Sports Medicine 2013 Flashcards
11.
A 20-year-old college basketball player has lateral ankle pain after sustaining an ankle sprain. His pain persists despite allowing a sufficient period of rest and rehabilitation. He has a history of multiple previous sprains, and describes this pain as being different than his usual pain after a sprain. He has tenderness to palpation along the posterior fibula and reproducible pain with resisted eversion. What is the most appropriate treatment option?
- Core repair and tubularization of the peroneus brevis tendon
- Deirect repair of the anterior talofibular and calcaneofibular ligaments
- Ankle arthroscopy and debridement of the lateral gutter and tibiofibular joint
- Lateral ankle stabilization with a transfer of the peroneus brevis through the fibula
- Continued physical therapy with proprioceptive training and peroneal strengthening
- Core repair and tubularization of the peroneus brevis tendon
RECOMMENDED READINGS
Philbin TM, Landis GS, Smith B. Peroneal tendon injuries. J Am Acad Orthop Surg. 2009 May;17(5):306- 17. Review. PubMed PMID: 19411642.
Reed ME, Feibel JB, Donley BG, Giza E. Athletic ankle injuries. In: Kibler WB, ed. Orthopaedic Knowledge Update: Sports Medicine 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:199-214.
- During preparticipation physicals for college football, an athlete tests positive for the sickle-cell trait. With regard to clearance to play, his team physician should
- counsel the athlete about his personal risk for bone infarcts.
- recommend a prophylactic splenectomy prior to participation.
- bar the athlete from participating in National Collegiate Athletic Association-sanctioned events.
- assure the athlete that he can participate in football without concern.
- ensure that the athlete is given adequate recovery time and remains hydrated.
- ensure that the athlete is given adequate recovery time and remains hydrated.
RECOMMENDED READINGS
2011-2012 NCAA Sports Medicine Handbook. Indianapolis, IN: The National Collegiate Athletic Association.
Kark JA, Posey DM, Schumacher HR, Ruehle CJ. Sickle-cell trait as a risk factor for sudden death in physical training. N Engl J Med. 1987 Sep 24;317(13):781-7. PubMed PMID: 3627196.
- Figure 39 is the anteroposterior radiograph of a marathon runner who has left groin pain that prevents her from running. She recently got back into her usual running routine after an ankle injury prevented her from running for several months. She now has pain with any weight bearing. What is the most appropriate treatment option?
- Hip resurfacing arthroplasty
- Hip arthroscopy with removal of the cam lesion
- Internal fixation of the femoral neck with mutliple screws
- Trial of nonsurgical treatment with no weight bearing on the left leg
- Vitamin D level assessment and supplementation with 50000 units weekly
- Internal fixation of the femoral neck with mutliple screws
RECOMMENDED READINGS
Shin AY, Gillingham BL. Fatigue fractures of the femoral neck in athletes. J Am Acad Orthop Surg. 1997 Nov;5(6):293-302. PubMed PMID: 10795065.
Hajek MR, Noble HB. Stress fractures of the femoral neck in joggers: case reports and review of the literature. Am J Sports Med. 1982 Mar-Apr;10(2):112-6. PubMed PMID: 7081524
- A 36-year-old man who was playing recreational basketball felt a pop in the back of his leg and is now unable to walk. Rest, ice, and elevation have been ineffective at restoring his leg. Examination reveals pain over the posterior calf, some ecchymosis, and weak plantar flexion strength. A Thompson test result is positive. Compared with nonsurgical treatment, surgical treatment is more likely to
- carry a lower risk for equinus contracture.
- restore strength (closer to usual levels).
- reduce risk for rerupture.
- allow for quicker ambulation and recovery.
- result in better outcomes on blind randomized studies.
- reduce risk for rerupture.
RECOMMENDED READINGS
Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg Br. 2011 Aug;93(8):1071-8. PubMed PMID: 21768631.
- A 14-year-old girl has a 6-week history of diffuse pain in both knees after attending cheerleading camp without trauma. She denies mechanical symptoms or swelling, but does state her knees “give-way” and “click” occasionally. Examination and radiographs are unremarkable, with the exception of global discomfort to palpation of both knees. What is the most appropriate next step?
- MRI scans of both knees
- Corticosteroid injection into both knees
- Bone scan with pinhole views of both knees
- Lab studies to rule out a rheumatologic condition
- A physical therapy regimen to both lower extremities
- A physical therapy regimen to both lower extremities
RECOMMENDED READINGS
Dalton SE: Overuse injuries in adolescent athletes. Sports Med 1992;13:58-70. PubMed PMID: 1553456. Earl JE, Vetter CS: Patellofemoral pain. Phys Med Rehabil Clin N Am 2007;18:439-458. PubMed PMID: 17678761.
Outerbridge AR, Micheli LJ: Overuse injuries in the young athlete. Clin Sports Med 1995;14:503-516. PubMed PMID: 7553920.
- A 20-year-old collegiate rower has pain along the left side of his chest just anterior to the midaxillary line. The pain began approximately 4 weeks after he started preseason training. The pain occurs almost immediately after he begins rowing and goes away when he stops. He has not noticed the pain while running. Which study will most likely reveal the diagnosis?
- Echocardiogram
- Electrocardiogram
- 3-phase bone scan
- Rib series radiographs
- Posteroanterior chest radiograph
- 3-phase bone scan
RECOMMENDED READINGS
Karlson KA. Rib stress fractures in elite rowers. A case series and proposed mechanism. Am J Sports Med. 1998 Jul-Aug;26(4):516-9. Review. PubMed PMID: 9689370.
- A 42-year-old man has a chondral defect of the medial femoral condyle that is approximately 1 cm in diameter. He has a very athletic lifestyle, wishes to remain active, and is now seeking a third opinion. He has seen 2 orthopaedic surgeons; the first surgeon recommended microfracture for the chondral defect, and the other recommended an osteochondral autograft transplantation (OATS). What should the patient be told?
- Recovery is faster with microfracture, the outcomes are better with OATS, and both techniques
produce the same reparative surface.
- Recovery is faster with OATS, the outcomes are better with microfracture, and both techniques
produce the same reparative surface.
- The outcomes are better with OATS, rehabilitation is faster with OATS, and the reparative
surface is articular cartilage with OATS.
- Recovery time and outcomes are similar between these 2 techniques, and the reparative surface with microgracture is fibrocartilage
- Recovery and outcomes are similar between these 2 techniques, and the reparative tissue with OATS is fibrocartilage
- Recovery time and outcomes are similar between these 2 techniques, and the reparative surface with microgracture is fibrocartilage
RECOMMENDED READINGS
Alfond JW, Cole BJ: Cartilage restoration, Part 1: Basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med 2005;33:295-306. PubMed PMID: 15701618.
Magnussen RA, Dunn WR, Carey JL, Spindler KP: Treatment of focal articular cartilage defects in the knee: a systemic review. Clin Orthop Relat Res 2008:466:952-962. PubMed PMID: 18196358.
- While performing an arthroscopic procedure, an instrument has a mechanical failure resulting in a 1.5-mm segment of metallic debris incarcerated within soft tissue. After 45 minutes of fluroscopic localization and special arthroscopic techniques, the fragment is determined to cause no harm to the patient. Upon recognizing the event, the treating surgeon should
- immediately abandon the procedure, close the portals, and obtain further imaging.
- complete the surgery, determine the risk for potential injury to the patient, and immediately
notify the patient and family following the procedure.
- complete the surgery, follow the patient clinically for any unintended consequences before
disclosing the event.
- call the patient’s family from the operating room to explain the error before proceeding to
complete the procedure.
- refrain from formal disclosure if the fragment is unlikely to cause any further damage.
- complete the surgery, determine the risk for potential injury to the patient, and immediately
RECOMMENDED READINGS
Lundy DW, Weinstein SL. Patient safety and risk management. In: Flynn JM, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:3-10. http://www.aaos.org/about/papers/advistmt/1015.asp (Accessed 8/1/2012).
- A 23-year old woman sustained an aankle inversion injury 6 weeks ago. She reports pain and difficulty returning to recreational basketball. Examination reveals tenderness of the anterior talofibular ligament, pain laterally with inversion stress, weakness without pain in eversion against resistance, and a negative anterior drawer. What is the best next treatment step?
- Physical therapy
- Cast immobilization
- Peroneal tendon repair
- Chrisman-Snook reconstruction
- Modified Brostrum Reconstruction
- Physical therapy
RECOMMENDED READINGS
Digiovanni BF, Partal G, Baumhauer JF: Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med 2004;23:1-19. PubMed PMID: 15062581.
Berlet GC, D’Onofrio MM, Lee TH: Acute ankle sprain, chronic ankle instability, and subtalar laxity. In: Thordarson DB, ed. Foot and Ankle. Philadelphia, PA: Lippincott-Raven; 2004:242-249.
- An elite-level pitcher with a history of chronic moderate medial elbow pain reports a sudden pop and severe pain along the medial elbow while throwing a pitch. Examination reveals a positive moving valgus stress test. What is the most appropriate next treatment step?
- Rehabilitation of hte flexor-pronator musculature.
- Bracing of the elbow to facilitate a return to pitching
- Early primary repair of the ulnar collateral ligament
- Early ulnar collateral ligament reconstruction
- Early ulnar collateral ligament reconstruction and ulnar nerve transposition
- Early ulnar collateral ligament reconstruction
RECOMMENDED READINGS
Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008 Jun;36(6):1193-205. Review. PubMed PMID: 18490476.
Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001 Jan-Feb;29(1):15-7. PubMed PMID: 11206249.
Safran MR: Nonacute medial elbow injuries. In: Kibler WB, ed. Orthopaedic Knowledge Update: Sports Medicine 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:47-57.
- At her 6-week follow-up visit after arthroscopic repair of a full-thickness rotator cuff tear, a patient has not yet attended formal physical therapy. Which outcome at 1 year is expected?
- Persistent stiffness of the shoulder, resulting in loss of function
- High likelihood of needing a second procedure for a capsular release
- Improved healing of the rotator cuff despite persistent stiffness of the shoulder
- No long-term difference in motion compared to early physical therapy
- A significant decrease in Constant score compared to early physical therapy.
- No long-term difference in motion compared to early physical therapy
RECOMMENDED READINGS
Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness? J Shoulder Elbow Surg. 2010 Oct;19(7):1034- 9. Epub 2010 Jul 24. PubMed PMID: 20655763.
Trenerry K, Walton JR, Murrell GA. Prevention of shoulder stiffness after rotator cuff repair. Clin Orthop Relat Res. 2005 Jan;(430):94-9. PubMed PMID: 15662309.
- Which of the following is the most important restraint to medial instability of the long head of the biceps tendon?
- Tendon of the subscapularis
- Coracohumeral ligament
- Superior glenohumeral ligament
- Morphology of the bicipital groove
- Origin of the long head of the biceps in the supraglenoid tubercle
- Tendon of the subscapularis
RECOMMENDED READINGS
Walch G, Nové-Josserand L, Boileau P, Levigne C: Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg 1998;7:100-108. PubMed PMID: 9593086.
Maier D, Jaeger M, Suedkamp NP, Koestler W: Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears. J Bone Joint Surg Am 2007;89:1763-1769. PubMed PMID: 17671016.
- An inferior placement of the posterior shoulder portal endangers which vital structure?
- Radial nerve
- Axillary nerve
- Long thoracic nerve
- Thoracoacromial artery
- Anterior humeral cirumflex artery
- Axillary nerve
RECOMMENDED READINGS
Lo IK, Lind CC, Burkhart SS. Glenohumeral arthroscopy portals established using an outside-in technique: neurovascular anatomy at risk. Arthroscopy. 2004 20(6):596-602.PubMed PMID: 15241310.
Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy. 2007 23(5):529-536. PubMed PMID: 17478285.
- Toward the end of a preseason football practice, a player approaches his trainer with difficulty remembering what he is supposed to do during his position drills. He is confused and disoriented, clearly fatigued, soaked in sweat, and his skin is pale. What is the most appropriate next step?
- Have the athlete lie down on the sidelines for administration of intravenous fluid.
- Immediately perform a thorough neurologic evaluation on the sidelines.
- Assure the athlete that he is simply dehydrated and can return after rehydrating.
- Administer a Sideline Assessment of Concussion test to determine return to play.
- Obtain a core temperature in a cooled training room while hydrating the athlete.
- Obtain a core temperature in a cooled training room while hydrating the athlete.
RECOMMENDED READINGS
American College of Sports Medicine, Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007 Mar;39(3):556-72. Review. PubMed PMID: 17473783.
- A 29-year-old athlete reports recurrent anterior shoulder instability after surgery. Performing an arthroscopic revision surgery is contraindicated when there is capsular attenuation or
- glenoid bone loss of 15%.
- an associated rotator cuff tear.
- postthermal capsular necrosis.
- a Hill-Sachs lesion involving 20% of the humeral head.
- the patient participates in sports that involve contact and collision.
- postthermal capsular necrosis.
RECOMMENDED READINGS
Creighton RA, Romeo AA, Brown FM Jr, Hayden JK, Verma NN. Revision arthroscopic shoulder instability repair. Arthroscopy 2007;23:703-709. PubMed PMID: 17637404.
Miniaci A, Codsi MJ: Thermal capsulorrhaphy for the treatment of shoulder instability. Am J Sports Med 2006:34:1356-63. PubMed PMID: 16685091
- What is an absolute contraindication to meniscal transplantation?
- Stable joint
- Angular deformity
- Inflammatory Arthritis
- Localized chondral defect
- Anterior Cruciate Ligament Deficiency
- Inflammatory Arthritis
RECOMMENDED READINGS
West RV, Fu FH. Soft-tissue physiology and repair. In: Vaccaro AR ed: Orthopaedic Knowledge Update 8. Rosemont, IL, American Academy of Orthopaedic Surgeons; 2005:15-27.
Cole BJ, Carter TR, Rodeo SA: Allograft meniscal transplantation: Background, techniques, and results. Instr Course Lect 2003;52:383-396. PubMed PMID: 12690865.
- Figures 275a through 275c are the radiographs of a 28-year-old recreational basketball player who underwent autograft anterior cruciate ligament reconstruction and a partial medial meniscectomy 4 years ago. Although his initial results were favorable, he has persistent instability symptoms and “giving way” when attempting to participate in desired sports activities. Examination reveals the following: a 2A Lachman, 3+ pivot shift, negative external rotation dial, and a positive McMurray maneuver for the medial compartment. His recurrent instability symptoms are most likely related to
- an unstable lateral meniscal tear.
- the development of posterolateral instability.
- femoral tunnel placement that did not restore rotatory stability.
- femoral tunnel placement that did not restore the posteromedial bundle.
- femoral tunnel fixation that did not adequately address the anterolateral bundle
- femoral tunnel placement that did not restore rotatory stability.
RECOMMENDED READINGS
Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S. Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 1: Basic science. Am J Sports Med August 2011 39 1789-1799. PubMed PMID: 21596902.
