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5. OITE > Sports Medicine 2016 > Flashcards

Sports Medicine 2016 Flashcards

1
Q
  1. 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?
  2. Activity modification and decreased weight bearing
  3. Arthroscopic removal of the fragment
  4. Arthroscopic retrograde drilling
  5. Arthroscopic open reduction and internal fixation
  6. Observation with no change in athletic activity
A
  1. 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.

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2
Q
  1. Which anterior cruciate ligament (ACL) bundle likely is responsible for rotatory stability of the knee?
  2. Anteromedial
  3. Anterolateral
  4. Central
  5. Posteromedial
  6. Posterolateral
A
  1. 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.

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3
Q
  1. Which computer-based neurocognitive test assesses users’ attention, memory, and processing speed?
  2. Immediate Post-Concussion Assessment and Cognitive Testing Battery (ImPACT)
  3. Sport Concussion Assessment Tool II (SCAT-3)
  4. King-Devick (K-D) Test
  5. Standardized Assessment of Concussion (SAC)
  6. Safe Concussion Outcome Recovery & Education (SCORE) Program
A
  1. 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.

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4
Q
  1. 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?
  2. MR imaging
  3. Rest, ice, and observation
  4. Physical therapy to regain motion
  5. Knee arthroscopy and medial patellofemoral ligament (MPFL) repair
  6. Open surgical repair
A
  1. 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.

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5
Q
  1. According to the World Health Organization (WHO), an appropriate surgical “time-out” just prior to an incision consists of which verifications and components?
  2. Patient’s date of birth, planned surgery, team introductions, aspiration risk
  3. Patient’s name, surgical laterality, administration of deep venous thrombosis

(DVT) prophylaxis

  1. Planned surgery, DVT prophylaxis, postsurgical bracing
  2. Team introductions, patient identification, site and procedure, antibiotic prophylaxis
  3. Team introductions, patient identification, planned surgery, nurse break schedule
A
  1. 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.

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6
Q
  1. 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?
  2. A corticosteroid injection into the flexor origin
  3. Physical therapy and evaluation of his tennis swing
  4. Arthroscopic debridement of the flexor origin
  5. Open debridement of the flexor origin with submuscular ulnar nerve transposition
  6. Continued tennis play with use of a hinged elbow brace
A
  1. 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.

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7
Q
  1. 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?
  2. Conversion to a full-thickness tear and repair with suture anchors
  3. Debridement alone
  4. Debridement and acromioplasty
  5. No further arthroscopic treatment
  6. Acromioplasty alone
A
  1. 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.

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8
Q
  1. 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?
  2. Loss of sensation at the lateral aspect of the upper arm
  3. Weakness in abduction with atrophy in the supraspinatus fossa only
  4. Weakness in forward flexion with atrophy in the infraspinatus fossa only
  5. Weakness in internal rotation with a positive belly-press test result
  6. Weakness in external rotation and abduction, with atrophy in the supraspinatus and infraspinatus fossa
A
  1. 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.

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9
Q
  1. 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?
  2. Anteroposterior, lateral, and oblique radiographs of the left knee
  3. MR imaging of the left knee
  4. Arthrogram of the left knee
  5. Ultrasound examination of the left hip
  6. Stress radiographs of the left knee
A
  1. 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.

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10
Q
  1. 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?
  2. Glenohumeral internal rotation deficit (GIRD)
  3. Long head of the biceps tendinosis
  4. Subscapularis rupture
  5. Superior labral anterior posterior tear
  6. Bankart lesion
A
  1. 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.

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11
Q
  1. 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?
  2. Varus alignment
  3. Estrogen levels
  4. ACL size
  5. Intra-articular notch size
  6. Neuromuscular coordination and training
A
  1. 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.

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12
Q
  1. 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?
  2. Distal biceps brachii
  3. Extensor carpi radialis brevis (ECRB)
  4. Extensor carpi radialis longus (ECRL)
  5. Brachioradialis
  6. Pronator teres
A
  1. 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.

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13
Q
  1. 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?
  2. Genitofemoral
  3. Pudendal
  4. Femoral
  5. Obturator
  6. Superior gluteal
A
  1. 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.

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14
Q
  1. What is the most common reason for hip arthroscopy revision that addresses femoroacetabular impingement?
  2. Untreated chondral defect
  3. Iatrogenic chondral injury
  4. Adhesive capsulitis
  5. Persistent femoroacetabular impingement
  6. Hip instability
A
  1. 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.

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15
Q
  1. 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?
  2. 7 mm
  3. 7.5 mm
  4. 8.5 mm
  5. 9 mm
  6. 10 mm
A
  1. 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.

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16
Q
  1. A collegiate swimmer develops medial winging of the scapula. Which nerve roots are most likely to be involved in an electromyography or nerve conduction study with abnormal findings?
  2. C7, C8, T1
  3. C6, C7, C8
  4. C5, C6, C7
  5. C4, C5, C6
  6. C3, C4, C5

PREFERRED RESPONSE: 3

A
  1. C5, C6, C7

RECOMMENDED READINGS

Meininger AK, Figuerres BF, Goldberg BA. Scapular winging: an update. J Am Acad Orthop Surg. 2011 Aug;19(8):453-62. Review. PubMed PMID: 21807913.

Gregg JR, Labosky D, Harty M, Lotke P, Ecker M, DiStefano V, Das M. Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am. 1979 Sep;61(6A):825-32. PubMed PMID: 479228.

17
Q
  1. Which exercise should typically be avoided during initial therapy following anterior cruciate ligament (ACL) reconstruction?
  2. Vertical squat
  3. Stationary bike riding
  4. Light leg press
  5. Seated leg extensions
  6. Use of a stair-climbing machine
A
  1. Seated leg extensions

RECOMMENDED READINGS

McMullen J. Rehabilitation principles: kinetic chain therapeutic exercise application and progression. In: Garrick JG, ed. Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2004:129-136.

Kruse LM, Gray B, Wright RW. Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am. 2012 Oct 3;94(19):1737-48. doi: 10.2106/JBJS.K.01246. Review. PubMed PMID: 23032584.

Andersson D, Samuelsson K, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy. 2009 Jun;25(6):653-85. doi: 10.1016/j.arthro.2009.04.066. Review. PubMed PMID: 19501297.

18
Q
  1. What is an advantage of the lateral decubitus position for arthroscopy vs the beach-chair position?
  2. Lower rate of deep venous thrombosis (DVT)
  3. Lower rate of nerve injury with creation of an anteroinferior portal
  4. Easier conversion to an open procedure
  5. Ease of airway management
  6. Decreased concern about cerebral hypoperfusion with hypotensive analgesia
A
  1. Decreased concern about cerebral hypoperfusion with hypotensive analgesia

RECOMMENDED READINGS

Gelber PE, Reina F, Caceres E, Monllau JC. A comparison of risk between the lateral decubitus and the beach-chair position when establishing an anteroinferior shoulder portal: a cadaveric study. Arthroscopy. 2007 May;23(5):522-8. PubMed PMID: 17478284.

Li X, Eichinger JK, Hartshorn T, Zhou H, Matzkin EG, Warner JP. A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications. J Am Acad Orthop Surg. 2015 Jan;23(1):18-28. doi: 10.5435/JAAOS-23-01-18. Review. PubMed PMID: 25538127.

19
Q
  1. Figure 236 is the sagittal MR image of a 19-year-old football player. What is the strongest predisposing factor to this condition?
  2. Playing on soft surfaces
  3. Hamstring and quadriceps inflexibility
  4. Lower weight
  5. Increased quadriceps strength
  6. Decreased training frequency
A
  1. Hamstring and quadriceps inflexibility

RECOMMENDED READINGS

Beam JW, Lozman PR, Uribe JW. Surgical treatment of chronic patellar tendinitis in a collegiate football player. J Athl Train. 1995 Oct;30(4):342-4. PubMed PMID: 16558360.

Witvrouw E, Bellemans J, Lysens R, Danneels L, Cambier D. Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study. Am J Sports Med. 2001 Mar- Apr;29(2):190-5. PubMed PMID: 11292044.

Zwerver J, Bredeweg SW, van den Akker-Scheek I. Prevalence of Jumper’s knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med. 2011 Sep;39(9):1984-8. doi: 10.1177/0363546511413370. Epub 2011 Jul 7. PubMed PMID: 21737835.

20
Q
  1. Figure 244 is the radiograph of an 11-year-old boy who has had foot pain for 4 weeks while playing basketball for his school team. What is the best next step?
  2. Coalition excision with fat interposition
  3. Coalition excision with extensor digitorum brevis interposition
  4. Subtalar arthrodesis
  5. 4 weeks of immobilization in a short-leg cast
  6. Excision of accessory navicular
A
  1. 4 weeks of immobilization in a short-leg cast

RECOMMENDED READINGS

Vincent KA. Tarsal coalition and painful flatfoot. J Am Acad Orthop Surg. 1998 Sep-Oct;6(5):274-81. Review. PubMed PMID: 9753754.

Mosca VS. Subtalar coalition in pediatrics. Foot Ankle Clin. 2015 Jun;20(2):265-81. doi: 10.1016/j. fcl.2015.02.005. Epub 2015 Apr 18. Review. PubMed PMID: 26043243.

21
Q
  1. A 38-year-old recreational runner experiences occasional mild hip pain after long, aggressive runs. An examination reveals full range of motion with nonspecific tenderness in the groin area and no pain with hip flexion and internal rotation. Plain radiographs are unremarkable. MR imaging obtained by his primary care provider shows a labral tear. Initial treatment should include
  2. a 3-month trial of nonsteroidal anti-inflammatory drugs.
  3. arthroscopy for labrum excision vs repair.
  4. an intra-articular steroid injection.
  5. an MRI arthrogram to confirm the labrum tear.
  6. reassurance and treatment of symptoms.
A
  1. reassurance and treatment of symptoms.

© 2016 American Academy of Orthopaedic Surgeons 2016 Orthopaedic In-Training Examination

A 38-year-old recreational runner experiences occasional mild hip pain after long, aggressive runs. An examination reveals full range of motion with nonspecific tenderness in the groin area and no pain with hip flexion and internal rotation. Plain radiographs are unremarkable. MR imaging obtained by his primary care provider shows a labral tear. Initial treatment should include

  1. a 3-month trial of nonsteroidal anti-inflammatory drugs.
  2. arthroscopy for labrum excision vs repair.
  3. an intra-articular steroid injection.
  4. an MRI arthrogram to confirm the labrum tear.
  5. reassurance and treatment of symptoms.

PREFERRED RESPONSE: 5

RECOMMENDED READINGS

Schmitz MR, Campbell SE, Fajardo RS, Kadrmas WR. Identification of acetabular labral pathological changes in asymptomatic volunteers using optimized, noncontrast 1.5-T magnetic resonance imaging. Am J Sports Med. 2012 Jun;40(6):1337-1341. PubMed PMID: 22422932.

Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012 Dec;40(12):2720-2724. PubMed PMID: 23104610.

22
Q
  1. What is the proper location of the femoral insertion of the medial patellofemoral ligament (MPFL) in Figure 264, and what position should the knee be in when setting tension?
  2. Position A and fixed with the knee in full extension
  3. Position A and fixed with the knee in 70 degrees of flexion
  4. Position A and fixed with the knee at 30 degrees of flexion
  5. Position B and fixed with the knee at 30 degrees of flexion
  6. Position B and fixed with the knee in full extension
A
  1. Position B and fixed with the knee at 30 degrees of flexion

RECOMMENDED READINGS

Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007 May;35(5):801-804. PubMed PMID: 17267773.

Wijdicks CA, Griffith CJ, LaPrade RF, et al. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am. 2009 Mar 1;91(3):521-529. PubMed PMID: 19255211.

23
Q
  1. Figures 275a and 275b are MR images of a 27-year-old recreational athlete who has no history of trauma but is having pain and mechanical symptoms when performing overhead activities and lifting. He has not experienced pain relief after participating in 2 months of physical therapy, but did experience 6 weeks of pain relief after receiving an acromioclavicular joint injection. An examination reveals full range of motion, good rotator cuff strength, mild pain with O’Brien testing, positive cross-arm pain, and tenderness over the acromioclavicular joint. He has no tenderness in the bicipital groove. Arthroscopic images are shown in Figures 275c and 275d. In addition to a distal clavicle resection, how would you treat the lesion shown in the arthroscopic images?
  2. Anterior capsulorrhaphy
  3. No additional treatment
  4. Rotator cuff debridement
  5. Biceps tenodesis
  6. Arthroscopic superior labrum anterior and posterior (SLAP) repair
A
  1. No additional treatment

RECOMMENDED READINGS

Weber SC, Martin DF, Seiler JG 3rd, Harrast JJ. Superior labrum anterior and posterior lesions of the shoulder: incidence rates, complications, and outcomes as reported by American Board of Orthopaedic Surgery Part II candidates. Am J Sports Med. 2012 July;40(7):1538-1543. PubMed PMID: 22628153.

Gobezie R, Zurakowski D, Lavery K, Millett PJ, Cole BJ, Warner JJ. Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med. 2008 Jul;36(7):1373-1379. PubMed PMID: 18354142.

Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1453-9. doi: 10.1007/s00167-013-2798-z. PubMed PMID: 24318507.

Tuite MJ, Currie JW, Orwin JF, Baer GS, del Rio AM. Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography. Skeletal Radiol. 2013 Mar;42(3):353-62. doi: 10.1007/s00256-012-1496-0. PubMed PMID: 22893302.

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Q
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