Sports Flashcards
how is bundle of ACL tight in flexion tested
the anteromedial bundle of ACL is tested with lachman and anterior drawer test
how is bundle of ACL tight in extension tested
the posterolateral bundle of ACL tested with the pivot shift
motion resisted by bundle of ACL tight in flexion
the anteromedial bundle of ACL is primarily an anterior restraint
motion resisted by bundle of ACL tight in extension
the posterolateral bundle of ACL is primarily an rotatory restraint
origin of the superficial MCL
superficial MCL = 3.2 mm proximal and 4.8 mm posterior to the medial femoral epicondyle
these superficial MCL fibers are tight in the first 90* of flexion
the anterior fibers of the superficial MCL are tightened in the first 90* of motion
these superficial MCL fibers are tight in the extension
the posterior fibers of the superficial MCL are tight in extension
position of the superficial MCL relative to the hamstrings
the superficial MCL lies deep to the gracilis and semitendinosus
this portion of the MCL forms the coronary ligaments
the deep fibers of the MCL are intimately associated with the medial meniscus
femoral origin of the LCL relative to the popliteus tendon
posterior superior and superficial to the popliteus
most anterior structure inserting on the proximal fibula
LCL
description of tightness of the LCL in relation to motion
LCL is an anterior structure, and therefore tight in extension; loose in flexion
3 components of the posteromedial corner
multiple insertions of semimembranosus, posterior oblique ligament, and the oblique popliteal ligament
PLC is the primary stabilizer to
tibial external rotation
more C shaped meniscus
medial
more mobile meniscus
lateral
more stable meniscus
medial
more circular meniscus
lateral
tibial external rotation primarily restrained by
the PLC
MPFL origin
just anterior and distal to the adductor tubercle
MPFL insertion
jxn of the proximal and middle thirds of the patella, and onto the undersurface of VMO
approx tensile strength of the ACL
2200 N
this is the center of rotation in the knee joint
the intersection of the ACL and PCL
these fibers dissipate meniscal hoop stresses
longitudinal fibers
ACL deficiency: more meniscal strain in the
posterior horn medial meniscus
fall onto plantarflexed foot
PCL injury
fall onto dorsiflexed foot
patellar injury
mechanism that would make you think PLC injury
hyperextension, varus, and tibial external rotation
an ACL tibial tunnel that is too anterior
limits extension through roof impingement
an ACL tibial tunnel that is too posterior
PCL impingement
an ACL femoral tunnel that is too anterior
limits both flexion and extension
an ACL femoral tunnel that is too posterior
too lax in both flexion and extension
interference screw divergence
> 30* on the femur or 15* on the tibia decreases graft pullout strength
vertical ACL femoral tunnel
AP stability is fine but the rotational stability is not
this is the most sensitive view for revealing early OA
45* flexed standing PA
patellar tilt thresholds
> 15* is too lax
varus/valgus instability at 0 degrees
MCL/LCL and the PCL
chronic MCL radiograph
pellegrini lesion (MFC)
threshold for distal realignment in patellar maltracking
TT-TG distance more than 20mm
meniscus torn more frequently
medial
meniscus torn more frequently with acute ACL tears
lateral
primary determinant of healing potential in meniscal injuries
vascular supply
gold standard for meniscus repairs
inside-out vertical mattress
position of the peroneal nerve during a lateral meniscal repair
posterior to the biceps femoris
position of the saphenous nerve during a medial meniscal repair
anterior to semi-T and gracilis; posterior to inferior border of sartorius
meniscal cysts occur with
horizontal cleavage tears of the lateral meniscus
to be effective meniscal transplants have to be
within 5% of the size of the native meniscus
this can be used to help determine candidacy for meniscal transplant
three phase bone scan; would show subchondral edema if present
this test is most sensitive for diagnosis of an ACL injury
lachman
this test is most correlated to outcome after ACL reconstruction
pivot shift testing
low long to avoid open chain after ACLR
6 wks
this risks damage to the infrapatellar br of saphenous in ALCR
use of transverse incision to get the HS autograft
12mm difference on this is indicative of PCL injury
stress radiographs compared to other side
grade one and isolated PCL injuries
non-op with PT focused on the quads
chronic PCL deficiency
PFJ, medial condyle chondrosis
single bundle PCL tensioning
90*
average distance between screws and popliteal artery during PCLR using tibial inlay technique
20mm
why does the most common MCL injury heal better than the others
most common is injury to the femoral insertion and proximal injuries heal better than distal ones
this is associated with higher failure rates in PLCR
varus malalignment
treatment for chronic PLC injuries
valgus opening osteotomy
incidence of vascular injury after knee dislocation
30-50%
frequency of resolution with OCD lesions
these resolve spontaneously in nearly all juveniles, 50% of adolescents, and no adults
threshold for microfracture
up to 4cm2?
displaced OCD, more than 3mm subchondral bone
ORIF
runners on hills
ITBS; Ober test
best candidate for lateral release PFS
extensive non-op obviously; neutral or negative tilt with 1 quadrant medial glide and 3 quadrants lateral glide
contraindication to distal realignment for patellar maltracking
TT-TG less than 20mm, yes, but also proximal arthrosis of the medial patellar facet
these tibial eminence fractures can be treated closed
displacement less than 3mm or elevation of less than the anterior half
these tibial tubercle fxs need surgery
displaced more than 5mm, immobilize in extension 6 wks
acute mgmt quad contusions
ice, overnight immobilization in 120* flexion
RTP after hamstring strain
when strength is 90% of the other side
what is sports hernia
groin pain from injury to adductor longus or abdominal wall, without classic hernia findings
etiology of sports hernia
combination of abdominal hyperextension and thigh hyperabduction
these can occur as the result of intense training of core muscles
ilioinguinal, obturator, sciatic impingements
when to IMN THE DREADED BLACK LINE
after 6 months of nonop if a tibial stress fx is present it is gettin the bizness
most specific test for stress fxs
MRI
why are labral tears a common cause of mechanical hip pain
they provide the lubrication for the hip joint
incidence of hip labral tears highest in this group
acetabular dysplasia
two things that can cause pincer impingement
inadequate femoral anteversion or acetabular protrusio
how to differentiate external and internal snapping hips
external (i.e. IT band snapping over the GT) does not need rotation like psoas impingement does
anterior hip scope portal danger
LFCN
anterolateral hip scope portal danger
SGN
posterolateral hip scope portal danger
sciatic nerve especially in ER
dorsal foot tingling worse with plantar flexion and inversion
SPN entrapment, where it exits the fascia 12cm proximal to fibular tip
this move can confirm subluxing peroneal tendons
eversion and dorsiflexion
two general rules about the mgmt of achilles ruptures
rerupture is less with surgery, complications are fewer with nonop
thresholds for diagnosing exertional compt syndrome
> 20mmHg after 5 mins, or >30 after 1 min
this test can help differentiate intermittent calf pain and foot paresthesias
popliteal artery syndrome can mimic compt syndrome. Having the pt actively plantarflex the foot can occlude pop art.
ankle sprains usually, occasionally, and rarely involve which ligaments
usually the ATFL, sometimes the CFL, but rarely do they affect the PTFL
what do you have to have to get surgery for your ankle sprain
recurrent symptomatic instability, positive tilt, positive anterior drawer either by exam or xrays
why a high ankle sprain might get surgery
synostosis can occur with these and excision could be performed later
snowboarders fx
lateral talar process fx.
soft tissue cause for posterior ankle impingement
FHL synovitis
lateral talar OCD mechanism
inversion and dorsiflexion
medial talar OCD mechanism
inversion, plantarflexion, and rotation
ankle scope portal that endangers DPN and dorsalis
anterocentral
ankle scope portal that endangers SPN
anterolateral
ankle scope portal that endangers saphenous vein
anteromedial
what is the rotator cable
thickening of the coracohumeral ligament present at the avascular margin of the rotator cuff
these two ligaments in the shoulder can be thought of as performing same action
SGHL and coracohumeral ligaments, as they both limit posterior translation with arm adducted, forward flexed, and internally rotated
five phases of throwing, and two with highest torque
wind-up, cocking, acceleration, deceleration, and follow-through. Late cocking and decel have maximal torque generation
active compression test
10* adduction, forward flexed 90*, max pronation (O’Briens?) indicates SLAP lesion
Yerguson
resisted supination = biceps tendinitis
Speed
resisted forward flexion = biceps tendinitis
anteroinferior labral tear
bankart
posteroinferior labral tear
kim (usually incomplete and concealed)
rehab focus in MDI
closed chain exercises emphasized with AMBRI issues
indication for coracoid transfer in shoulder instability
greater than 25% glenoid deficiency (compared to humeral head)
MDI shoulder that fails rehab?
capsular shift
chronic dislocation with more than 40% articular surface deficit
allograft for the young, prosthesis for the old
lightbulb sign
seen on AP film of posterior GH dislocation
jerk test
posterior force with arm adducted and forward flexed
% of those over 60 with full-thickness RTC tear
1/4
% of those over 70 without a full-thickness RTC tear
35%. Roughly a quarter don’t have a tear after 70
% of asymptomatic tears that become symptomatic
50% within 3 years
This size of PASTA lesion should be considered significant
7mm of exposed footprint is 50%. More than that should be considered significant
mgmt of combined supra and infraspinatus tear
lat dorsi transfer to the GT
arthroscopic evidence of chronic subscap tear
SGHL avulsion, represented by a comma sign
3 requirements for RTSA
RTC tear arthropathy, a working deltoid, and adequate glenoid
more complications, hemi or RTSA for RTCA
RTSA more complications
functional results bt hemi or RTSA for RTCA
RTSA more predictable
can occur after procedure that results in posterior capsular tightness and decreased internal rotation
subcoracoid impingement
mineralization of the posterior inferior glenoid
bennett lesion, seen in internal impingement
athletic etiology for internal impingement
external rotation and anterior translation (throwing) leads to GIRD, which causes posterosuperior shift of the humeral head and results in RTC and posterosuperior labrum impingement
shoulder adduction and internal rotation weakness, palpable defect in a weightlifter
pec major rupture. Surgical repair
adhesive capsulitis mgmt
supervised PT, NSAIDS, +/- injections. Cures most within 12 weeks
when can pt with burner RTP
after complete resolution of symptoms
when can pt with a second burner RTP
not until c-spine films can be obtained
scapular winging
serratus, medial, long thoracic. most resolve spontaneously
deltoid weakness and lateral shoulder parethesias with overhead activity
quadrilateral space syndrome.
pattern of GH wear in OA vs RA
in RA the glenoid is worn centrally, in OA it is posterior
transfer done for medial scapular winging
pec major
transfer done for lateral scapular winging
levator scapulae and rhomboids (Eden-Lange). spinal accessory nerve issue, trapezius.
maybe only radiographic sign of little leaguer shoulder
physeal widening
main muscle affected in tennis elbow
ECRB
why excessive resection avoided in mgmt of tennis elbow
puts LCL at risk
most common nerve injury associated with repair of distal biceps tendon rupture
LABC. Runs parallel to the cephalic vein in the antecubital fossa
two phases of throwing that stress the medial stabilizer of the elbow in flexion
the anterior band of the MUCL has high stress during late cocking and acceleration
this has high sensitivity and specificity for injury to the MUCL of the elbow
moving valgus stress test
who needs surgery for their MUCL rupture
only those high-level athletes that desire a return to sport
this is usually the first ligament disrupted in an elbow dislocation
the LCL
method for testing the elbow LCL
supinate the forearm, apply valgus and axial load. clunk at ~ 40* reduces the radiocapitellar joint (like pivot shift for the elbow)
complaints of PLRI besides inability to do pushup or use arms to pushup from a chair
clicking or locking in extension
elbow portal dangers of anteromedial
median nerve, MABCN
elbow portal dangers of anterolateral
radial nerve, LABC
most common nerve palsy after an elbow scope
ulnar nerve
elbow stiffness associated with this structure?
posterior band LCL?
this would put an athlete with concussion out for the season
a second episode
when a CT head would be obtained in an athlete with a concussion
LOC longer than 5 mins
exam for spondy
SPECT
most common cause of amenorrhea in female athletes
not enough calories in diet
female athlete triad
stress fxs, amenorrhea, eating disorder
most commonly injured organ in sports
kidney
length of time athlete is out after mono infection
3-5 wks, or when splenomegaly resolves, whichever is later
ADI more than X on presport eval of SPECIAL athlete is indication for spinal fusion
> 9mm
the pts that do worst with lat transfers
women, those with poor motion, subscap tears
best pt for a lat dorsi transfer
Young. With irreparable RTC tear, active deltoid, active subscap, and no glenohumeral OA
