166/189

Front 1

I have radiculopathy and complain of numbness and tingling of the thumb and weakness with extension at the wrist wears the lesion

Back 1

C6

Front 2

 

I have radiculopathy and complaint of numbness and tingling affecting the middle finger where his lesion

Back 2

C7

Front 3

if there is radiculopathy the patient complains of difficulty with overhead activities whereas the lesion

Back 3

C7

Front 4

the patient complains of difficulty with grip and has a radiculopathy with lesion

Back 4

C7

Front 5

the patient complains of deltoid and biceps weakness where is the lesion what of the physical exam finding 

Back 5

C5

diminished biceps reflex

Front 6

patient complains of weakness with wrist extension and paresthesias of the thumb wears the lesion what other physical exam findings

Back 6

C6 diminished brachial radialis reflex

Front 7

patient complains of triceps and wrist flexion weakness and paresthesias of the middle index and ring fingers wears a lesion what other physical exam finding is that

Back 7

C7 diminished triceps reflex

Front 8

patient complains of difficulty with fine motor that is weakness of the distal phalanx flexion of the middle and index fingers paresthesias of the little finger with a lesion

Back 8

C8

Front 9

what chemical mediators contributed to the pain associated with nerve root irritation and radiculopathy

Back 9

substance P, BRADYkiNAN, TNF alpha,

• prostaglandins

, I L1 IL6

Front 10

what physical exam provocative test relieves the pain of cervical radiculopathy

Back 10

shoulder abduction test

Front 11

what Should be ordered prior to surgery if the patient has subacromial hardware and is causing artifact on the MRI

Back 11

CT myelography

Front 12

1. with the treatment of cervical radiculopathy
2.  athlete have a single level ACDF and return to play

Back 12

1. goal standard treatment – anterior cervical discectomy and fusion ACDF
2. yes this is not a contraindication

Front 13

what is the treatment of a foraminal disc herniation causing a single level radiculopathy

Back 13

posterior foraminotomy 91% success rate

Front 14

1. what is the most common complication with an ACDF in a patient with diabetes and smoking
2. treat this complication

Back 14

1. pseudoarthrosis 10% single level 30% multiple levels
2. posterior cervical fusion or repeat anterior decompression plating the patient has symptoms of radiculopathy

Front 15

after ACDF patient returns to the office with difficulty breathing (dyspnea) during physical activity.

1. what is the complication
2. what is the treatment
3. What is the treatment at 8 weeks

Back 15

1. RIGHT recurrent laryngeal nerve injury
2. Observation for 6 weeks
3. 8 weeks ENT consult to scope patient and injected Teflon

Front 16

patient had an ACDF returns to the office in sticks the tongue on achieving deviates was a complication and wears the injury

Back 16

complication is hypoglossal nerve CN12 injury and it deviates to the side of the injury

Front 17

A 49-year-old male presents with left arm pain of four weeks duration. A T2-weighted axial MRI is shown in Figure A. Which of the following statements would most accurately describe his diagnosis and physical exam findings?

1.  A C5 radiculopathy leading to deltoid and biceps weakness.

2.  A C5 radiculopathy leading to brachioradialis and wrist extension weakness.

3.  A C5 radiculopathy leading to triceps and wrist flexion weakness.

4.  A C6 radiculopathy leading to brachioradialis and wrist extension weakness.

5.  A C6 radiculopathy leading to finger flexion weakness.

 

Back 17

 C6 radiculopathy, which is most likely presents with dermatomal arm pain, paresthesias in the thumb, weakness to brachioradialis and and wrist extension, and a diminished brachioradialis reflex.Incorrect Answers:
Answer 1 & 2: A C5 radiculopathy leads to deltoid and biceps weakness, and would be caused by a posterolateral disc herniation at C4/5.
Answer 3: A C7 radiculopathy leads to triceps and wrist flexion weakness, and would be caused by a posterolateral disc herniation at C6/7.
Answer 5: A C8 radiculopathy leads to finger flexion weakness, and would be caused by a posterolateral disc herniation at C7/T1. ans4

Front 18

A 33-year-old male presents with neck and left arm pain. He denies symptoms in his right arm. Based on the MRI image shown in Fig A, what findings would be expected on physical exam? 

1.  weakness to shoulder shrug

2.  weakness to shoulder abduction and elbow flexion

3.  weakness to elbow flexion and wrist extension

4.  weakness to elbow extension and wrist flexion

5.  weakness to finger abduction

Back 18

The MRI shows an axial T2-weighted image with a left sided disc herniation causing foraminal stenosis at the C4/5 level. This would affect the C5 nerve root, and lead to deltoid (shoulder abduction) and biceps (elbow flexion) weakness.
ans2

Front 19

 A 38-year-old male presents with a cervical disc herniation at the C7/T1 level with associated foraminal stenosis, but no significant central stenosis. What would be the expected symptoms and physical exam findings.

1.  Numbness of the lateral shoulder and deltoid weakness

2.  Numbness of 2nd and 3rd fingers and triceps weakness

3.  Numbness of the thumb with weakness to wrist extension

4.  Numbness of 5th finger with weakness to long flexor function in all digits and thumb

5.  Numbness of the medial elbow and weakness to long finger flexion of the 4th and 5th digits only

 

Back 19

A disc hernation at the C7/T1 level will most likely affect the C8 nerve root. A C8 radiculopathy usually presents with sensory symptoms in the medial border of the forearm and hand, and weakness in long flexor function in all digits and thumb. It is important to differentiate a C8 radiculopathy from a peripheral ulnar neuropathy which also presents with sensory symptoms in the ulnar hand and finger. One way to do so is to test DIP flexion of the middle and index finger. The function of the flexor digitorum profundus in the index and middle fingers can be affected by 8th cervical radiculopathy, but they are not affected by ulnar nerve entrapment. The reference by Rao is a review of the pathoanatomy of cervical spondylosis and the different clinical manifestations. They recommend a simplified clinical approach of dividing the presenting findings into the categories of axial neck pain, radiculopathy, myelopathy, or some combination of these three. ans4

Front 20

A 52-year-old woman underwent a C5/6 ACDF for cervical radiculopathy through a left-sided approach two years ago. Radiographs are shown in Figure A. She has had an altered voice since this operation. Recently, the patient has developed myelopathic symptoms including gait instability and dexterity problems with her hands. An MRI shows a fusion at C5/6, and an adjacent-level midline disc herniation at C4/5 with cord compression and myelomalacia. Laryngoscopy of the vocal cords demonstrates abnormal function of the vocal cords on the left hand side. Which of the following is the most appropriate treatment for this patient?  Review Topic

FIGURES: A           

QID: 1005

 

1.  Physical therapy and NSAIDS

2.  High dose methylprednisone

3.  C5/6 hardware removal and C4/5 ACDF using a left sided anterior approach

4.  C5/6 hardware removal and C4/5 ACDF using a right sided anterior approach

5.  C5 to C7 posterior laminectomy and fusion

 

Back 20

. The most appropriate treatment at this time is hardware removal at C5/6 (she is fused) and anterior cervical discectomy and fusion at C4/5 utilizing a left sided approach through her old incision. One should avoid using a right-sided approach, as a right recurrent larygngeal nerve (RLN) injury would cause denervation of both vocal cords leading to breathing difficulties and aphonia. 
ans3

Front 21

what does AMBRI referred to

Back 21

A – atraumatic

M– multidirectional

B– bilateral

R – rehabilitation

I – inferior capsular shift

Front 22

AMBRI what other  general signs of hypermobility.  The patient have-5

Back 22

1. hypermobility
2. genu recurvatum
3. Elbow hyperextension
4. MCP hyperextension
5. Thumb abduction ipsilateral forearm

Front 23

what x-rays are included with complete trauma series of the shoulder

Back 23

1. AP internal rotation
2. AP XLR rotation
3. AP true
4. Axillary
5. Scapular Y

Front 24

what arthroscopic findings diagnostic of a AMBRI/MDI?

Back 24

patient drive-through sign,  although there are only 2 lb of traction, it is very easy to push the arthroscope between the humeral head and glenoid surfaces

Front 25

what is the differential diagnosis for patient with MDI/AMBRI

 

Back 25

1. unidirectional instability
2. cervical spine disease
3. Brachial plexitis
4. Thoracic outlet syndrome

Front 26

when arthroscopic surgery is done to treat MDI what areas must be addressed

Back 26

1. capsule shifted superiorly with a inferior capsular shift
2. Plication of redundant capsule
3. Rotator interval closure which reduces external rotation with arm at the side
4. Addressed the anterior posterior labral pathology of present

Front 27

 postop on physical exam there is a positive liftoff test and excessive external rotationwith the diagnosis

Back 27

subscapular deficiency

Front 28

postop there is loss of motion after treating an arthroscopic MDI what is the treatment

Back 28

the lengthening of the subscapularis

Front 29

1. most common complication with capsular shift
2. how to prevent this complication

Back 29

1. axillary nerve injury
2. Abduction and external rotation of the arm moves the axillary nerve away from the glenoid

Front 30

1. the patient develops late arthritis after a capsular shift  arthroscopically where is the pattern of wear inside the shoulder
2. with physical exam findings and late arthritis

Back 30

1. posterior glenoid wear pattern may have internal rotation contracture
2. internal rotation contracture

Front 31

Which of the following is true regarding closure of the rotator interval in patients undergoing arthroscopic shoulder stabilization?

1.  It can lead to recurrent instability

2.  It restricts external rotation predominately in the "arm cocking" phase of throwing

3.  It restricts combined flexion and cross-body adduction

4.  It restricts external rotation predominately with the arm at 0 degrees of shoulder abduction

5.  It restricts internal rotation predominately with the arm at 90 degrees of shoulder abduction

Back 31

Rotator interval closure involves plicating the anterior-superior region of the capsule by suturing the superior and middle glenohumeral ligaments together. This has been advocated as a treatment for certain recurrent instability patterns such as multi-directional instability (MDI). It was felt to address inferior subluxation in patients with a sulcus sign, however, the greatest effect is a decrease in external rotation at the patient's side (0 degrees of abduction). In general, a tighter anterior capsule tends to decrease external rotation most, and a tighter posterior capsule causes a decrease in internal rotation. ans4

Front 32

1. patient had an arthroscopic procedure where the rotator interval closed for stabilization what is the effect on the physical exam
2. Anatomically what tissues are addressed in order to execute closure of the rotator interval

Back 32

1. restriction of external rotation with the arm at 0° of shoulder abduction
2. suturing the superior and middle glenohumeral ligaments together.

Front 33

what is the primary biomechanical role on the rotator cuff muscles

Back 33

in the dynamic restraint  to stabilize the glenohumeral joint by compressing the humeral head against the glenoid

Front 34

what is the primary role of the SGHL in the shoulder

Back 34

resistant to inferior translation and 0° abduction or neutral rotation

Front 35

what is the primary role of the MGHL in the shoulder

Back 35

resistance anterior posterior translation in mid range abduction i.e. 45° in next all rotation

Front 36

1. what is the primary role of the posterior band of the IGHL in the shoulder
2. If this band is tight what does it lead to

 

Back 36

1. resistance posterior subluxation at 90° flexion and internal rotation
2. internal impingement an increased shear forces on the superior labrum leading to SLAP lesions

Front 37

what is the primary role of the anterior band of the IGHL in the shoulder

Back 37

primary restraint to anterior inferior translation at 90° abduction and maximal external rotation that is late cocking phase of throwing

Front 38

1. what is the primary role of the superior band of the  IGHL in the shoulder
2. if the patient has a Coexistent SLAP lesion was the effect on the superior band of the IGHL

 

Back 38

1. most important static stabilizer
2. 100% increase strain

Front 39

which ligament is a primary stabilizer to posterior subluxation with the shoulder in flexion abduction internal rotation and limits inferior translation and external rotation at the adduction position

Back 39

coracohumeral ligament CHL

Front 40

which area of the labrum has a worst blood supply

Back 40

anterior superior labrum 

Front 41

1. what anatomic structure is the weak link and leads to a Bankart lesion
2. what contribute to the extra stress in this area of the labrum

Back 41

1. the anterior labrum
2. the anchor of the IGHL

Front 42

1. what anatomic structure is the weakest link and leads to a SLAP lesion
2. what contributes to extra in this area of the labral

Back 42

1. the superior labrum
2. Anchor of the biceps tendon

Front 43

1. what is the diagnosis
2. What is the treatment

Back 43

1.  sublabral foramen
2. do nothing normal variant

Front 44

1. what is the diagnosis
2. What is the treatment
3. What is definition

Back 44

1. BUFORD complex
2. Do nothing normal variant
3. Cordlike middle glenohumeral ligament attaches at the base of the biceps tendon and complete absence of the anterior superior labrum

Front 45

1. what is the structure labeled #6
2. whAT ARE the boundaries

Back 45

1. rotator interval
2. Superiorly – anterior edge of the supraspinatus
3. Inferiorly – superior border of the subscapularis
4. Lateral apex form the transverse humeral ligament
5. Medially by the lateral coracoid base

Front 46

what is the anatomic direction of the glenoid

Back 46

5° up or tilt

5° retroversion in relation to the axis of the scapular body and varies from 7° of retroversion to 10° anteversion

Front 47

1. what of the 4 types of acromial morphology name them 1 through 4
2. which morphology type is most common
3. Which morphology type is most commonly associated with impingement syndrome

Back 47

1. flat inferiorly
2. Curved which is most common
3. Follow-up into these incidences of shoulder impingement
4. Convex or upturn

•  curved is most common
• most likely cause shoulder impingement

Front 48

with vessel provides main blood supply to the humeral head what numberon this arteriogram

Back 48

#4 –posterior humeral circumflex artery

Front 49

was the optimal position for arthrodesis of the shoulder joint

Back 49

30/30/30/

30°-45° abduction

30° – 10° of flexion

30°– 45° of internal rotation

Front 50

The superior glenohumeral ligament is under the greatest stress when the humeral head and arm are in which of the following positions?

1.  Anteriorly translated with the arm in 90 degrees of abduction and externally rotated

2.  Inferiorly translated with the arm in 5 degrees of adduction

3.  Anteriorly translated with the arm in 90 degrees of abduction and internally rotated

4.  Inferiorly translated with the arm in 45 degrees of abduction and internal rotation

5.  Inferiorly translated with the arm in 90 degrees of abduction and neutral rotation

Back 50

The role of each glenohumeral ligament has been clearly defined by previous cadaveric studies that have sectioned different ligaments during different periods of stress on the glenohumeral joint. These studies have demonstrated that the superior glenohumeral ligament provides the most restraint to the shoulder joint when the arm is at zero degrees of abduction or in adduction and pulled inferiorly. Incorrect answers:
1: The anterior inferior glenohumeral ligament is stressed when the arm is in this position
3: An arm positioned as such does not classically stress any of the glenohumeral ligaments
4 and 5: The arm is more adducted in answer 2
ans2

Front 51

A 67-year-old female who sustained a proximal humerus fracture as a result of a fall goes on to develop avascular necrosis (AVN). An injury was most likely sustained to which of the following arteries labeled 1-5 in Figure A? 

1.  Artery labeled 1

2.  Artery labeled 2

3.  Artery labeled 3

4.  Artery labeled 4

5.  Artery labeled 5

NAME THE ARTERIES 1-5

Back 51

The artery labeled 4 on the arteriogram is the posterior humeral circumflex artery, which is the primary blood supply to the humeral head, and most likely to lead to AVN when injured. 

1. deltoid branch of the thoracoacromial artery
2. Axillary artery
3. anterior humeral circumflex artery
4. Posterior humeral circumflex artery
5. Profunda brachii artery

Front 52

Besides the biceps tendon, which of the following structures also pass through the rotator interval? 

1.  The coracohumeral ligament only

2.  The coracohumeral and superior glenohumeral ligaments

3.  The coracohumeral, superior and middle glenohumeral ligaments

4.  The superior and middle glenohumeral ligaments

5.  The superior glenohumeral ligament only

Back 52

The rotator cuff is perforated anterosuperiorly by the coracoid process, which separates the anterior border of the supraspinatus tendon from the superior border of the subscapularis tendon, creating the triangular rotator interval, which is bridged by capsule. The base of the interval is the coracoid process, from which capsular tissue (the coracohumeral ligament) originates. The transverse humeral ligament at the biceps intertubercular sulcus forms the apex of the rotator interval. The coracohumeral and superior glenohumeral ligaments are considered to be structural contents of the rotator interval capsule, but each have separate origins and insertions. These ligaments are considered to be the most constant structures of the fibrous joint capsule. ans2

Front 53

for patient to perform abduction what motion must they also have present in order for the bones to exhibit what kind of motion

Back 53

cannot have an internal rotation contracture or we'll be unable to abduct greater than 120° because the shoulder requires external rotation when performing abduction in order to clear the greater tuberosity to keep from impinging on the acromion

Front 54

abduction comes from motion in

1. what 2 joints
2. what ratio

Back 54

1. glenohumeral joint and the scapulothoracic joint
2. 2: 1  that is 120° from glenohumeral joint and 60° from the scapulothoracic joint = 180° of abduction

Front 55

1. what are the 3 dynamic stabilizer in the shoulder
2. which one placed the primary biomechanical roll and stabilization of the glenohumeral joint

Back 55

1. rotator cuff muscle, biceps, parascapular muscles
2. Rotator cuff muscles are primary

Front 56

1. what is the diagnosis
2. what is the treatment

Back 56

1. meniscoid
2. Live alone normal.

Front 57

what muscle is important stabilizer to posterior subluxation and external rotation

Back 57

subscapularis muscle AKA dynamics stabilized of the shoulder

Front 58

when performing a deltopectoral approach to the shoulder what is considered the

1. lighthouse
2.  Y is it called  this 

Back 58

1. the coracoid
2. It because the coracobrachialis pectoralis minor and short head of the biceps all attach on the coracoid

Front 59

1. what the diagnosis
2. What is the best diagnostic studies to confirm the diagnosis on x-ray what other x-ray views helpful if the differential can includes a fracture of the coracoid
3. which ligament provides horizontal stability
4. Which ligament provides vertical stability

Back 59

1. acromioclavicular joint separation
2. zanca  view– x-ray being tilted 10° to 15° cephalic direction with only 50% of penetration strength; Stryker Notch View-rule out fracture the coracoid process
3. Horizontal – acromioclavicular ligament
4. Vertical –  coracoclavicular ligaments

Front 60

1. what the diagnosis based on classification
2. describe this type of injury including what is torn
3. what is the best x-ray view to see this type of before meals separation
4. With the treatment

Back 60

1. acromioclavicular joint separation type 4–
2. lateral end of the clavicle is displaced to the posterior aspect of the trapezius; torn – AC ligament and CC ligaments
3. best seen on the axillary x-ray
4. ORIF with ligament reconstruction– modified WEAVER DUNN the reconstruct the coracoclavicular ligament or free tendon graft, sling without abduction ×6 weeks no shoulder motion for 6 weeks he'll return activities 6 months

Front 61

1. what the diagnosis based on classification
2. describe this type of injury include what is torn
3.  what is the treatment

Back 61

1. acromioclavicular separation type 6
2. the distal clavicle is name to either subacromial or subcoracoid that is inferior lateral to the conjoined tendon; torn AC ligament and CC ligaments
3. ORIF or ligament reconstruction

Front 62

1. what the diagnosis based on classification
2. describe this type of injury including what is torn
3. what is the treatment

Back 62

1. acromioclavicular  separation type V
2. >100% increase in the coracoclavicular 9100-300%) rupture of deltotrapezial fascia, resulting in subcutaneous distal clavicle both the acromioclavicular and the CC ligament is torn
3. ORIF with ligament reconstruction

Front 63

1. what the diagnosis based on classification
2. Describe this type of injury including what is torn
3. What is the treatment 
4. treatment professional athlete

Back 63

1. acromioclavicular separation type 3
2. greater than 25% less than 100%: Torn both CC and AC ligaments
3. controversial –sling for 3 weeks early range of motion normal activity at 12 weeks
4. ORIF with ligament reconstruction

Front 64

1. what is diagnosis based on classification
2. describe this type of injury including what is torn
3. What is the treatment

Back 64

1. AC 2
2. Less than 25% increase in the coracoclavicular interspace: Torn AC ligament and a coracoclavicular ligament is sprained
3. Sling

Front 65

1. what is the diagnosis based on classification
2. Describe this type of injury including what is torn
3. What his treatment

Back 65

1. AC separation type I
2. acromioclavicular ligament sprain the coracoclavicular ligament is normal
3. Sling

Front 66

1. of the different types of surgeries used to reconstruct the acromioclavicular injury which one is associated with a higher rate of acromial erosion
2. which technique is generally not used today because of the high complication rate

Back 66

1. hook plate
2. Primary acromioclavicular joint fixation with smooth K wire or pin

Front 67

1. what is the disadvantage of using a modified WEAVER DUNN technique to reconstruct the coracoclavicular ligament
2. describe the modified WEAVER DUNN technique

Back 67

1. the coracoacromial ligament is only 20% as strong as a normalcoracoclavicular ligament therefore lack of internal fixation the results in risk of failure of soft tissue repair
2. Transfer of the coracoacromial ligament to the distal clavicle to re-create the coracoclavicular ligament

Front 68

with the major disadvantage of surgical treatment of a grade 3 acromioclavicular joint separation 

Back 68

high complication rate

Front 69

For Grade III AC joint separations, surgical treatment results in which of the following when compared to non-operative management?

1.  Faster return to play

2.  Increased range of motion

3.  Increased functional rotator cuff strength

4.  Decreased funtional rotator cuff strength

5.  Higher complication rate

Back 69

Treatment of grade III AC separations remains somewhat controversial. A recent systematic review by Spencer concluded that the results of surgical treatment were not clearly any better than non-operative, had a higher complication rate, and a longer recovery prior to return to sport/work. ans5

Front 70

1. 18-year-old presents with pain, swelling and an acute fracture what is the diagnosis based on histology
2. what is the next best diagnostic study to confirm the diagnosis
3. With the treatment with the fracture
4. What is the treatment without fracture

Back 70

1. ABC histology shows Her, blood filled spaces without endothelial lined numerous benign giant cells spindle cell and we'll renew bone
2. which show multiple fluid lines
3. if fracture present the treatment is nonoperative until the fracture heals
4. IF No acute fracture then treat with aggressive curettage and bone grafting

Front 71

1. what are the common locations ABCs are found in the body 2 mn
2. was a classic x-ray finding of this condition
3. What of the associated tumors with this condition – 5

Back 71

1. posterior spine – differential diagnosis osteoid osteoma/osteoblastoma & sacral eccentric, MA-ABCG
2. bubbly apparent – expansile eccentric and lytic lesion with bone septae classic cases with thin rim of periosteal new bone surrounding lesion no matrix mineralization
3. Giant cell tumor, chondroblastoma, fibrous dysplasia,, chondromyxoid fibroma, and NOF

Front 72

 Intralesional curettage and bone grafting is an accepted component of the treatment plan for all of the following conditions EXCEPT?

1.  Giant cell tumor

2.  Aneurysmal bone cyst

3.  Chondroblastoma

4.  Chondromyxoid fibroma

5.  Osteofibrous dysplasia

Back 72

no role for curettage and bone grafting in patients with osteofibrous dysplasia. Nonoperative treatment is preferred for osteofibrous dysplasia until a child reaches maturity. These lesions usually regress and do not cause problems in adults unless the skeletal deformity requires surgical correction. Benign conditions that are OCCASIONALLY treated with curettage and bone grafting include unicameral bone cyst (UBC), enchondroma, and nonossifying fibroma (NOF). ans5
 

Front 73

 

A 12-year-old female is involved in a low speed motor vehicle accident and presents with a pathologic fracture in the ulna. A radiograph is shown in Figure A. A needle biopsy is performed and histology is shown in Figure B. What is the best next step in treatment?

1.  Open biopsy for adequate diagnostic tissue

2.  Open reduction internal fixation of the distal ulna

3.  Immediate curettage and adjuvant chemo/radiotherapy

4.  Nonoperative fracture management

5.  Preoperative chemotherapy and resection of tumor

Back 73

small nondisplaced fracture through an aneurysmal bone cyst. While the plain radiograph is not diagnostic, it does not suggest an aggressive lesion. The "lakes of blood" seen on the histology confirm the diagnosis. Given the alignment of the fracture, nonoperative management is preferred. Once the fracture has healed, if the ABC continues to grow treatment is curretage and grafting. If the fracture stimulates the bone cyst to resolve then no further treatment is required. ans4

Front 74

1. baseball pitcher complains of vague shoulder pain and loss of velocity on his pitches what is the diagnosis, 
2. what is the next best diagnostic study to confirm the diagnosis and rule out the differential diagnosis
3. What is the treatment
4. What is the surgical treatment

Back 74

1.  GIRD glenohumeral internal rotation deficiency
2. CT scan –glenoid retroversion, MRI –internal impingement, SLAP lesion
3. physical therapy – posterior capsular stretching: Sleeper stretch– performed with internal rotation straight and 90° abduction with scapular stabilizing, pectoralis minor stretching, subscapularis and serratus anterior strengthening
4. Only if extending onto parenting fails posterior capsular release versus anterior stabilizationcontroversial treatment 

Front 75

what are the associated conditions with this diagnosis-4

Back 75

1. glenohumeral instability
2. Internal impingement which is abutment of the greater tuberosity against the posterior superior bone or joint abduction and external rotation
3. SLAP lesion 25% 
4. retroversion of the glenoid

Front 76

Which of the following shoulder motions is characteristically decreased in the throwing arm of athletes when compared to the nondominant side? 

1.  Internal rotation

2.  External rotation

3.  Abduction

4.  Adduction

5.  Forward elevation

 

Back 76

throwing shoulder in pitchers frequently exhibits excessive external rotation at the expense of decreased internal rotation. The cited study by Crockett et al is a CT study of athletes and nonathletes that showed that athletes had a significant increase in dominant shoulder humeral head retroversion, glenoid retroversion, external rotation at 90 degrees, and external rotation in the scapular plane when compared to the nondominant shoulder. Internal rotation was decreased in the dominant shoulder of athletes.ans1

Front 77

1. what is the most common mechanism of neck injury in football
2. the diagnosis with this condition when can the plantar go back to play
3. when a player is injured on the field out as one addressed the facemask and the helmet and shoulder pads

 

Back 77

1.  with a canal diameter all Spirit tackler spine AKA cervical stenosis with a canal diameter of <13 mm normal 17 mm or torque PAVLOV ratio < 0.8 normal 1.0
2. retire  AKA contraindication to return to play
3. MAY remove facemask to protect airway or do CPR however do not remove helmet or shoulder pads

Front 78

1. which neck conditions are a contraindication to return to play career over-5 dealy sins of cerical spine

Back 78

1. transient quadriplegia with severe stenosis
2. SPEAR TACKER spine
3. Cervical neurapraxia with ligamentous instability
4. Odontoid hypoplasia and os odontoid p.m.
5. Klippel-Feil anomalies

Front 79

1. what cervical spine injury may have player experiencing be allowed to return to play
2. What physical exam findings must be present with this condition in order to be cleared to return to play
3. what is an indication to get an MRI

Back 79

1. burner/ STINGER
2. Complete resolution of symptoms with normal strength and normal range of motion
3. bilateral neurologic symptoms looking for cervical stenosis or loss of CSF around the cervical spine

Front 80

Proper tackling techniques should be taught to adolescent football players to prevent catastrophic cervical spine injury. These injuries most commonly occur through which of the following mechanisms?

1.  Axial loading of the subaxial spine that occurs with spear tackling

2.  Traction injury leading to nerve-root avulsion from arm tackling

3.  Excessive lateral bending from high impact shoulder tackling

4.  Flexion-distraction injuries due to a whiplash mechanism during cut blocking

5.  Rotational injuries from pulling on the face mask during a tackle

 

Back 80

 the most common type of traumatic neck injury involves fracture, dislocation, or ligamentous disruption of the subaxial cervical spine. These are typically due to axial loading mechanisms which, in football, most commonly occur during spear tackling by defensive backs. ans1

Front 81

1. was the etiology of AVN of the humeral head in the shoulder
2. What is the most common cause of AVN in the shoulder

Back 81

pneumonic – ASEPTIC

A – alcohol, age

S– Steroids, sickle cell, SLE

E-ERLENMEYER flask (the Gaucher's disease)

P – pancreatitis

T – trauma 4 part fracture dislocation 100% AVN and 4 part displaced 45% AVN

I – idiopathic/infection

C –Caisson’s (the bends)

• steroids

Front 82

patient presents with insidious onset shoulder pain loss of motion and crepitus weakness limited range of motion no history of trauma patient being treated with steroids

1. With the diagnosis
2. With the treatment
3. What what is the next most appropriate step in management of this condition

Back 82

1. AVN  of the humeral head
2. Treatment is 100% dependent upon the stage of the disease
3. MRI to determine edema and site of subchondral sclerosing

Front 83

1. what is the diagnosis based on the stage
2. describe the characteristic findings and this stage
3. what is the  treatment

Back 83

1. AVN, Stage II
2. sclerosis and osteopenia
3. Core decompression since there is no collapse of the articular surface

Front 84

1. what is the diagnosis based on stage
2. Describe the characteristic findings of this stage
3. What is the treatment

Back 84

1. AVN stage III
2. Crescent sign indicating subchondral fracture
3. Hemiarthroplasty because the articular surface has collapsed

Front 85

1. what is the diagnosis based on the stage
2. Describe the characteristic findings of the stage
3. What is the treatment

Back 85

1. AVN stage IV
2. Flattening and collapse
3. Hemiarthroplasty

Front 86

1. what is the diagnosis based on the stage
2. Describe the characteristic findings of the stage
3. What is the treatment

Back 86

1. AVN stage V
2. Degenerative changes that extend to the glenoid as well
3. Total shoulder arthroplasty

Front 87

A 66-year-old male presents with a three-month history of increasing right shoulder pain. He denies any trauma or prior shoulder problems, and has good rotator cuff strength. His medical history is significant for Crohn's disease which is controlled medically with prednisone therapy during flares. A current MRI image of his shoulder is shown in Figure A. What is the most likely diagnosis?

1.  Gaucher disease

2.  Osteoarthritis

3.  Chronic rotator cuff tendinopathy

4.  Osteonecrosis

5.  Calcific tendinitis

Back 87

atraumatic lesion shown in Figure A is most consistent with osteonecrosis (also known as avascular necrosis, or AVN). Initial MRI findings of AVN include decreased signal intensity in the subchondral region on both T1- and T2-weighted images, suggesting edema in early disease. In the shoulder, this is most commonly associated with the chronic use of corticosteroids, such as prednisone. ans4

Front 88

1. "dead arm syndrome" AKA
2. Underlying pathology
3. physical exam finding

Back 88

1.   burners or stinger
2. transient brachioplexus weakness unilateral and C5/C6 causing a neurapraxia
3. transient weakness and positive SPURLING's test

Front 89

1. what is the criteria for return to play after stinger-3
2. when should one order an x-ray
3. when should one order an MRI
4. when should one order an EMG
5. when should a CAT scan be ordered

Back 89

1. completely resolved in 1-2 minutes
2. normal strength
3. Normal range of motion

• x-ray if recurring symptoms to rule out a fracture or cervical stenosis
• MRI if symptoms are bilateral rule out herniated disc or cervical stenosis, cervical neuropraxia
• His symptoms persist >3 weeks rule out abnormalities in the roots cord strokes and peripheral nerves
• A short period of loss of consciousness rule out subdural hematoma

Front 90

 In college level football players with symptoms of arm numbness and tingling following contact, which of the following is an indication for a cervical MRI prior to return to play?

1.  Unilateral symptoms do not resolve within 15 minutes.

2.  Symptoms follow a short period of loss of conciousness.

3.  Player has had unilateral symptoms on two prior occasions.

4.  Transient unilateral weakness in the deltoid and biceps is present.

5.  Symptoms and physical exam findings are found in both upper extremities.

Back 90

In football player with numbness and tingling in the arms, it is critical to differentiate between a transient brachial plexopathy (burner) and cervical neuropraxia. In the latter, symptoms are bilateral, and an MRI is indicated prior to return to play.Incorrect Answers:
Answer 1: Unilateral symptoms that don't resolve within 15 minutes is not an indication for an MRI. 
Answer 2: If a patient experiences a short period of loss of consciousness, than a CT of the head is indicated, not an MRI of the cervical spine.
Answer 3: Recurrent "burners" is an indication for cervical radiographs, not an MRI.
Answer 4: Unilateral transient weakness of the deltoid and biceps is commonly seen with "burners", and is not an indication for an MRI.
ans5

Front 91

When performing an arthroscopic distal clavicle excision for acromioclavicular joint arthrosis, which of the following structures must be preserved to prevent post-operative anteroposterior instability of the clavicle? 

1.  Trapezoid ligament

2.  Anterior and inferior acromioclavicular joint capsule

3.  Superior and posterior acromioclavicular joint capsule

4.  Coracohumeral ligament

5.  Conoid ligament

Back 91

primary restraint to anteroposterior translation of the clavicle is the ligamentous thickenings of the acromioclavicular joint capsule. Debski et al showed in one such study that the strongest of these ligaments is the superior one, verifying the findings of several other authors. They reported that the superior ligament supplies around 50% of the strength against anteroposterior translation, and it is thickest in its posterior aspect. Additionally, the posterior AC ligament adds an additional 25% of the overall strength. For this reason, these ligaments should be preserved when performing a distal clavicle resection. ans3

Front 92

1. the most common cause of  brachioplexus injury in trauma
2. what the most common injury pattern
3. What is the worst prognosis

Back 92

1. high-speed vehicle accident most, a motorcycle
2. upper brachial plexus most commonly do to caudally forced shoulder and injury pattern
3. root avulsion as a preganglionic injury because it not repairable arthrodesis or tendon transfers are needed

Front 93

 A 21-year-old collegiate football player has been diagnosed with a left superior trunk brachial plexus injury following a tackle. Which of the following would most likely be normal on physical exam?  

1.  Sensation over the lateral aspect of shoulder

2.  Biceps reflex

3.  Shoulder abduction

4.  Sensation over radial aspect of forearm

5.  Finger abduction

Back 93

Examination of finger abduction would be normal in a patient with an isolated superior trunk brachial plexus injury. Finger abduction is performed by the ulnar nerve, which is supplied by the inferior trunk of the brachial plexus. 

Incorrect Answers:
Answer A: Decreased sensation over the lateral aspect of shoulder = axillary nerve.
Answer B: Decreased biceps reflex = C5 +/- C6 reflex arc.
Answer C: Weakness to shoulder abduction = axillary nerve.
Answer D: Decreased sensation over the radial aspect of the forearm = lateral antebrachial cutaneous nerve of the forearm (branch of musculocutaneous nerve).ans5

Front 94

A patient sustains a transection of the posterior cord of the brachial plexus from a knife injury. This injury would affect all of the following muscles EXCEPT?

1.  Subscapularis

2.  Latissimus dorsi

3.  Supraspinatus

4.  Teres minor

5.  Brachioradialis

Back 94

posterior cord of the brachial plexus gives rise to the 1) upper subscapular nerve 2) lower subscapular nerve 3) thoracodorsal nerve 4) axillary nerves 5) radial nerve. The upper subscapular nerve innervates the subscapularis. The lower subscapular nerve innervates teres major and also subscapularis. The thoracodorsal nerve innervates latissimus dorsi. The axillary nerves innervates deltoid and teres minor. The radial nerve innervates the triceps, brachioradialis, wrist extensors, and finger extensors. The supraspinatus is innervated by the suprascapular nerve off the upper trunk and therefore would not be affected by an injury to the posterior cord. The anatomy of the brachial plexus is shown in Illustration A.ans3