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JT's Epic Cards > Sports > Flashcards

Sports Flashcards

1
Q

What view do you get to identify acromial morphology?

A

supraspinatus outlet view

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2
Q

What are the radiographic findings with subacromial impingement? (6)

A
  1. proximal humerus migration;
  2. traction osteophytes;
  3. CA lig. calcification;
  4. GT cysts;
  5. Type III acromion;
  6. OS acromiale
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3
Q

What is the most common RTC tendon to calcify?

A

supraspinatus

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4
Q

What are the treatment options for calcific tendinitis?

A
  1. NSAID, physio;
  2. steroids;
  3. ECSWT;
  4. decompression - a) open, b) arthroscopic - only as last resort
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5
Q

What is the medial-to-lateral distance of the SS on the footprint?

A

14-16 mm

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6
Q

What is the Seebauer classification of RTC arthropathy?

A

Type IA - centered, stable;

Type IB - centered, medialized;

Type IIA - decentered, stable;

Type IIB - decentered, unstable

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7
Q

How do you perform a zanca view?

A

cephalic tilt 10-15 degrees from AP + 50% penetration

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8
Q

What is the most reliable P/E test for AC joint pathology?

A

cross body adduction test

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9
Q

What xray shows glenoid bone loss in shoulder?

A

West Point view

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10
Q

What xray shows Hill-Sachs lesion best?

A

Stryker view

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11
Q

How do you treat an overtightened anterior shoulder for stabilization post-procedure?

A

Z-lengthening of subscapularis

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12
Q

What are the complications of Putti-Platt and Magnuson-Stack procedures for anterior stabilization? (2)

A
  1. decreased external rotation;
  2. posterior loading + glenoid wear
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13
Q

How do you perform a Stryker notch view?

A

hand placed on top of head with 10 degrees of cephalic tilt

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14
Q

What is the most common arthroscopic finding with shoulder dislocation?

A

anteroinferior labral/capsular avulsion

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15
Q

What are the primary stabilizers to posterior shoulder D/L?

A
  1. posterior band IGHL;
  2. subscapularis;
  3. CH ligament
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16
Q

What are the indications for a McLaughlin procedure?

A
  1. chronic dislocation <6 months old;
  2. reverse Hill-Sachs defect <50%
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17
Q

What are the indications for hemiarthroplasty for posterior D/L of the shoulder?

A
  1. chronic dislocation >6 months old;
  2. GH OA;
  3. head collapse;
  4. reverse Hill-Sachs defect >50%
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18
Q

What are the MRI findings of MDI?

A
  1. patulous inferior capsule;
  2. Bankart;
  3. Kim lesion;
  4. bony erosion of glenoid
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19
Q

What must be addressed when attempting to operate on an MDI shoulder?

A
  1. inferior capsular shift;
  2. plication of redundant capsule in a balanced fashion;
  3. rotator interval closure;
  4. anterior/posterior lesions
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20
Q

Name 3 complications of Luxatio Erecta?

A
  1. axillary nerve palsy;
  2. axillary artery thrombosis;
  3. RTC tear
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21
Q

Where is the most common attachment of the biceps anchor?

A

posterior to the 12 o’clock position

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22
Q

What is the Snyder classification of SLAP tears?

A

Type I - fraying, intact anchor;

Type II - fraying with detached anchor (most common);

Type III - bucket handle with intact anchor;

Type IV - bucket handle with detached anchor

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23
Q

What intraoperative test can be done to confirm presence of a SLAP tear?

A

“peel back” test - lift off of biceps anchor with 90 degrees of external rotation and abduction

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24
Q

What are physical therapy indications for a SLAP?

A
  1. GIRD;
  2. scapular dyskinesis;
  3. RTC strengthen/ROM
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25
Q

What shoulder condition is associated with internal impingement of the shoulder?

A

GIRD

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26
Q

What is a Bennett lesion in the shoulder?

A

glenoid exostosis of posterior glenoid caused by internal impingement

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27
Q

What are the spectrum of diseases associated with internal impingement of the shoulder?

A
  1. fraying of the posterior cuff (PASTA lesion);
  2. posterior superior labral lesions;
  3. hypertrophy and scarring of posterior capsule/glenoid;
  4. posterior glenoid cartilage damage
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28
Q

What nerve is at most risk with posterior capsular release?

A

inferior suprascapular nerve (infraspinatus)

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29
Q

What are the operative indicators for internal impingement?

A
  1. failed 6/12 non-op;
  2. PASTA >50%;
  3. Bennett lesions
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30
Q

What are associated conditions with GIRD? (3)

A
  1. GH instability;
  2. SLAP;
  3. internal impingement
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31
Q

What specific MRI do you need in GIRD to see associated lesions?

A

MRI in ABER view

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32
Q

What are 3 specific physical therapy maneuvers for GIRD Tx?

A
  1. posterior capsule stretch (sleeper’s);
  2. pectoral minor stretch;
  3. subsar/seratus strengthen

(Need 6 months physical therapy)

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33
Q

What is the definition of little leaguer’s shoulder?

A

Salter Harris Type I # of proximal humerus

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34
Q

What is the weakest portion of the growth plate?

A

hypertrophic zone

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35
Q

What are the complications of undiagnosed little leaguer’s shoulder? (2)

A
  1. growth arrest;
  2. angular deformity
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36
Q

What are the most common at risk sports for posterior labral tear?

A
  1. football lineman (blocking);
  2. weightlifters (bench press)
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37
Q

What is the diagnostic test of choice for posterior labral tear?

A

MRA

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38
Q

What are the contraindications to TSA in GH OA? (4)

A
  1. active infection;
  2. deltoid dysfunction;
  3. insufficient bone stock;
  4. RTC arthropathy
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39
Q

What is the Walch classification of glenoid wear?

A

Type A - concentric wear;

Type B - biconcave wear;

Type C - retroversion wear >25 degrees with posterior subluxation

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40
Q

What is the position of fusion of the shoulder?

A

30 degrees flexion;

30 degrees IR;

30 degrees ABD

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41
Q

What are the 2 most important anatomical structural implications in frozen shoulder?

A
  1. corahumeral ligament;
  2. rotator interval
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42
Q

What is the pathology behind frozen shoulder?

A

fibroblastic proliferation

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43
Q

What are 5 common associated conditions with adhesive capsulitis?

A
  1. diabetes;
  2. thyroid disease;
  3. previous Sx (lung/breast);
  4. prolonged immobilization;
  5. prolonged hospitalization
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44
Q

What is the first motion loss in adhesive capsulitis?

A

ER

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45
Q

What is the important MRI finding in frozen shoulder?

A

loss of inferior axillary recess

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46
Q

What is the classification of shoulder AVN?

A

Cruess classification:

Stage I - normal xray, changed on MRI;

Stage II - sclerosis, no collapse;

Stage III - crescent sign;

Stage IV - flattening and collapse;

Stage V - degeneration extends to glenoid

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47
Q

What is the most common site of humeral head AVN?

A

superior middle articular portion

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48
Q

What is the Tx for AVN humeral head and associated?

A

Creuss I and II - core decompression;

Creuss III - humeral head resurfacing if enough remaining epiphyseal bone stock;

Creuss III and IV - hemiarthroplasty;

Creuss V - TSA due to involvement of glenoid

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49
Q

What are 4 testable causes of scapulothoracic crepitus?

A
  1. osteochondroma;
  2. elastofibroma dorsi;
  3. skapulothoracic dyskinesis;
  4. bursitis
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50
Q

What are the operative options for scapulothoracic crepitus?

A
  1. removal of osseus lesions;
  2. removal of ST tumors;
  3. bursectomy;
  4. resection of scapular border
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51
Q

Define/Direction/Nerve of:

  1. medial scapular winging;
  2. lateral scapular winging
A
  1. medial winging - absent pull of serratus (long thoracic);
  2. lateral winging - absent pull of trapezius (spinal accessory)
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52
Q

What is the most common cause of lateral scapular winging?

A

iatrogenic damage to spinal accessory nerve due to neck Sx

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53
Q

What is the most common cause of medial scapular winging?

A

repetitive stretch injury with head tilted away during overhead activity

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54
Q

What are the Tx options for lateral scapular winging?

A
  1. trap. strengthening;
  2. nerve exploration if nerve injury;
  3. Eden-Lange transfer - lateralize levator scapula/rhomboids (medial to lateral transfer);
  4. scapulothoracic fusion
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55
Q

What are the causes of suprascapular notch entrapment?

A
  1. ganglion cyst;
  2. transverse scapular ligament entrapment;
  3. callus from scapular #;
  4. tumor
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56
Q

What are the indications for suprascapular nerve decompression?

A
  1. failure of 1 year non-op;
  2. compressive mass in suprascapular notch
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57
Q

What are the causes of compression at the spinoglenoid notch?

A
  1. posterior labral tears;
  2. spinoglenoid ligament entrapment;
  3. ganglion cyst;
  4. traction injury
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58
Q

What approach do you use to decompress the spinoglenoid notch?

A

posterior approach to shoulder

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59
Q

What surgical techniques to address sites of compression in TO syndrome? (5)

A
  1. repair clavicle/1st rib non union;
  2. transaxillary 1st rib resection (90% good results);
  3. scalene takedown;
  4. pectoralis minor tenotomy;
  5. release fibroanomalous bands
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60
Q

What 2 xray films must you order in suspected TO syndrome?

A
  1. C-spine xray - R/O cervical rib;
  2. chest xray - R/O Pancoast tumor
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61
Q

Name 3 provocative tests for TO syndrome and describe each.

A
  1. Wright-Aber with neck away causes a) loss of pulse and b) reproduction of symptoms;
  2. Adson - extend arm with neck extended toward affected arm = loss of pulse and reproduction of symptoms;
  3. Roos - open and close hands overhead = loss of pulse and reproduction of symptoms
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62
Q

What is Paget-Schroetter syndrome?

A

TO syndrome due to SC vein compression due to scalene hypertrophy

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63
Q

What are vascular causes of TO syndrome? (2)

A
  1. compressed subclavicle vessel;
  2. aneurysm
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64
Q

What are the causes of TO syndrome? (5)

A
  1. scalene abnormalities;
  2. scapular ptosis;
  3. clavicle/1st rib malunion;
  4. cervical rib;
  5. vertebrae TP
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65
Q

What are the pathophys. principles of TO syndrome?

A

compression of NV bundle as it passes over 1st rib or through scalenes

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66
Q

What is the Tx algorithm for TO syndrome induced hand emboli?

A
  1. acute heparinization or TPA;
  2. 7-10 days of neparin;
  3. 3/12 of warfarin or equivalent
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67
Q

What are the risk factors for Brachial Neuritis/Parsonage-Turner syndrome/neurologic amyotrophy? (5)

A
  1. viral infections;
  2. immunizations;
  3. medications;
  4. extreme stress;
  5. autoimmune disease
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68
Q

What are the 1 year and 3 year outcomes for Brachial Neuritis?

A

35% recover at 1 year;

90% recover at 3 years

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69
Q

What are the contents of the quadrilateral space? (2)

A
  1. axillary nerve;
  2. posterior humeral circumflex artery
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70
Q

What are the boundaries of the quadrilateral space? (4)

A
  1. superior - teres minor;
  2. inferior - teres major;
  3. medial - long head of triceps;
  4. lateral - humerus
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71
Q

What is the Tx algorithm for quadrilateral space syndrome?

A
  1. non-op - most recover within 3-6/12;
  2. Sx nerve decompression
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72
Q

What are the indications for quadrilateral space syndrome decompression? (3)

A
  1. failed non-op;
  2. sig. weakness + disability;
  3. space occupying lesion
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73
Q

Describe the Sx technique for open quadrilateral space syndrome.

A
  1. lateral decubitus;
  2. 3-4 cm incision over QS;
  3. identify posterior border of deltoid;
  4. retract sup/lat;
  5. identify fat;
  6. avoid/protect axillary nerve/PHC artery
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74
Q

What are 3 at risk structures for athletes with scapulothoracic dyskinesis?

A
  1. labrum;
  2. RTC;
  3. capsule
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75
Q

What is the physical therapy emphasis for scapulothoracic dyskinesis? (4)

A
  1. core strength;
  2. scapular stabilization;
  3. RTC strength;
  4. teaching throwing mechanism
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76
Q

What is the most common location for pec. major rupture?

A

tendinous avulsion

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77
Q

What are the indications for non-op Tx of pec major rupture? (3)

A
  1. partial ruptures;
  2. musclotendinous ruptures;
  3. low demand patients
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78
Q

What are the indications for open exploration + pec major repair? (2)

A
  1. tendon avulsions from humerus;
  2. high level athletes
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79
Q

What are the risk factors for triceps rupture?

A
  1. systemic illness (osteodystrophy);
  2. steroids;
  3. fluoroquinolone;
  4. chronic olecranon bursitis;
  5. previous triceps surgery
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80
Q

What is the xray hallmark of triceps rupture?

A

“flake sign” - self explanatory

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81
Q

What are the indications for triceps repair? (2)

A
  1. complete avulsions;
  2. >50% partial tears with weakness to gravity
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82
Q

What are the indications for non-op Tx of triceps tears?

A
  1. partial tears - able to extend against gravity;
  2. low demand patients with multiple comorbidities
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83
Q

What are the contraindications to shoulder hemarthroplasty? (4)

A
  1. infection;
  2. unmotivated patient;
  3. neuropathic joint;
  4. CA lig. compromise (AS escape)
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84
Q

How to perform humeral prosthesis implant height?

A
  1. 3-5 mm below top of humerous;
  2. 10 mm below top of articular surface of HH;
  3. biceps/deltoid tension;
  4. recreate calcar;
  5. PMI 53-56 mm below top of prothesis;
  6. template off contra shoulder;
  7. measure native head
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85
Q

What are 3 key points to tuberosity reduction in shoulder-hemi for trauma?

A
  1. anatomic reduction;
  2. secure tuberosities to shaft/prothesis;
  3. autograft from head decreases pull out of tuberosities
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86
Q

What is the TSA survival at 10 years?

A

93%

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87
Q

What are 6 contraindications to TSA for OA?

A
  1. rotator cuff arthropathy;
  2. irrepairable RTC;
  3. deltoid dysfunction;
  4. insufficient glenoid bone stock;
  5. active infection;
  6. brachial plexopathy
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88
Q

What is the most common complication of TSA?

A

axillary nerve neuropraxia

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89
Q

What is the definition and Tx of anterior capsule contraction in TSA?

A
  1. ER <40 degrees;
  2. Z-plasty of capsule/subcap
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90
Q

What is the most common cause of TSA failure?

A

glenoid loosening

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91
Q

What are the indications for RevTSA? (6)

A
  1. pseudoparalysis;
  2. incompetent coraco acromial arch;
  3. low functional patient;
  4. age >70 yoa;
  5. sufficient bone stock;
  6. working deltoid muscle
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92
Q

What are the contraindications to RevTSA? (4)

A
  1. deltoid deficiency;
  2. bony acromion deficiency;
  3. glenoid osteoporosol deficiency;
  4. active infection
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93
Q

What are the risk factors for D/L with RevTSA? (6)

A
  1. irreparable subscap (#1);
  2. proximal humeral bone loss;
  3. prior failed arthroplasty;
  4. proximal humeral non-union;
  5. pre-op chronic D/L;
  6. RTC NOT implicated
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94
Q

What are the indications for shoulder fusion? (8)

A
  1. paralytic disorders;
  2. brachial plexopalsy;
  3. irreparable cuff/deltoid;
  4. TSA salvage;
  5. tumor resection;
  6. post-chronic;
  7. recurrent shoulder instability
  8. paralytic D/O in infancy
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95
Q

What are the contraindications to shoulder arthrodesis? (7)

A
  1. ipsilateral elbow arthrodesis;
  2. contralateral shoulder arthrodesis;
  3. lack of scapulothoracic motion;
  4. trap/levator/serratus paralysis;
  5. charcot;
  6. neurology;
  7. elderly patients
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96
Q

What plate should you use for shoulder fusion?

A
  1. 10 hole 4.5 mm pelvic reconstruction plate;
  2. compression screws placed across GH;
  3. screw from scapular spine to coracoid
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97
Q

Where does the anterior capsule attach to the coronoid?

A

6 mm distal

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98
Q

Where is the spiral groove for the radial nerve located?

A

13 cm proximal to distal humerus articulation

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99
Q

What are the static stabilizers of the elbow? (5)

A
  1. UH joint;
  2. anterior bundle of the MCL;
  3. LCL complex (includes LUCL);
  4. RC joint;
  5. capsule
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100
Q

What is the optimal position for unilateral elbow arthrodesis?

A
  1. 90 degrees flexion;
  2. 0-7 degrees of valgus.

Do not fuse RC joint

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101
Q

What is the optimal position for bilateral elbow arthrodesis?

A
  1. 110 degrees flexion (feeding);
  2. 65 degrees flexion (hygiene)
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102
Q

What are 3 physical exam tests for MCl instability of elbow?

A
  1. valgus stress test - 20-30 degrees;
  2. milking maneuver - pull on thumb @ 90 degrees flex + supinate;
  3. moving valgus stress test - #1 + #2 through full arc of motion
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103
Q

What is the diagnostic xray for MCL elbow rupture?

A

gravity stress with >3 mm opening

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104
Q

What is the gold standard to diagnose elbow MCL injury?

A

MRA with capsular “T-sign” + fluid extravasation

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105
Q

Where do partial distal biceps avulsions occur?

A

radial side of tuberosity footprint

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106
Q

What are the indications for MCL reconstruction? (2)

A
  1. high level throwers who want to return to competitive sports;
  2. failed non-op management - patient willing extensive rehab.
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107
Q

What is the best reconstruction method for MCL reconstruction?

A

humeral docking better than figure 8

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108
Q

What are the complications for MCL elbow reconstructive Sx? (5)

A
  1. ulnar nerve injury;
  2. MABC nerve injury;
  3. # ulnar/medial epicondyle;
  4. elbow stiffness;
  5. cannot regain pre-op throwing ability
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109
Q

What are the 4 ligaments of the LUCL complex?

A
  1. LUCL;
  2. radial collateral lig;
  3. accessory LCL;
  4. annular lig.
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110
Q

What are the 5 tests for PLRI?

A
  1. lateral pivot shift - arm overhead, supinated, valgus, flexing;
  2. apprehension test;
  3. chair rise test;
  4. table-top relocation test;
  5. push-up test
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111
Q

What are 3 key technical points for LUCL reconstruction?

A
  1. must cross posterior 25% of radial head;
  2. suture to capsule to augment repair;
  3. secured @ neutral rotation + 45 degrees of flexion
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112
Q

What are the pathological results from valgus extension overload syndrome? (4)

A
  1. chondrolysis (RC joint);
  2. posteromedial osteophytes (humerus/olecranon);
  3. loose bodies;
  4. MCL attenuated
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113
Q

What is the most common associated condition with valgus extension overload syndrome?

A

cubital tunnel syndrome (25% of cases)

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114
Q

What is the contraindication to arthroscopic debridement in valgus extension overload syndrome?

A

MCL instability or insufficiency

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115
Q

What is complication of arthroscopic debridement in valgus extension overload syndrome?

A

too much olecranon resection can lead to valgus instability

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116
Q

How much loss of supination strength is associated with distal biceps avulsion?

A

50%

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117
Q

How much 1. supination; 2. flexion; 3. grip strength do you lose in distal biceps avulsion Tx non-op?

A
  1. sup - 50%;
  2. flex. - 30%;
  3. grip - 15%
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118
Q

What is the most common nerve injury in distal biceps repair?

A

LABCN (lateral antebrachial cutaneous nerve)

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119
Q

What muscle origin is primarily implicated in tennis elbow?

A

ECRB may extend to ECRL/ECU

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120
Q

What is the histopathology of tennis elbow?

A

angiofibroblastic hyperplasia (disorganized collagen)

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121
Q

What is the most common associated condition with tennis elbow?

A

radial tunnel syndrome

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122
Q

What are 3 complications of ECRB release and debridement for tennis elbow?

A
  1. LUCL injury;
  2. radial nerve injury;
  3. missed radial nerve entrapment syndrome
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123
Q

What are 2 common associated conditions with medial epicondylitis?

A
  1. ulnar neuropathy;
  2. MUCL insufficiency
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124
Q

What is the open operative Tx for medial epicondylitis?

A
  1. flexor pronator splits;
  2. debride involved tendon;
  3. re-attach diseased tendon;
  4. assess ulnar nerve +/- transposition
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125
Q

What is the most common nerve injury following open medial epicondylitis debridement?

A

MABCN

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126
Q

What is the most common location of OCD of the elbow?

A

capitellum of dominant arm

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127
Q

What are risky activities for OCD elbow?

A
  1. gymnast;
  2. weight lifter
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128
Q

What is the radiographic difference between Panner disease and OCD elbow?

A
  1. Panner - irregular epiphysis;
  2. OCD - well defined subchondral lesion
129
Q

What is functional elbow flex/ext?

A

30-130 degrees

130
Q

What are contraindications to elbow arthroscopy?

A
  1. prior trauma;
  2. surgical scarring;
  3. previous ulnar nerve transposition
131
Q

Which portal is usually avoided in elbow arthroscopy and why?

A

postero medial portal - 2 degrees to ulnar nerve proximity

132
Q

What are the 2 most common nerve palsy in elbow arthroscopy?

A
  1. ulnar - 1st;
  2. radial - 2nd
133
Q

What are the contraindications to elbow arthroplasty? (4)

A
  1. active infection;
  2. charcot joint;
  3. poor neurologic control;
  4. active young patient <65 yoa
134
Q

What is the 10 year survivorship for TEA in RA patients?

A

93%

135
Q

What are the complications of TEA? (7)

A
  1. aseptic loosening (6%);
  2. infection (8%);
  3. instability (7-19%);
  4. bushing wear (VV >10 degrees concerning);
  5. wound healing;
  6. ulnar neuropathy;
  7. triceps insufficiency
136
Q

What are the indications for ORIF of an ASIS avulsion? (2)

A
  1. displacement >3 cm;
  2. painful non-unions
137
Q

What are the 2 most common sports for sports hernia/athletic pubalgia?

A
  1. hockey;
  2. soccer
138
Q

What is the mechanism of injury for sports hernia?

A
  1. abdominal hyperextension;
  2. thigh abduction
139
Q

What is the physical exam for sports hernia?

A
  1. tender along adductor longus;
  2. pain with resisted situp;
  3. pain with valsalva
140
Q

What are 3 Tx options for sports hernia?

A
  1. non-op/PT - 6-8/52;
  2. pelvic floor repair or adductor release/rectus recession;
  3. decompression of genital branch of genitofemoral nerve
141
Q

What are 4 anatomical anomalies that may cause piriformis syndrome?

A
  1. bipartite piriformis;
  2. variations in sciatic nerve path;
  3. tumor;
  4. aneurysm of gluteus medius
142
Q

What is the cause of external snapping hip? (1)

A

IT band over GT

143
Q

What are the causes of internal snapping hip? (4)

A
  1. (femoral head) iliopsoas snaps over IT;
  2. prominent iliopectineal ridge;
  3. exostosis of LT;
  4. iliopsoas burst
144
Q

What are the causes of intra-articular snapping hip? (2)

A
  1. loose bodies (synovial chondromatosis);
  2. labral tears
145
Q

What are the operative options for snapping hips:

  1. external;
  2. internal;
  3. intra-articular
A
  1. external - excision GT bursa + IT Z-plasty;
  2. internal - iliopsoas release;
  3. intra-articular - hip scope - loose bodies or labral repair
146
Q

What is the most common location of hip labral tear?

A

anterosuperior labrum

147
Q

What is the imaging study of choice for hip labral tears?

A

MRA +/- Dx injection

148
Q

What are the anatomical characteristics of a CAM FAI lesion? (4)

A
  1. decreased head to neck ratio;
  2. aspherical femoral head;
  3. decreased femoral offset;
  4. femoral neck retroversion
149
Q

What is the key xray needed to obtain for femoral coverage?

A

false profile view

150
Q

What is the complication of femoral osteochondroplasty for FAI?

A

femoral neck #

151
Q

What depth minimizes the risk of femoral neck # for femoral osteochondroplasty?

A

<30%

152
Q

Which training modality usually leads to GT bursitis?

A

training on banked surfaces

153
Q

What are the contraindications to hip arthroscopy?

A
  1. advanced DJD;
  2. hip ankylosis;
  3. joint contracture;
  4. osteoporatic bone;
  5. sig. acetab. protrusio
154
Q

What causes superio gluteal nerve injury during hip scopes?

A

anterolateral portal

155
Q

What causes sciatic nerve injury in hip scopes?

A

posterolateral portal

156
Q

What causes LFCN injury during hip scopes?

A

anterior portal

157
Q

What structure is the intra-articular landmark for the psoas tendon?

A

zona orbicularis

158
Q

What position do you put the hip during posterolateral portal placement during hip arthroscopy?

A

internal rotation

159
Q

What is the most common location for hamstring injuries?

A

myotendinous junction

160
Q

What cell is responsible for muscle healing post muscle injury?

A

satellite cells

161
Q

When do you consider return to sport following hamstring injuries?

A

when active 90% hamstring strength compared to contralateral side

162
Q

How do you immobilize a player with quads contusion?

A

120 degree knee flexion X 24 hours, then therapy with hinged brace

163
Q

What are 2 complications following quads contusions?

A
  1. compartment syndrome;
  2. myositits ossificans
164
Q

What is the most common compartment affected in exertional leg compartment syndrome?

A

anterior leg compartment

165
Q

What diagnostic test to confirm exertional leg compartment syndrome?

A

compartment pressures

166
Q

What pressures need to be measured when establishing exertional leg compartment syndrome? (3)

A
  1. resting pressure;
  2. immediate post-exercise pressure;
  3. continuous post-exercise pressure X 30 mins.
167
Q

What are the diagnostic criteria for exertional leg compartment syndrome?

A
  1. resting pressure >15 mmHg;
  2. immediate post-exercise pressure >30 mmHg;
  3. continuous post-exercise does not return to normal or stays above 15 mmHg @ 15 min. post-exercise
168
Q

What is the most common locations for tibial stress syndrome? (shin splints)

A

medial (posteromedial)

169
Q

What are the 2 types of femoral neck stress #s?

A
  1. compression side;
  2. tension side
170
Q

What is the most common associated condition with femoral neck #s?

A

female athlete triad

171
Q

What is the modality of choice to Dx femoral neck stress #?

A

MRI

172
Q

What is the Tx of compression side femoral neck stress #s?

A

PWB + activity restricted until Sx resolve

173
Q

What is the Tx of tension side femoral neck stress #s?

A

ORIF with percutaneous screws

174
Q

What are the risk factors for femoral shaft stress #s? (3)

A
  1. metabolic bone disease;
  2. bisphosphonates;
  3. osteopenia/osteoporosis in endurance athletes
175
Q

What is the physical exam test for femoral stress #s?

A

fulcrum test

176
Q

What are the indication for prophylactic nail fixation for femoral shaft stress #s? (2)

A
  1. patients with low bone mass;
  2. patients >60 yoa
177
Q

What is the main MRI indication in the setting of a stinger?

A

B/L symptoms

178
Q

What are the indications for IM nailing of tibial stress #s? (1)

A

If ‘dreaded black line’ is present

179
Q

What is the most reliable (strongest) risk factor for non-union post IM nail for tibial stress #s?

A

If ‘dreaded black line’ is present anterior cortex of tibia

180
Q

What are the American Academy of Neurology (AAN) grades of head injury?

A

Grade I - no loc - confusion lasts <15 min;

Grade II - no loc - confusion lasts >15 min;

Grade IIIa - loc seconds;

Grade IIIb - loc minutes

181
Q

What are the absolute indications for CT scan post sports related HI?

A

loc >5 min

182
Q

What is the most reliable post concussion assessment tool?

A

ImPACT - computer based

183
Q

What are the contraindications to return to play post concussion (delayed RTP)? (6)

A
  1. loc;
  2. prior Grade I or > in same season;
  3. symptoms > 15 min.;
    • exertional stress test;
  5. amnesia;
  6. post concussion syndrome
184
Q

What is the gradual return to play protocol post concussion?

A

Each step takes 24 hours.

  1. no activity;
  2. light aerobics;
  3. sport specific (no contact);
  4. non-contact training;
  5. full contact;
  6. normal game play
185
Q

What is 2nd impact syndrome?

A

2nd blow to head before initial symptoms resolve

186
Q

What is mortality rate associated with 2nd impact syndrome?

A

50%

187
Q

Name 5 clinical conditions that are contraindications to play contact sports.

A
  1. previous trauma;
  2. clinical stenosis;
  3. congenital odontoid hypoplasia;
  4. os odontoideum;
  5. Klippel-Feil syndrome
188
Q

Define stingers.

A

non-dermatomal unilateral tingling that resolves in 1-2 min

189
Q

What are the return to play criteria post stinger? (2)

A
  1. complete resolution of symptoms;
  2. normal strength + ROM
190
Q

What is the Tx of heat cramps?

A
  1. rapid cooling;
  2. stretching;
  3. electrolyte/fluids
191
Q

What is the Tx of syncope? (2)

A
  1. fluids;
  2. supine with elevated feet
192
Q

What is the definition of heat exhaustion?

A
  1. >39 degrees C;
  2. CNS depression
193
Q

What is the Tx of heat exhaustion?

A
  1. table salts;
  2. IV hydration;
  3. cooling
194
Q

What is the definition of heat stroke? (6)

A
  1. hyperthermia;
  2. tachycardia;
  3. CNS depression;
  4. cessation of sweating (hot + dry);
  5. anhidrosis;
  6. temp >40.5 degrees C
195
Q

What is the Tx of heat stroke?

A

decrease core body temp - int/ext cooling modalities

196
Q

What is the most common cause of sudden death in athletes?

A

cardiac (HoCM)

197
Q

What is commotio cordis and Tx?

A
  1. blunt chest trauma causing V-fib;
  2. defibrilation
198
Q

When can athletes return to sports following mono?

A

only when splenomegaly completely resolved

199
Q

What is the most common cause of death by abdominal trauma in sports?

A

splenic rupture

200
Q

What are the indications for DEXA scan in female athletes?

A
  1. Hx of amenorrhea +
  2. Hx of stress #s
201
Q

What is the Tx of female athletes with triad?

A

multidisciplinary -

  1. psych;
  2. nutrition;
  3. coaching (reduced intensity);
  4. OCP (amenorrhea)
202
Q

What side miniscal tear is the most common in ACL injury?

A

lateral

203
Q

What is the typical location for degenerative meniscal tears?

A

posterior horn medial meniscus

204
Q

What is the MRI finding of bucket-handle medial meniscal tear?

A

“double PCL”

205
Q

What is the gold standard technique for meniscal repair?

A

inside out technique

206
Q

What is the most common location for discoid meniscus?

A

lateral

207
Q

What is the most common cause of ACL failure?

A

tunnel malposition

208
Q

How much graft screw divergence is acceptable?

A

15-30 degrees

209
Q

What is the indication for HTO in PCL injury?

A

chronic deficiency - medial opening wedge to correct a) varus malalignment + b) increase tibial slope to prevent posterior sag

210
Q

What is a Pellegrini-Steida lesion?

A

calcification of femoral MCL indicates chronic MCL injury

211
Q

What are the 5 attachments of the semimembranous complex?

A
  1. VMO;
  2. medial retinaculum;
  3. sartorius;
  4. semi_T;
  5. gracilis
212
Q

What is the MCL therapy for Grade I MCL sprain?

A
  1. quads strength;
  2. hip adduction;
  3. cycling

Right away

213
Q

When do you brace MCL injuries?

A

Grade II and III;

return to play - Grade II - 2-4 weeks;

return to play - Grade III - 4-8 weeks

214
Q

What is the order of insertion of the LCL, popliteofibular lig., biceps femoris?

A

anterior to posterior - LCL to PFL to BF

215
Q

What are 4 reconstruction techniques for LCL/PLC?

A
  1. BPTB (single limb);
  2. larson technique (figure 8);
  3. double bundle (LCL/popliteofibular lig);
  4. anatomic recon. using split Achilles grafts
216
Q

What is the most common nerve injury in PLC?

A

CPN

217
Q

What are 3 components of miserable malalignment syndrome?

A
  1. femoral anteversion;
  2. genu valgum;
  3. ext. tibial torsion
218
Q

What are 4 ways to measure patella alta?

A
  1. Blumensaat’s;
  2. Insall-Salvati;
  3. Blackburne-Peel;
  4. Caton-Deschamps
219
Q

What is abnormal TT-TG distance?

A

>20 mm

220
Q

What is the physio protocol for lateral patella tilt + patella syndromes?

A
  1. VMD strength;
  2. short arc, closed chain, quads strength
221
Q

What are 3 patella re-alignment procedures?

A
  1. Maquet - anteriorization;
  2. Trillat - medialization;
  3. Fulkerson - ant/medialization
222
Q

What are the contraindications to a Fulkerson osteotomy? (2)

A
  1. medial patellar facet arthrosis;
  2. skeletal immaturity
223
Q

What is the more common - quads tendon rupture or patella tendon rupture?

A

quads

224
Q

What are the PF joint reaction forces when:

  1. squatting;
  2. going up stairs?
A
  1. 7X BW;
  2. 2-3X BW
225
Q

What is the concern for pre-patellar bursitis in wrestlers?

A

septic bursitis

226
Q

What type of meniscal tear most commonly causes clicking/locking? (3)

A
  1. oblique;
  2. flap;
  3. parrot beak
227
Q

What are 4 predictors of success for partial meniscectomy?

A
  1. age <40;
  2. normal alignment;
  3. min. arthritis;
  4. single tear
228
Q

What is the best candidate for meniscal repair? (5)

A
  1. peripheral in red zone;
  2. low rim width;
  3. vertical/longitudinal;
  4. 1-4 cm in length;
  5. with ACL recons.
229
Q

What are the contraindications to meniscal transplant? (6)

A
  1. inflammatory arthritis;
  2. OA;
  3. instability;
  4. obese;
  5. Grade IV chondrosis;
  6. malalignment
230
Q

How soon can you return to sports following meniscal transplant?

A

6-9 months

231
Q

What type of stitch technique is strongest for meniscal repair?

A

vertical mattress

232
Q

What are the risks to meniscal repair by:

  1. medial inside/out;
  2. lateral inside/out?
A
  1. medial inside/out - saphenous nerve and vein;
  2. lateral inside/out - peroneal nerve
233
Q

What percentage of discoid meniscus are bilateral?

A

25%

234
Q

Give 7 reasons why female athletes are predisposed to all injuries.

A
  1. quads dominant;
  2. landing biomechanics (more extension);
  3. smaller notch;
  4. COL5A1 gone;
  5. smaller lig;
  6. hormone levels;
  7. valgus leg alignment
235
Q

What is the collagen composition of ACL?

A
  1. 90% type I;
  2. 10% type III
236
Q

Where do bone bruises occur in ACL injuries? (2)

A
  1. middle 1/3 LFC (solcus terminalis);
  2. posterior 1/3 lateral tibial plateau
237
Q

What is the incidence of anterior knee pain with BPTB?

A

10-30%

238
Q

What are the factors that lead to increased physeal injury? (4)

A
  1. oblique tunnel;
  2. interference screws;
  3. high speed tunnel reaming;
  4. diameter >8 mm
239
Q

What is the treatment algorithm for arthrofibrosis post ACL recons.?

A
  1. <12/52 - physical therapy/splinting;
  2. >12/52 - scope with lysis of adhesions +MUA
240
Q

What are 3 mechanisms to PCL injury?

A
  1. direct blow to proximal tibia with flexed knee;
  2. hyperextension;
  3. hyperflexion with plantar-flexed foot
241
Q

What are the indications for PCL recon/repair of bony avulsion? (3)

A
  1. combined lig. injuries;
  2. isolated with bony avulsions;
  3. isolated chronic PCL injury with unstable knee
242
Q

In what postion do you fix PCL graft?

A

flexion

243
Q

What are 2 key components of PCL rehab. post recon.?

A
  1. immobilize in extension and protecting against gravity;
  2. early motion in prone position
244
Q

What is a distal MCL injury (avulsion) called?

A

stener lesion

245
Q

What are the operative indications for MCL repair/recon.? (repair - 4) (recon - 2)

A

Repair -

  1. multi lig. injury;
  2. stener lesions;
  3. medial compartment entrapment;
  4. chronic instability >10 mm

Recon. -

  1. chronic;
  2. no soft tissue for repair
246
Q

What are the graft options for MCL recon.?

A
  1. semi-T autograft;
  2. hamstring autograft;
  3. tib. ant. allograft;
  4. Achilles allograft
247
Q

Where does LCl insert on the femur relative to popliteus?

A

proximal and posterior

248
Q

What are the non-op Tx for PLC injuries?

A

Grade I or II - brace full ext. X 2/52 with protected WB; then, progressive rehab focusing on quads + light sports at 8 weeks

249
Q

What is the post-op rehab protocol for PLC injury?

A
  1. PWB X 4/52;
  2. passive ROM @ 4/52;
  3. no active hamstring @ rehab;
  4. full active extension allowed
250
Q

What are the associated injuries with proximal tib-fib D/L? (3)

A
  1. posterior hip dislocation;
  2. open tib-fib #s;
  3. knee/ankle #s
251
Q

What is the Ogden classification of prox. tib-fib D/L?

A
  1. anterolateral (most common);
  2. posteromedial;
  3. superior
252
Q

What is the reduction maneuver for prox. tib-fib D/L?

A
  1. flex knee 80-100 degrees - apply pressure over fibular head opposite direction of D/L;
  2. cast and keep in extension for healing
253
Q

What are the options for chronic proximal tib-fib D/L? (4)

A
  1. ligament recon.;
  2. ORIF with pins;
  3. arthrodesis;
  4. fibular head resection
254
Q

What is Basset’s sign?

A

sign of jumper’s knee (patellar tendinitis) - pain distal pole patella with extension; - no pain in flexion

255
Q

Where is the femoral origin of the MPFL?

A

between the adductor tubercle and the medial epicondyle

256
Q

What are the risk factors for quads tendon rupture? (7)

A
  1. renal failure;
  2. diabetes;
  3. RA;
  4. hyperparathyroidism;
  5. connective tissue disease;
  6. steroids;
  7. intraarticular injections
257
Q

Name the 2 most important quads mechanism exercises post ext. mech. repair.

A
  1. heel slides closed chain knee flexion;
  2. open chain knee flexion (prone)
258
Q

Patellectomy decreases extension force by what percentage?

A

30%

259
Q

What % of prepatellar bursitis are septic?

A

20%

260
Q

What is ICRS classification of chondral lesions?

A

Grade 0 - normal;

Grade 1 - superficial (fray/fissure);

Grade 2 - <50% depth;

Grade 3 - >50% depth;

Grade 4 - exposed SC bone

261
Q

What is the most sensitive xray for joint space narrowing in the knee?

A

45 degree WB PA knee

262
Q

What is the most common location for SONK?

A

distal epiphysis MFC

263
Q

What is the Clanton and DeLee classification of OCD lesions?

A

Type I - depressed;

Type II - with osseus bridge;

Type III - unstable non-displaced;

Type IV - unstable and displaced

264
Q

What is the Wilson’s test of the knee?

A

pain with interior rotation of knee 30-90 degrees flexion to extension;

relieved with external rotation

265
Q

What is the rehab for microfracture of knee?

A

NWB for 4-6 weeks + progressive ROM + WB

266
Q

What is Sinding-Larsen-Johansson syndrome?

A

chronic apophysitis of distal pole of patella

267
Q

Which HTO has the better 10 year survival @ 10 years?

A

varus producing osteotomy - 87% @ 10 years;

valgus producing - 50-85% @ 10 years

268
Q

What are the contraindications for HTO? (8)

A
  1. inflammatory arthritis;
  2. obese BMI >35;
  3. flexion contracture >15 degrees;
  4. knee flexion < 90 degrees;
  5. >20 degrees correction;
  6. PF OA;
  7. instability;
  8. varus thrust gait
269
Q

Where should the mechanical axis cross the knee?

A

medial to the medial tibial spine

270
Q

What are 2 causes of patella baja post HTO?

A
  1. raising tibial slope usually with medial opening wedge osteotomy;
  2. patella tendon scarring
271
Q

What is the contribution of the GH + SThoracic joints to shoulder abduction?

A

180 degrees = 120 degrees GH + 60 degrees ST;

2:1

GH:ST

272
Q

What are the static restraints to GH subluxation? (4)

A
  1. GH ligs.;
  2. labrum;
  3. congruity of glenoid;
  4. neg. intraarticular pressure
273
Q

What are the dynamic GH restraints? (3)

A
  1. RTC;
  2. LHB;
  3. periscapular muscles
274
Q

What will happen if you attach a Buford complex?

A

pain + restricted external rotation and elevation

275
Q

What are the contents of the rotator interval? (4)

A
  1. capsule;
  2. SGHL;
  3. CHL;
  4. LHB
276
Q

What is the optimal position for arthrodesis of shoulder?

A

15-20 degrees - ABD;

20-25 degrees - FF;

40-50 degrees int. rot.

277
Q

What is the strongest AC lig?

A

superior

278
Q

What are the distances of the CC ligs. from AC?

A

trapezoid - 3 cm;

conoid - 4.5 cm

279
Q

What is the most common location for OS acromiale?

A

junction of meso/meta acromion

280
Q

What is the Tx for OS acromiale 1. non-op; 2. op?

A
  1. observe + therap;
  2. failed non-op - then 2 stage - 1. ORIF with BG, 2. acromioplasty
281
Q

What pathology is associated with cocking phase of throwing? (2)

A
  1. GIRD;
  2. internal impingement
282
Q

What is the most harmful phase of throwing?

A

deceleration

283
Q

What are associated pathologies in throwing? (4)

A
  1. SLAP;
  2. LHB;
  3. brachialis;
  4. teres minor
284
Q

What is the Dx test of choice to Dx coracohumeral impingement?

A

CT with arm cross body

285
Q

What is the operative Tx of CH impingement?

A
  1. scope - +/- SSc repair - goal is >7 mm between CH;
  2. open coracoplasty - remove lateral coracoid and reattach conjoined tendon
286
Q

What is the Bigliani classification of acromion morphology?

A

Type I - flat;

Type II - curved;

Type III - hooked

287
Q

What is the most common arthroscopic finding with shoulder dislocation?

A

anteroinferior labral/capsular avulsion

288
Q

What is the Beighton score for GLL?

A
  1. dorsi D5th >90 degrees: R=1, L=1;
  2. thumb dorsi to flexor arm: R=1, L=1;
  3. elbow hyperext. beyond 10 degrees: R=1, L=1;
  4. knee hyperext. beyond 10 degrees: R=1, L=1;
  5. hands flat on floor =1.

Positive score if >=5/9

289
Q

What is the pathologic coracohumeral distance for CH impingement?

A

<6 mm

290
Q

What movement does the rotator internal prevent?

A

ER @ 0 degrees abduction

291
Q

What are the 3 areas to focus on when doing arthroscopic lysis of adhesions?

A
  1. circumfrential lysis of adhesions;
  2. rotator interval (ER);
  3. posterior capsule (IR)
292
Q

How do you define scapular winging?

A

medial to lateral in reference to top medial border of scapula

293
Q

What are the Tx options for medial scapular winging?

A
  1. observe 6/12;
  2. TL brace;
  3. pec. major transfer to inferolateral border of scapula

(Wait 1-2 years)

294
Q

What is the major complication with vascular TO syndrome?

A

emboli to hands + ischemic digits on hands

295
Q

What are the bounds of the thoracic outlet? (5)

A
  1. clavicle;
  2. 1st rib;
  3. subclavius muscle;
  4. costoclavicular lig.;
  5. anterior scalene muscle
296
Q

Under what circumstances can you proceed with TSA in the setting of RTC tear?

A
  1. supraspinatus only;
  2. no retraction;
  3. repairable
297
Q

What is the limit of glenoid version you can eccentrically ream without compromising bone stock?

A

15 degrees

298
Q

What are the dynamic stabilizers of the elbow?

A
  1. anconeus;
  2. brachialis;
  3. triceps;
  4. lateral extensor mass;
  5. med. flexor mass
299
Q

What motion limitation pre-op places patients @ risk for ulnar nerve injury post OA elbow Sx?

A
  1. extension >60 degrees (flexion contracture);
  2. <100 degrees of flexion
300
Q

What is little leaguer’s elbow?

A

constellation of medial sided pathology in throwing athletes and includes:

  1. med. epi. stress #s;
  2. MUCL injuries;
  3. flexor/pronator strain
301
Q

What is the xray finding of little leaguer’s elbow?

A

medial epiphyseal widening on xray

302
Q

What are the Tx options for little leaguer’s elbow?

A
  1. physical therapy/NSAIDS/rest/coaching pitching mechanics/limit innings per week. This the mainstay of Tx.
  2. ORIF of med. epi. #s;
  3. MCL recon.
303
Q

What motion is concerning in TEA for bushing wear?

A

varus/valgus >10 degrees

304
Q

What is the muscle/innervation + typical athlete that get AIIS avulsions?

A
  1. rectus/femoris;
  2. femoral nerve;
  3. trailing leg in hurdlers
  4. sports involving kicking
305
Q

What is an associated condition with piriformis syndrome?

A

FAI - decreased IR - leads to short external rotator contracture + sciatic compression

306
Q

What is the physical exam maneuvre for piriformis syndrome?

A

FAdIR hip (places piriformis on stretch + reproduces Sxs)

307
Q

What is the post-op protocol for labral debridement (scope)?

A
  1. PWB X 4/52;
  2. limit flex/abduc. X 4/52;
  3. slow back to sports - over 3-6 months
308
Q

What causes pudendal nerve injury in hip scopes?

A

perineal post

309
Q

What causes peroneal nerve injury during hip scopes?

A

boot traction

310
Q

What is the mechanism of ischial avulsion injuries?

A

hip flexion + knee extension

311
Q

What is the percentage of OCD with location in the knee?

A
  1. medial Fc - 80%;
  2. lateral Fc - 15%;
  3. patella - 5%
312
Q

What is the most common knee injury ligament wise?

A

MCL

313
Q

What is the most common site of MCL injury? (prox. or dist.)

A

femoral insertion avulsion

314
Q

What is the role of MPFL?

A

primary restraint to lateral patella subluxatal between 0-20 degrees flexion

315
Q

What are acceptable parameters for meniscus mismatch for transplant?

A

5-10% only

316
Q

What is the progression of OA for chronic PCL injury?

A

PF OA + med. comp. OA due to varus alignment

317
Q

What are 2 key points on posteromedial accessory portal in knee arthroscopy?

A
  1. 1 cm proximal to joint + posterior to MCL;
  2. 70 degrees arthroscope - use to view posteromedial corner through notch
318
Q

What are the indications for LCL operative repair?

A
  1. Grade III LCL;
  2. LCL/PLC;
  3. LCL/cruciate
319
Q

What is the upper limit of microfracture for OCD based on size alone?

A

2 cm squared (orthobullets says 4 cm squared)

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