Sports UE Flashcards
What is normal HH and glenoid version?
HH 30deg RV
G 5deg RV
Which ligaments provide AP vs sup-inf stability at the AC joint?
AC = AP (horizontal stability)
- Superior thickest
CC = sup inf (vertical stability)
1. Trapezoid = lateral
2. Conoid = medial
AC tend to rupture before CC
What is a sublabral foramen and Buford complex?
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
GHL - what do they do
SGHL
MGHL
IGHL - ant and post
SGHL - arm at side
MGHL - arm 45deg
aIGHL - arm 90deg, ant translation
pIGHL - arm 45-90deg, post translation
What 4 structures are contained in the rotator interval?
Capsule
SGHL
CH lig
LH biceps
Name nerve innervation + 4 rotator cuff muscles
Supra - suprascap, C5/6 - Jobe
Infra - “ “ - ER lag
Teres - axillary, C5/6 - Hornblowers
SS - upper/lower SS, C5/6 - lift off
What is the rotator cable/cresent?
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
What BV runs in the bicipital groove - what is it a branch of?
Ax art -> AHCA -> arcuate art
What is the difference between the following:
ALPSA
GLAD
HAGL
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
What is the track equation?
Track = 0.83D - d
D : glenoid diameter
d : glenoid defect
If HS > track = off track
What is the comma sign tissue?
Avulsed SGHL in a SS tear
What are Walch A-C?
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
Hamada classification
Normal AHI 8-10mm
H1 = AHI >6mm (normal-ish)
H2 = AHI <5
H3 = “ “ + acetabularization
H4 = GH joint narrowing
H5 = HH collapse
Position for glenohumeral fusion
20 abd
30 FF
40 IR
Fuse HH high so fuses to glenoid and undersurface acromion
Risks of medialized vs lateralized rTSA
Medialized: notching, loss shoulder contour
Lateralized: acromial stress, stress at bone implant interface
What structures are at risk during late cocking and deceleration in the shoulder?
Late cocking = internal impingement (SLAP, partial articular RC tears)
Deceleration = cuff
What is a Bennett lesion?
Posterior glenoid exostosis - think result of internal impingement
Non op -> excision
Name 4 parts of LCL and 3 parts UCL
LCL
1. RCL
2. Annular
3. Accessory
4. LUCL
MCL
1. Ant bundle - 0-90deg
2. Post bundle - >90deg
3. Transverse bundle
What are the major medial and lateral elbow scope portals / structures at risk
Medial - think ULNAR n
- Ant med = viewing
Lateral - think RADIAL n (PIN)
- Ant lat
- Mid lat
- Post lat
Otherwise, direct posterior goes through triceps
What phase of throwing most stresses UCL?
Late cocking
What are 2 physical exam maneuvers to differential ant vs post band UCL
Ant: valgus stress test
Post: milking maneuver
What are the late signs of UCL insuff
Post med ostephytes
Recognize because this is an adaptation. If you remove these without reconstruction UCL, bad news!
What are the percentage loss supination vs flexion for distal biceps
40% loss supination strength / 85% supination endurance
20% loss flexion strength
What is Speed vs Yergason test for biceps
Speed: resisted flexion in supination
Yergason: resisted supination
Any difference in outcomes for scope suprapec vs open subpec biceps tenodesis
Nope
What are the 3 types of acromion?
1 flat
2 curved
3 hooked
Best seen on scap Y
What are the 3 ossification centers of acromion? Most common location for os acromiale?
A->P: pre, meso, meta
Most common at meso/meta junction
Often bilateral so look for both sides
What ligament is the “essential lesion” for adhesive capsulitis?
CH lig
Which athlete is the gimme for distal clavicle osteolysis? Treat
Weight lifters
Nonop 1st
Distal clavicle resection -> preserve sup + post capsule for stability, don’t resect >1cm
What is the most common SC injury
PHYSEAL
1st to ossify, last to fuse (around 20yo)
Which head of the pec is involved in rupture
Sternal
Both insert at the same spot, question is where originate (sternum vs clavicle)
Sx quadrilateral space syndrome
Weak deltoid + teres minor bc compression post br ax n
Dx with arteriogram bc can also see post hum circum art compression
Medial scapular winging
- Nerve / muscle
Surgery if fail non op
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
Lateral scapular winging
- Nerve / muscle
Surgery if fail non op
Inf border lateral
Trap weak / spinal accessory nerve (CN 11)
Non-op -> Eden Lange trsf = move levator and rhomboids lateral
Best next test if see charcot joint
C spine imaging - syringomyelia
Swollen arms - 2 ddx
Thoracic outlet
Ax/subclavian art aneurysm/thrombosis
