167/189 Day A & B (4/23 & 4/24) Mastery Training Program

Front 1

1-which shoulder dislocation has the MC incidence of neurovascular injury?
2-inferior dislocation of the glenohumeral joint aka

Back 1

1-MC nv injury=inferior dislocation of the glenohumeral joint aka Luxatio Erecta, Axillary nerve palsy, Axillary artery thrombosis
2-Luxatio Erecta

Front 2

A 35-year-old male injured his right shoulder while playing basketball. He presents emergently with significant pain and his shoulder abducted at 140 degree. He is unable to lower his arm. Radiographs will most likely show that his glenohumeral joint has dislocated in what direction?
1. Anterior
2. Posterior
3. Superior
4. Inferior
5. Lateral

Back 2

This patient has suffered an inferior shoulder dislocation (luxatio erecta). This is a rare type of shoulder dislocation, representing only about 0.5% of all shoulder dislocations. Anterior and posterior dislocations are much more common but don't present with a shoulder fixed in abduction or flexion such as this case. Ans4

Front 3

A 26-year-old right hand dominant male is involved in a motor vehicle collision and sustains the left humerus injury demonstrated in Figure A. The brachial artery is disrupted and requires urgent attention in the operating room. The patient's preoperative nerve evaluation demonstrates that the patient is unable to initiate extensor carpi radialis longus, extensor carpi radialis brevis, extensor pollicis brevis, extensor indicis proprius, and extensor pollicis longus motor activity. What is the most likely etiology for this observed neurologic examination?
1. Neurapraxia of the median nerve
2. Axonotmesis of the radial nerve
3. Neurotmesis of the ulnar nerve
4. Neurotmesis of the radial nerve
5. Axonotmesis of the ulnar nerve

Back 3

MCC radial nerve palsy in a high energy open hum fx is laceration or complete disruption of the radial nerve (Neurotmesis). Neurotmesis is complete disruption of nerve and is assoc w/ no spontaneous recovery w/out intervention. Axonotmesis constitutes axon disruption, but the surrounding neural connective tissue is intact & nerve regeneration can occur(Wallerian or antegrade degeneration). Neurapraxias occur often by compression & axon maintains continuity but local demyelination and ischemia occur. All 6 patients with a transected radial nerve had an open humerus fracture also. The results of primary nerve repair in this circumstance found that there was no recovery in any of the pts.
Incorrect Answers:
Answer 1,3,5: The radial nerve provides distal motor activity to the ECRL, ECRB, EPB, EIP, and EPL.
Answer 2: Axonotmesis of the radial nerve is not the most common form of injury associated with closed or open humerus fractures.Ans4

Front 4

A 45-year-old male sustains a Gustilo and Anderson Type II open transverse humeral shaft fracture. He undergoes the treatment shown in Figures A and B. What is the advantage of this treatment choice as compared to antegrade intramedullary nailing?
1. Decreased risk of post-operative elbow pain
2. Decreased risk of radial nerve injury
3. Decreased risk of reoperation
4. Decreased risk of infection
5. Decreased risk of blood loss

Back 4

Humeral shaft fractures treated with antegrade intramedullary nailing (IMN) have a higher risk of receiving an additional operation compared to those treated with plate fixation as seen in Figures A and B. Additionally, there is a higher incidence of shoulder impingement following IMN compared to plate fixation. There has been no difference found between the incidence of infection, elbow pain or radial nerve injury when comparing the two treatment options. Blood loss is not lower in an open case compared to nailing. Bhandari et al, found a significant relative risk reduction of 74% to reoperation with the use of plates and screws versus IMN. They also found a relative risk reduction of 90% in shoulder impingement with the use of plates and screws versus IMN. No significant difference was found between the two regarding rates of infection and/or radial nerve palsies. Ans3

Front 5

On average, the radial nerve travels from the posterior compartment of the arm and enters the anterior compartment at which of the following sites?
1. Spiral groove of the humerus
2. At the arcuate ligament of Osborne
3. 10 cm distal to the lateral acromion
4. 10 cm proximal to radiocapitellar joint
5. At the origin of the deep head of the triceps

Back 5

The radial nerve enters the anterior compartment through the intercompartmental fascia on average 10 cm proximal to the radiocapitellar joint. It has never been found to remain in the posterior compartment within 7.5cm of this joint, leading to this area being named the "safe zone". During the posterior approach to the humerus, the radial nerve is found in the spiral groove in the middle third of the posterior humerus, medial to the long and lateral heads and proximal to the deep head of the triceps. When performing an ORIF of a humerus fracture from a posterior approach it should be identified and protected.

Front 6

During an open reduction internal fixation of a humerus fracture using the posterior approach, a surgeon can identify the posterior antebrachial cutaneous nerve and trace it proximally to which of the following nerves?
1. Ulnar
2. Musculocutaneous
3. Radial
4. Median
5. Axillary

Back 6

The posterior antebrachial cutaneous nerve (PABCN) branches from the radial nerve in the axilla.

The posterior antebrachial cutaneous nerve branches from the radial nerve just distal to the posterior brachial cutaneous nerve (PBCN) in the axilla and they course through the arm in closely to each other. In the proximal forearm, the posterior antebrachial cutaneous nerve is found on the lateral border of the brachioradialis muscle. The terminal branches innervate the posterior aspect of the forearm distally.
Ans3

Front 7

A polytrauma patient sustains a right bicondylar tibial plateau fracture and a right humeral shaft fracture both treated with open reduction and internal fixation. He also underwent statically locked intramedullary nailing of a left femoral shaft fracture. What is the appropriate weightbearing status?
1. Non-weight bearing bilateral lower extremities and right upper extremity
2. Weight bearing as tolerated bilateral lower extremities and right upper extremity
3. Non-weight bearing left lower extremity and weight bearing as tolerated right upper and right lower extremities
4. Non-weight bearing right lower extremity and weight bearing as tolerated right upper and left lower extremities
5. Weight bearing as tolerated bilateral lower extremities and non-weight bearing right upper extremity

Back 7

The standard treatment for a bicondylar tibial plateau fractures is a period of post-operative non-weight bearing.

Tingstad et al found favorable results of immediate weightbearing on humeral shaft fractures treated with plating and full weightbearing did not have any effect on the union or malunion rates.

Brumback et al evaluated the feasibility, safety and efficacy of immediate weightbearing after treatment of femoral shaft fractures with statically locked IM nail. All the patients went on to union and no loss of fixation occurred. Ans4

Front 8

A 25-year-old male involved in a motor vehicle accident sustains multiple injuries. He undergoes operative treatment for his humeral shaft fracture. Figures A and B show his preoperative and postoperative radiographs. The distal interlocks for this implant place which of the following nerves at risk?
1. Radial
2. Ulnar
3. Median
4. Axillary
5. Musculocutaneous

Back 8

With intramedullary (IM) nailing of the humerus, the distal anterior-to-posterior interlocking screws place the musculocutaneous nerve at high risk for injury as it goes through the coracobrachialis muscle and courses anteriorly along the brachialis (of which it innervates the medial half).
Ans5

Front 9

Which of the following is a known risk factor for the development of adhesive capsulitis of the shoulder?
1. Menopause
2. Steroid use
3. Diabetes mellitus
4. Renal disease
5. All of the above

Back 9

Diabetic patients are at greater risk of adhesive capsulitis than the general population. The condition is often bilateral and resistant to all forms of treatment. It is more common in women, but there is no known association with menopause. Steroids are often used to treat this condition. Ans3

Front 10

Which of the following statements is true regarding the anatomical boundaries of the rotator interval in the shoulder?
1. Superior border is defined by the biceps long head tendon
2. Inferior border is defined by anterior band of inferior glenohumeral ligament
3. Contains the axillary pouch which is a common site for intra-articular loose bodies
4. Superior border is defined by anterior edge of suprapinatus tendon
5. Inferior border is defined by middle glenohumeral ligament

Back 10

The rotator interval is the area between the anterior edge of the supraspinatus tendon superiorly, and the superior edge of the subscapularis tendon inferiorly. The medial border is comprised of the coracoid process and the lateral border is formed by the transverse humeral ligament.
Incorrect answers:
1- Long head of biceps is located within the rotator interval.
2- Anterior inferior glenohumeral ligament is located inferior to the rotator interval.
3- Axillary pouch is located inferior to the rotator interval.
5- Inferior edge is defined by superior border of subscapularis tendon. Ans4

Front 11

A newborn child born via a difficult breech delivery is found to have a brachial plexus birth palsy. While initially born with a flail limb, the child regained elbow flexion at 10 weeks. At age 18 months (1.5 years old), which of the following deficits is most likely to be seen on physical exam?
1. Claw hand
2. Fixed adduction and internal rotation at shoulder with elbow extension
3. Hyperextension of the MCP joints and flexion of the IP joints of the hand
4. Weakness in elbow flexion
5. Normal physical exam without deficits

Back 11

At 18 months, a majority of children who have sustained an obstetric brachial plexus birth (OBPBP) injury will have a complete recovery without weakness or noticeable asymmetry. Fortunately, most newborns with OBPBP, and almost all children that have regained elbow flexion by 3 months, will have complete recovery by 18 months of age without intervention. Ans5

Front 12

A 3-month-old is brought to clinic for evaluation of a right upper extremity abnormaility present since birth. Which of the following physical exam findings is associated with the best functional outcome?
1. Loss of hand function with preserved shoulder function
2. Absent shoulder abduction and external rotation with intact wrist and digit flexion and extension
3. Rotator cuff dysfunction, elevated hemidiaphragm, and absence of rhomboid function
4. Loss of shoulder and wrist function
5. Ptosis, myosis and anhydrosis

Back 12

The findings provided are all associated with neonatal brachial plexus palsy. The best prognosis is seen in patients with the classic 'Erb palsy' presentation consisting of absent shoulder abduction and external rotation. Bicep activity is associated with a more favorable prognosis.
Wrong Answers:
Answer 1: Additional involvement of the wrist is associated with a worse prognosis, as is the rare 'Klumpke palsy' presenting with absent hand function seen in lower plexus lesions.
Answer 3: A flail extremity can be seen with preganglionic lesions as well and portends poor outcomes.
Answer 4: The additional involvement of the wrist motors is associated with a worse prognosis compared to those with shoulder involvement only
Answer 5: Preganglionic lesions are associated with the worse prognosis and are suggested when Horners syndrome or loss of rhomboid function is seen.
Ans2

Front 13

An infant is born with total brachial plexus palsy and Horner’s syndrome after a difficult vaginal delivery. What is the prognosis for spontaneous recovery of motor function in the involved arm by 3 months?
1. >90%
2. 75%
3. 50%
4. 25%
5. <10%

Back 13

Infants with total brachial plexus palsy (C5, C6, C7, C8, T1) with an associated Horner's syndrome have a very little (<10%) chance of ever recovering spontaneous motor function. A study by Al-Qattan et al found that 0 of 22 infants with Horner's and total plexus palsy recovered spontaneously. The presence of concurrent Horner's syndrome (ptosis, miosis, and anhidrosis on the ipsilateral side of the face) indicates injury to T1 root and the origin of the sympathetic branch that supplies the face. Ans5

Front 14

Which of the following muscles would be affected if a 6-month-old child sustains a birth-related brachial plexopathy affecting C5 nerve root?
1. Trapezius
2. Triceps
3. Biceps
4. Interossei
5. Flexor digitorum profundus

Back 14

The biceps and brachialis muscles are supplied by C5-6 and as such a brachial plexopathy affecting the C5 nerve root would affect the child's ability to perform elbow flexion and forearm supination. The deltoid is also supplied by C5 and palsy would lead to deficient shoulder abduction. Finally, extensor carpi radialis longus and brevis are supplied by C5-6 and palsy would result in weak wrist extension.

The trapezius is supplied by the spinal accessory nerve (cranial nerve XI) and palsy would lead to scapular winging. The interossei are supplied by T1, the triceps by C6-7, and the flexor digitorum profundus by C7-8.Ans3

Front 15

Congenital pseudoarthrosis of the clavicle almost always presents on:
1. the right side, middle 1/3
2. the right side, lateral 1/3
3. the left side, middle 1/3
4. the left side, lateral 1/3
5. both sides equally

Back 15

Congenital pseudarthrosis of the clavicle may be confused with a fracture but almost always involves the right middle 1/3 of the clavicle. Its cause is thought to be related to subclavian artery pulsations. It does not have associated fracture callus and is not painful at birth. Surgical repair should be considered for pain or sometimes cosmesis. Ans1

Front 16

the radial nerve courses along the spiral groove how many centimeters is it proximal to the lateral epicondyles and the medial upper condyle?

Back 16

14 cm  proximal to lateral condyle and 20 cm proximal to the medial condyle

Front 17

what kind of humerus fracture is most commonly associated with neuropraxia of the radial nerve

Back 17

HOLSTEIN LEWIS fracture which is a spiral fracture distal 3rd humeral shaft

Front 18

1. with the indication for coaptation splint for humerus fracture
2. what kind of fracture pattern has the highest risk of nonunion with humerus fracture in a brace

Back 18

1. 20/30/3–20 degrees anterior angulation, 30° varus valgus angulation, 3 cm shortening
2. Proximal 3rd oblique or spiral fracture, varus angulations, but rarely has any functional cosmetic sequela

Front 19

1. is radial nerve palsy a contraindication to functional bracing,
2. what is a contraindication to bracing

 

Back 19

1. no
2. Gunshot wound vascular injury brachial plexus injury severe soft tissue injury bone loss

Front 20

what of the indications for open reduction internal fixation of the humerus fracture "dirty dozen" + traffic light

Back 20

1. open fracture
2. Vascular injury requiring repair
3. Brachioplexus injury
4. Ipsilateral forearm fracture
5. Bilateral humerus fractures
6. Polytrauma patient
7. Pathologic factors
8. Overlying skin compromise-burn or soft tissue injury
9. Distraction at the fracture site
10. Long oblique fracture
11. Spiral proximal fracture
12. Intra-articular extension fracture

Front 21

order the relative indications for IM nailing of a humeral shaft fracture

Back 21

1. Segmental fractures
2. Severely osteoporotic fracture
3. limited open approach

Front 22

1. when performing ORIF of the humerus with a plate what is the approach for a proximal 3rd tibia middle 3rd shaft fracture
2. where his radial nerve lay between what 2 muscles

Back 22

1. anterior lateral approach to the humerus which is an extension of the deltopectoral approach
2. the radial nerve lies between the brachialis and the brachioradialis distally

Front 23

1. when performing ORIF of the humerus with a plate what approach is chosen for a distal to middle 3rd shaft fracture
2. what is radial nerve exit the posterior compartment____and how far is it proximal to the radial capitellar joint

 

Back 23

1. posterior approach
2. the lateral intermuscular septum 10 cm proximal to radiocapitellar joint

Front 24

when placing the distal screw of an IM nail in the humerus what nerves at risk in what direction

Back 24

radial nerve is at risk from lateral to medial distal locking screw and musculocutaneous nerve is at risk from anterior posterior locking screw

Front 25

1. what is the treatment for a nonunion of the humerus shaft
2. with the treatment of a midshaft humerus fracture with a nerve root avulsion

 

Back 25

1. compression plating with bone graft
2. open reduction internal fixation with plating

 

Front 26

1. radial nerve innervation, mn-Gold
2. when the radial nervePalsy occurs what is expected to be regained 1st what is the last recovery
3. at what time point as one do a surgical exploration for radial nerve palsy after closed fracture that failed to improve and what is expected to be seen on EMG at the same time MARK

 

Back 26

1. Radial nerve, proximal to distal 

"Try A Big Brazilian Chocolate PECAN 
Chip Sundae, Double Dip Cherries And PeanutButter Please Immediately"
T-Triceps,

A-Anconeus,

B-Brachioradialis,

B-Brachials Lateral 1/2,

C-ext. Carpi radialis longus(ECRL), 
P-PIN only innervation
C-ext. Carpi radialis brevis (ECRB),

S-Supinator, 
D-ext. Digitorum comminunus (EDC),

D-ext.Digiti minimi, ext.(EDM)

C-extensor Carpi ulnaris (ECU),

A- Abductor poll. longus (APL),

P-ext. Poll. Brevis (EPB),

P- ext. Poll. longus (EPL),

I- ext. Indicis proprius (EIP)

• 1st radial deviation from the brachial radialis and last extensor indices proprius
• 3-6 months and 3-4 months EMG study fibrillations

Front 27

 A 23-year-old man presents with the injury seen in Figure A after a motor vehicle collision. He undergoes the treatment seen in Figure B. Which of the following statements is most accurate when comparing his treatment with open reduction and internal fixation? 

1.  Higher rates of radial nerve injury

2.  Higher total complication rate

3.  Lower rates of nonunion

4.  Lower rates of shoulder impingement

5.  Lower rates of malunion

Back 27

Antegrade intramedullary (IM) nailing of humeral shaft fractures has been found to be associated with increased complication rates when compared with open reduction and internal fixation (ORIF). ans2

Front 28

 Figure A is a radiograph of an 80-year-old woman who sustained a closed injury to her left arm 10 months ago. She presents to office today complaining of persistent pain in her arm. What is the most likely metabolic or endocrine abnormality contributing to this patients presentation?

1.  Vitamin D deficiency

2.  Central hypogonadism

3.  Thyroid disorder

4.  Parathyroid hormone disorder

5.  Calcium deficiency

Back 28

oligotrophic nonunion of a proximal third humeral shaft fracture. The most likely underlying metabolic or endocrine abnormality with this presentation is vitamin D deficiency. Predisposing factors include: mechanical instability, poor bone-to-bone contact, infection and biological/biochemical factors. A variety of other contributing factors, such as cigarette smoking and malnutrition, have also been described. Correctable metabolic or endocrine abnormalities are common in elderly patients and are considered contributory in the etiology of fracture non-union. Correction of these abnormalities should be considered prior to surgical fixation. The most common newly diagnosed abnormality was vitamin D deficiencyans1

Front 29

 A 26-year-old right hand dominant male is involved in a motor vehicle collision and sustains the left humerus injury demonstrated in Figure A. The brachial artery is disrupted and requires urgent attention in the operating room. The patient's preoperative nerve evaluation demonstrates that the patient is unable to initiate extensor carpi radialis longus, extensor carpi radialis brevis, extensor pollicis brevis, extensor digitorum, extensor indicis proprius, and extensor pollicis longus motor activity. What is the most likely etiology for this observed neurologic examination?  Review Topic

FIGURES: 

1.  Neurapraxia of the median nerve

2.  Axonotmesis of the radial nerve

3.  Neurotmesis of the ulnar nerve

4.  Neurotmesis of the radial nerve

5.  Axonotmesis of the ulnar nerve

Back 29

Neurotmesis means"to cut" the entire Nerve. NErVE NOT together, everthing is cut both the nerve and the nerve sheath are cut

Axonotmesis means"to cut"  nerve cell axon-ONLY  with Wallerian degeneration occurring below and slightly proximal to the site of injury BUT  the endoneurium, perineurium & epineurium remain intact ( use  an AXE to cut the noddle inside the straw empty tube) 

Neurapraxia apraxia, meaning “impairment of the ability to "s a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery. temporary damage to the myelin sheath but leaves the nerve intact and is an impermanent condition; thus, Wallerian degeneration does not occur in neurapraxia, very common in professional athletes, specifically American football players. The most likely cause of the radial nerve palsy in a high energy open humerus fracture is laceration or complete disruption of the radial nerve (Neurotmesis).ans4

Front 30

A 45-year-old male sustains a Gustilo and Anderson Type II open transverse humeral shaft fracture. He undergoes the treatment shown in Figures A and B. What is the advantage of this treatment choice as compared to antegrade intramedullary nailing?

1.  Decreased risk of post-operative elbow pain

2.  Decreased risk of radial nerve injury

3.  Decreased risk of reoperation

4.  Decreased risk of infection

5.  Decreased risk of blood loss

Back 30

Humeral shaft fractures treated with antegrade intramedullary nailing (IMN) have a higher risk of receiving an additional operation compared to those treated with plate fixation as seen in Figures A and B. Additionally, there is a higher incidence of shoulder impingement following IMN compared to plate fixation. There has been no difference found between the incidence of infection, elbow pain or radial nerve injury when comparing the two treatment options. Blood loss is not lower in an open case compared to nailing. ans3

Front 31

All of the following are considered contraindications to the use of functional bracing of a humeral shaft fracture EXCEPT: 

1.  Mid-diaphyseal segmental fracture with ipsilateral pilon fracture

2.  Mid-diaphyseal fracture with radial nerve palsy from nonballistic penetrating injury

3.  Proximal one-third oblique fracture

4.  Mid-diaphyseal closed fracture with a radial nerve palsy on presentation

5.  Mid-diaphyseal fracture with a L1 burst fracture and paraplegia on presentation

 

Back 31

A closed mid-diaphyseal humerus fracture with a radial nerve palsy on presentation is not a contraindication to functional brace management.  "seems reasonable, however, to consider surgical intervention (radial nerve exploration) between 4 and 6 months based on the patient’s clinical course." ans4

Front 32

_ligaments and attached to the clavicle which of the 2 is most medial and is the strongest and which is the lateral ointment the most strongest

Back 32

1. medial strongest ligament is a coronoid ligament of the coracoclavicular
2. The superior aspect of of the acromioclavicular ligament

Front 33

absolute and relative indications for ORIF of the clavicle

Back 33

1. unstable group 2 or lateral clavicle fracture
2. Open fracture
3. Fracture with tenting the skin
4. Subclavian artery injury
5. Floating shoulder
6. Symptomatic - painful nonunion with bone graft
7. Posteriorly displaced group 3 or medial fractures
8. Middle 3rd fracture >2 cm of shortening
9. Brachioplexus injury
10. Closed head injury
11. Seizure disorder
12. Polytrauma

• Coracoid ligament repair versus reconstruction for group to types to a and B
• Placement of the plate superiorly biomechanically stronger and high risk for neurovascular injury with drilling, high risk of irritation and patient requesting having it removed

Front 34

A 22-year-old male sustains the injury shown in Figures A and B as the result of a fall from a ladder. Which of the following has been shown to be true regarding operative versus nonoperative treatment of this injury?

1.  Decreased chance of nonunion with nonoperative treatment

2.  Improved Constant and DASH scores with operative treatment at all time points

3.  Increased symptomatic malunion rate with operative treatment

4.  No change in shoulder abduction strength at union

5.  Increased time to union with operative treatment

Back 34

Surgical management of displaced, shortened clavicle fractures is associated with a decreased rate of nonunion and malunion, while improving shoulder strength and function at follow-up. Most recommendations for surgical treatment include shortening of greater than 2 centimeters.Incorrect Answers:
Answer 1: Operative treatment increases the union rate.
Answer 3: Operative treatment decreases the rate of symptomatic malunion.
Answer 4: Operative treatment increases shoulder abduction strength.
Answer 5: Time to union is decreased with operative treatment. ans2

Front 35

 Which of the following factors is associated with the highest rate of nonunion of a midshaft clavicle fracture?

1.  younger patients

2.  female gender

3.  simple fracture pattern

4.  sling immobilization

5.  early range-of-motion

Back 35

The risk of nonunion in patients sustaining middle 1/3 clavicle fractures is increased in female patients. ans2

Front 36

1. diagnosis
2. What is associated with
3. With the treatment
4. Was most common complications

Back 36

1. distal humerus by physis separation pediatric patient
2. child abuse very difficult to diagnose posterior medial displacement of the radial ulnar shaft relative to the humerus also consider ultrasound, MRI arthrogram
3. Closured reduction percutaneous pinning versus ORIF
4. Cubital varus and medial condyle AVN

Front 37

A 7-month-old girl cries when the mother touches her swollen elbow. A radiograph is shown in Figure A. What is the most appropriate treatment?

1.  Open reduction and internal fixation

2.  Closed reduction and percutaneous pinning

3.  Closed reduction and casting

4.  Functional bracing

5.  Closed reduction and hinged external fixation

Back 37

distal humeral physeal separation and is most appropriately treated with closed reduction and percutaneous pinning. Interpretation of this radiograph is difficult because the distal aspect of the humerus is cartilaginous and is not visible on x-ray, and at this age none of the secondary ossification centers have yet developed. ans2

Front 38

most common location for congenital pseudoarthrosis of the clavicle RIGHT or LEFT

with the surgical treatment

Back 38

RIGHT-Middle one third

when his pain and functional impairment for prosthesis than the treatment is ORIF with iliac crest bone grafting a 3–6 years

Front 39

most commonly associated condition with pseudoarthrosis of the clavicle

Back 39

leading of the scapula

Front 40

1. Erb's palsy which comes from a difficult vaginal delivery involves what part of the brachial plexus
2. what is his condition associated with
3. what is the treatment
4. what is a good sign for favorable outcome ×2

 

Back 40

1. Erb's palsy affects the upper trunk C5/C6
2. glenoid dysplasia
3. spontaneous recovery in 90% of cases may take up to 2 years 
4. early biceps muscle twitch.  at 2 months if there is biceps and deltoid M1 activity(muscle contraction without movementhat is the treatment forw), bad equals no biceps that 3 months syndrome last the rhomboid function avulsion injuries and Klumpke's palsy

Front 41

what is the treatment for total plexus palsy with a flail arm in 1 month or syndrome at one month or N0 at 3 months

Back 41

microsurgery nerve repair or nerve grafting or nerve transfer

Front 42

A newborn child born via a difficult breech delivery is found to have a brachial plexus birth palsy. While initially born with a flail limb, the child regained elbow flexion at 10 weeks. At age 18 months (1.5 years old), which of the following deficits is most likely to be seen on physical exam?

1.  Claw hand

2.  Fixed adduction and internal rotation at shoulder with elbow extension

3.  Hyperextension of the MCP joints and flexion of the IP joints of the hand

4.  Weakness in elbow flexion

5.  Normal physical exam without deficits

Back 42

At 18 months, a majority of children who have sustained an obstetric brachial plexus birth (OBPBP) injury will have a complete recovery without weakness or noticeable asymmetry. ans5

Front 43

1. what is most prevalent inflammatory process affecting the shoulder
2. what is most commonly associated condition with this disorder

Back 43

1. rheumatoid arthritis
2. 50% Full-thickness rotator cuff Tears

Front 44

what 4 conditions commonly cause glenohumeral arthritis in the shoulder

Back 44

1. osteoarthritis
2. Rheumatoid arthritis
3. Connective tissue diseases
4. Spondyloarthropathies

Front 45

which form of osteoarthritis has a low association of rotator cuff tears

Back 45

primary arthritis only 5-10% compared to secondary arthritis who had an overtightening of the anterior capsule do a reconstruction of the shoulder

Front 46

was the most common condition associated with intra-articular local anesthetic infusion pump after shoulder surgery

Back 46

chondrolysisc

Front 47

when evaluating the images of the shoulder with glenohumeral arthritis what a pathologic findings on

1. x-ray – humeral head, glenoid
2. CT scan
3. MRI

Back 47

1. x-ray – true AP –

• inferior aspect of the humeral head osteophytes KA goats.,  
• Posterior glenoid wear
• Posterior humeral head subluxation
• superior migration of the head if there is rotator cuff deficiency
• medialization of the glenoid if there is inflammatory arthritis

1. CT scan for inflammatory arthritis if there are any large bony defects
2. MRI rule out rotator cuff tear

Front 48

1. what is the diagnosis
2. What is the treatment when the patient is unable to perform activities of daily living
3. The contraindications to this treatment
4. What is the treatment when the patient has rheumatoid arthritis
5. With the treatment.  The patient is at the deltoid deficiency

Back 48

1. glenohumeral arthritis
2. Total shoulder arthroplasty
3. Contraindications – deltoid dysfunction, insufficient posterior glenoid, rotator cuff arthropathy
4. Hemiarthroplasty
5. fusion –30 3030

Front 49

the patient presents with primary osteoarthritis the shoulder what is the incidence of rotator cuff tear along with the osteoarthritis 

Back 49

it is rare to have rotator cuff tear and primary arthritis and shoulder <10%

Front 50

patient presents with a frozen shoulder what are the central lesions associated with this diagnosis 2

Back 50

1. scarring involving the coracohumeral ligament
2. Loss of the rotator interval

Front 51

if the patient presents with a frozen shoulder what other associated conditions may predispose the patient is diagnosis-5

Back 51

1. diabetes
2. Thyroid disorders
3. Previous surgeries lung and breast
4. Prolonged immobilization
5. Extended hospitalization

Front 52

if the patient presents to the office with adhesive capsulitis what is a normal amount of time for gradual return of the motion to occur

Back 52

approximately 26 months or 2 years

Front 53

patient presents to the office with frozen shoulder what physical exam finding are most suggestive of this diagnosis

Back 53

decreased range of motion especially external rotation with loss of motion in all 7 planes

Front 54

when treating frozen shoulder arthroscopically what 3 areas in the shoulder need to be addressed surgically to specific improved which directions of range of motion

Back 54

1.  lysis of adhesions
2. increase external rotation--Release of the rotator interval this will 
3. release internal rotation--Posterior capsular release this for a 

Front 55

1. what is the most common neurologic complication with surgical treatment for frozen shoulder
2. What are the common complications

Back 55

1. most, neurologic complication is – axillary nerve injury
2. Common complications – rotator cuff disruption
3. Fracture with osteoporotic bone
4. Recurrent stiffness
5. Iatrogenic chondral injury

Front 56

1. what is the diagnosis in a weightlifter
2. what is the treatment
3. What is the arthroscopic treatment

Back 56

1. distal clavicle ostial lysis
2. stop weightlifting or modified technique by moving arms further apart CORTISONE injection =first-line treatment
3. distal clavicle excision only resecting 0.5-1 cm of the distal clavicle

Front 57

 

 A 31-year-old professional bodybuilder reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint. Based on the radiograph shown in Figure A, which treatment is likely to provide the most successful result? 

1.  glenohumeral joint injection

2.  periscapular muscle strengthening

3.  labral repair

4.  arthroscopic resection of the distal clavicle

5.  capsular release

Back 57

Osteolysis of the distal clavicle is one cause of shoulder pain that can occur after acute injury or repetitive microtrauma. It is more common in weight-lifters. Open resection of the distal clavicle has been shown to be a reliable treatment for isolated painful acromioclavicular (AC) joint pathology refractory to nonoperative treatment. Arthroscopic resection of the distal clavicle has been reported to provide pain relief and allow a return to function comparable to open techniques. The arthroscopic approach offers the advantages of decreased morbidity, with fewer postoperative restrictions on motion, earlier return to normal activity, faster return to sport in a series of 10 weightlifters treated with a more limited arthroscopic resection than is usually advocated. improved cosmesis. 
ans4

Front 58

1. was diagnosis
2. What is the treatment
3. Was the most common complication  with this condition an older patient was
4. what to other common complications are seen with this condition

Back 58

1. inferior dislocation of the glenohumeral joint AKA luxatio erecta
2. closured reduction and immobilization however if in a young active patient surgical arthroscopy with reconstruction of the labral
3. Rotator cuff tear
4. Axillary nerve palsy which usually resolves with relocation of the shoulder and axillary artery thrombosis made currently

Front 59

1. patient presents with pain that decreases over time & hasn't grown what is the diagnosis,
2. describe the histology
3. What is the treatment–first-line and operative
4. what is contraindicated treatment
5. X-rays done what is important to see prior to performing surgery & what is most common location

 

Back 59

1. myositis ossificans
2. Zonal pattern – periphery of lesion mature trabecular lamellar and woven bone calcification seen on x-ray Center of lesion irregular mass of immature fibroblast cartilage component may be seen calcification not seen on x-ray
3. first-line treatment is rest active range of motion exercises and activity modification: Surgical incision > 6 months
4. Passive stretching is contraindicated
5. peripheral bone formation with a central lucent area may appear as a "dotted veil" pattern, most common location is the diaphysis of long bones after direct trauma or intramuscular hematoma must be differentiated from tumor

Front 60

1. what is the diagnosis
2. What gene mutation occurs with this condition

Back 60

1. fibrousdysplasia ossificans progressiva a rare subtype of heterotopic ossification
2. mutation of the capital ACVR1 gene–  transduces signals via a BMP type-1 receptor

Front 61

A 25-year-old male presents complaining of a groin mass which he noticed after a football injury. He states he was struck in the groin with an opposing player's helmet during a tackle and had a large amount of bruising and pain. While his pain and bruising subsided, he states he noticed this groin mass soon there after and that it hasn't grown and is non-tender. He is otherwise healthy. Inlet pelvis radiograph and T2 MRI with gadolinium scan are shown in Figures A and B. What is the most likely diagnosis?

1.  Ossifying lipoma

2.  Synovial sarcoma

3.  Myositis ossificans

4.  Periosteal chondrosarcoma

5.  Inguinal hernia

 

Back 61

myositis ossificans. This benign condition is common after trauma, burns, or surgery secondary to a circulating factor which activates mesenchymal stem cells residing within muscle to form extra-osseous bone. Treatment is conservative in nature and if required, it is recommended treatment be delayed until complete ossification. ans3

Front 62

1. what the diagnosis after traumatic delivery 10 pound baby,
2. describe the condition
3. what is the next most appropriate step in the management of this condition
4. What other associated conditions are found – 4
5. was a treatment for the 1st year of life
6. What is the treatment if the child 2 years old

Back 62

1. congenital muscular  torticollis
2. The head tilts towards the affected side in this child on the RIGHT and a palpable neck mass with fibrosis is noted within the 1st 4 weeks of life
3. Order C-spine x-ray  to rule out rotary atlantoaxial instability and Klippel-Feil syndrome additionally an ultrasound may be ordered
4. associated conditions

• DDH
• Metatarsus adductus
• Plagiocephaly AKA head asymmetry
• Congenital axial occipital abnormalities
• Rule out Grisel's disease-caused by an upper respiratory infection linked to lymphatic edema in the cervical spine
• Klippel-Feil disease– multiple abnormal segments of the cervical spine – failure of normal segmentation or formation of the cervical so might week 3–8 gestation with the classic triad – low posterior hairline, short web neck, limited cervical motion

1. treatment for the 1st year of life his exercises passive stretching with 90% success rate
2. Z-plasty lengthening or distal bipolar release of the sternocleidomastoid muscle reserve for children's greater than 1 year of life with limitation greater than 30°

Front 63

A 6-week-old female infant presents with the neck deformity and palpable mass shown in Figure A. She has had persistent lateral tilting of her head to the right since birth, and rotation of the neck is restricted. In this age group, what is the most common cause of this rotational abnormality? 

1.  Congenital muscular torticollis

2.  Klippel-Feil syndrome

3.  Arnold-Chiari malformation

4.  Atlantoaxial rotatory displacement

5.  Paroxysmal torticollis of infancy

Back 63

Congenital muscular torticollis (CMT) is the most common cause of torticollis in infancy. Neurologic disorders and osseous abnormalities, such as Klippel-Feil, are less common. Ultrasonography is considered the modality of choice for differentiating (CMT) from other more serious pathologies in the neck when a palpable mass is present. The initial treatment of of CMT is conservative, and good outcomes can be expected in the majority of these cases. Tang et al used US to examine affected sternocleidomastoid muscles in patients with CMT classified as having one of four types of fibrosis.ans1