111
Q

The tibial tunnel for ACL should be placed…

A

9 mm posterior to the posterior aspect of the intermeniscal ligament.

112
Q

An anteriorly placed tibial tunnel will lead to…

A

a graft that is tight in flexion and notch impingement with extension.

113
Q

The greatest risk factor for recurrent ACL rupture after reconstruction is…

A

patient age.

114
Q

What level of graft-screw divergence decreases pullout strength?

A

> 30 degrees and this leads to fixation failure.

115
Q

What is the most common cause of septic arthritis following ACL reconstruction?

A

S epidermidis

116
Q

Physeal sparing techniques in pediatric ACL reconstruction prevent

A
  1. tibial recurvatum (due to tibial tubercle apophyseal arrest)
  2. prevent LLD or angular deformity (distal femoral physeal arrest)
117
Q

PCL injury is usually due to…

A

direct blow (dashboard injury) or a fall onto a flexed knee with foot in plantarflexion

118
Q

chronic PCL deficiency causes arthritis in the…

A

medial and patellofemoral knee compartments.

119
Q

Blood supply to PCL

A

middle geniculate artery

120
Q

PT for PCL injury should focus on…

A

quad strengthening to counter posterior translation of the tibia.

(and avoid immediate hamstring exercises if you do reconstruct)

121
Q

For PCL reconstruction, the graft should be tensioned at…

A

90 degrees of knee flexion (native AL bundle is tight in flexion).

122
Q

When performing HTO to correct varus malalignment in a PCL deficient knee, increasing tibial slope will…

A

decrease posterior tibial subluxation leading to greater stability.

123
Q

In ACL deficient knee, decreasing the tibial slope will…

A

shift the tibia posteriorly –> less anterior translation of the tibia and more stability.

124
Q

MCL injury is usually a…

A

ligamentous avulsion at the femoral insertion.

125
Q

Do proximal or distal MCL tears heal better?

A

proximal heal better

126
Q

Relative to the popliteus insertion, the femoral origin of the LCL is…

A

posterior and proximal.

(POP is DAD - popliteus is distal, anterior and deep).

127
Q

Relative to the popliteofibular ligament, the LCL inserts….

A

anteriorly on the fibular head.

128
Q

If osgood-schlatter fails non-op management, then tx w/

A

ossicle resection and tibial tubercleplasty.

129
Q

Sinding-Larsen-Johansson syndrome

A

traction apophysitis at the inferior pole of the patella

130
Q

Most common location for knee OCD

A

posterolateral aspect of medial femoral condyle

131
Q

Microfracture acts to…

A

perforate subchondral bone to stimulate mesenchymal stem cells to fill the defect with fibrocartilage (type I collagen)

132
Q

For an OCD, < 2 cm by 2 cm defect, treat with…

A

microfracture or osteochondral autograft

133
Q

For an OCD, > 2x2 cm, treat with…

A

osteochondral allograft transplantation (OAT) or autologous chonrocyte implantation (ACI)

134
Q

in autologous osteochondral mosaicplasty, bone graft will incorporate…

A

into subchondral bone and cartilage will remain viable.

135
Q

Treatment of patellofemoral OCD

A

ACI w/ anteromedial tibial tubercle transfer provides better results than ACI alone

136
Q

Most common injury of the MPFL is…

A

soft tissue avulsion off the femoral attachment.

137
Q

Most common osteochondral injury during a traumatic lateral patellar dislocation is…

A

medial patellar facet.

138
Q

MPFL should be reconstructed in…

A

30 degrees of knee flexion.

139
Q

Lateral patellar instability normally causes…

A

increased contact pressure over the inferior and lateral aspects of the patella.

Anteromedialization of the TT will increase contact over the superior and medial aspects of the patella.

140
Q

Suture anchor fixation of quad tendon rupture results in…

A

smaller gap formation and higher ultimate failure strength than transosseous suture fixation.

141
Q

Tibial stress syndrome (shin splints)

A

traction periostitis of the posterior tibialis and soleus –> medial stress syndrome

(medial tibial stress syndrome is more common)

traction periostitis of tib ant –> anterior stress syndomre

142
Q

In tibial stress syndrome, pain improves with…

A

training running (unlike stress fx).

143
Q

An anterior sided tibial stress fx is…

A

more difficult to heal than posterior side.

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