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Exam Question Notes Flashcards

1
Q

Valgus Extension Overload Syndrome

A

May occur in a lax elbow (especially if UCL weakened) and the athlete continues to throw with this laxity. Athlete c/o posteromedial elbow pain during late acceleration or follow through. There is shearing of the olecranon in the fossa and continued forces lead to lateral compartment synovitis of Osteochondrosis. Often find pathological changes of articular surfaces as posterior trochlea and anteromedial olecranon.

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2
Q

Percentages of macronutrients in diet?

A

Protein: 10-35%
Fat: 25-35%
Carbs: 45-65% (ultra endurance 70-75%)

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3
Q

Where are the UCL ligaments taut for the elbow?

A

Anterior Bundle:
- Strongest/most important
- Primary valgus restraint from 30-90
- Taut throughout flexion/extension

Oblique Bundle:
- Variable in attachments

Posterior Bundle:
- Tensions from 90-120
- Only taut in flexion

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4
Q

What is radial tunnel syndrome?

A

Often confused with lateral epicondylitis. It’s about 2 inches in length from the capitellum, between the brachioradialis/brachialis, and distally through supinator. The radial nerve can become entrapped and result in persistent pain around extensor mass. Nerve usually impinged at Arcade of Froshe.

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5
Q

Where is graft taken for UCL reconstruction? What are the types of surgeries used for it? How long before return to throwing program?

A
  1. Palmaris longus > hamstring tendon
  2. Docking procedure and Modified Jobe
  3. 4 months
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6
Q

How long should helmets be around for before being replaced?

A

National athletic equipment reconditioners association (NAERA) will no longer accept helmets for reconditioning that are >10 years old. They are licensed by the National Operating Committee for Sports Equipment (NOCSAE).

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7
Q

Largest risk factor for increased incidence of adductor strains?

A

Adductor weakness

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8
Q

When should scoliosis screening start?

A

You want to screen at the peak of incidence, which is from 11-14 years old. If you screen too early you will miss too many people.

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9
Q

What is the difference between shunt and spurt muscles?

A

Spurt (sudden burst of speed): Pulls more across the bone (perpendicular; except in full extension). Usually good at moving the joint.

Shunt (Stability): Pull more in line with the bone in most positions. Usually pulls the joint surfaces together.

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10
Q

Return to sports info. with cartilage repair procedures?

A

Highest return rates can be achieved with osteochondral autograft transfer, but best durability is seen after autologous chondrocyte transplantation.

Good Variables:
- Younger competitive players with small defect
- Short duration of symptoms
- Fewer prior surgical interventions

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11
Q

Best cartilage surgeries based on defect size?

A

Microfracture and osteochondral autograft indicated for smaller defects and chondrocyte implantation for small and large defects.

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12
Q

Best Tests For Meniscus Tears

A

Screens:
1. Thessaly at 20
2. Joint line TTP
3. Thessaly at 5

Rule In:
1. Thessaly at 20
2. Thessaly at 5
3. McMurray

Apley’s sucks

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13
Q

Throwing Mechanics (Question 32)

A
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14
Q

Where does revascularization of BPTB ACL autograft occur most rapidly?

A

Mid-substance

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15
Q

Asthma medications used to manage asthma (38)

A
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16
Q

Where does neuroma most commonly occur? What is it? What causes it?

A

Between 3rd/4th mets. Thickening of nerve tissue between METS. Anything that causes compression or irritation of the nerve.

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17
Q

What factors most closely associated with failure of conservative management with lateral elbow pain?

A
  1. Having worker’s compensation claim
  2. Prior injection
  3. Radial tunnel syndrome
  4. Previous orthopedic surgery
  5. Duration > 12 months
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18
Q

What symptoms come on quickest with steroid use?

A
  1. Associated weakness of tendons

Liver strain, reproductive dysfunction, and increased CV disease come on later.

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19
Q

How to manage a contusion?

A

Need to position the athlete in maximal lengthening of muscle and apply ice pack. This is to maintain flexibility of the muscle group while swelling may be present maintain the functional integrity of the muscle. After ice treatment is performed, use 6 inch compression wrap over thigh with slightly overlapping circles from knee working up to thigh. Should be snug but not too tight. If pain while walking then placed on crutches and NWB for first 24-48 hours. As pain diminishes can go from NWB to PWB.

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20
Q

Risk factors for diastasis recti?

A
  1. Obesity
  2. Narrow pelvis
  3. Multiple births
  4. 3rd trimester
  5. Excess uterine fluid
  6. Large babies
  7. Weak abdominal muscles prior to pregnancy
21
Q

PCL Reconstruction Contraindications?

A

Gravity assisted position contraindicated

22
Q

Recommended maximum percent of body weight changes before/after practice?

A

2%

23
Q

Blood pressures and exercise?

A

According to ACSM, resting SBP of >160 or DBP of >100 are relative contraindications to strength training in older adults.

24
Q

Graft placement and ROM limitations

A

Anteriorly placed tibial graft could account for decreased extension.

25
Q

Confounding variable? Selection bias? Measurement Bias? Detection bias?

A
26
Q

Lisfranc Injury (108)

A

Grade 1 and 2 can be managed with closed reduction and immobilization. Grade 3 needs percutaneious screw fixation.

27
Q

Protein grams during well balanced meal?

A

25-30 grams

28
Q

What symptoms warrant EMS transport after concussion?

A

Focal neurologic deficits, prolonged loss of consciousness, or progressively worsening symptoms.

29
Q

Medications after concussion?

A

Avoid anti platelet medications due to concerns for intracranial bleeding.

30
Q

Nonresponder bias? Detection bias? Selection Bias? Interviewer bias?

A

Nonresponder bias: subject drops out, refuses to participate, or can’t be contacted for inclusion.

Selection bias: subjectis in the study are not representative of the target population

Detection bias: differences in how outcomes are determined

Interviewer bias: when one is able to elicit better responses from one type of patient relative to another

31
Q

What do braces do for ACL tears?

A

Can improve early coordination and jumping mechanics and provide positive psychological effect. They have been shown at preventing recurrent ACL injury in skiers but no increase in stability or RTP for other sports. Some studies show they may potentially decrease speed and turning quickness.

32
Q

How is SCFE managed?

A

All grades are managed with ORIF

33
Q

Young vs Old For Heat Illness?

A

Younger more susceptible than old (given their surface area).

34
Q

Internal hip snapping.

A

Abrupt movement of the iliopsoas tendon over iliopectineal eminence. Newer studies show th presence of multiple iliopsoas tendons which could cause snapping of the medial head flipping over the lateral head tendon. Dynamic US study showed abnormal movement of the iliacus muscle between the pubic bone and iliopsoas tendon, resulting in a snap.

35
Q

TFCC Tears and Healing?

A

Peripheral tears have the highest liklihood of healing due to their proximity to blood supply. Radial and central tears have low healing potential and best treated with debridement.

Athletes who bear weight through wrist have lower rate of return. Ulnar variance can play a role in success of TFCC treatment.

36
Q

Common nerve injury during lymph node resection?

A

Spinal accessory nerve during lymph node resection of neck and thoracodorsal (lat during axillary dissection)

37
Q

Gymnast Wrist

A

Wrist pain (usually radial) in skeletally immature during periods of increased intensity. Leads to inflammation and irritation at the growth plate. Can lead to premature closure of growth plate and radius being shorter than ulna. Diagnosed with TTP at radius and radiographs.

38
Q

Prophylactic Knee Bracing For Knee Injuries?

A

No evidence to support this.

39
Q

3 Categories of People After ACL Tear

A
  1. Adapters
  2. Copers
  3. Non-copers
40
Q

Differences between Copers and non-Copers?

A

Copers:
1. Less deficits in quad strength
2. Less VL atrophy
3. Less quad activation deficits
4. Less altered knee movement patterns
5. Increased knee flexion moments
6. Less quad/hamstring cocontraction

Testing:
1. >80% on timed hop test
2. >80 on knee outcome survey
3. >60% for global rating of knee function
4. < or = 1 episode giving way

Testing done about 60 days post-tear at around 10 session but less than 6 months

41
Q

Rehab before ACL surgery

A

But what is more important, is that up to 2 years after ACL reconstruction, those treated with an extended period of pre-operative rehabilitation – the Delaware Oslo Cohort (n=150) – fared much better in IKDC, KOOS and had a significantly higher rate of return to sport than those who didn’t

42
Q

Difference between stress and strain?

A

Stress is the magnitude of force dispersed over an area. Strain is the amount of deformation.

43
Q

Joint instability versus hypermobility?

A

Hypermobility just refers to increased ROM and flexibility. Instability is the ability of a joint to maintain a posture/trajectory when disturbed compared to what it would look like when undisturbed.

44
Q

How long does it take for the strength of bone to return to normal after screw removal?

A

Between 4-12 months.

45
Q

Discuss stress-strain curve?

A
  1. Toe Region (uncrimping of the collagen fibers)
  2. Elastic Region (tissue returns to original form)
  3. Yield Point (Point where elastic ends and plastic begins; if you don’t reach this point then structure will return to original length)
  4. Plastic Region (beyond this point, permanent deformation will occur even after the load is removed)
46
Q

Differences between:
RFS/FFS

A

FFS:
1. Greater rearfoot excursion
2. Greater knee flexion at IC
3. Shorter stride length
4. Less vertical loading rate
5. Increased plantarflexion forces

Big difference: forefoot and midfoot strikers don’t appear to exposed to the high loading rates seen by rearfoot strikers

47
Q

Risk factors for sudden cardiac death? Other causes of sudden cardiac death?

A
  1. Males
  2. African Americans
  3. Basketball participation

Other causes:
1. Coronary artery anomalies
2. Aortic rupture
3. Marfans
4. Myocarditis
5. Arrhythmogenic right ventricular cardiomyopathy
6. Ion channel disorders
7. WPWS
8. Commotio cortis

48
Q

Prophylactic ankle bracing

A

Can decrease in incidence of ankle sprains but not necessarily the severity.

scs (27 decks)

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