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AD Orthobullets Study Plan > Sports > Flashcards

Sports Flashcards

1
Q

WHat are the cutoffs for PCL and PCL + PLC on posterior stress xrays?

A

10 - 12 mm = PCL

> 12 mm = PCL and PLC

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2
Q

What two ligaments form a complex that marks the superolateral margin of the subscapularis tendon?

A

SGHL and CH

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3
Q

2 indications for surgical intervention in hamstring ruptures

A

1) Athletes when all of the hamstring tendons have avulsed off their origin or
2) Two tendons have avulsed and retracted more than 2 cm.

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4
Q

3 contraindications to hamstrings graft in ACL reconstruction

A

ligamentous laxity (pathologic graft)

previous hamstrings injury (pathologic graft)

Sprinter (they need it)

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5
Q

In the UE, which artery is dominant?

A

Ulnar in 88% of population

Median in the rest

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6
Q

What abnormal motion of the humerus on the glenoid will there be in a patient with an internal rotation deficit of his shoulder?

A

Posterosuperior

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7
Q

What degree of flexion is best for rehab of ACL when doing:

a) Hamstring isometric
b) Isometric quads
c) Active ROM

A

a) Any angle
b) greater 60
c) between 35 and 90

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8
Q

Most common sites for osteochondral injury in lateral patellar dislocation

A

Medial patellar facet

Lateral trochlear ridge

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9
Q

Muscles most commonly affected by Parsonage-Turner syndrome?

A

Shoulder Motor: muscles (RTC)

Sensory: lateral antebrachial cutaneous nerve

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10
Q

4 elbow problems in the overhead throwing athlete

A

Valgus instability

Valgus extension overload

Medial epicondylitis

Ulnar neuropathy (cubital tunnel)

JAAOS 2001

No mention of ulnohumeral arthritis

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11
Q

2 Options for treating medial winging

A

Nonoperative: bracing

Operative: Pec major transfer: sternal head transferred to scapula

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12
Q

What’s an Eden Lange Transfer?

A

Transfer of rhomboids from medial to lateral border of scapula for treating lateral scapular winging

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13
Q

What type of muscles are more at risk for muscle strains?

A

Ones that cross 2 joints

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14
Q

Management algorithm for a chronic anterior shoulder dislocation with boney bankart.

A

When the glenoid defect is greater than 20-30% then bony augmentation is indicated.

The humeral head defect should be addressed if engaging or 20-40% head loss

Hemiarthroplasty should be considered if >40% of the head is involved.

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15
Q

Most common location for hip labral tear.

A

anterosuperior labrum

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16
Q

What nerve is at risk with a posterior capsular releas ein shoulder?

A

Inferior suprascapular nerve

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17
Q

Physical findings of shoulder instability?

A

+ Apprehension

+ Relocation

+ Suprise

+ Sulcus

+ Load and shift

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18
Q

What is the arthroscopic landmark to the iliopsoas?

A

Zona orbicularis

Can use as a guide for arthorscopic release

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19
Q

Describe provocative test for posterior labral tear.

A

Pain if hip is brought from a flexed, adducted, and internally rotated position to one of abduction, external rotation, and extension.

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20
Q

Three reasons to consider open Bankart repair

A
  1. large boney bankart
  2. engaging hills sachs
  3. HAGL lesion
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21
Q

What is the exam finding of someone with scapulothoracic dyskinesis and what is the main treatment?

A
  1. low, protracted scapula
  2. Physio with emphasis on coordination of scapular motion with trunk and hip movements
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22
Q

Normal TT-TG ratio?

A

Normal: Less than 15mm (ie 14mm or less)

Abnormal not until greater than 20mm

In between is a grey zone

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23
Q

What is the most common variant of attachment site of Biceps to glenoid?

A

Posterior attachment (70%)

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24
Q

6 contraindications to TSA?

A

insufficient glenoid bone stock

rotator cuff arthropathy

deltoid dysfunction

irreparable rotator cuff :

  • hemiarthroplasty or reverse total shoulder are preferable
  • risk of loosening of the glenoid prosthesis is high (“rocking horse” phenomenon)

active infection

brachial plexus palsy

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25
Q

What is the Thessaly test?

A

Patient stands at 20 degrees of flexed knee and twists.

Positive test is discomfort or clicking and suggests a meniscal injury.

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26
Q

What sort of osteotomy is helpful in a chronic PCL injury?

A

Medial opening wedge with an increase of tibial slope

Usually have a varus deformity

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27
Q

3 things that cause decreased knee flexion

A

Quads adhesions

  • (Yes. Or excessive tightening of the extensor mechanism).

Adhesions in medial/lateral gutters/Arthrofibrosis

  • (Yes. Arthrofibrosis anywhere in the joint can lead to stiffness).

Patella baja

  • (Yes. Patella baja usually secondary joint line elevation. > 10 mm joint line elevation found to result in significantly less flexion).

Cyclops lesion will NOT. It will cause decreased EXTENSION

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28
Q

What causes Os Acromiale?

A

Failure of fusion between the meso-acromion and meta-acromion.

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29
Q

What is a STIR sequence on MRI?

A

T1 with fat suppression

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30
Q

What are cruciate cysts associated with?

A

meniscal tears

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31
Q

Rotator Interval:

a) name the borders
b) contents (4)

A

a) Anterior Surpaspinatus tendon to superior Subscapularis tendon
b) SGHL, CHL, capsule LH biceps

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32
Q

Management of Heat-stroke

A

Caused by core temp >40C

Whole body cooling (ice bath)

can be fatal

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33
Q

Indications for transport to hospital after sports head injury: (8)

A

Concussion with spinal-cord like symptoms

LOC > 1minute

Seizure in patient with no history of seizure

Deep scalp laceration with substantial blood loss

Persistent drowsiness

Worsening HA, especially when accompnied by vomiting

Severe neck pain

Difficulty moving the arms or legs

Any lateralizng neurologic sign such as motor asymmtery, pupil asymmetry, hemisensory loss

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34
Q

MPFL femoral insertion during reconstruction

A

Schottle et al have described the radiographic landmark to be:

  • 1 mm anterior to the posterior cortex extension line
  • 2.5 mm distal to the posterior origin of the medial femoral condyle
  • Proximal to the level of the posterior point of the Blumensaat line.
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35
Q

Meniscal cyst is indicative of what?

A

Meniscal tear

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36
Q

Patient with mononucleosis - can they play non-contact sports?

Why or why not?

If they sit out - for how long?

A

No - 50% of splenic ruptures are atraumatic due to increased Valsalva (rowing)

Off for 3-5 weeks at least

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37
Q

What is the maximal amount of glenoid retroversion that can be dealt with by eccentrically reaming the anterior glenoid?

A

15 degrees.

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38
Q

List 6 things to evaluate on MRI for RTC tears?

A
  1. Partial vs. Full thickness
  2. Shape of tear
  3. Tendons involved
  4. Atrophy
  5. Degree of retraction
  6. Subluxation of biceps
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39
Q

What is Miserable Malalignment Syndrome?

A

Triad of:

  • Femoral anteversion
  • Genu Valgum
  • External tibial torsion/pronated feet

Leads to:

  • increased risk of patellar instability (due to increased Q-angle)
  • Exacerbation of patellofemoral dysplasia
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40
Q

What is the name of the condition caused by vascular insufficiency and repetitive microtrauma to the capitellum in someone

A

Panner Disease

Similar to OCD, but younger population and more benign course

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41
Q

Differentiate GLAD and APSLA lesions.

A

Glenoid labral articular defect (GLAD) is a sheared off portion of articular cartilage along with the labrum.

Anterior labral periosteal sleeve avulsion (ALPSA) can cause torn labrum to heal medially along the medial glenoid neck.

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42
Q

List 5 intrinsic causes of elbow stiffness:

A
  1. joint incongruity
  2. synovitis
  3. loose bodies
  4. intra-articular fractures
  5. osteochondritis dissecans
  6. post-traumatic arthritis
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43
Q

What type of meniscal tear is more common in ACL tears?

A

Lateral meniscal tear

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44
Q

Three complications associated with biceps repair?

A
  1. LCNFA injury
  2. Synostosis
  3. H.O.
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45
Q

What is a FAIR test and what does it test for?

A

Flexion, adduction and IR test

Tests for piriformis syndrome

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46
Q

What is the expected clinical finding with an anterior placed tibial tunnel with ACL?

A

Tightness in flexion

Impingement with extension

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47
Q

Causes of Thoracic Outlet Syndrome

A

General:

cervical rib

vertebral TP

clavicle malunion

1st rib malunion

Scapular ptosis

scalene muscle insertion abnormalities

Causes in Athletes:

Fibromuscular bands

abnormal pec minor

repetitive shoulder use

extreme arm position

weightlifting, rowing, swimming

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48
Q

4 radiographic findings of pincer deformity.

A
  1. anterosuperior acetabular rim overhang
  2. acetabular retroversion
  3. acetabular protrusio
  4. coxa profunda
  5. Crossver sign
  6. Ischial spine sign
  7. Posterior wall sign
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49
Q

Can you change slope with tibial osteotomy?

A

Yes

opening wedge is easier

by changing position of Puudu plate

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50
Q

Blood supply of ACL

A

middle geniculate artery

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51
Q

Which bundle of the ACL is shorter?

A

Posterolateral

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52
Q

Biceps pathology is associated most with pathology of what rotator cuff muscle?

A

Subscapularis

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53
Q

What is the expected finding with a too-vertical femoral ACL tunnel?

A

Rotational instability

+ pivot shift

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54
Q

Indications for meniscal root repair (as opposed to menisectomy)

A

Young

Active

no significant arthritis

No joint space narrowing

No malalignment

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55
Q

If LCL injury suspected what position do you splint in?

A

Pronation

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56
Q

Components of PLC?

A

included structures

  • LCL (295N)
  • popliteus muscle and tendon (680N)
  • popliteofibular ligament (229N)
  • lateral capsule

variable

  • arcuate ligament
  • iliotibial track
  • fabellofibular ligament
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57
Q

What is Sinding-Larsen-Johansson Syndrome?

A

Traction apophysitis at base of patella.

Similar to OGS.

Jumpers knee.

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58
Q

What is Remplissage and when do you do it?

A

Transfer of posterior capsule and Infraspinatus into a large, enagaging Hills Sachs

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59
Q

What causes subcoracoid impingement and what is the physical test?

A

Impingement of the LT/Subscap on the coracoid.

Pain over coracoid with flexion, IR and Adduction

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60
Q

List 4 causes of cardiovascular caused sudden death in athletes

A

HOCM: hypertrophic cardiomyopathy (most common)

Coronary artery abnormality: 2nd most common

Long QT syndrome

Commotio cordis: blow to anterior chest wall causes v.fib

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61
Q

What two nerves supply branches to the hip labrum?

A
  1. branch of nerve to the quadratus femoris
  2. obturator nerve
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62
Q

Physical exam maneouver to test for politeal entrapment syndrome?

A

Loss of pulses or diminished pulses with active plantarflexion or passive dorsiflexion.

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63
Q

Nerve most commonly injured during pec major transfer?

A

MSK

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64
Q

Extrusion of meniscus >3mm on imaging is worrisome for what?

Why does it matter?

A

Meniscal root tear

>3mm extrusion associated with increased articular cartilage loss and osteophyte formation

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65
Q

4 static GH stabilizers?

A

glenohumeral ligaments

glenoid labrum

articular congruity and version

negative intraarticular pressure

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66
Q

Indications for diagnostic arthorscopy in OCD of Knee

A

Skeletally mature/impending physeal closure

Signs of instability (of fragment, ie mechanical symptoms)

Expanding lesion on plain films

Failure of non-operative management

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67
Q

Late complaint after PCL insufficient knee?

A

Medial compartment OA

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68
Q

Risk factors for Parsonage-Turner Syndrome

A

Viral infections (most common - question stem has this feature in it)

Immunizations

Medications

Extreme stress

Autoimmune diseases

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69
Q

Mechanism for sports hernia

A

Hip hyperextension and abduction

causes eccentric contraction of the hip adductors

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70
Q

What is the most common Baker’s cyst?

A

the gastrocnemius-semimembranosus bursa

Located under the medial head of gastrocs and semimembranosus

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71
Q

What is TUBS?

A

Traumatic Unilateral Dislocation with a Bankart Lesion

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72
Q

What is the advantage of tenodesis vs. tenotomy?

A

Thought to reduce crampoing and improve cosmesis. But not proven with quality studies.

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73
Q

If a patient has decreased ER with arm at side following surgery for instability what procedure was most likely done?

A

Closure of rotator interval

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74
Q

4 xray findings of cam deformity.

A
  • decreased head-to-neck ratio
  • aspherical femoral head
  • decreased femoral offset
  • femoral neck retroversion
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75
Q

Three stages of calcific tendinosis?

A
  1. Formative
  2. Resting
  3. Resorptive
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76
Q

2 surgical treatment options for sports hernia

A

pelvic floor repair vs. adductor/rectus recession

Decompression of genitofemoral nerve

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77
Q

Three differences between Panner disease and OCD?

A
  1. Panner disease exhibits an irregular epiphysis, OCD a well-defined subchondral lesion
  2. Panner is younger,
  3. Panner shows a more benign course
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78
Q

Posterior labral tear and weakness with external rotation of shoulder only. What is the cause?

A

Cyst at spinoglenoid notch compressing suprascapular nerve branch supplying infraspinatus

Posterior labral tears are associated with cysts at either the spinoglenoid notch or suprascapular notch

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79
Q

What is Parsonage-Turner syndrome?

A

Brachial neuritis

Self-resolving

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80
Q

What positional adjustment do you have to make to the leg before placing a posterior hip portal?

A

Make sure it is internally rotated to bring portal entry site away from sicatic nerve.

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81
Q

Risk factors for quad tendon rupture (8)

A

Renal failure

Diabetes

RA

Hyperparathyroidism

Connective tissue disorders

Steroid use

Intra-articular injections

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82
Q

4 complications of Laterjet?

A

Hardware problems

non-union

axillary injury

MSK injury

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83
Q

Post ACL reconstruction, how many people returned to play at the same level:

A

45%

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84
Q

Best predictor of successful non-operative management in OCD of knee?

A

Open distal femoral growth plate.

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85
Q

What does a west point view look for?

A

Glenoid bone loss

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86
Q

Most common compartment affected by exertional compartment syndrome?

A

Anterior

(worse prognosis if posterior involved)

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87
Q

What arthroscopic finding is a contraindication to a Faulkerson?

A

Supero-medial arthrosis

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88
Q

Which meniscus carries more of the load of the knee?

A

Lateral

THiNK: normal is valgus

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89
Q

Diagnostic criteria for exertional compartment syndrome (3)

A
  1. resting (pre-exercise) pressure > 15 mmHg
  2. immediate (1 minute) post-exercise is > 30 mmHg and/or
  3. continuous post-exercise failed to return to normal or remains > 15 mmHg at 15 minutes after cessation of exercise
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90
Q

Closure of the rotator interval has what effects?

A

Decreased ER

Decreased AP glenohumeral translation

So it decreases risk of instability

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91
Q

Deficiency of what bundle causes a pivot shift?

A

PL bundle of ACL

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92
Q

Clinical features of thoracic outlet syndrome? (3)

A

Arterial ischaemia

Venous congestion

Raynauds

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93
Q

Main blood supply of the patella?

A

Come from inferior

Can’t find exactly what artery tho

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94
Q

What should be assumed in any unconscious athlete?

A

C-spine injury

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95
Q

Management of a femoral stress fracture at inferomedial neck

A

If

If >50% across neck: operative with percutaneous fixation

Inferomedial neck is compression side and may be treated non-op

Superolateral neck is tension side and needs an operation

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96
Q

ACL: what bundle is tight in flexion? Extension?

A

Anteromedial bundle: tight in flexion

Posterolateral bundle: tight in extension

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97
Q

When do you do an outside in meniscal repair?

A

anterior horn tear

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98
Q

3 surgical options for Internal Impingement

A
  1. Posterior release vs. anterior stabilization if unstable
  2. Posterior labral repair
  3. Debridement of Bennet lesion
  4. Repair of PASTA if present
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99
Q

Ideal position for glenosphere baseplate?

A

inferior on glenoid with an inferior tilt

to avoid notching

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100
Q

How does weight training increase strength in adults vs. kids?

A

Adults: muscle hypertrophy

Kids: increased muscle firing efficiency and coordination

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101
Q

Two xray findings associated with little leaguers elbow.

A

Physeal widening

Fragmentation or avulsion of the medial epicondyle

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102
Q

In ACL reconstruction with hamstring graft, what characteristic of the interference screw improves fixation?

A

Longer screw

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103
Q

What is Beighton’s Score?

A

passive hyperextension of each small finger >90° (1 point each)

passive abduction of each thumb to the surface of forearm (1 point each)

hyperextension of each knee >10° (1 point each)

hyperextension of each elbow >10° (1 point each)

forward flexion of trunk with palms on floor and knees fully extended (1 point)

a score of 5 or more on 9-point Beighton-Horan scale defines joint hypermobility

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104
Q

What has the highest correlation with TUBS (traumatic anterior shoulder dislocation)?

A

Age

Most happen young: 80-90% in teenagers

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105
Q

What is the thick bundle of fibers found at the avascular zone of the coracohumeral ligament running perpendicular to the supraspinatous fibers and spanning the insertions of the supra- and infraspinatus tendons?

A

The rotator cable.

Sounds like horseshit.

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106
Q

What is the blood supply to the ACL?

A

Middle geniculate artery

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107
Q

Three ways that Laterjet improves stability.

A
  1. Increases excursion prior to subluxation
  2. By passing the conjoint through a slit in the subscapularis, this prvides a supportive sling
  3. You can sugment capsular repair with remanant of CA ligament
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108
Q

What phase of throwing does internal impingement occur?

A

Late Cocking

When the arm is most abducted and ER’ed

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109
Q

Specific first line treatment for Internal Impingement?

A

posterior capsule stretching with sleeper stretches for at least 6 months

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110
Q

What is better for meniscal repairs, horizontal or vertical mattress stitches?

A

Vertical

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111
Q

Why do vertical femoral tunnels cause ACLs to fail?

A

Placement of the ACL graft vertically at the apex of the notch causes the graft to wrap around the PCL

This causes high tension in the graft when the knee is flexed.

Will also stretch out the graft, preventing full extension

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112
Q

What is the interval for a lateral approach to capsule for a lateral inside out meniscal repair?

A

Between ITB and Biceps

Retract lateral head of gastrocs posteriorly

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113
Q

At what range should the MPFL ligament be isometric?

A

0-30 degrees of flexion

This reflects the native anisometry of the ligament and the range where it is isometric (0-30 degrees flexion)

Therefore tension at 30 degrees

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114
Q

What does AMBRI stand for and what is it referring to?

A

Atraumatic

Multidirectional

Bilateral (often)

Rehabilitation (responds to)

Inferior Capsular shift (best surgial management)

Refers to MDI - good b/c tells you everything you need to know about it!

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115
Q

What is the Pellegrini Stieda Sign?

A

Medial femoral condyle avulsion fx (Chronic MCL injury)

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116
Q

Name two treatment modalities unique to quadriceps contusions (moderate - severe)

A
  1. Use of Losartan - angiotensin 2 inhibitor - which decreases muscle death and fibrosis
  2. Immobilization in 120 degrees of felxion for 24 hours
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117
Q

Meniscal cysts are more common on what side?

A

medial (2/3)

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118
Q

Post-SLAP repair, what amount of patients return to pre-activity level of sports?

A

75%

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119
Q

5 pitching rules of paediatric pitchers

A
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120
Q

Radiographic signs of discoid meniscus

A

lateral joint space widening

squaring of the lateral condyle

cupping of lateral tibial plateau

hypoplasia of the lateral tibial spine.

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121
Q

What structure is at risk during posteiror shoulder labral repair?

A

Posterior branch of axillary nerve

Rusn 1mm from inferior border of shoulder capsule

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122
Q

Most common direction of proximal Tib-FIb dislocations?

A

Antero Lateral

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123
Q

Management of meniscal cyst

A

partial menisectomy + cystectomy

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124
Q

What two patient populations would cause you to think twice about doing an acromioplasty?

A

1 - WOrkmans Comp - do poorly

2 - Massive rotator cuff tear - plasty can compromise the superior arch and allow for excape in these cases

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125
Q

2 indications to operate on tibial stress fracture

A

Presence of dreaded black line

failure of non-operative

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126
Q

What condition is characterized by excessive lateral patellar tilt, a lack of excessive mobility and an inability to passivey evert the patella?

A

Lateral faet compression syndrome

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127
Q

What is the female athlete triad?

A

Amenorrhea

Disordered eating

Osteoporosis

(JAAOS CORE 2)

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128
Q

Causes of shoulder AVN? (give 6)

A

Remember ASEPTIC mneumonic:

Alcohol, AIDS

Steroids (most common), Sickle, SLE

Erlenmeyer flask (Gaucher’s)

Pancreatitis

Trauma

Idiopathic/ Infection

Caisson’s (the bends)

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129
Q

What bacteria is especially known for causing biofilms in TEA and may need revision even if early infection?

A

S. Epidermidis

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130
Q

What has been associated with the use of intra-articular shoulder local anesthetic infusions?

A

Chondrolysis

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131
Q

Contraindications to return to play after head injury (6)

A

LOC

Prior Grade 1 concussion in same season

Symptoms >15 mins (grade II)

Positive exertional stress test

Amnesia

Post-concussion syndrome

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132
Q

What is the consequence of overdebridement during surgery for valgus extension overload?

A

Osteophyte is at posteromedial corner. Debridement into normal olcerenion can cause increased tensiuon on MCL and lead to symptoms or failure.

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133
Q

What is a Kim lesion?

A

Reverse bankart lesion occuring in posterior shoulder dislocation

Avulsion of the deep posteroinferior labrum

May have intact superoinferior labrum

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134
Q

During which stage of throwing is valgus load the highest?

A

Acceleration

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135
Q

What is a Sleeper Stretch used for?

A

Posterior capsule stretching in internal impingement or internal rotation deficit (GIRD) of the shoulder

Specifically targets the posterior band of the IGHL

136
Q

What’s an ALPSA?

A

Anterior labral periosteal sleeve avulsion

137
Q

Deficiency in what two structures with a shoulder hemi leads to increased instances of anterosuperior excape?

A

RTC and CA ligament

138
Q

Which bundle of the ACL is shorter?

A

Posterolateral

139
Q

What a HAGL? What structure does it involve?

A

Humeral avuslion of the glenohumeral ligament

Specifically involves inferior GHL and occurs in conjunction with TUBS

140
Q

Max correction with Valgus producing HTO?

A

12 degrees

141
Q

List 5 extrinsic causes of elbow stiffness:

A
  1. formation of eschar following a burn
  2. heterotopic ossification
  3. adhesions/contraction of the capsule
  4. myositis ossificans
  5. ligament contractures
    1. scarring of posterior oblique portion of medial ulnar collateral
142
Q

List 5 risk factors for triceps rupture:

A

systemic illness (renal osteodystrophy)

anabolic steroid use

local steroid injection

flouroquinolone use

chronic olecranon bursitis

previous triceps surgery

143
Q

Describe Foucher Sign

A

Change in size of popliteal cyst with different positioning

Indicative of popliteal cyst

144
Q

What muscle shares an origin with ECRB?

A

Anconeus

145
Q

Which stage of calcific tendinosis is most painful?

A

Resorptive (Stage 3)

146
Q

What is Hoffa’s test for?

A

Fat pad impingement - infrapatellar impingement

147
Q

Name 5 risk factors associated with frozen shoulder

A

DM

Thyroid pathology

Previous shoulder surgery

Xtended hospitalization

Extended immobilization

148
Q

Activity instructions after arthroscopic hip labral debridement.

A
  1. limited weight-bearing x4 weeks
  2. flexion and abduction are limited for 4 to 6 weeks
149
Q

Three technical errors that will lead to failure of meniscal transpalnt?

A
  1. Not correcting axial alignment
  2. Not fixing ACL tear
  3. > 15% mismatch between donor and recipient condyle

Pre-existing arthritic change, obesity and inflammatory arthritis are also bad.

150
Q

3 physical exam findings of FAI

A
  • limited hip flexion (
  • anterior impingement test (flexion, adduction, internal rotation) elicits pain
  • externally rotated extremity
151
Q

3 athletic injuries that women are more prone to

A

ACL rupture

Patellofemoral instability

Stress fractures

152
Q

What has been shown to decrease ACL ruptures in female athletes?

A

Neuromuscular training, jump training and plyometrics

Because a major modifiable cause of increased ACL tears in women is lack/worse neuromuscular coordination and training

153
Q

Prognostic indicators for OCD in Knee: (good and bad)

A

Good:

Young age (open physis)

Bad:

Skeletally mature

fluid behind lesion on MRI

Location other than medial femoral condyle (lateral femoral condyle and patella have worst prognosis)

154
Q

3 radiographic findings with spear tacklers spine?

A
  1. developmental narrowing (stenosis) of the cervical canal
  2. persistent straightening or reversal of the normal cervical lordotic curve
  3. concomitant posttraumatic roentgenographic abnormalities of the cervical spine
155
Q

What are the 3 most important PLC structures that need to be reconstructed after injury?

A

LCL

popliteus tendon

popliteofibular ligament

156
Q

Average retroversion and neck shaft angle of humeral head?

A

30 degrees retroversion

130 neck shaft angle

157
Q

Closing wedge HTO does what to posterior slope? Opening wegge

A

Closing: decreases it

Opening wedge: opens it - but medial opening wedge says it preserves slope

158
Q

If MCL injury suspected what position do you splint in?

A

Supination

159
Q

What treatment regimen has the most reliable increase in DASH score with post traumatic elbow stiffness?

A

Supervised exercise therapy with static progressive elbow splinting.

160
Q

4 indications for RSA

A
  1. Cuff tear arthropathy
  2. antero-superior escape of hemi
  3. pseudoparalysis - irreperable cuff tear and OA
  4. 3 or 4 part fractures in the elderly
161
Q

What does SONK look like on MRI?

A

Crescent shaped lesion on medial femoral condyle

162
Q

Steps to performing an olecrenon osteotomy?

A
  1. Part of the anconeus and the flexor carpi ulnaris are released off the olecranon to identify the position of the osteotomy
  2. Osteotomy performed at the apex of the semilunar notch
  3. Preserve at least 1 cm of intact olecranon proximal to the apex of the osteotomy.
  4. Osteotomy is made near to completion with an oscillating saw and completed with a sharp osteotome cracking through the articular cartilage.
  5. The osteotomized olecranon is then reflected superiorly with the triceps tendon.
163
Q

Four surgical options for a large, engaging Hill Sachs?

A
  1. Remplissage
  2. Arthroplasty
  3. Rotational Osteotomy
  4. Allograft recon
164
Q

What does a patulous inferior capsule on MRI suggest?

A

MDI

165
Q

Name 2 tests for LHB pathology:

A

Speeds: resisted FF with elbow extended and arm supinated

Yeargason’s: resisted supination

166
Q

How do you do a lateral pivot shift of elbow?

A

The patient is placed in the supine postion with forearm overhead and elbow extended. The elbow is then supinated with force and flexed to >40° while a valgus load applied. A positive result is palpable / visible clunk as the ulna and radius reduce suddenly.

167
Q

What muscles are affeted in quadrilateral space syndrome?

A

Teres minor & deltoid

both innervated by axillary nerve, which runs in quadrilateral space

168
Q

What is little leaguers shoulder and three methods of prevention.

A

A Salter Harris Type I physeal injury to proximal humerus.

  1. no breaking pitches
  2. pitch counts
  3. max 2 games per week
169
Q

What is the most important medial restraint to LHB subluxation/dislocation?

A

Subscapularis

170
Q

What is an important LATE complication of inferior shoulder dislocation?

A

Axillary artery thrombus

171
Q

What motions are weak after Pec Major tendon rupture?

A

Adduction & IR

172
Q

When is Lat Dorsi transfer indicated in the treament of RTCR?

A

Irreparable posterosuperior tears with intact subscapularis

173
Q

What’s GLAD?

A

glenoid labral articular defect

174
Q

Where do muscle strains occur?

A

myotendinous junction

175
Q

Ideal position for elbow fusion?

A

in a unilateral arthrodesis

90° of flexion

0-7° of valgus

in a bilateral arthrodesis

one elbow in 110 ° of flexion for feeding

one elbow in 65 ° of flexion for perineal hygiene

176
Q

Name and describe three provocative tests for MCL deficiency of the elbow.

A

  1. valgus stress test

place elbow at 20 to 30 degrees (unlocks the olecranon), externally rotate the humerus, and apply valgus stress

50% sensitive

  1. milking maneuver

create a valgus stress by pulling on the patient’s thumb with the forearm supinated and elbow flexed at 90 degrees

positive test is a subjective apprehension, instability, or pain at the MCL origin

  1. moving valgus stress test

place elbow in same position as the “milking maneuver” and apply a valgus stress while the elbow is ranged through the full arc of flexion and extension

positive test is a subjective apprehension, instability, or pain at the MCL origin between 70 and 120 degrees

100% sensitive and 75% specific

177
Q

Minimally invasive treatment for calcific tendinosis by stage (3)

A
  1. Formative: Extracorporeal shock wave therapy
  2. Resting: Extracorporeal shock wave therapy
  3. Resorptive: U/S guided needle lavage
178
Q

When can this guy go back to wrestling?

A

Herpes gladiatorum

No new lesions within the preceeding 72 hours

AND

at least 5 days of anti-viral medications

AND wouds have scabbed over

just gross….

179
Q

Consequence of not fixing distal biceps tear?

A

will lose 40-50% supination

will lose ~30% flexion

will lose 15% grip strength

180
Q

What are the main surgical options for RTC arthropathy?

A

1) Hemiarthroplasty - consider if younger, deltoid deficient or not enough glenoid bone to do revers
2) RTSA - mainstay, better pain and functional outcomes

181
Q

What important structure runs along the lateral aspect of the long head of the biceps?

A

Ascending branch of the anterior humeral circumflex artery

182
Q

What is another, more commonly used term for AMBRI?

A

MDI

183
Q

How does cardio improve CO?

A

Increased stroke volume

184
Q

Entrapment at spinoglenoid notch. What nerve and muscles will it affect?

A

Suprascapular nerve

Infraspinatus only

185
Q

During arthroscopic rotator cuff repair in a 45 year old man, you find a SLAP tear incidentally. How do you manage?

A

NOT necessary to repair if it is incidental and patient was asymptomatic AND patient is older >40

Repair may actually cause shoulder stiffness

186
Q

What is the “movie theatre sign”?

A

Patellar tendon pain with extended sitting (knee in flexion)

Coincides with Blazina Type 3 tendonitis

187
Q

Contraindications to HTO

A

Multi-compartment arthritis

Patellofemoral especially

Inflammatory arthritis

Age >50

Obese with BMI >35

Knee flexion

Knee flexion contracture >15 degrees

Procedure needing >20 degrees of correction

Ligament instability

Varus thrust during gait

188
Q

Benefits of medial opening wedgie high tibial osteotomy vs. lateral closing wedge

1 drawback

A

Maintenance of posterior slope

Avoids tib-fib joint

Avoids peroneal nerve and anterior compartment

Downside: patella baja

189
Q

What is a normal acromial-humeral interval?

A

7-8 mm

190
Q

Femoral condyle articular cartilage lesion >4mm^2. Treatment options:

A

Autologous chondrocyte implantation (2-stage)

Allograft osteochondral transplantation

191
Q

4 causes of internal impingement

A

fraying of posterior rotator cuff

posterior and superior labral lesions

hypertrophy and scarring of posterior capsule glenoid (Bennet lesion)

cartilage damage at posterior glenoid

192
Q

MRI diagnosis of discoid meniscus

A

3 or more 5mm sagittal images with meniscal continuity (“bow-tie sign”)

193
Q

Pre-op ACL, what 3 factors are assocaited with increased knee pain?

A

higher body mass index (BMI)

female gender

concurrent lateral collateral ligament injury

194
Q

What radiologic finding precludes use of ACI for patellofemoral joint?

A

Joint space narrowing on merchant view.

195
Q

Where do most partial biceps tears occur?

A

Radial side of tuberosity

196
Q

Causes of thoracic outlet syndrome? (7)

A

cervical rib

Vertebral TP

Anamalous insertion of scalenes

Fibromuscular bands

Clavicular malunion

1st rib malunion

Repetitive shoulder use

197
Q

How long until considering surgical management with a stiff knee post ACL recon?

A

12 weeks of physio

Then consider LOA/MUA

198
Q

Poor prognositc indicators of osteochondritis dissecans

A

Increased age

Location: Posterolateral aspect of lateral femoral condyle or patella

Fluid behind lesion on MRI

199
Q

Risk factors for growth arrest in paediatric ACL reconstruction

A

Transphyseal reconstruction

Oblique tunnel position across physis

Interference screw across physis

High-speed burring across physis

Large diameter tunnels >8mm across physis

200
Q

What ligaments are most imporant for AC stability?

A

Posterior & superior AC ligaments

201
Q

Is there a major difference in growth arrest between trans-physeal and physeal sparing ACL reconstruction in paeds?

A

No

202
Q

Name 1 legal supplement that actually improves performance

A

Caffeine

2-3mg/kg improves performance

Allowed by IOC up to 12 micrograms/mL of urine

203
Q

Treatment of cruciate cysts

A

Arthroscopic excision ± percutaneous aspiration

204
Q

When is the saphenous nerve most likely to be injured during ACL surgery?

A

Hamstring harvest with leg in extension

205
Q

Does scapular elevation or depression lead to thoracic out let syndrome?

A

Depression

Tractions all the nerves/roots

206
Q

List 3 effects and 13 side effects of anabolic steroids

A

Effects:

increased muscle strength

increased aggressive behaviour

increased erythropoiesis

Side Effects

Hypertension

Liver tumours

Increased LDL

Decreased HDL

Hypercholesterolemia

Increased body weight

Testicular atrophy

Irreverisble deepending of the female voice

Alopecia (irreversible)

Reduction in gonadotropic and sex hormones (estrogens & testosterone)

  • Results in Decreaed bone mineral density, Oligospermia or azoospermia

Growth retardation

Gynecomastia

Insulin resistance (HGH specifically)

Incresed blood viscosity –> stroke/MI (EPO specifically)

207
Q

INdications for RTC repair?

A
  1. Bursal sided tears > 3 mm
  2. PASTA tears > 50%
  3. Complete tears in a younger patient
208
Q

Greatest risk factor in recurrence of shoulder instability?

A

Age <25

Recurrence rates 60-90%

209
Q

What percentage of asymptomaic patients over 60 have RCT tear?

A

55%

210
Q

What is the biggest risk factor for sciatic nerve traction injury duing hip scope?

A

Maximal traction weight (not traction time)

211
Q

What are 4 surgical treatments for posterior shoulder instability?

A
  1. Arthroscopic posterior labral repair/capsular shift
  2. McLaughlin - Transfer of subscap/LT into reverse Hill Sachs (has to be less than 50%
  3. Hemiarthroplasty - Hill Sachs > 50% or humerhead arthritis
  4. TSA - GH artritis
212
Q

Name 3 absolute contraindications to play (neck injuries)

A

odontoid hypoplasia

os odontoideum

Klippel-Feil anomalies: mass fusion of the cervical and thoracic vertebrae is an absolute contraindication to play

213
Q

What is released with an a) anterior or b) posterior interval slide?

A

a) SS from rotator interval
b) SS from IS (needs to be repaired after)

214
Q

Name the types of snapping hip syndrome:

A

External: ITB over GT

Internal: iliopsoas over:

  • femoral head
  • prominent iliopectineal ridge
  • exostoses of LT
  • iliopsoas bursa

Intra-articular: loose body or labral tears

215
Q

Contents and borders or cubital fossa.

A

contents– biceps tendon (lateral), brachial artery, median nerve (medial)

lateral border–brachoradialis

medial border–pronator teres

proximal border –distal humerus

216
Q

Interval for lateral approach to knee (i.e. for LCL repair)?

A

Split biceps and ITB

217
Q

While outcomes are equivocal, name 2 areas in which proximal biceps tenodesis is better at than tenotomy

A

Cosmesis

Less arm cramping

*NO difference in functional outcomes

218
Q

Indications and contraindications for meniscal transplant

A

Indications:

Young patients with near total menisectomy, especially lateral

Young is

Absolute Contraindications:

Inflammatory arthritis

Instability

Marked obesity

Grade IV condrosis (if not concurrently addressed)

Malalignment (if not concurrently addressed)

Diffuse arthritis

219
Q

6 structures visible in the peripheral compartment during hip scope.

A
  1. femoral head
  2. labrum
  3. zona orbicularis
  4. medial synovial fold
  5. femoral neck
  6. peripheral capsular attachments
220
Q

Main difference in treatment between acute and chronic AC separation?

A

For acute there are many options, including hook plate.

With chronic you have to reconstruct the CC ligaments in addition to ORIF.

221
Q

Does early physio and ROM improve outcomes with RTCR at 1 year?

A

No.

222
Q

What is the main type of valgus producing tibial osteotomy?

A

Medial opening wedge osteotomy

223
Q

4 causes of suprascapular ligament compression at the spinoglenoid notch

A

posterior labral tears causing a cyst

spinoglenoid ligament

spinoglenoid notch ganglion

traction injury

224
Q

Dial Test: results and interpretation

A

+ is >10 degrees ER asymmetry

+ at 30: PLC injury

+ at 30/90: PLC & PCL injury

225
Q

What is the most important muscle group in a) ACL and b) PCL rehab?

A

a) Hamstrings
b) Quadriceps

226
Q

Name the high risk sites for stress fracture

A

Femoral neck:

  • superolateral
  • inferomedial: Lower risk than superolateral

Patella

Anterior tibial diaphysis

Medial malleolus

Talus

Tarsal navicular

5th MT

Sesamoid bones

227
Q

Politeal cysts are larger in flexion or extesion?

A

Extension

This decreases joint space, increases pressure and fluid into cyst, and closes off the communication between cyst and joint entrapping the fluid

228
Q

What does EMG show with brachial neuritis?

A

Sharp waves and fibrillations.

229
Q

Desscribe treatment for SLAP tears by type

A

Type I - debride labrum

Type II - reattach labrum

Type III - debridement of flaps

Type IV

if tendon involvement

if tendon involvement >1/3, same and perform biceps tenodesis or tenotomy.

decompress any cysts

230
Q

For what stages of shoulder AVN is core needle decompression most appropriate?

A

Creuss stage 1-2

231
Q

What is the treatment for proximal tib/fib cysts?

A

cystectomy

don’t want it causing pressure on the peroneal nerve

232
Q

What is a HAGL lesion?

A

Humeral avulsion of the glenohumeral ligament, which happends with TUBS.

Older patients than Bankarts.

Often missed.

Important to repair.

May have to repair open.

233
Q

Risk factors for knee OA after ACL tear

A

meniscal lesions

osteochondral lesions

malalignment

concomitant ligamentous pathology

*NO evidence that the ACL injury itself predisposes to arthritis*

234
Q

When is it safe for return to play following a hamstring injury?

A

When it has 90% strength of other side.

235
Q

How to do you protect the sciatic nerve during insertion of the posterior hip portal?

A

IR the hip

ER is bad

236
Q

Name three radiographic signs of a discoid meniscus:

A
  1. Widened joint space (11 mm)
  2. Squaring of lateral femoral condyle
  3. Hypoplastic lateral spine
237
Q

What is the cause of cruciate cysts?

A

Mucoid degeneration of the cruciate ligaments in areas subjected to constant stress

238
Q

Name the hip scope portals

A

Anterior

Anterolateral

Posterolateral

Distal anterolateral (3-5cm distal to anterolateral)

239
Q

Classification of discoid meniscus

A

Watanabe

Type I: complete

Type II: Incomplete

Type III: Wrisberg - thickened posterior horn with no posterior attachmends, held on only by ligament or Wrisberg

240
Q

Closure of the rotator interval has what effect?

A

Decreass ER with arm at 0 deg of abduction (arm at side)

Involves plication of SGHL & MGHL

THINK: closure of anterior capsular structures decreases ER, while closure of posterior capsule strucures decrease IR

241
Q

Most common muscle injured in adductor strain?

A

Adductor longus

242
Q

Drugs that cause osteoporosis

A

NOT NSAIDs - they cause decreased bone healing (controversial)

Steroids

Thyroid medication

Antacids

Anti-convulsants

PPIs

Tetracycline

Loop diuretics

Lithium

MTX

Cyclsporine

243
Q

indications for surgery in PLC injuries

A

Grade III

Combined injuries

within 2 weeks

Isolated Grade 1, 2 - can observe

244
Q

Tension on the ACL increaes with____________

A

Extension

Hyperextenion places most strain on ACL

245
Q

What concomitant injury do young (teenagers/20’s) and older people (>40) get with traumatic shoulder dislocation?

A

Young: bankart

Old: rotator cuff tear

246
Q

Name 5 indications for meniscal repair

A

Tear between 1 and 4cm

Red-red zone tears

longitudinal/vertical tears

Patient

No mechanical axis malalignment

acute tears (

Concurrent ACL reconstruction

247
Q

4 treatment options for lateral winging

A

Nonoperative:

Observation & trapezius strengthening

Operative:

Nerve exploration (if iatrogenic)

Eden-Lange transfer: rhomboids transferred from medial border of scapula to lateral border

Scapulothoracic fusion

248
Q

What is the direction of winging clinically defined by

A

Direction of the supermedial corner of the shoulder

Medial winging: superomedial border moves medially

Lateral winging: superomedial border moves laterally

249
Q

What two structures are important to release when doing a release for extrinsic elbow stiffness?

A
  1. anterior capsule
  2. posterior band of MCL
250
Q

Nerve deficit in lateral winging

A

CN XI (spinal accessory)

Trapezius is weak

251
Q

Risk factors for females for ACL tear

A

Landing biomechanics and neuromuscular control differences

Genetic predisposition

Cyclic hormone levels (greater risk during 1st half - preovulatory)

Leg alignment

smaller notches

smaller ACL size

252
Q

What position of the forearm is avoided for first 6 weeks after LUCL recon?

A

Supination

253
Q

What type of exersizes cause co-contraction of the scapular and rotator cuff muscles during physio for MDI?

A

closed kinetic chain exercises

254
Q

Good prognostic indicators for meniscal repair

A

Tear in peripheral red-red zone

  • AKA decreased rim width: the distance from the tear to the peripheral meniscocapsular junction (blood supply)
  • Rim width correlates with ability of a meniscal tear to heal
  • Lower rim width has a better blood supply
  • Basically if it’s in the red-red zone

Vertical and longitudinal tear

1-4cm in length

Acute repair combined with ACL reconstruction

255
Q

4 components of PMC?

A
  1. insertion of semimembranosus
  2. posterior oblique ligament
    1. resists tibial internal rotation in full extension
  3. oblique popliteal ligament
  4. posterior capsule
256
Q

What is RTS after meniscal transplant?

A

6-9 months

At 10 years most have improved function and pain

257
Q

Suprascapular notch impingement. What nerve and muscles will it affect?

A

Suprascapular nerve

Affects supra & infraspinatus b/c it occurs before the nerve branches

258
Q

Treatment for the following causes of patellar instability:

Patella alta:

Excessively lateral tibial tuberosity:

Severe trochlear dysplasia:

Excessive limb rotation:

A

Patella alta: distal tibial tuberosity transfer

Excessively lateral tibial tuberosity: medial tibial tuberosity transfer

Severe trochlear dysplasia: trochleoplasty

Excessive limb rotation: femoral/tibial derotation osteotomy

Medial patellar dislocation and medial PF arthritis are major complications of the overcorrection of lateral patellar dislocation.

259
Q

Three most common placees for OCD?

A
  1. Knee
  2. Capiteelum
  3. Talus
260
Q

What is the significance of having a concurrent peroneal nerve injury in a patient with hamstring rupture?

A

It means short head of biceps may not function and will significantly delay the rehabilitation process.

261
Q

Values for:

mechanical lateral proximal femoral angle (mLPFA)

anatomic medial proximal femoral angle (aMPFA)

mechanical lateral distal femoral angle (mLDFA)

anatomic lateral distal femoral angle (aLDFA)

mechanical medial proximal tibial angle (mMPTA)

mechanical lateral distal tibial angle (mLDTA)

A

mechanical lateral proximal femoral angle (mLPFA): 90

anatomic medial proximal femoral angle (aMPFA): 84

mechanical lateral distal femoral angle (mLDFA): 88

anatomic lateral distal femoral angle (aLDFA): 81

mechanical medial proximal tibial angle (mMPTA): 87

mechanical lateral distal tibial angle (mLDTA): 89

*Remember in tibia, anatomic = mechanical axis

262
Q

How many patients at the highschool and college level returned to play post ACL reconstruction?

How many of these returned to the same level of play?

A

Highschool: 63% returned to play (45% at same level)

College: 69% returned to play (45% at the same level)

263
Q

How much distal clavicle can you safely excise?

A

1-1.5 cm

264
Q

What is a fulkerson osteotomy? Name a contraindication

A

Antermedialization of tibial tubercle

CI if there is medial patellar facet arthrosis

265
Q

Survivorship for TEA done for RA at 15 years?

A

> 90%

266
Q

When can you return to play after a stinger?

A

complete resolution of symptoms

normal strength and range of motion

267
Q

Nerve injury in medial winging

A

Long thoracic nerve (C 5, 6, 7)

Serratus anterior weak

268
Q

What is Paget-Schroetter Syndrome?

A

thoracic outlet syndrome with compression of subclavian vein in the developed athlete due to scalene muscle hypertrophy

269
Q

What connects the dMCL to the medial meniscus?

A

Coronary Ligament

270
Q

Risk of injury with medial and lateral inside-out meniscal repair techniques?

A

Medial: saphenous nerve and vein injury

Lateral: peroneal nerve injury

271
Q

Risk factors for patellar ligament ruptures

A

Systemic

  • SLE
  • RA
  • Chronic Renal Disease
  • Diabetes

Local

  • Patellar degeneration (most common)
  • Previous injury
  • Patellar tendinopathy
  • Corticosteroid injection
272
Q

What is the Outerbridge-Kashiwagi procedure?

A

It is used for patients with hypertrophic osteoarthritis of the elbow and associated contracture.

Burr through the olecrenon fossa to get anterior osteophytes.

Need to decompress the ulnar nerve.

273
Q

2 absolute contraindications to TEA

A

Infection

Charcot Joint

274
Q

5 complications following open capsular shift of shoulder?

A

Axillary nerve injury

Loss of ROM

Late arthritis (posterior wear)

Recurrance of instability

Subscapularis deficiency (has to be tenotomized and repaired as part of procedure)

275
Q

What approach and fixation for MCL recon of elbow has the best outcomes?

A

Splitting of flexor-pronator mass and docking graft fixation.

276
Q

Risk Factors for patellar instability

A

General:

  • ligamentous Laxity (Ehlers-Danlos)
  • Previous patellar instability event

Miserable Malaignment syndrome: (Increased Q angle)

  • Femoral anteversion
  • Genu vlagum
  • External tibial torsion/pronated feet

Anatomic Factors:

  • Patellar alta
  • trochlear dysplasia
  • excessive lateral patellar tilt
  • Lateral femoral condyle dysplasia
  • Increased TT-TG distance

Muscular:

  • Dysplastic VMO
  • Overpull of lateral structures (ITB, Vastus lateralis)
277
Q

If you do HTO concurrently with ACL reconstruction, what else do you want to correct?

A

tibial slope

decrease it to tibia doesn’t slide forwards on femur (prevents drawer) to protect graft

278
Q

What is the expected clinical finding with an anterior placed femoral tunnel with ACL?

A

Tightness in flexion

279
Q

2 hallmark findings of MDI

A

Patulous inferior capsule (IGHL & posterior bands)

Rotator interval deficiency

280
Q

ACL graft choice with the highest rate of failure?

Highest risk population?

A

Allograft

Highest risk population was age 10-19

Jaaos 2015 (MOON Group)

281
Q

What is a Bennett Lesion in the shoulder?

A

Hypertrophy and scarring of posterior capsule glenoid

Warrants operative intervention

282
Q

Best predictor of good outcome in osteochondritis dissecans of the knee:

A

Open distal femoral physis

283
Q

Where is the origin of LCL relative to politeus and where does it insert on fibula?

A

a) Proximal and posterior
b) Anterior to ITB

284
Q

In frozen shoulder, what is the main direction of ROM lost?

A

ER

285
Q

What percentage of OCD lesions in the knee treated non-operatively in a skeletally immature patient will heal?

A

50-75%

286
Q

Classification system for AVN of the shoulder?

A

Cruess Classification

I: normal x-ray but +MRI

II: Sclerosis & Osteopenia

III: Crescent sign (subchondral fracture)

IV: Flattening & collapse of the humeral head

V: Degenerative changes extend to the glenoid

287
Q

Presentation of cruciate cysts

A

Mechanical symptoms

Pain

288
Q

3 diagnostics tests for thoracic outlet syndrome

A

Hyperabduction test

  • Have them abduct their shoulder to >90 degrees with extension. Ask the patient to take a deep breath and hold. A positive test is a decrease in radial pulse vigor.

Costoclavicular maneuvers

  • Shoulders drawn downward and back causing + arm symptoms and loss of radial pulse

Adson test:

  • the loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration. NOT USED as this happens to many people without TOS
289
Q

Most common mechanism for PCL injury

A

Direct posteriorly directed blow to tibia

In athletes: most common is fall onto flexed knee with foot in plantarflexion

290
Q

3 imporant factors with non-operative treatment of MCL tear of elbow.

A
  1. 6 weeks rest from throwing
  2. flexor-pronator strengthening
  3. progressive return to throwing
291
Q

3 steps for medial approach to knee capsule for an inside out meniscal repair?

A

Insice the sartorius fascia

Retracting the pes tendons and semimembranosus posteriorly

Develop the plane between the medial gastrocnemius and capsule

292
Q

Nerve invovled and surgical treatment of medial scapular winging.

A

Long thoracic

Pec major transfer (only in cases of extreme failure of non-op)

293
Q

what percentage of proximal tib/fib joints communicate with the knee joint?

A

10%

294
Q

What is the success rate with treatment of Type 1 stable elbow OCD with activity modification and brief immoblization?

A

90%

Must be for 3-6 weeks followed by 6-12 weeks gradual return to sport

295
Q

Strenght of ACL

native

BTB

quadrupled hamstrings

A

Native ACL: 2200N

BPTB: 3000N

Quadrupled hamstring: 4000N

So hamstring is 2x native ACL

296
Q

Three strategies to avoid neural injury with elbow portal placement:

A
  1. Fully distend joint through lateral soft spot before placing portals
    • capsule distension moves NV structures away from the joint when trocar is introduced
  2. Careful “nick and spread” technique using hemostat
  3. Selection of portals
    • posterior medial portal usually avoided due to proximity to ulnar nerve
297
Q

What type of xray is most sensitive for detecting knee joint degenerative changes

A

Weight bearing 45 degree flexion views.

298
Q

Indications for HTO

A

Single compartment disease

Young: age

Healthy patient with good vascular status

Pain interfering with daily life

Compliant patient

Correction

299
Q

What does biopsy of frozen shoulder capsule show?

A

Fibroblastic proliferation

300
Q

Main indication for arthroscopic hip labral repair?

A

Full-thickness tears at the labral-chondral junction

301
Q

If indicated, what is the timeframe that ACL reconstruction should be performed within?

A

5 months

AAOS CPG 2014

302
Q

Treatment of Type 2 slap tear in patient 40 or older?

A

Tenotomy or tenodesis. Do not repair the slap tear - they do poorly

303
Q

What has better long term functional outcomes, proximal biceps tenotomy or tenodesis?

A

Equivocal

304
Q

2 indications for surgery in pec major tear?

A

Tendon avulsion from bone (will see ecchymosis on arm)

High level athletes

*May show improvement regardless of location of tear - so maybe do in all

305
Q

3 ways to radiologically diagnose an mcl tear of the elbow.

A
  1. gravity stress ragiograph - > 3mm medial joint opening
  2. MRA - t-sign
  3. dynamic ultrasound
306
Q

Most common site of injury for hamstring rupture

A

myotendinous junction

307
Q

What is the average medial-to-lateral distance of the supraspinatus tendon footprint on the greater tuberosity?

A

14-16mm

308
Q

Name three exam tests for posterior labral tear.

A

Jerk Test

Posterior load and shift

Kim test

309
Q

During what part of a bench press is the pec major most susceptible to rupture?

A

Downward motion

It is eccentrically contracting

310
Q

For a valgus knee, why is distal varus producing femoral osteotomy preferred to a tibial procedure?

A

It prevents obliquity at the joint line

A distal varus osteotomy will maintain a congruent, non-oblique joint at the same time as it fixes alignment

311
Q

Describe provocative test for anterior labral tear.

A

Pain if hip is brought from a fully flexed, externally rotated, and abducted position to a position of extension, internal rotation, and adduction

312
Q

Classification of cruciate cysts?

A

Anterior to ACL

between ACL & PCL

Posterior to PCL

313
Q

5 signs of generalized hypermobility

A

able to touch palms to floor while bending at waist

genu recurvatum

elbow hyperextension

MCP hyperextension

thumb abduction to the ipsilateral forearm

314
Q

Femoral condyle articular defect

A

Microfracture

Osteochondral allograft transfer (OATS)

315
Q

Outerbridge Arthroscopic Grading System

A

Grade 0: Normal

Grade 1: softening of cartilage

Grade 2: superficial fissure

Grade 3: Deep fissures, without exposed bone

Grade 4: Exposed subchondral bone

316
Q

What is the most anterior structure inserting on the fibular head?

A

LCL

317
Q

When I say Thermal capsulorraphy, you say:

A

High rate of recurrent instability

Contraindication to revision soft tissue labral repair

318
Q

Physical exam maneuver to test for internal snapping hip.

A

Passively move hip from a flexed and externally rotated position to an extended and internally rotated position.

Will reproduce psoas snapping over pectineal eminence or femoral head.

319
Q

What is internal impingement?

A

Impingement of posterior under-surface of supraspinatus tendon on greater tuberosity insertion on the posterosuperior glenoid rim

320
Q

What does a Stryker view look for?

A

Hill Sachs Lesion

321
Q

What is the female athlete triad?

A

Amenorrhea

Disordered eating

Osteoporosis

Must workup all 3 if 1 is present (ie a stress fracture)

322
Q

What do the ACL bundles do?

A

Anteromedial bundle: provides anterior-posterior stability

Posterolateral bundle: provides the rotational stability.

323
Q

What are the four most important technical considerations for shoulder hemiarthroplasty?

A
  1. Retroversion: Should be 30 degrees, lateral fin should be just posterior to biceps groove
  2. Head Size: Don’t overstuff, compare to other side and compare to removed head
  3. Implant height: 56 mm from top of prosthesis to pec tendon, 10 mm from top of prosthesis to GT
  4. Fixation of tuberosities: Can use autograft from head to aid in healing
324
Q

What is Paget-Schretter Sydrome

A

Throacic Outlet syndrome with concurrent subclavian vessel compression

Occurs in athletes due to scalene muscle hypertrophy

325
Q

What is pec major transfer for?

A

Irreperable subscapularis tears.

Transferred UNDER conjoitn tendon.

326
Q

What hormone/cytokine promotes scar formation in lacerated muscle?

A

TGF-Beta

327
Q

List the meniscal tear injury patterns

A
328
Q

What structure provides the limit for acromioplasty?

A

Anterior fibers of deltoid.

329
Q

Most common location for patellar tendon rupture?

A

Off inferior pole of patella ± bone (avulsion)

330
Q

Name 5 benefits to aquatic training/rehab

A

decreases joint stress by lowering vertical component of the ground reaction force through buoyancy

unique advantages in cardiorespiratory fitness when compared to land training

less abrupt increases in heart rate

increased oxygen consumption

prevents secondary injuries to the lower limb

331
Q

3 causes of suprascapular nerve impingement at the suprascapular notch

A

ganglion cyst (often associated with labral tears)

transverse scapular ligament entrapment

fracture callus

332
Q

How many corticosteroid injections for tennis elbow is too many?

A

4

(up to 3 is the reccomendation)

333
Q

What is the landmark that is the limit for ecrb release?

A

Equator of radial head, or else risks injury to LUCL

334
Q

Risk factors for dislocation following RSA (4)?

A
  1. proximal humeral bone loss
  2. chronic fracture sequelae with malunited/ununited tuberosities
  3. failed previous arthroplasty
  4. fixed glenohumeral dislocation preoperatively

NOT RA**

335
Q

3 primary stabilizers of posterior shoulder?

A

Posterior badn of IGHL

Subscap

CH ligament

Also:

labrum

SGHL

336
Q

What type of HTO has higher rates of:

a) loss of posterior slope
b) patella baja
c) peroneal nerve injury

A

a) lateral closing wedge
b) medial opening wedge
c) lateral closing wedge

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