2019 (Jan-Sept) Flashcards
Where does the deltoid ligament typical rupture
Off the medial malleolus side
1mm of lateral deviation of the talus = what decrease in contact
42% reduction in tibiotalar contact
What are the two things you look for on plain XRs for deltoid rupture?
>4mm of medial clear space widening >1mm more than superior tibiotalar space
If reduced on WB views of ankle do you still need a stress?
Yes - doesn’t maximally stress syndesmosis
Does MRI help with deltoid ruptures
No - not useful to make surgical decision
When should you repair deltoid?
Controversial Right now algorithm: Fix fibular +/- syndesmosis PRN If persistent widening on ER stress and talar tilt on EVERSION stress consider it
What are you looking for on Eversion stress test of ankle
Valgus tilt of talus greater than 7 degrees
What’s the literature on deltoid repair vs. no?
Literature to support either side - One RTC shows no difference but lacked power, short FU and lacked ability to test medial instability - Perhaps better for preventing medial widening and better pain IF the syndemosis was also fixed
Name five diagnostic tests for ACJ pathology
- TTP over ACJ 2. O’Brien test 3. Paxino test 4. Cross-body adduction 5. AC resisted extension ACJ TTP – best screening test to r/o ACJ pathology O’Brien/cross-body adduction/AC resisted extension useful in confirming ACJ pathology if positive
Describe the Paxino test
Pt sitting with arm resting @ side Create shearing force over ACJ by applying thumb pressure over PL acromial corner and counterpressure with index and middfle fingers over distal clavicle Positive if pain occurs @ ACJ
Describe the O’Brien test as it applies to ACJ pathology
FF of arm to 90 deg with elbow extended and arm adducted 10 deg Examiner applies downward force and patient resists first with forearm IR/pronated (thumb points down) and then with arm ER/supinated ACJ pain exacerbated by pronated position but alleviated with supinated position
Name five diagnostic tests for LHBT pathology
- Palpation of LHBT 2. Speed’s test 3. Yergason test 4. Upper Cut test TTP at biceps – not reliable test for detecting or r/o biceps pathology Speed’s/Yergason/Upper Cut tests – good confirmatory test Upper cut test – highest clinical utility as screening and confirmatory test Combining Speed and upper cut test significantly improves predictability of detecting biceps pathology
Describe the Upper Cut test
Pt makes fist while flexing elbow to 90 deg, and supinating forearm Examines places hand over first and resists pt bringing their hand up and toward examiner’s chin (boxing uppercut motion) Pain/painful pop @ anterior shoulder indicates positive test
Name nine diagnostic tests for SLAP tears
- O’Brien tetst 2. Crank test 3. Anterior slide test 4. Biceps Load I test 5. Biceps Load II test 6. Modified Dynamic Labral Shear 7. Labral tension 8. Resisted Supination External Rotation 9. Forced Shoulder Abduction and Elbow Flexion • Only test to show consistency as screening test was modified dynamic labral shear test • Combining anterior slide and crank tests improves ability to rule in SLAP tear
Describe the O’Brian test as it applies to SLAP tears
FF arm 90 deg with elbow extended and arm adducted 10 deg Examiner applies downward force and patient resists first with forearm IR/pronated (thumb points down) and then with forearm ER/supinated GHJ pain with pronated position that decreases with supinated position is positive test
Describe the Crank test for SLAP tears
Pt seated and examiner positions arm @ 160 deg FF in scapular plane GHJ axially loaded with passive IR/ER of humerus Positive if pain with/out a click develops
Describe the Anterior Slide test for SLAP tears
Pt places hands on hips with thumbs pointed posteriorly Examiner places one hand across top of shoulder (index finger extends over anterior acromion) Examiner’s other hand placed behind elbow, and applies antero-superior force to elbow while pt resists this force Pain and/or click @ anterior shoulder is positive test
Describe the Biceps Load I test
Designed for patients with anterior instability and a SLAP tear Pt supine, and examiner grasps pt’s wrist and elbow, and abducts arm to 90 deg Examiner ER arm until apprehension felt and resists pt’s attempted elbow flexion Positive test if apprehension does not change or if increased pain with resisted elbow flexion
Describe the Biceps Load II test
Designed to assess potential isolated SLAP pathology Patient supine, and examiner places shoulder in 120 deg abduction, elbow in 90 deg flexion, forearm in supination, and then ER shoulder Pt flexes elbow against resistance Positive if pain with resisted elbow flexion
Describe the Modified Dynamic Labral Shear test for SLAP tears
Examiner flexes elbow to 90 deg and abducts arm to 120 deg while maximally ER arm Examiner lowers arm to 60 deg abduction Positive test with pain/painful click along posterior joint line bw 120-90 deg abduction
Name the Beighton criteria for joint hyper mobility
- Passive DF for fifth finger > 90 deg 2. Passive flexion of thumb to forearm 3. Hyperflexion of elbows > 10 deg 4. Hyperflexion of knees > 10 deg 5. Forward flexion of trunk with knees fully extended and palms resting on floor Score greater than or equal to 5 indicates joint hyper mobility
Name four tests for anterior instability of the GHJ
- Anterior apprehension 2. Jobe relocation and surprise 3. Anterior drawer test 4. Anterior load and shift