Sports UE

Question 1

What is normal HH and glenoid version?

Answer 1

HH 30deg RV
G 5deg RV

Question 2

Which ligaments provide AP vs sup-inf stability at the AC joint?

Answer 2

AC = AP (horizontal stability)
- Superior thickest

CC = sup inf (vertical stability)
1. Trapezoid = lateral
2. Conoid = medial

AC tend to rupture before CC

Question 3

What is a sublabral foramen and Buford complex?

Answer 3

Sublabral foramen = labrum not firmly attached to glenoid ant sup (12%)
Buford complex = absent ant sup labrum with thick MGHL

Normal variants that can be confused with SLAP. Don’t fix, will lose ER

Question 4

GHL - what do they do
SGHL
MGHL
IGHL - ant and post

Answer 4

SGHL - arm at side
MGHL - arm 45deg
aIGHL - arm 90deg, ant translation
pIGHL - arm 45-90deg, post translation

Question 5

What 4 structures are contained in the rotator interval?

Answer 5

Capsule
SGHL
CH lig
LH biceps

Question 6

Name nerve innervation + 4 rotator cuff muscles

Answer 6

Supra - suprascap, C5/6 - Jobe
Infra - “ “ - ER lag
Teres - axillary, C5/6 - Hornblowers
SS - upper/lower SS, C5/6 - lift off

Question 7

What is the rotator cable/cresent?

Answer 7

Thickening of CH lig
A thicker part of the rotator cuff that run from behind biceps to the infra (perpendicular to the lateral tendon insertion)
Acts as a suspension bridge - talk about lateral cuff tears not being functionally significant because of cable being intact
Anterior SS tears that involve the interval may disrupt the cable, theoretical higher risk of progression/FI

Question 8

What BV runs in the bicipital groove - what is it a branch of?

Answer 8

Ax art -> AHCA -> arcuate art

Question 9

What is the difference between the following:
ALPSA
GLAD
HAGL

Answer 9

ALPSA - labrum + periosteum go medial down anterior glenoid neck
GLAD - glenoid cartilage goes with the labrum, may need microfracture at time of repair
HAGL - capsule off humerus, some people repair

Question 10

What is the track equation?

Answer 10

Track = 0.83D - d
D : glenoid diameter
d : glenoid defect

If HS > track = off track

Question 11

What is the comma sign tissue?

Answer 11

Avulsed SGHL in a SS tear

Question 12

What are Walch A-C?

Answer 12

A: HH Centered
A1 - minor wear
A2 - deep central erosion

B: HH posterior sublux
B1 - posterior wear
B2 - biconcave
B3 - neoglenoid takes over the entire glenoid

C: glenoid RV >25deg aka dysplastic

Question 13

Hamada classification

Answer 13

Normal AHI 8-10mm

H1 = AHI >6mm (normal-ish)
H2 = AHI <5
H3 = “ “ + acetabularization
H4 = GH joint narrowing
H5 = HH collapse

Question 14

Position for glenohumeral fusion

Answer 14

20 abd
30 FF
40 IR

Fuse HH high so fuses to glenoid and undersurface acromion

Question 15

Risks of medialized vs lateralized rTSA

Answer 15

Medialized: notching, loss shoulder contour
Lateralized: acromial stress, stress at bone implant interface

Question 16

What structures are at risk during late cocking and deceleration in the shoulder?

Answer 16

Late cocking = internal impingement (SLAP, partial articular RC tears)
Deceleration = cuff

Question 17

What is a Bennett lesion?

Answer 17

Posterior glenoid exostosis - think result of internal impingement
Non op -> excision

Question 18

Name 4 parts of LCL and 3 parts UCL

Answer 18

LCL
1. RCL
2. Annular
3. Accessory
4. LUCL

MCL
1. Ant bundle - 0-90deg
2. Post bundle - >90deg
3. Transverse bundle

Question 19

What are the major medial and lateral elbow scope portals / structures at risk

Answer 19

Medial - think ULNAR n
- Ant med = viewing

Lateral - think RADIAL n (PIN)
- Ant lat
- Mid lat
- Post lat

Otherwise, direct posterior goes through triceps

Question 20

What phase of throwing most stresses UCL?

Answer 20

Late cocking

Question 21

What are 2 physical exam maneuvers to differential ant vs post band UCL

Answer 21

Ant: valgus stress test
Post: milking maneuver

Question 22

What are the late signs of UCL insuff

Answer 22

Post med ostephytes
Recognize because this is an adaptation. If you remove these without reconstruction UCL, bad news!

Question 23

What are the percentage loss supination vs flexion for distal biceps

Answer 23

40% loss supination strength / 85% supination endurance
20% loss flexion strength

Question 24

What is Speed vs Yergason test for biceps

Answer 24

Speed: resisted flexion in supination
Yergason: resisted supination

Question 25

Any difference in outcomes for scope suprapec vs open subpec biceps tenodesis

Answer 25

Nope

Question 26

What are the 3 types of acromion?

Answer 26

1 flat
2 curved
3 hooked
Best seen on scap Y

Question 27

What are the 3 ossification centers of acromion? Most common location for os acromiale?

Answer 27

A->P: pre, meso, meta
Most common at meso/meta junction
Often bilateral so look for both sides

Question 28

What ligament is the “essential lesion” for adhesive capsulitis?

Answer 28

CH lig

Question 29

Which athlete is the gimme for distal clavicle osteolysis? Treat

Answer 29

Weight lifters

Nonop 1st
Distal clavicle resection -> preserve sup + post capsule for stability, don’t resect >1cm

Question 30

What is the most common SC injury

Answer 30

PHYSEAL
1st to ossify, last to fuse (around 20yo)

Question 31

Which head of the pec is involved in rupture

Answer 31

Sternal
Both insert at the same spot, question is where originate (sternum vs clavicle)

Question 32

Sx quadrilateral space syndrome

Answer 32

Weak deltoid + teres minor bc compression post br ax n

Dx with arteriogram bc can also see post hum circum art compression

Question 33

Medial scapular winging
- Nerve / muscle

Surgery if fail non op

Answer 33

Inf border of the scapula is medial (vs sup)

Serratus ant / long thoracic nerve is OUT
Overpower of the trap

Rehab -> split pec major transfer

Question 34

Lateral scapular winging
- Nerve / muscle

Surgery if fail non op

Answer 34

Inf border lateral

Trap weak / spinal accessory nerve (CN 11)

Non-op -> Eden Lange trsf = move levator and rhomboids lateral

Question 35

Best next test if see charcot joint

Answer 35

C spine imaging - syringomyelia

Question 36

Swollen arms - 2 ddx

Answer 36

Thoracic outlet
Ax/subclavian art aneurysm/thrombosis