All are true except in septic arthritis post ACL reconstruction?
C)
Higher likelihood infection with allograft vs BTB
late presentation: infrequent
Which is true about anterior shoulder instability?
A)
All are options for >25% Hill-Sachs lesions, except?
D)
B is for posterior intability (modified mclaughlan)
Which is a risk factor for poor outcome with rotator cuff repair?
B)
Forward flexion or ER weakness indicate infra/teres minor tear which indicates ita a large tear
Where do the long and short heads of biceps insert?
B)
Insert on radial tuberosity
- What do you tell a patient considering non-op treatment of distal biceps rupture?
a) Loss of 40% supination strength
b) Loss of 50% flexion strength
A)
30% flexion
15% grip strenght
What is true of the MPFL reconstruction?
B)
Should be tight in extension and lax in flexion > 110
Isometric zero to 110 flexion: tighten in extension
Distal femoral tunnel leads to graft tension in extension and laxity in flexion
Best indication for non-op pectoralis major tear?
B)
non op if tear in musculotendinous junction
Low demand patients
Regarding internal impingement of the shoulder, all are true EXCEPT?
B)
leads to partial thickness tears
Sleeper stretch for GIRD
Overhead athlete: GIRD
Posterior capsular tightness: GIRD
All are strategies to decrease risk of nerve injury during elbow arthroscopy, except?
C)
What is true about biologic suture anchors in rotator cuff surgery?
C)
What is true about muscle transfers for rotator cuff disease?
B)
PEC major transfer is treatment for subscap insufficiency
What percent of overhead athletes are returning to their previous level of sport after a SLAP repair?
D)
Which is a closed chain exercise
D)
closed chain: distal end is fixed
Regarding double row and single row rotator cuff repairs
D)
Double row has higher healing rates
In ACL recon, what is true?
a) Single bundle anatomic reconstruction recreates normal mechanics
b) Double bundle recon has the best outcomes
c) Knee flexion strength will return after harvest of HT for recon if adequate physio
d) PL bundle longer than AM bundle
None are true
Other variant of question has that PL shorter than AM which is true
PL bundle is shorter
AM bundle is longer
Double bundle is stronger biomechanically but similar outcomes
Regular TSA in a patient with cuff tear arthropathy will fail by which mechanism?
A)
head lever superior > rocking horse phenomena
What is the optimal step for a hemiarthroplasty component for 4-part proximal humeral fracture to optimize outcomes?
D)
retroversion should be 0-30
Should be 5.8 cm above pec
Cemented
Which is a NOT a risk factor for recurrence after arthroscopic Bankart repair?
B)
Age <20
From isis score
Hill sach
Contact sport
Age <20
Bony bankart
Hyperlaxity
>4 need bony procedure
Regarding triceps tendon injuries:
A)
Which of these is a static gleno-humeral stabilizer? REPEAT
D)
Regarding pediatric ACL which is true
A)
IF TUNNEL < 5% PHYSIS: no problem
Risk factors for growth disturbance
Fixation hardware across physis
Large tunnels >12mm
Dissection close to perichondrial ring
Suturing near tibial tubercle
When doing an HTO, all are true except
A)
Patient has both PCL and PLC injury, what will you see on physical exam? REPEAT
A)
Positive dial if >10 degree difference in ER
Regarding evaluation of bone loss in anterior shoulder instability, which is true?
C)
Garth view is best for bnakart
AP with ER is for reverse hill sach
Stryker notch is for hill sachs
Which of these is not a cause of pain in throwers? REPEAT
D)
What is true regarding varus posteromedial rotatory instability of the elbow?
Regarding a distal biceps tendon rupture, where does the long head of the biceps insert?
C)
Short head is distal and radial
Long head: supination
Short head: Flexion
Where is the posterolateral bundle of the ACL tightest?
A)
A 20yo male football player sustains an isolated, grade III MCL tear. Which of the following is true?
B)
femoral insertion is most common location of avulsion for superficial MCL
Intrasubstance: most common for Deep MCL
Avg return to play is 9 weeks
Which of the following is true about cruciate ganglion/synovial cysts?
B)
Regarding a Hill-Sachs lesion following anterior shoulder dislocation, which of the following is true?
D)
AP with IR is the best: stryker
AP with ER is for reverse hillsach
What causes muscular tears?
A)
Myotendinous junction is the weakest point
What type of fibres in the meniscus resist hoop stresses?
A)
Which of the following is a poor prognostic indicator of healing of a rotator cuff tear?
D)
Regarding internal impingement of the shoulder, all are true EXCEPT?
A)
Internal impingement in throwing motions
Regarding rate of success in treatment for osteochondral defects, which is true?
D)
Guy with Anterior dislocation. Has Hill Sachs lesion. All are possible treatments, except?
B)
Subscap transfer is mclouglan procedure for posterior hill sach lesion
All of the following are considered stabilizers of the posterolateral corner, except?
A)
Isolated sectioning of PCL leads to no effect in ER tibia
You do hemi shoulder. What is best position?
D)
Retroversion 0-30
Prosthesis 5.6 cm above pec
All are true about fem acetabular impingement, except?
C)
head is aspherical in CAM
Which of the following would lead you to treat a pec major tear non op?
D)
What is most common problem in adults after traumatic elbow disloc?
D)
During elbow arthroscopy, which of the following portals places a sensory nerve at greatest risk?
A)
Proximal medial: MABCN
All occur with chronic acl insufficiency except?
D)
Medial meniscus tears more often because it acts as an anterior restraint in the ACL deficient knee
Think there was a question that talked about a sports injury then says result of the mri (PCL and PLC injury) and the question asks you what would you find on physical exam?
A)
need > 10 degree difference in ER
If only positive at 30 then means isolated PLC injury
Arm is flexed, adducted and int rotated. What is primary restraint against posterior disloc?
C)
In overhead throwing athletes, all are a cause of arm pain, except?
B)
All true except about bicep tendon repairs?
B)
No difference in rates of HO!
Which of the following are true EXCEPT re: Elbow dislocation (May have remembered this one wrong just know about elbow dislocation)
B)
All of the following are false except? About elbow injuries.
B)
Structure most at risk when doing 2 incision distal biceps repair (LCNF NOT an option)
D)
Most common complication post acute distal biceps repair
C)
18 year-old female presents to you complaining of her shoulder going “in and out” when swimming or playing volleyball. Which of the following is the best option for treatment of her instability?
A)
AMBRI: surgical treatment is inferior capsular shift
Regarding Hill Sachs of the humeral head after anterior dislocation, which of the following is true Except?
D)
Best seen with AP in IR: stryker view
What is the best view for AC joint?
B)
Zanca: aim 1o degrees cephalad
Which of the following structures is most important to assess in acute posterolateral elbow instability? (NOT acute posterior elbow dislocation)
D)
Which of the following is true re: ACL reconstruction?
D)
anterior placement: knee tight in flexion and loose in extension
Posterior placement: Loose in flexion and tight in extension
When is a J sign present?
C)
The presence of an HAGL lesion can cause the normally U-shaped axillary pouch to appear J-shaped as a result of extravasation of contrast or joint fluid across the torn capsule and ligament
Which of the following positions will cause the ECU to pop?
B)
Snapping ECU: symptoms with supination and ulnar deviation and flexion
PL elbow dislocation-stable in extension, opens in valgus? What to do.
A)
Initial is to splint 1-2 weeks
If failed non op then do UCL reconstruction
Most important to check? After elbow dislocation
A)
Elbow dislocation how to splint if: MCL injury
LCL injury
Supination
Pronation
When placing the graft on the tibia in an ACL replacement, which is best position to avoid impingement?
D)
During ACL replacement, which position is preferred for tensioning of the graft?
B)
Maximal tensioning at 0 degrees to avoid overconstraint
If tensioning at 30 degrees need to tension submaximal force
Which of the following vessels is the main blood supply to the PCL?
B)
Which of the following positions will cause the ECU to pop?
B)
Relocates with pronation
PL elbow dislocation-stable in extension, opens in valgus? What to do.
A)
SPlint 1-2 weeks in supination if LCL ok
Most common site of compression of suprascapular nerve
A)
50 year old male, anterior shoulder dislocation reduced in ER w/ numbness. Dx of numbness?
D)
50 year-old man with anterior shoulder dislocation. Closed reduction. Weakness of elevation with lateral arm numbness. What do you do?
B)
50 year-old patient with weakness in shoulder abduction after closed reduction of shoulder dislocation. What is the cause?
A)
The development of arthritis following ACL reconstruction is most correlated with:
C)
In TSA, what is cause of anterior instability?
A)
Which of the following structures is most important to assess following an acute posterior elbow dislocation?
A)
Which of the following is the main stabilizer of the elbow?
C)
Which of the following is the most common anatomic location for suprascapular nerve compression?
B)
Volleyball player has weakness while playing. On exam they have infraspinatus wasting. What do you expect to find on arthroscopy?
A)
SAP tear associated with spinoglenoid notch impingement of suprascapular nerve >>>>infraspinatus wasting only
Frozen shoulder (“which is true”? OR “all true EXCEPT”!! Different institutions differ)
D)
Elbow OA and weakness … OA elbow see all except
A)
OA elbow differs from the rest: early signs are capsular contracture and osteophyte formation
Predictors of a bad outcome in ACL all except:
D)
Bracing does not predict bad outcome
A swimmer presents with shoulder pain. All are possible etiologies except—
C)
Studies suggest that the zone of impingement there is hypervascularity
At one year, what are the results of an ulnar nerve transposition, compared to just release:
B)
Same outcome but more compications with transposition (9 vs 31%)
Regarding forearm (radioulnar) synostosis, which is true?
D)
Which of the following is true regarding radioulnar synostosis:
B)
With regard to radioulnar synostosis which of the following is true:
C)
Synostosis better position: supination
All of the following are done when you test for posterolateral rotatory instability (PLRI) of elbow except:
A)
Apply VALGUS STRESS
Fracture of anteromedial tubercle of coronoid leads to
With a posterolateral corner injury (PLC) which structures does NOT tear
E)
Posterior oblique: medial structure
Young football player has a knee injury with planted foot in ER and knee extended. He has a positive external rotation recurvatum test and opening to varus stress at full extension and 30 degrees. Which are you most likely to see?
A)
Which of the following is correct with respect to (Type 3) acromion morphology:
D)
Type 1: flat
Type 2: Curved
Type 3: hooked
Use supraspinatus outlet view to classify
Posterior shoulder dislocation, all true except:
D)
Elbow PL dislocation, simple (no fracture), concentrically reduces, opens with valgus testing, management:
D)
Opens in valgus: Supination for MCL
Opens in Varus: Pronation for LCL
Injury to the elbow with anteromedial coronoid fragment, what is patient at risk for?
A)
Dude with ACL injury and grade 3 MCL, best treatment?
D)
Staged ACL after MCL heals
72 year old man 6 months ago with shoulder trauma now presents to you with mild pain and can raise shoulder up to 80 degrees, xrays show posterior dislocation, what to do?
A)
D if no pain and functional
45 yo logger with total medial menisectomy 20 years ago, ROM 5 to 120, no ACL from previous injury. Has a painful knee. Given an xray of isolated medial compartment varus OA in obvious varus alignment of limb, tx?
A)
Cannot do uni bc missing ACL
40 year old with patellar tendon tear, all true EXCEPT?
A)
What is true about the baseball pitcher during acceleration phase (I cannot recall all this, will need some fillers here...)
I)
Baseball elbow question, which is true (need help with recall here too)?
E)
pro wrestler. Global shoulder pain. Activity related. Postive Yergason’s and pain with lift off test. Etiology?
C)
Long term PCL injury will show what with time?
C)
PCL injury makes you more prone to Medial and PF OA
What is a common late presentation for PCL deficient knee?
A)
ACL injury in knee will show what of the following? Ottawa & UBC: ACL deficient gait pattern?
C)
Alter gait to avoid anterior displacement of the tibia which happens with quads contracture
Maximum anterior translation at 15-20 degrees of flexion
What regarding SLAP is true?
A)
Baseball pitcher with mild shoulder pain and infraspinatus wasting, next step?
C)
Infraspinatus wasting concern for spinoglenoid notch impingement of suprascapular nerve
With regards to a cyst in spinoglenoid notch:
B)
What factors improves the strength of the tibial fixation in a 4 strand ACL hamstring graft fixation, except:
B)
all others are true
Divergence <10-15 degrees
Bioabsorbable or steel screws are the same
The most important ligament in the elbow is:
C)
Along with ULCL
AVN of radial head
A)
Symptoms 23 months
x rays only later
Young guy with SC joint pain, acne and pustules on palms, what is it?
C)
Pectoralis major tear, best indication for Non-op treatment
A)
Proximal or muscle belly: non op
Myotendinous: maybe on op
Tendinous: op
When assessing acute PLRI, what else is the most important thing to check
B)
Rotator cuff SS tear, bad prognosis
C)
Size, tear and fatty degeneration: affect rate of re rupture
Distal graft attachment site for Tommy John medial elbow instability surgery
B)
Sublime tubercle: attachment of MCL
Swimmer with multidirection instablility. What surgery is best
C)
AMBRI: inferior capsular shift
Closing wedge osteotomy for valgus knee with 17 degree tibiofemoral axis. You correct tibiofemoral to 0 degrees with an HTO. What is most likely outcome
C)
It changes joint line obliquity
Thats why it is preferred to do femoral osteotomy for valgus correction
Shoulder instability – posterior – tx –
a) rehab
b) surgery
A)
50 y o guy with shoulder dislocation and difficulty elevating his arm
a: rotator cuff tear
b: nerve injury
A)
Older than 40 and dislocation: rule out RCT
question on PLRI elbow and what constitutues a positive test
a) clunk/pain at 40 deg of flex
b) dislocation
a)
38 year old lady with elbow dislocation with radial head fracture. Joint reduced concentrically, but elbow unstable with radial head in 4 pieces. No wrist pathology on x-ray. Exam reveals a non-tender wrist and IOM. What gives the best outcome
A)
Becasue head in > 3 pieces
45 year old firefighter with picture showing proximal biceps tear. Which is true?
C)
Proximal bicep tear is reflection of internal impingement and RCT
Postero-lateral elbow dislocation, no fracture, post-reduction is concentric but elbow opens in valgus. What is best treatment
D)
IGHL – except question
D)
Most common cause of quadriparesis in football players
C)
Regarding Baker’s cyst in adults –? all true except
C)
It is btw semiM and MEDIAL head of gastrics
Cause of small osteochondral allograft failure
D)
Humeral response
Atraumatic SC arthritis
A)
treatment is conservative unless symptoms severe
45 year old firefighter with picture showing proximal biceps tear. Which is true?
A)
Proximal bicep + old: rotator cuff
RA elbow with joint space loss with symmetric joint contour (grade 2). Results of synovectomy (?except)
C)
Recurrence increases after 10 years.
Athlete agrees to ACL tear surgery, how do you manage concurrent grade 3 MCL?
A)
ACL reconstructed after 6 weeks of non op MCL treatment
Knee MCL grade 3 injury
C)
Takes 9 weeks
Operate only if still lax after non op
Fracture of antero-medial coronoid – what is associated instability of elbow
D)
Regarding Baker’s cyst in adults –? all true except
D)
Dark on T1 bright on T2
Rest are true
ACL: when is it under maximal strain?
B)
45 yo lady with mayo grade 2 RA of the elbow, no symptoms from head of radius
a) Open synovectomy will give 80% relief for 3 years
b) 70% increase in motion
A)
What is a Pelligrini-Stieda sign/lesion?
MCL Avulses from femoral condyle
ACL stress highest with
A)
for PCL its Ascending ramp
ACL autograft, which has greatest tensile strength:
A)
Quadruple hamstring > BTB > Intact ACL
> Quad tendon
Failed ORIF Proximal humerus for NON-UNION. Now hemiarthroplasty. What is common reason for poor ROM?
D)
GT osteotomy worsened results: from neer study
Bad prognostic factor for rotator cuff tear undergoing repair:
D)
Bad rotator cuff is bad prognostic factor
Thoracic Outlet Syndrome, all are false except:
B)
It is btw anterior and middle scalene
Worse with scapular lowering
Watson is for DISI
O’Brien’s pivot shift for Posterolateral Rotatory Instability, starting position:
B)
Hinged elbow brace should have axis of rotation:
C)
All are reasons why you should not use hamstring graft for ACL except:
B)
Bone bruise on MRI after ACL Injury:
C)
37 yr-old guy with lateral knee pain. You are shown an X-ray showing Isolated lateral compartment OA with the knee in valgus (12 degrees) + Good ROM 5-130. What’s the best treatment?
B)
If you do HTO you will change the joint orientation and make it more varus
Posterior shoulder instability. All are true EXCEPT
C)
During an extensive rotator cuff repair, the subscapularis is released using the following releases EXCEPT?
A)
Components of 360 release of subscap
1) its superior margin from the coracoid
(2) the posterior surface from the anterior capsule and scapular neck
(3) the inferior border from the axillary nerve and circumflex vessels
(4) the anterior surface from the conjoined tendon
Repeat spinoglenoid cyst
B)
Mechanism of posterior shoulder dislocation
A)
ACL tunnels
D)
Anterior: tight in flexion
Posterior: Tight in extension
When do you not use medial hamstring for ACL, except?
A)
What is true about Bone Bruise in ACL injury?
B)
50% show bruising
Its on posterolateral tibia
What is the best test for a SLAP lesion?
B)
MRI best imaging
Young swimmer with shoulder pain. All are likely reasons except:
C)
Usually hypervascularity from internal impingement
Throwing athlete with pain during late cocking phase and decrease internal rotation, what is the diagnosis?
E)
GIRD in throwing athlete
Presented with an X-ray of a knee dislocation in obvious varus alignment. What is the most likely finding on physical exam?
A)
common peroneal injured
Shown a drawing of the lift-off test. Which muscle does this test for?
