Sports Medicine 2016 Flashcards
- Figures 11a through 11c are the radiograph and MR images of a 10-year-old boy who has had 4 weeks of lateral knee pain that began while he was playing soccer. The pain is only present with physical activity, and he does not have any catching symptoms. An examination reveals minimal symptoms with provocative maneuvers and no effusion. What is the most appropriate initial treatment?
- Activity modification and decreased weight bearing
- Arthroscopic removal of the fragment
- Arthroscopic retrograde drilling
- Arthroscopic open reduction and internal fixation
- Observation with no change in athletic activity
- Activity modification and decreased weight bearing
RECOMMENDED READINGS
Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006 Feb;14(2):90-100. Review. PubMed PMID: 16467184.
Polousky JD. Juvenile osteochondritis dissecans. Sports Med Arthrosc. 2011 Mar;19(1):56-63. doi: 10.1097/JSA.0b013e31820b94b9. Review. PubMed PMID: 21293239.
Carey JL, Grimm NL. Treatment algorithm for osteochondritis dissecans of the knee. Orthop Clin North Am. 2015 Jan;46(1):141-6. doi: 10.1016/j.ocl.2014.09.010. Review. PubMed PMID: 25435043.
- Which anterior cruciate ligament (ACL) bundle likely is responsible for rotatory stability of the knee?
- Anteromedial
- Anterolateral
- Central
- Posteromedial
- Posterolateral
- Posterolateral
RECOMMENDED READINGS
Amis AA. The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc. 2012 Apr;20(4):613-20. doi: 10.1007/ s00167-011-1864-7. Epub 2012 Jan 26. Review. PubMed PMID: 22278656.
Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Ménétrey J. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006 Mar;14(3):204-13. Epub 2005 Oct 19. Review. PubMed PMID: 16235056.
- Which computer-based neurocognitive test assesses users’ attention, memory, and processing speed?
- Immediate Post-Concussion Assessment and Cognitive Testing Battery (ImPACT)
- Sport Concussion Assessment Tool II (SCAT-3)
- King-Devick (K-D) Test
- Standardized Assessment of Concussion (SAC)
- Safe Concussion Outcome Recovery & Education (SCORE) Program
- Immediate Post-Concussion Assessment and Cognitive Testing Battery (ImPACT)
RECOMMENDED READINGS
Schatz P. Long-term test-retest reliability of baseline cognitive assessments using ImPACT. Am J Sports Med. 2010 Jan;38(1):47-53. doi: 10.1177/0363546509343805. Epub 2009 Sep 29. PubMed PMID: 19789333.
Okonkwo DO, Tempel ZJ, Maroon J. Sideline assessment tools for the evaluation of concussion in athletes: a review. Neurosurgery. 2014 Oct;75 Suppl 4:S82-95. doi: 10.1227/NEU.0000000000000493. Review. PubMed PMID: 25232887.
- Figures 51a and 51b are the radiographs of a 40-year-old recreational basketball player who injured his knee while jumping for a rebound. He felt a pop and developed immediate swelling. What is the best next step?
- MR imaging
- Rest, ice, and observation
- Physical therapy to regain motion
- Knee arthroscopy and medial patellofemoral ligament (MPFL) repair
- Open surgical repair
- Open surgical repair
RECOMMENDED READINGS
Brooks P. Extensor mechanism ruptures. Orthopedics. 2009 Sep;32(9). pii: orthosupersite.com/view. asp?rID=42852. doi: 10.3928/01477447-20090728-31. Review. PubMed PMID: 19751001.
Matava MJ. Patellar Tendon Ruptures. J Am Acad Orthop Surg. 1996 Nov;4(6):287-296. PubMed PMID: 10797196.
- According to the World Health Organization (WHO), an appropriate surgical “time-out” just prior to an incision consists of which verifications and components?
- Patient’s date of birth, planned surgery, team introductions, aspiration risk
- Patient’s name, surgical laterality, administration of deep venous thrombosis
(DVT) prophylaxis
- Planned surgery, DVT prophylaxis, postsurgical bracing
- Team introductions, patient identification, site and procedure, antibiotic prophylaxis
- Team introductions, patient identification, planned surgery, nurse break schedule
- Team introductions, patient identification, site and procedure, antibiotic prophylaxis
RECOMMENDED READINGS
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-9. doi: 10.1056/NEJMsa0810119. Epub 2009 Jan 14. PubMed PMID: 19144931.
Nakano JM: In search of the perfect surgical timeout. AAOS Now February 2014;8.2:34.
http://www.aaos.org/AAOSNow/2014/Feb/managing/managing9/. Accessed 26 May 2016.
WHO Surgical Safety Checklist and Implementation Manual. http://www.who.int/patientsafety/ safesurgery/ss_checklist/en/. Accessed 26 May 2016.
- A 45-year-old right-handed recreational tennis player has been experiencing pain localized to the medial side of his elbow for 2 weeks. The pain began after playing in a tournament, but he did not sustain a specific injury that he can recall. What is the most appropriate treatment?
- A corticosteroid injection into the flexor origin
- Physical therapy and evaluation of his tennis swing
- Arthroscopic debridement of the flexor origin
- Open debridement of the flexor origin with submuscular ulnar nerve transposition
- Continued tennis play with use of a hinged elbow brace
- Physical therapy and evaluation of his tennis swing
RECOMMENDED READINGS
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015 Jun;23(6):348-55. doi: 10.5435/JAAOS-D-14-00145. Review. PubMed PMID: 26001427.
Cain EL Jr, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003 Jul-Aug;31(4):621-35. Review. PubMed PMID: 12860556.
- During shoulder arthroscopy performed on a 56-year-old recreational tennis player, the patient’s rotator cuff appears intact on the articular side, but he has a partial-thickness tear that is approximately 4-mm thick and 1.5 cm in the anterior-to-posterior direction. What is the appropriate treatment?
- Conversion to a full-thickness tear and repair with suture anchors
- Debridement alone
- Debridement and acromioplasty
- No further arthroscopic treatment
- Acromioplasty alone
- Conversion to a full-thickness tear and repair with suture anchors
RECOMMENDED READINGS
Cordasco FA, Backer M, Craig EV, Klein D, Warren RF. The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med. 2002 Mar-Apr;30(2):257-60. PubMed PMID: 11912097.
Wolff AB, Sethi P, Sutton KM, Covey AS, Magit DP, Medvecky M. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg. 2006 Dec;14(13):715-25. PubMed PMID: 17148619.
- An arthroscopic nerve release in which a transverse scapular ligament is transected is seen in Video 112. If the nerve being released is injured during this procedure, which findings can be expected upon examination?
- Loss of sensation at the lateral aspect of the upper arm
- Weakness in abduction with atrophy in the supraspinatus fossa only
- Weakness in forward flexion with atrophy in the infraspinatus fossa only
- Weakness in internal rotation with a positive belly-press test result
- Weakness in external rotation and abduction, with atrophy in the supraspinatus and infraspinatus fossa
- Weakness in external rotation and abduction, with atrophy in the supraspinatus and infraspinatus fossa
RECOMMENDED READINGS
Scully WF, Wilson DJ, Parada SA, Arrington ED. Iatrogenic nerve injuries in shoulder surgery. J Am Acad Orthop Surg. 2013 Dec;21(12):717-26. doi: 10.5435/JAAOS-21-12-717. Review. PubMed PMID: 24292928.
Boykin RE, Friedman DJ, Higgins LD, Warner JJ. Suprascapular neuropathy. J Bone Joint Surg Am. 2010 Oct 6;92(13):2348-64. doi: 10.2106/JBJS.I.01743. Review. PubMed PMID: 20926731.
- A 12-year-old football player was struck on the outside of his left leg, causing a valgus buckling injury to his knee. He heard a pop and was unable to bear weight following the injury. After performing a thorough knee examination, what is the best next step?
- Anteroposterior, lateral, and oblique radiographs of the left knee
- MR imaging of the left knee
- Arthrogram of the left knee
- Ultrasound examination of the left hip
- Stress radiographs of the left knee
- Anteroposterior, lateral, and oblique radiographs of the left knee
RECOMMENDED READINGS
Mayer S, Albright JC, Stoneback JW. Pediatric Knee Dislocations and Physeal Fractures About the Knee. J Am Acad Orthop Surg. 2015 Sep;23(9):571-80. doi: 10.5435/JAAOS-D-14-00242. Epub 2015 Aug 13. PubMed PMID: 26271758.
Wall EJ, May MM. Growth plate fractures of the distal femur. J Pediatr Orthop. 2012 Jun;32 Suppl 1:S40- 6. doi: 10.1097/BPO.0b013e3182587086. PubMed PMID: 22588102.
- Video 146 depicts a rehabilitation maneuver that is critical in shoulder pathology treatment for a 21-year-old Minor League baseball pitcher who is treated for shoulder pain with a focused rehabilitation program. What is the most likely diagnosis?
- Glenohumeral internal rotation deficit (GIRD)
- Long head of the biceps tendinosis
- Subscapularis rupture
- Superior labral anterior posterior tear
- Bankart lesion
- Glenohumeral internal rotation deficit (GIRD)
RECOMMENDED READINGS
Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009 Apr;91(4):966-78. doi: 10.2106/JBJS.H.01341. Review. PubMed PMID: 19339585.
Crockett HC, Gross LB, Wilk KE, Schwartz ML, Reed J, O’Mara J, Reilly MT, Dugas JR, Meister K, Lyman S, Andrews JR. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):20-6. PubMed PMID: 11798991.
- Which risk factor for anterior cruciate ligament (ACL) injuries contributes most to the higher rate of ACL injuries among female athletes vs male athletes participating in the same sport?
- Varus alignment
- Estrogen levels
- ACL size
- Intra-articular notch size
- Neuromuscular coordination and training
- Neuromuscular coordination and training
RECOMMENDED READINGS
Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, Dick RW, Engebretsen L, Garrett WE Jr, Hannafin JA, Hewett TE, Huston LJ, Ireland ML, Johnson RJ, Lephart S, Mandelbaum BR, Mann BJ, Marks PH, Marshall SW, Myklebust G, Noyes FR, Powers C, Shields C Jr, Shultz SJ, Silvers H, Slauterbeck J, Taylor DC, Teitz CC, Wojtys EM, Yu B. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006 Sep;34(9):1512-32. PubMed PMID: 16905673.
Voskanian N. ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Curr Rev Musculoskelet Med. 2013 Jun;6(2):158-63. doi: 10.1007/s12178-013-9158-y. PubMed PMID: 23413024.
Zebis MK, Bencke J, Andersen LL, Døssing S, Alkjaer T, Magnusson SP, Kjaer M, Aagaard P. The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players. Clin J Sport Med. 2008 Jul;18(4):329-37. doi: 10.1097/JSM.0b013e31817f3e35. PubMed PMID: 18614884.
- A 45-year-old laborer has lateral elbow pain with forceful use of the upper extremity. An examination reveals he has pain with resisted wrist extension while his elbow is fully extended. Which muscle origin is most likely involved?
- Distal biceps brachii
- Extensor carpi radialis brevis (ECRB)
- Extensor carpi radialis longus (ECRL)
- Brachioradialis
- Pronator teres
- Extensor carpi radialis brevis (ECRB)
RECOMMENDED READINGS
Brummel J, Baker CL 3rd, Hopkins R, Baker CL Jr. Epicondylitis: lateral. Sports Med Arthrosc. 2014 Sep;22(3):e1-6. doi: 10.1097/JSA.0000000000000024. Review. PubMed PMID: 25077751.
Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008 Jan;16(1):19-29. Review. PubMed PMID: 18180389.
- Figure 181 is the anteroposterior radiograph of a 13-year-old track athlete who had the immediate onset of right hip pain after his trailing limb struck a hurdle and he fell down. The muscle originating at the injured structure is innervated by which nerve?
- Genitofemoral
- Pudendal
- Femoral
- Obturator
- Superior gluteal
- Femoral
RECOMMENDED READINGS
Holden CP, Holman J, Herman MJ. Pediatric pelvic fractures. J Am Acad Orthop Surg. 2007 Mar;15(3):172-7. Review. PubMed PMID: 17341674.
Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 2001 Mar;30(3):127-31. PubMed PMID: 11357449.
- What is the most common reason for hip arthroscopy revision that addresses femoroacetabular impingement?
- Untreated chondral defect
- Iatrogenic chondral injury
- Adhesive capsulitis
- Persistent femoroacetabular impingement
- Hip instability
- Persistent femoroacetabular impingement
RECOMMENDED READINGS
Phillippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ. Revision hip arthroscopy. Am J Sports Med. 2007 Nov;35(11):1918-1921. PubMed PMID: 17703000.
Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail? Clin Orthop Relat Res. 2013 Aug;417(8):2523-2529. PubMed PMID: 23637056.
- 17-year-old gymnast sustains an anterior cruciate ligament (ACL) injury during an awkward landing. After counseling and discussion, it is decided that she will undergo ACL reconstruction using hamstring autograft. What is the smallest-diameter graft that can minimize risk for rupture?
- 7 mm
- 7.5 mm
- 8.5 mm
- 9 mm
- 10 mm
- 8.5 mm
RECOMMENDED READINGS
Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy. 2012 Apr;28(4):526-531. PubMed PMID: 22305299.
Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1111-1118. PubMed PMID: 22688502.