Sports Flashcards
(319 cards)
1
Q
What view do you get to identify acromial morphology?
A
supraspinatus outlet view
2
Q
What are the radiographic findings with subacromial impingement? (6)
A
- proximal humerus migration;
- traction osteophytes;
- CA lig. calcification;
- GT cysts;
- Type III acromion;
- OS acromiale
3
Q
What is the most common RTC tendon to calcify?
A
supraspinatus
4
Q
What are the treatment options for calcific tendinitis?
A
- NSAID, physio;
- steroids;
- ECSWT;
- decompression - a) open, b) arthroscopic - only as last resort
5
Q
What is the medial-to-lateral distance of the SS on the footprint?
A
14-16 mm
6
Q
What is the Seebauer classification of RTC arthropathy?
A
Type IA - centered, stable;
Type IB - centered, medialized;
Type IIA - decentered, stable;
Type IIB - decentered, unstable
7
Q
How do you perform a zanca view?
A
cephalic tilt 10-15 degrees from AP + 50% penetration
8
Q
What is the most reliable P/E test for AC joint pathology?
A
cross body adduction test
9
Q
What xray shows glenoid bone loss in shoulder?
A
West Point view
10
Q
What xray shows Hill-Sachs lesion best?
A
Stryker view
11
Q
How do you treat an overtightened anterior shoulder for stabilization post-procedure?
A
Z-lengthening of subscapularis
12
Q
What are the complications of Putti-Platt and Magnuson-Stack procedures for anterior stabilization? (2)
A
- decreased external rotation;
- posterior loading + glenoid wear
13
Q
How do you perform a Stryker notch view?
A
hand placed on top of head with 10 degrees of cephalic tilt
14
Q
What is the most common arthroscopic finding with shoulder dislocation?
A
anteroinferior labral/capsular avulsion
15
Q
What are the primary stabilizers to posterior shoulder D/L?
A
- posterior band IGHL;
- subscapularis;
- CH ligament
16
Q
What are the indications for a McLaughlin procedure?
A
- chronic dislocation <6 months old;
- reverse Hill-Sachs defect <50%
17
Q
What are the indications for hemiarthroplasty for posterior D/L of the shoulder?
A
- chronic dislocation >6 months old;
- GH OA;
- head collapse;
- reverse Hill-Sachs defect >50%
18
Q
What are the MRI findings of MDI?
A
- patulous inferior capsule;
- Bankart;
- Kim lesion;
- bony erosion of glenoid
19
Q
What must be addressed when attempting to operate on an MDI shoulder?
A
- inferior capsular shift;
- plication of redundant capsule in a balanced fashion;
- rotator interval closure;
- anterior/posterior lesions
20
Q
Name 3 complications of Luxatio Erecta?
A
- axillary nerve palsy;
- axillary artery thrombosis;
- RTC tear
21
Q
Where is the most common attachment of the biceps anchor?
A
posterior to the 12 o’clock position
22
Q
What is the Snyder classification of SLAP tears?
A
Type I - fraying, intact anchor;
Type II - fraying with detached anchor (most common);
Type III - bucket handle with intact anchor;
Type IV - bucket handle with detached anchor
23
Q
What intraoperative test can be done to confirm presence of a SLAP tear?
A
“peel back” test - lift off of biceps anchor with 90 degrees of external rotation and abduction
24
Q
What are physical therapy indications for a SLAP?
A
- GIRD;
- scapular dyskinesis;
- RTC strengthen/ROM
25
What shoulder condition is associated with internal impingement of the shoulder?
GIRD
26
What is a Bennett lesion in the shoulder?
glenoid exostosis of posterior glenoid caused by internal impingement
27
What are the spectrum of diseases associated with internal impingement of the shoulder?
1. fraying of the posterior cuff (PASTA lesion);
2. posterior superior labral lesions;
3. hypertrophy and scarring of posterior capsule/glenoid;
4. posterior glenoid cartilage damage
28
What nerve is at most risk with posterior capsular release?
inferior suprascapular nerve (infraspinatus)
29
What are the operative indicators for internal impingement?
1. failed 6/12 non-op;
2. PASTA \>50%;
3. Bennett lesions
30
What are associated conditions with GIRD? (3)
1. GH instability;
2. SLAP;
3. internal impingement
31
What specific MRI do you need in GIRD to see associated lesions?
MRI in ABER view
32
What are 3 specific physical therapy maneuvers for GIRD Tx?
1. posterior capsule stretch (sleeper's);
2. pectoral minor stretch;
3. subsar/seratus strengthen
(Need 6 months physical therapy)
33
What is the definition of little leaguer's shoulder?
Salter Harris Type I # of proximal humerus
34
What is the weakest portion of the growth plate?
hypertrophic zone
35
What are the complications of undiagnosed little leaguer's shoulder? (2)
1. growth arrest;
2. angular deformity
36
What are the most common at risk sports for posterior labral tear?
1. football lineman (blocking);
2. weightlifters (bench press)
37
What is the diagnostic test of choice for posterior labral tear?
MRA
38
What are the contraindications to TSA in GH OA? (4)
1. active infection;
2. deltoid dysfunction;
3. insufficient bone stock;
4. RTC arthropathy
39
What is the Walch classification of glenoid wear?
Type A - concentric wear;
Type B - biconcave wear;
Type C - retroversion wear \>25 degrees with posterior subluxation
40
What is the position of fusion of the shoulder?
30 degrees flexion;
30 degrees IR;
30 degrees ABD
41
What are the 2 most important anatomical structural implications in frozen shoulder?
1. corahumeral ligament;
2. rotator interval
42
What is the pathology behind frozen shoulder?
fibroblastic proliferation
43
What are 5 common associated conditions with adhesive capsulitis?
1. diabetes;
2. thyroid disease;
3. previous Sx (lung/breast);
4. prolonged immobilization;
5. prolonged hospitalization
44
What is the first motion loss in adhesive capsulitis?
ER
45
What is the important MRI finding in frozen shoulder?
loss of inferior axillary recess
46
What is the classification of shoulder AVN?
Cruess classification:
Stage I - normal xray, changed on MRI;
Stage II - sclerosis, no collapse;
Stage III - crescent sign;
Stage IV - flattening and collapse;
Stage V - degeneration extends to glenoid
47
What is the most common site of humeral head AVN?
superior middle articular portion
48
What is the Tx for AVN humeral head and associated?
Creuss I and II - core decompression;
Creuss III - humeral head resurfacing if enough remaining epiphyseal bone stock;
Creuss III and IV - hemiarthroplasty;
Creuss V - TSA due to involvement of glenoid
49
What are 4 testable causes of scapulothoracic crepitus?
1. osteochondroma;
2. elastofibroma dorsi;
3. skapulothoracic dyskinesis;
4. bursitis
50
What are the operative options for scapulothoracic crepitus?
1. removal of osseus lesions;
2. removal of ST tumors;
3. bursectomy;
4. resection of scapular border
51
Define/Direction/Nerve of:
1. medial scapular winging;
2. lateral scapular winging
1. medial winging - absent pull of serratus (long thoracic);
2. lateral winging - absent pull of trapezius (spinal accessory)
52
What is the most common cause of lateral scapular winging?
iatrogenic damage to spinal accessory nerve due to neck Sx
53
What is the most common cause of medial scapular winging?
repetitive stretch injury with head tilted away during overhead activity
54
What are the Tx options for lateral scapular winging?
1. trap. strengthening;
2. nerve exploration if nerve injury;
3. Eden-Lange transfer - lateralize levator scapula/rhomboids (medial to lateral transfer);
4. scapulothoracic fusion
55
What are the causes of suprascapular notch entrapment?
1. ganglion cyst;
2. transverse scapular ligament entrapment;
3. callus from scapular #;
4. tumor
56
What are the indications for suprascapular nerve decompression?
1. failure of 1 year non-op;
2. compressive mass in suprascapular notch
57
What are the causes of compression at the spinoglenoid notch?
1. posterior labral tears;
2. spinoglenoid ligament entrapment;
3. ganglion cyst;
4. traction injury
58
What approach do you use to decompress the spinoglenoid notch?
posterior approach to shoulder
59
What surgical techniques to address sites of compression in TO syndrome? (5)
1. repair clavicle/1st rib non union;
2. transaxillary 1st rib resection (90% good results);
3. scalene takedown;
4. pectoralis minor tenotomy;
5. release fibroanomalous bands
60
What 2 xray films must you order in suspected TO syndrome?
1. C-spine xray - R/O cervical rib;
2. chest xray - R/O Pancoast tumor
61
Name 3 provocative tests for TO syndrome and describe each.
1. Wright-Aber with neck away causes a) loss of pulse and b) reproduction of symptoms;
2. Adson - extend arm with neck extended toward affected arm = loss of pulse and reproduction of symptoms;
3. Roos - open and close hands overhead = loss of pulse and reproduction of symptoms
62
What is Paget-Schroetter syndrome?
TO syndrome due to SC vein compression due to scalene hypertrophy
63
What are vascular causes of TO syndrome? (2)
1. compressed subclavicle vessel;
2. aneurysm
64
What are the causes of TO syndrome? (5)
1. scalene abnormalities;
2. scapular ptosis;
3. clavicle/1st rib malunion;
4. cervical rib;
5. vertebrae TP
65
What are the pathophys. principles of TO syndrome?
compression of NV bundle as it passes over 1st rib or through scalenes
66
What is the Tx algorithm for TO syndrome induced hand emboli?
1. acute heparinization or TPA;
2. 7-10 days of neparin;
3. 3/12 of warfarin or equivalent
67
What are the risk factors for Brachial Neuritis/Parsonage-Turner syndrome/neurologic amyotrophy? (5)
1. viral infections;
2. immunizations;
3. medications;
4. extreme stress;
5. autoimmune disease
68
What are the 1 year and 3 year outcomes for Brachial Neuritis?
35% recover at 1 year;
90% recover at 3 years
69
What are the contents of the quadrilateral space? (2)
1. axillary nerve;
2. posterior humeral circumflex artery
70
What are the boundaries of the quadrilateral space? (4)
1. superior - teres minor;
2. inferior - teres major;
3. medial - long head of triceps;
4. lateral - humerus
71
What is the Tx algorithm for quadrilateral space syndrome?
1. non-op - most recover within 3-6/12;
2. Sx nerve decompression
72
What are the indications for quadrilateral space syndrome decompression? (3)
1. failed non-op;
2. sig. weakness + disability;
3. space occupying lesion
73
Describe the Sx technique for open quadrilateral space syndrome.
1. lateral decubitus;
2. 3-4 cm incision over QS;
3. identify posterior border of deltoid;
4. retract sup/lat;
5. identify fat;
6. avoid/protect axillary nerve/PHC artery
74
What are 3 at risk structures for athletes with scapulothoracic dyskinesis?
1. labrum;
2. RTC;
3. capsule
75
What is the physical therapy emphasis for scapulothoracic dyskinesis? (4)
1. core strength;
2. scapular stabilization;
3. RTC strength;
4. teaching throwing mechanism
76
What is the most common location for pec. major rupture?
tendinous avulsion
77
What are the indications for non-op Tx of pec major rupture? (3)
1. partial ruptures;
2. musclotendinous ruptures;
3. low demand patients
78
What are the indications for open exploration + pec major repair? (2)
1. tendon avulsions from humerus;
2. high level athletes
79
What are the risk factors for triceps rupture?
1. systemic illness (osteodystrophy);
2. steroids;
3. fluoroquinolone;
4. chronic olecranon bursitis;
5. previous triceps surgery
80
What is the xray hallmark of triceps rupture?
"flake sign" - self explanatory
81
What are the indications for triceps repair? (2)
1. complete avulsions;
2. \>50% partial tears with weakness to gravity
82
What are the indications for non-op Tx of triceps tears?
1. partial tears - able to extend against gravity;
2. low demand patients with multiple comorbidities
83
What are the contraindications to shoulder hemarthroplasty? (4)
1. infection;
2. unmotivated patient;
3. neuropathic joint;
4. CA lig. compromise (AS escape)
84
How to perform humeral prosthesis implant height?
1. 3-5 mm below top of humerous;
2. 10 mm below top of articular surface of HH;
3. biceps/deltoid tension;
4. recreate calcar;
5. PMI 53-56 mm below top of prothesis;
6. template off contra shoulder;
7. measure native head
85
What are 3 key points to tuberosity reduction in shoulder-hemi for trauma?
1. anatomic reduction;
2. secure tuberosities to shaft/prothesis;
3. autograft from head decreases pull out of tuberosities
86
What is the TSA survival at 10 years?
93%
87
What are 6 contraindications to TSA for OA?
1. rotator cuff arthropathy;
2. irrepairable RTC;
3. deltoid dysfunction;
4. insufficient glenoid bone stock;
5. active infection;
6. brachial plexopathy
88
What is the most common complication of TSA?
axillary nerve neuropraxia
89
What is the definition and Tx of anterior capsule contraction in TSA?
1. ER \<40 degrees;
2. Z-plasty of capsule/subcap
90
What is the most common cause of TSA failure?
glenoid loosening
91
What are the indications for RevTSA? (6)
1. pseudoparalysis;
2. incompetent coraco acromial arch;
3. low functional patient;
4. age \>70 yoa;
5. sufficient bone stock;
6. working deltoid muscle
92
What are the contraindications to RevTSA? (4)
1. deltoid deficiency;
2. bony acromion deficiency;
3. glenoid osteoporosol deficiency;
4. active infection
93
What are the risk factors for D/L with RevTSA? (6)
1. irreparable subscap (#1);
2. proximal humeral bone loss;
3. prior failed arthroplasty;
4. proximal humeral non-union;
5. pre-op chronic D/L;
6. RTC NOT implicated
94
What are the indications for shoulder fusion? (8)
1. paralytic disorders;
2. brachial plexopalsy;
3. irreparable cuff/deltoid;
4. TSA salvage;
5. tumor resection;
6. post-chronic;
7. recurrent shoulder instability
8. paralytic D/O in infancy
95
What are the contraindications to shoulder arthrodesis? (7)
1. ipsilateral elbow arthrodesis;
2. contralateral shoulder arthrodesis;
3. lack of scapulothoracic motion;
4. trap/levator/serratus paralysis;
5. charcot;
6. neurology;
7. elderly patients
96
What plate should you use for shoulder fusion?
1. 10 hole 4.5 mm pelvic reconstruction plate;
2. compression screws placed across GH;
3. screw from scapular spine to coracoid
97
Where does the anterior capsule attach to the coronoid?
6 mm distal
98
Where is the spiral groove for the radial nerve located?
13 cm proximal to distal humerus articulation
99
What are the static stabilizers of the elbow? (5)
1. UH joint;
2. anterior bundle of the MCL;
3. LCL complex (includes LUCL);
4. RC joint;
5. capsule
100
What is the optimal position for unilateral elbow arthrodesis?
1. 90 degrees flexion;
2. 0-7 degrees of valgus.
Do not fuse RC joint
101
What is the optimal position for bilateral elbow arthrodesis?
1. 110 degrees flexion (feeding);
2. 65 degrees flexion (hygiene)
102
What are 3 physical exam tests for MCl instability of elbow?
1. valgus stress test - 20-30 degrees;
2. milking maneuver - pull on thumb @ 90 degrees flex + supinate;
3. moving valgus stress test - #1 + #2 through full arc of motion
103
What is the diagnostic xray for MCL elbow rupture?
gravity stress with \>3 mm opening
104
What is the gold standard to diagnose elbow MCL injury?
MRA with capsular "T-sign" + fluid extravasation
105
Where do partial distal biceps avulsions occur?
radial side of tuberosity footprint
106
What are the indications for MCL reconstruction? (2)
1. high level throwers who want to return to competitive sports;
2. failed non-op management - patient willing extensive rehab.
107
What is the best reconstruction method for MCL reconstruction?
humeral docking better than figure 8
108
What are the complications for MCL elbow reconstructive Sx? (5)
1. ulnar nerve injury;
2. MABC nerve injury;
3. # ulnar/medial epicondyle;
4. elbow stiffness;
5. cannot regain pre-op throwing ability
109
What are the 4 ligaments of the LUCL complex?
1. LUCL;
2. radial collateral lig;
3. accessory LCL;
4. annular lig.
110
What are the 5 tests for PLRI?
1. lateral pivot shift - arm overhead, supinated, valgus, flexing;
2. apprehension test;
3. chair rise test;
4. table-top relocation test;
5. push-up test
111
What are 3 key technical points for LUCL reconstruction?
1. must cross posterior 25% of radial head;
2. suture to capsule to augment repair;
3. secured @ neutral rotation + 45 degrees of flexion
112
What are the pathological results from valgus extension overload syndrome? (4)
1. chondrolysis (RC joint);
2. posteromedial osteophytes (humerus/olecranon);
3. loose bodies;
4. MCL attenuated
113
What is the most common associated condition with valgus extension overload syndrome?
cubital tunnel syndrome (25% of cases)
114
What is the contraindication to arthroscopic debridement in valgus extension overload syndrome?
MCL instability or insufficiency
115
What is complication of arthroscopic debridement in valgus extension overload syndrome?
too much olecranon resection can lead to valgus instability
116
How much loss of supination strength is associated with distal biceps avulsion?
50%
117
How much 1. supination; 2. flexion; 3. grip strength do you lose in distal biceps avulsion Tx non-op?
1. sup - 50%;
2. flex. - 30%;
3. grip - 15%
118
What is the most common nerve injury in distal biceps repair?
LABCN (lateral antebrachial cutaneous nerve)
119
What muscle origin is primarily implicated in tennis elbow?
ECRB may extend to ECRL/ECU
120
What is the histopathology of tennis elbow?
angiofibroblastic hyperplasia (disorganized collagen)
121
What is the most common associated condition with tennis elbow?
radial tunnel syndrome
122
What are 3 complications of ECRB release and debridement for tennis elbow?
1. LUCL injury;
2. radial nerve injury;
3. missed radial nerve entrapment syndrome
123
What are 2 common associated conditions with medial epicondylitis?
1. ulnar neuropathy;
2. MUCL insufficiency
124
What is the open operative Tx for medial epicondylitis?
1. flexor pronator splits;
2. debride involved tendon;
3. re-attach diseased tendon;
4. assess ulnar nerve +/- transposition
125
What is the most common nerve injury following open medial epicondylitis debridement?
MABCN
126
What is the most common location of OCD of the elbow?
capitellum of dominant arm
127
What are risky activities for OCD elbow?
1. gymnast;
2. weight lifter
128
What is the radiographic difference between Panner disease and OCD elbow?
1. Panner - irregular epiphysis;
2. OCD - well defined subchondral lesion
129
What is functional elbow flex/ext?
30-130 degrees
130
What are contraindications to elbow arthroscopy?
1. prior trauma;
2. surgical scarring;
3. previous ulnar nerve transposition
131
Which portal is usually avoided in elbow arthroscopy and why?
postero medial portal - 2 degrees to ulnar nerve proximity
132
What are the 2 most common nerve palsy in elbow arthroscopy?
1. ulnar - 1st;
2. radial - 2nd
133
What are the contraindications to elbow arthroplasty? (4)
1. active infection;
2. charcot joint;
3. poor neurologic control;
4. active young patient \<65 yoa
134
What is the 10 year survivorship for TEA in RA patients?
93%
135
What are the complications of TEA? (7)
1. aseptic loosening (6%);
2. infection (8%);
3. instability (7-19%);
4. bushing wear (VV \>10 degrees concerning);
5. wound healing;
6. ulnar neuropathy;
7. triceps insufficiency
136
What are the indications for ORIF of an ASIS avulsion? (2)
1. displacement \>3 cm;
2. painful non-unions
137
What are the 2 most common sports for sports hernia/athletic pubalgia?
1. hockey;
2. soccer
138
What is the mechanism of injury for sports hernia?
1. abdominal hyperextension;
2. thigh abduction
139
What is the physical exam for sports hernia?
1. tender along adductor longus;
2. pain with resisted situp;
3. pain with valsalva
140
What are 3 Tx options for sports hernia?
1. non-op/PT - 6-8/52;
2. pelvic floor repair or adductor release/rectus recession;
3. decompression of genital branch of genitofemoral nerve
141
What are 4 anatomical anomalies that may cause piriformis syndrome?
1. bipartite piriformis;
2. variations in sciatic nerve path;
3. tumor;
4. aneurysm of gluteus medius
142
What is the cause of external snapping hip? (1)
IT band over GT
143
What are the causes of internal snapping hip? (4)
1. (femoral head) iliopsoas snaps over IT;
2. prominent iliopectineal ridge;
3. exostosis of LT;
4. iliopsoas burst
144
What are the causes of intra-articular snapping hip? (2)
1. loose bodies (synovial chondromatosis);
2. labral tears
145
What are the operative options for snapping hips:
1. external;
2. internal;
3. intra-articular
1. external - excision GT bursa + IT Z-plasty;
2. internal - iliopsoas release;
3. intra-articular - hip scope - loose bodies or labral repair
146
What is the most common location of hip labral tear?
anterosuperior labrum
147
What is the imaging study of choice for hip labral tears?
MRA +/- Dx injection
148
What are the anatomical characteristics of a CAM FAI lesion? (4)
1. decreased head to neck ratio;
2. aspherical femoral head;
3. decreased femoral offset;
4. femoral neck retroversion
149
What is the key xray needed to obtain for femoral coverage?
false profile view
150
What is the complication of femoral osteochondroplasty for FAI?
femoral neck #
151
What depth minimizes the risk of femoral neck # for femoral osteochondroplasty?
\<30%
152
Which training modality usually leads to GT bursitis?
training on banked surfaces
153
What are the contraindications to hip arthroscopy?
1. advanced DJD;
2. hip ankylosis;
3. joint contracture;
4. osteoporatic bone;
5. sig. acetab. protrusio
154
What causes superio gluteal nerve injury during hip scopes?
anterolateral portal
155
What causes sciatic nerve injury in hip scopes?
posterolateral portal
156
What causes LFCN injury during hip scopes?
anterior portal
157
What structure is the intra-articular landmark for the psoas tendon?
zona orbicularis
158
What position do you put the hip during posterolateral portal placement during hip arthroscopy?
internal rotation
159
What is the most common location for hamstring injuries?
myotendinous junction
160
What cell is responsible for muscle healing post muscle injury?
satellite cells
161
When do you consider return to sport following hamstring injuries?
when active 90% hamstring strength compared to contralateral side
162
How do you immobilize a player with quads contusion?
120 degree knee flexion X 24 hours, then therapy with hinged brace
163
What are 2 complications following quads contusions?
1. compartment syndrome;
2. myositits ossificans
164
What is the most common compartment affected in exertional leg compartment syndrome?
anterior leg compartment
165
What diagnostic test to confirm exertional leg compartment syndrome?
compartment pressures
166
What pressures need to be measured when establishing exertional leg compartment syndrome? (3)
1. resting pressure;
2. immediate post-exercise pressure;
3. continuous post-exercise pressure X 30 mins.
167
What are the diagnostic criteria for exertional leg compartment syndrome?
1. resting pressure \>15 mmHg;
2. immediate post-exercise pressure \>30 mmHg;
3. continuous post-exercise does not return to normal or stays above 15 mmHg @ 15 min. post-exercise
168
What is the most common locations for tibial stress syndrome? (shin splints)
medial (posteromedial)
169
What are the 2 types of femoral neck stress #s?
1. compression side;
2. tension side
170
What is the most common associated condition with femoral neck #s?
female athlete triad
171
What is the modality of choice to Dx femoral neck stress #?
MRI
172
What is the Tx of compression side femoral neck stress #s?
PWB + activity restricted until Sx resolve
173
What is the Tx of tension side femoral neck stress #s?
ORIF with percutaneous screws
174
What are the risk factors for femoral shaft stress #s? (3)
1. metabolic bone disease;
2. bisphosphonates;
3. osteopenia/osteoporosis in endurance athletes
175
What is the physical exam test for femoral stress #s?
fulcrum test
176
What are the indication for prophylactic nail fixation for femoral shaft stress #s? (2)
1. patients with low bone mass;
2. patients \>60 yoa
177
What is the main MRI indication in the setting of a stinger?
B/L symptoms
178
What are the indications for IM nailing of tibial stress #s? (1)
If 'dreaded black line' is present
179
What is the most reliable (strongest) risk factor for non-union post IM nail for tibial stress #s?
If 'dreaded black line' is present anterior cortex of tibia
180
What are the American Academy of Neurology (AAN) grades of head injury?
Grade I - no loc - confusion lasts \<15 min;
Grade II - no loc - confusion lasts \>15 min;
Grade IIIa - loc seconds;
Grade IIIb - loc minutes
181
What are the absolute indications for CT scan post sports related HI?
loc \>5 min
182
What is the most reliable post concussion assessment tool?
ImPACT - computer based
183
What are the contraindications to return to play post concussion (delayed RTP)? (6)
1. loc;
2. prior Grade I or \> in same season;
3. symptoms \> 15 min.;
4. + exertional stress test;
5. amnesia;
6. post concussion syndrome
184
What is the gradual return to play protocol post concussion?
Each step takes 24 hours.
1. no activity;
2. light aerobics;
3. sport specific (no contact);
4. non-contact training;
5. full contact;
6. normal game play
185
What is 2nd impact syndrome?
2nd blow to head before initial symptoms resolve
186
What is mortality rate associated with 2nd impact syndrome?
50%
187
Name 5 clinical conditions that are contraindications to play contact sports.
1. previous trauma;
2. clinical stenosis;
3. congenital odontoid hypoplasia;
4. os odontoideum;
5. Klippel-Feil syndrome
188
Define stingers.
non-dermatomal unilateral tingling that resolves in 1-2 min
189
What are the return to play criteria post stinger? (2)
1. complete resolution of symptoms;
2. normal strength + ROM
190
What is the Tx of heat cramps?
1. rapid cooling;
2. stretching;
3. electrolyte/fluids
191
What is the Tx of syncope? (2)
1. fluids;
2. supine with elevated feet
192
What is the definition of heat exhaustion?
1. \>39 degrees C;
2. CNS depression
193
What is the Tx of heat exhaustion?
1. table salts;
2. IV hydration;
3. cooling
194
What is the definition of heat stroke? (6)
1. hyperthermia;
2. tachycardia;
3. CNS depression;
4. cessation of sweating (hot + dry);
5. anhidrosis;
6. temp \>40.5 degrees C
195
What is the Tx of heat stroke?
decrease core body temp - int/ext cooling modalities
196
What is the most common cause of sudden death in athletes?
cardiac (HoCM)
197
What is commotio cordis and Tx?
1. blunt chest trauma causing V-fib;
2. defibrilation
198
When can athletes return to sports following mono?
only when splenomegaly completely resolved
199
What is the most common cause of death by abdominal trauma in sports?
splenic rupture
200
What are the indications for DEXA scan in female athletes?
1. Hx of amenorrhea +
2. Hx of stress #s
201
What is the Tx of female athletes with triad?
multidisciplinary -
1. psych;
2. nutrition;
3. coaching (reduced intensity);
4. OCP (amenorrhea)
202
What side miniscal tear is the most common in ACL injury?
lateral
203
What is the typical location for degenerative meniscal tears?
posterior horn medial meniscus
204
What is the MRI finding of bucket-handle medial meniscal tear?
"double PCL"
205
What is the gold standard technique for meniscal repair?
inside out technique
206
What is the most common location for discoid meniscus?
lateral
207
What is the most common cause of ACL failure?
tunnel malposition
208
How much graft screw divergence is acceptable?
15-30 degrees
209
What is the indication for HTO in PCL injury?
chronic deficiency - medial opening wedge to correct a) varus malalignment + b) increase tibial slope to prevent posterior sag
210
What is a Pellegrini-Steida lesion?
calcification of femoral MCL indicates chronic MCL injury
211
What are the 5 attachments of the semimembranous complex?
1. VMO;
2. medial retinaculum;
3. sartorius;
4. semi\_T;
5. gracilis
212
What is the MCL therapy for Grade I MCL sprain?
1. quads strength;
2. hip adduction;
3. cycling
Right away
213
When do you brace MCL injuries?
Grade II and III;
return to play - Grade II - 2-4 weeks;
return to play - Grade III - 4-8 weeks
214
What is the order of insertion of the LCL, popliteofibular lig., biceps femoris?
anterior to posterior - LCL to PFL to BF
215
What are 4 reconstruction techniques for LCL/PLC?
1. BPTB (single limb);
2. larson technique (figure 8);
3. double bundle (LCL/popliteofibular lig);
4. anatomic recon. using split Achilles grafts
216
What is the most common nerve injury in PLC?
CPN
217
What are 3 components of miserable malalignment syndrome?
1. femoral anteversion;
2. genu valgum;
3. ext. tibial torsion
218
What are 4 ways to measure patella alta?
1. Blumensaat's;
2. Insall-Salvati;
3. Blackburne-Peel;
4. Caton-Deschamps
219
What is abnormal TT-TG distance?
\>20 mm
220
What is the physio protocol for lateral patella tilt + patella syndromes?
1. VMD strength;
2. short arc, closed chain, quads strength
221
What are 3 patella re-alignment procedures?
1. Maquet - anteriorization;
2. Trillat - medialization;
3. Fulkerson - ant/medialization
222
What are the contraindications to a Fulkerson osteotomy? (2)
1. medial patellar facet arthrosis;
2. skeletal immaturity
223
What is the more common - quads tendon rupture or patella tendon rupture?
quads
224
What are the PF joint reaction forces when:
1. squatting;
2. going up stairs?
1. 7X BW;
2. 2-3X BW
225
What is the concern for pre-patellar bursitis in wrestlers?
septic bursitis
226
What type of meniscal tear most commonly causes clicking/locking? (3)
1. oblique;
2. flap;
3. parrot beak
227
What are 4 predictors of success for partial meniscectomy?
1. age \<40;
2. normal alignment;
3. min. arthritis;
4. single tear
228
What is the best candidate for meniscal repair? (5)
1. peripheral in red zone;
2. low rim width;
3. vertical/longitudinal;
4. 1-4 cm in length;
5. with ACL recons.
229
What are the contraindications to meniscal transplant? (6)
1. inflammatory arthritis;
2. OA;
3. instability;
4. obese;
5. Grade IV chondrosis;
6. malalignment
230
How soon can you return to sports following meniscal transplant?
6-9 months
231
What type of stitch technique is strongest for meniscal repair?
vertical mattress
232
What are the risks to meniscal repair by:
1. medial inside/out;
2. lateral inside/out?
1. medial inside/out - saphenous nerve and vein;
2. lateral inside/out - peroneal nerve
233
What percentage of discoid meniscus are bilateral?
25%
234
Give 7 reasons why female athletes are predisposed to all injuries.
1. quads dominant;
2. landing biomechanics (more extension);
3. smaller notch;
4. COL5A1 gone;
5. smaller lig;
6. hormone levels;
7. valgus leg alignment
235
What is the collagen composition of ACL?
1. 90% type I;
2. 10% type III
236
Where do bone bruises occur in ACL injuries? (2)
1. middle 1/3 LFC (solcus terminalis);
2. posterior 1/3 lateral tibial plateau
237
What is the incidence of anterior knee pain with BPTB?
10-30%
238
What are the factors that lead to increased physeal injury? (4)
1. oblique tunnel;
2. interference screws;
3. high speed tunnel reaming;
4. diameter \>8 mm
239
What is the treatment algorithm for arthrofibrosis post ACL recons.?
1. \<12/52 - physical therapy/splinting;
2. \>12/52 - scope with lysis of adhesions +MUA
240
What are 3 mechanisms to PCL injury?
1. direct blow to proximal tibia with flexed knee;
2. hyperextension;
3. hyperflexion with plantar-flexed foot
241
What are the indications for PCL recon/repair of bony avulsion? (3)
1. combined lig. injuries;
2. isolated with bony avulsions;
3. isolated chronic PCL injury with unstable knee
242
In what postion do you fix PCL graft?
flexion
243
What are 2 key components of PCL rehab. post recon.?
1. immobilize in extension and protecting against gravity;
2. early motion in prone position
244
What is a distal MCL injury (avulsion) called?
stener lesion
245
What are the operative indications for MCL repair/recon.? (repair - 4) (recon - 2)
Repair -
1. multi lig. injury;
2. stener lesions;
3. medial compartment entrapment;
4. chronic instability \>10 mm
Recon. -
1. chronic;
2. no soft tissue for repair
246
What are the graft options for MCL recon.?
1. semi-T autograft;
2. hamstring autograft;
3. tib. ant. allograft;
4. Achilles allograft
247
Where does LCl insert on the femur relative to popliteus?
proximal and posterior
248
What are the non-op Tx for PLC injuries?
Grade I or II - brace full ext. X 2/52 with protected WB; then, progressive rehab focusing on quads + light sports at 8 weeks
249
What is the post-op rehab protocol for PLC injury?
1. PWB X 4/52;
2. passive ROM @ 4/52;
3. no active hamstring @ rehab;
4. full active extension allowed
250
What are the associated injuries with proximal tib-fib D/L? (3)
1. posterior hip dislocation;
2. open tib-fib #s;
3. knee/ankle #s
251
What is the Ogden classification of prox. tib-fib D/L?
1. anterolateral (most common);
2. posteromedial;
3. superior
252
What is the reduction maneuver for prox. tib-fib D/L?
1. flex knee 80-100 degrees - apply pressure over fibular head opposite direction of D/L;
2. cast and keep in extension for healing
253
What are the options for chronic proximal tib-fib D/L? (4)
1. ligament recon.;
2. ORIF with pins;
3. arthrodesis;
4. fibular head resection
254
What is Basset's sign?
sign of jumper's knee (patellar tendinitis) - pain distal pole patella with extension; - no pain in flexion
255
Where is the femoral origin of the MPFL?
between the adductor tubercle and the medial epicondyle
256
What are the risk factors for quads tendon rupture? (7)
1. renal failure;
2. diabetes;
3. RA;
4. hyperparathyroidism;
5. connective tissue disease;
6. steroids;
7. intraarticular injections
257
Name the 2 most important quads mechanism exercises post ext. mech. repair.
1. heel slides closed chain knee flexion;
2. open chain knee flexion (prone)
258
Patellectomy decreases extension force by what percentage?
30%
259
What % of prepatellar bursitis are septic?
20%
260
What is ICRS classification of chondral lesions?
Grade 0 - normal;
Grade 1 - superficial (fray/fissure);
Grade 2 - \<50% depth;
Grade 3 - \>50% depth;
Grade 4 - exposed SC bone
261
What is the most sensitive xray for joint space narrowing in the knee?
45 degree WB PA knee
262
What is the most common location for SONK?
distal epiphysis MFC
263
What is the Clanton and DeLee classification of OCD lesions?
Type I - depressed;
Type II - with osseus bridge;
Type III - unstable non-displaced;
Type IV - unstable and displaced
264
What is the Wilson's test of the knee?
pain with interior rotation of knee 30-90 degrees flexion to extension;
relieved with external rotation
265
What is the rehab for microfracture of knee?
NWB for 4-6 weeks + progressive ROM + WB
266
What is Sinding-Larsen-Johansson syndrome?
chronic apophysitis of distal pole of patella
267
Which HTO has the better 10 year survival @ 10 years?
varus producing osteotomy - 87% @ 10 years;
valgus producing - 50-85% @ 10 years
268
What are the contraindications for HTO? (8)
1. inflammatory arthritis;
2. obese BMI \>35;
3. flexion contracture \>15 degrees;
4. knee flexion \< 90 degrees;
5. \>20 degrees correction;
6. PF OA;
7. instability;
8. varus thrust gait
269
Where should the mechanical axis cross the knee?
medial to the medial tibial spine
270
What are 2 causes of patella baja post HTO?
1. raising tibial slope usually with medial opening wedge osteotomy;
2. patella tendon scarring
271
What is the contribution of the GH + SThoracic joints to shoulder abduction?
180 degrees = 120 degrees GH + 60 degrees ST;
2:1
GH:ST
272
What are the static restraints to GH subluxation? (4)
1. GH ligs.;
2. labrum;
3. congruity of glenoid;
4. neg. intraarticular pressure
273
What are the dynamic GH restraints? (3)
1. RTC;
2. LHB;
3. periscapular muscles
274
What will happen if you attach a Buford complex?
pain + restricted external rotation and elevation
275
What are the contents of the rotator interval? (4)
1. capsule;
2. SGHL;
3. CHL;
4. LHB
276
What is the optimal position for arthrodesis of shoulder?
15-20 degrees - ABD;
20-25 degrees - FF;
40-50 degrees int. rot.
277
What is the strongest AC lig?
superior
278
What are the distances of the CC ligs. from AC?
trapezoid - 3 cm;
conoid - 4.5 cm
279
What is the most common location for OS acromiale?
junction of meso/meta acromion
280
What is the Tx for OS acromiale 1. non-op; 2. op?
1. observe + therap;
2. failed non-op - then 2 stage - 1. ORIF with BG, 2. acromioplasty
281
What pathology is associated with cocking phase of throwing? (2)
1. GIRD;
2. internal impingement
282
What is the most harmful phase of throwing?
deceleration
283
What are associated pathologies in throwing? (4)
1. SLAP;
2. LHB;
3. brachialis;
4. teres minor
284
What is the Dx test of choice to Dx coracohumeral impingement?
CT with arm cross body
285
What is the operative Tx of CH impingement?
1. scope - +/- SSc repair - goal is \>7 mm between CH;
2. open coracoplasty - remove lateral coracoid and reattach conjoined tendon
286
What is the Bigliani classification of acromion morphology?
Type I - flat;
Type II - curved;
Type III - hooked
287
What is the most common arthroscopic finding with shoulder dislocation?
anteroinferior labral/capsular avulsion
288
What is the Beighton score for GLL?
1. dorsi D5th \>90 degrees: R=1, L=1;
2. thumb dorsi to flexor arm: R=1, L=1;
3. elbow hyperext. beyond 10 degrees: R=1, L=1;
4. knee hyperext. beyond 10 degrees: R=1, L=1;
5. hands flat on floor =1.
Positive score if \>=5/9
289
What is the pathologic coracohumeral distance for CH impingement?
\<6 mm
290
What movement does the rotator internal prevent?
ER @ 0 degrees abduction
291
What are the 3 areas to focus on when doing arthroscopic lysis of adhesions?
1. circumfrential lysis of adhesions;
2. rotator interval (ER);
3. posterior capsule (IR)
292
How do you define scapular winging?
medial to lateral in reference to top medial border of scapula
293
What are the Tx options for medial scapular winging?
1. observe 6/12;
2. TL brace;
3. pec. major transfer to inferolateral border of scapula
(Wait 1-2 years)
294
What is the major complication with vascular TO syndrome?
emboli to hands + ischemic digits on hands
295
What are the bounds of the thoracic outlet? (5)
1. clavicle;
2. 1st rib;
3. subclavius muscle;
4. costoclavicular lig.;
5. anterior scalene muscle
296
Under what circumstances can you proceed with TSA in the setting of RTC tear?
1. supraspinatus only;
2. no retraction;
3. repairable
297
What is the limit of glenoid version you can eccentrically ream without compromising bone stock?
15 degrees
298
What are the dynamic stabilizers of the elbow?
1. anconeus;
2. brachialis;
3. triceps;
4. lateral extensor mass;
5. med. flexor mass
299
What motion limitation pre-op places patients @ risk for ulnar nerve injury post OA elbow Sx?
1. extension \>60 degrees (flexion contracture);
2. \<100 degrees of flexion
300
What is little leaguer's elbow?
constellation of medial sided pathology in throwing athletes and includes:
1. med. epi. stress #s;
2. MUCL injuries;
3. flexor/pronator strain
301
What is the xray finding of little leaguer's elbow?
medial epiphyseal widening on xray
302
What are the Tx options for little leaguer's elbow?
1. physical therapy/NSAIDS/rest/coaching pitching mechanics/limit innings per week. This the mainstay of Tx.
2. ORIF of med. epi. #s;
3. MCL recon.
303
What motion is concerning in TEA for bushing wear?
varus/valgus \>10 degrees
304
What is the muscle/innervation + typical athlete that get AIIS avulsions?
1. rectus/femoris;
2. femoral nerve;
3. trailing leg in hurdlers
4. sports involving kicking
305
What is an associated condition with piriformis syndrome?
FAI - decreased IR - leads to short external rotator contracture + sciatic compression
306
What is the physical exam maneuvre for piriformis syndrome?
FAdIR hip (places piriformis on stretch + reproduces Sxs)
307
What is the post-op protocol for labral debridement (scope)?
1. PWB X 4/52;
2. limit flex/abduc. X 4/52;
3. slow back to sports - over 3-6 months
308
What causes pudendal nerve injury in hip scopes?
perineal post
309
What causes peroneal nerve injury during hip scopes?
boot traction
310
What is the mechanism of ischial avulsion injuries?
hip flexion + knee extension
311
What is the percentage of OCD with location in the knee?
1. medial Fc - 80%;
2. lateral Fc - 15%;
3. patella - 5%
312
What is the most common knee injury ligament wise?
MCL
313
What is the most common site of MCL injury? (prox. or dist.)
femoral insertion avulsion
314
What is the role of MPFL?
primary restraint to lateral patella subluxatal between 0-20 degrees flexion
315
What are acceptable parameters for meniscus mismatch for transplant?
5-10% only
316
What is the progression of OA for chronic PCL injury?
PF OA + med. comp. OA due to varus alignment
317
What are 2 key points on posteromedial accessory portal in knee arthroscopy?
1. 1 cm proximal to joint + posterior to MCL;
2. 70 degrees arthroscope - use to view posteromedial corner through notch
318
What are the indications for LCL operative repair?
1. Grade III LCL;
2. LCL/PLC;
3. LCL/cruciate
319
What is the upper limit of microfracture for OCD based on size alone?
2 cm squared (orthobullets says 4 cm squared)
