Orthopedics - Many Topics 2

Front 1

Should you perform tenodesis vs tenotomy for long head of the biceps repair?

Back 1

Literature review by Frost et al. Am J Sports Med 2009 - inconclusive, recommend RCT

Front 2

Levels of Evidence:

Back 2

1A: Meta-analysis of RCTs
1B: RCT
2A: Non-R Controlled Trial
2B: Experimental, non-controlled trial
3: Non-Experimental Data (Case, Correlation, Comparative)
4: Panel of Experts

Hint 2

---short form--

1A: Meta-analysis
1B: Randomized
2A: Controlled
2B: Trial
3: Data
4: Expert Opinion

Front 3

Describe Giant Cell Tumors:
Age Range, Location (Body & Bone), Cellular Morhpology, Recurrence

Back 3

25-40 yo

Around the Knee, Distal Radius, Sacrum, Hand Phalanges
Metaphysis or Epiphysis (Not Diaphysis)

Multinucleated, but Nuclei look exactly like surrounding stromal cells

Recurrence Rate Significantly Increased if there is soft ts extension (Williams et al J Hand Surg Am 2010)

Front 4

EXT1 & EXT2 genes

Back 4

Autosomal Dominant
Tumor Suppressor Genes of Multiple Hereditary Exostoses
Multiple Osteochondromas
EXT1 mutation is more severe than EXT2 (more exostoses, worse, >flatbone involv, higher malign conversn, mn: named 1 because they found it first because more severe presentation)
Important for chondrocyte proliferation suppression

common locs? malignant risk?

Hint 4

Risk for malignant transformation: <1% solitary, 5-10% with MHE
Steiber: slightly increased risk of sarcomatous transformation in exsostosis (J Am Acad Orthop Surg 2005)
Pannier: EXT genes encode "exostosins" glycosyltransferases important in heparin sulfate synthesis

Front 5

Multiple Hereditary Exostosis

Back 5

Multiple Osteochondromas

EXT1 & EXT2 Genes = Tumor suppressors vs chondrocyte prolif

Locs: common locations: around the knee, prox humerus, subungual (esp hallux)

Risks for malig: 5-10% with MHE

Hint 5

Steiber: slightly increased risk of sarcomatous transformation in exsostosis (J Am Acad Orthop Surg 2005)
Pannier: EXT genes encode "exostosins" glycosyltransferases important in heparin sulfate synthesis

Front 6

Diastrophic Dyplasia

gene, gene fnx

4 morph features

Back 6

DTDST gene, sulfate transporter important in cartilage conversion to bone

cauliflower ear, diastrophic dwarfism, clubfoot, hitchhiker thumbs +/- cleft palate

Hint 6

Front 7

dwarfism characterized by cauliflower ear, clubfoot, hitchhiker thumbs

sro, gene, gene fnx

Back 7

Diastrophic Dyplasia: DTDST gene, sulfate transporter important in cartilage conversion to bone,

Hint 7

Front 8

Apert's Syndrome

Gene, Morph Features

Back 8

FGFr2

dysmorphic face

syndactyly

Hint 8

Front 9

sro, gene, fnx

Back 9

Multiple Hereditary Exostoses

Autosomal Dominant
Tumor Suppressor Genes of Chonrocytes

Multiple Osteochondromas
EXT1 mutation is more severe than EXT2

common locs? malignant risk?

Hint 9

Risk for malignant transformation: <1% solitary, 5-10% with MHE
Steiber: slightly increased risk of sarcomatous transformation in exsostosis (J Am Acad Orthop Surg 2005)
Pannier: EXT genes encode "exostosins" glycosyltransferases important in heparin sulfate synthesis

Front 10

Sro, Gene, Gene Funx, Morph Feat

Back 10

Disatrophic Dysplasia

DTDST gene

sulfate transporter important in cartilage conversion to bone,

cauliflower ear, diastrophic dwarfism, clubfoot, hitchhiker thumbs +/- cleft palate

Hint 10

Front 11

Sro, Gene, Gene Funx, Morph Feat

Back 11

Disatrophic Dysplasia

DTDST gene

sulfate transporter important in cartilage conversion to bone,

cauliflower ear, diastrophic dwarfism, clubfoot, hitchhiker thumbs +/- cleft palate

Hint 11

Front 12

FGFr2 gene

Sro, features

Back 12

Apert's Sro

Dysmorphic Face & Syndactyly

Hint 12

Front 13

Sro, Gene, Features

Back 13

Apert's Sro
FGFr2

dysmorphic face & syndactyly

Front 14

Back 14

Champagne Glass Pelvis of Achondroplasia

FGFR3 gene

Hint 14

Front 15

cleidocranial dysplasia

Back 15

RUNX2/CBFA1 gene

failure of formation of midline structures and absent clavicles

Hint 15

Front 16

RUNX2/CBFA1 gene mutation

Back 16

cleidocranial dysmorphism

failure to develop of clavicles & midline strx

Hint 16

Front 17

Back 17

cleidocranial dysmorphism

RUNX2/CBFA1 gene mutation

failure to develop of clavicles & midline strx

Front 18

Hill-Sachs Lesion

Back 18

cortical depression in posterolateral humeral head 2/2 anterior dislocxn vs glenoid rim

Front 19

cortical depression in posterolateral humeral head 2/2 anterior dislocxn vs glenoid rim

Back 19

Hill-Sachs Lesion

Front 20

Treatment for Open Wounds

Back 20

Gustillo Grade 1 & 2: 1G Cephalosporin (Ancef/Cefazolin)
Gustillo Grade 3: 1G Ceph + Aminoglycoside
Farm Injuries or possible bowel involvment: add PCN vs Clostridia
Continue for 24 hours following debridement

Front 21

Tetanus prophylaxis in open fractures:

Back 21

Wound: Clean & Minor
>=3 doses of tetanus in past:
give Tetanus vaccine if last dose >10 years, else not, no IVIG
<3 or ? = Give vaccine
All other wounds
>=3 doses in past: give tetanus vaccine if last dose >5 ya, no IVIG
<3 or ? = Give vaccine + IVIG

Toxoid Doses?

Hint 21

Toxoid 0.5mL regardless of age
IG:
<5 yo receives 75U
5-10 = 125 U
>10 = 250U

recap:

so IVIG only if <3 or ? status with non-minor or non-clean wound
Tetanus vaccine if <3 or unknown or >=3 and >5 ya or if minor clean wound >10 ya

Front 22

Tx: clavicular non-union

Back 22

aSx: observation for neurovascular sx
Sx: ORIF. no K wires since distraction & migration common
Boyer JBJS 97: lag screw + autograft
Bradbury Acta Orthop Scand 96: plate fix + graft

Front 23

Conversion of Hip Arthrodesis to THA

Indications, Age Limit, Outcome Predictors & Complixns

Back 23

Good for relieving knee & back pain
no time limit
most important predictor of ambulatory outcome: glut med status
perform an EMG on
Complications: Nerve Palsey, HO, Need for revision
Joshi JBJS 2002

Front 24

What velocity constitutes low velocity vs high velocity gunshots:

Back 24

Low: 1k feet/sec (civilian)
High: 2k f/s (military/hunting)

Front 25

Tx: low velocity gunshot wound, neurovascularly intact s fx

Back 25

Treat it like a normal open ound: tetanus prophylaxis, local I&D, 2-3 days of oral abx

Front 26

Indications for distal radius corrective osteotomy c bone graft & internal fixation

Back 26

symptomatic >25-30 degrees of angulated malunion in active pts s degenerative changes
--or--
who wish to have deformity corrected
Fernandez JBJS 82

Front 27

MCC: adult acquired flatfoot deformity

Back 27

posterior tibial tendon insufficiency (PTTI)

Front 28

Single heel rise test

Back 28

normally there is inversion of foot on plantarflexion (seen in creases of heel)
no inversion = posterior tibial tendon dysfunction

Front 29

Insertions of Posterior Tibial Tendon

Back 29

anterior limb: navicular & 1st cuneiform
middle limb: inferiorly to 2nd & third cuneiforms, cuboid & metatarsals 2-5
posterior limb: sustinaculum tali anteriorly

Front 30

Watershed area of posterior tibia

Back 30

between navicular and medeal malleolus

Front 31

PTT fnx in gait

Back 31

allows locking of transverse tarsal joints, creates a rigid lever arm for toe off

Front 32

PTTI classification

Back 32

I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 33

Posterior Tibial Tendon Insufficiency:
Arch Loss is indicative of grade...

Back 33

II+

Hint 33

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 34

Posterior Tibial Tendon Insufficiency:
Flatfoot Deformity is indicative of grade...

Back 34

II+

Hint 34

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 35

Posterior Tibial Tendon Insufficiency:
Forefoot Abduction is indicative of grade...

Back 35

IIB+

Hint 35

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 36

Posterior Tibial Tendon Insufficiency:
Rigit Hindfoot Valgus is indicative of grade...

Back 36

III+

Hint 36

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 37

Posterior Tibial Tendon Insufficiency:
Talar Tilt in Ankle Mortise is indicative of grade...

Back 37

Deltoid Ligament Compromise: IV+

Hint 37

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 38

Posterior Tibial Tendon Insufficiency:
Severe Sinus Tarsi Pain is indicative of grade...

Back 38

III+

Hint 38

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 39

Posterior Tibial Tendon Insufficiency:
Subtalar Arthritis is indicative of grade...

Back 39

III+

Hint 39

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 40

Posterior Tibial Tendon Insufficiency:
Arch Loss is indicative of grade...

Back 40

II+

Hint 40

PTTI classification
I: Tenosynovitis (Normal Anatomy, Radiographs, Physical Exm)
II: Flatfoot Deformity, Flexible Hindfoot (Arch Loss, Loss of Single-Leg Toe Raise, +/- Mild Sinus Tarsi Pain)
IIA: Normal Forefoot
IIB: Forefoot abduction ("too many toes," >40% talonavicular uncoverage)
III:Rigid Hindfoot Valgus (Severe Sinus Tarsi Pain, Subtalar Arthritis)
IV:Deltoid Lig Compromise (Ankle Pain, Talar Tilt in Ankle Mortise)

Front 41

Pes Planus may be 2/2 to what

Back 41

1. Posterior Tibial Tendon Insufficiency
2. Midfoot Pathology - OA, chronic Lisfranc injury
3. Incompetance of Spring Ligament (talonavicular stabalizer)

Front 42

Tx: Stage I Posterior Tibial Tendon Insufficiency

Back 42

Stage I is PTT tenosynovitis with no structural/functional changes
Treat with immobilization in walking/casting boot for 3-4 mos followed by custom molded in-shoe orthoses

Front 43

Open Chain vs Closed Chain Exercise:

Back 43

Open Chain: Foot or Hand is moving (end of a lever is moving)
Closed chain: foot or hand is planted, body is moving

Front 44

Isokinetic Exercise

Back 44

same speed throughout

Front 45

Most predictive factor of outcome in SCIWORA injuries:

Back 45

Severity of initial neurologic injury
complete transexn/major hemorrhage: profoundly poor
minor hemorrhage: 40% will return to mild grade
edema: 75% will return to mild grade

Front 46

Lisfranc ligament

Back 46

medial cuneiform to base of 2nd metatarsal

Front 47

eponychium

Back 47

epi (upon) onychion (little claw)

Front 48

Tx: Subungual Hematoma

Back 48

<50% of nailbed invovled --> perforation & drainage of hematoma
>50% of nailbed involved --> nail bed repair

Front 49

Tx: nail bed laceration

Back 49

tetanus/Abx, most cases req nail removal c D&I + nailbed repair

Front 50

Tx: Nail Avulsion:

Back 50

minimal or no loss of germinal matrix: nail removal, bed repair +/- Fx fix'n
significant matrix loss: add split thickness graft & matrix transfer

Front 51

What is the chemical name of dermabond

Back 51

2-octyl-cyano-acrylate

Front 52

Tx: PIN transection with failed primary repair

Back 52

Transfer of FCR to ED, and Palmaris Longus to EPL
Ropars et al J Hand Surg Br 2006

Front 53

x

Back 53

x

Hint 53

x

Front 54

ossification of the clavicle

Back 54

-clavicle is the last bone to ossify, medial growth plate fuses in early 20's

Front 55

Last bone to ossify

Back 55

-clavicle is the last bone to ossify, medial growth plate fuses in early 20's

Front 56

Os acromiale:

Back 56

unfused secondary ossification center within acromion
[which starts off as 4 separate ossification centers]
3% of population have it, 60% who have it are bilateral
If Sx --> ORIF

Front 57

Glenoid Tilt:

Back 57

4 degrees upward
7 retro to 10 anteroversion
[nb: humeral head is 30 degrees retrotoverted]

Front 58

Average diameter of humeral head:

Back 58

43mm

Front 59

Humeral Head Tilt:

Back 59

30 degrees retroverted
130 degrees from shaft

Front 60

Capsuloligamentous Strx of GH Joint:

Back 60

Coracohumeral Ligament
Superior GH Lig
Middle GH Lig
Inferior GH Lig complex
Posterior Capsule
Biceps Tendon

Front 61

Rotator Interval Boundaries & Contents

Back 61

(Btw Supraspinatus and Subscapularis/coracoid base & transverse humeral ligament):
cocracohumeral Ligament
Superior GHL
Biceps Tendon
Glenohumeral Capsule

Front 62

90 degrees of motion at the shoulder produces what clavicular rotation

Back 62

40 degrees

Front 63

what is the primary restraint of excessive AP translation of the sternoclavicular joint

Back 63

posterior capsule

Front 64

AC Joint (& Coracoid) Ligaments

Back 64

Acoracoclavicular Ligments: Surround Joint Capsule, vs AP translation
Coracoacromial Ligaments: prevents inferior translation of coracoid

Front 65

Coracoclavicular Ligaments:

Back 65

Trapezoid (lateral)
Coronoid (medial)
Prevent Inferior Translation from Clavicle

Front 66

Zanca View:

Back 66

X ray beam directed 10* cephalad at 50% normal penetrance

Front 67

best view of AC joint

Back 67

Zanca View:
X ray beam directed 10* cephalad at 50% normal penetrance

Front 68

Ratio of GH to Scapulothroacic motion (abduction)

Back 68

2:1

Front 69

Layers of the shoulder:

Back 69

Outer: Deltoid, Cephalic Vein, Pect Major
2nd: Conjointed Tendon, Pect Minor, Clavipectoral Fascia
3rd: Subdeltoid Bursa, rotator cuff, GH capsule Tuberosities, LH of Biceps, Synovium, glenoid suprascapular neurovascular bundle
Inner: GH capsule, Glenoid synovium, long head of biceps

Front 70

Changes of Dominant vs Non-Dominant Shoulder

Back 70

Dominant: Anterior Capsule selectively Stretched, Posterior Capsule Tightened
--> "GIRD" Glenohumeral internal Rotation Deficit
Dominant hand more easily externally rotates, does not internally rotate as far

Front 71

Standard Shoulder Athroscopy Portals

Back 71

Posterior: 2 cm distal & medial to posterolateral border of acromion
Anterior: Just Anterior to AC joint
Lateral: 1-2 cm distal to lateral acromial edge

Front 72

What is at risk with anterior shoulder dislocations

Back 72

Axillary nerve because of its relatively fixed location

Front 73

Bankart lesion:

Back 73

anteroinferior labral tear

Front 74

Osseus Bankart lesion

Back 74

glenoid rim fx c fnx labral detachment
ie nondisplaced labral tear with intact medial scapular perisoteum

Front 75

ALPSA:

Back 75

anterior labroligamentous poseriosteal sleeve avulsion
ie medialized bankart lesion: medial anterioinferior labral tear displaced medially by intact medial scapular periosteum

Front 76

reverse bankart lesion:

Back 76

posteroinferior labral tear

Front 77

Glenolabral articular disruption

Back 77

labral tear extending into glenoid cartilage

Front 78

GABL:

Back 78

humeral avulsion of inferior glenohumeral ligament

Front 79

Grading Load Shift of Shoulder

Back 79

0: normal amt of translation
1: to but not over labrum
2: Over labrum but reducible
3: Over labrum & locking

Front 80

TUBS Sro:

Back 80

Traumatic Unilateral dislocations with a Bankart lesion
young pts with 90% recurrence if nonoperatively managed (surgical)
most important risk factor for recurrent instability: age at initial insult

Front 81

AMBRI:

Back 81

Atraumatic Multidriectional Bilateral shoulder dislocation/subluxation which responds to Rehabilitation & sometimes requries Inferior capsular shift or plication
Focus on closed kinetic chain exercises

Front 82

closed kinetic chain exercises:

Back 82

Extremities planted/fixed on a surface with motion against
ie pushups, pullups, squats

Front 83

Tx: Glenoid deficiency greater than 25% of humeral head

Back 83

Latarjet procedure ie coracoid transfer

Front 84

Tx: failed repab for multidirectional instability

Back 84

capsular shift

Front 85

Tx: chronic shoulder dislocation with greater than 40% of articualr surface deficit:

Back 85

allograft for young pts
prosthesis for old pts

Front 86

Bankart procedure

Back 86

reattachment of labrum (&IGHLC) to glenoid
a gold standard procedure

Front 87

staple capsulorrhaphy:

Back 87

capsular reattachment & tightening
complciations; staple migration, articular injury

Front 88

Putti-Platt

Back 88

subscapularis advancement capsular coverage
complx: decreased ER, DJD

Front 89

Magnuson-Stack:

Back 89

Subscapularis transfer to greater tuberosity
Complx: Nonanatomic, Recurrance

Front 90

Bristow/Latarjet

Back 90

Coracoid transfer to Inferior Glenoid
Complx: nonunion, migration, labral tears

Front 91

Bone block osteotomy
(shoulder)

Back 91

Anterior bone block
Complx: nonunion, migration, articular injury

Front 92

(shoulder) Capsular Shift procedure:

Back 92

Inferior capsule shifted superiorly "pants over vest"
Complx: overtightening;
"gold standard"for multidirectional instability

Front 93

Rotator interval closure results

Back 93

decreased external rotation in shoulder adduction and posteroinferiro translation

Front 94

Thermal Capsular Shrinkage for Shoulder Instability

Back 94

No longer recommended
Good short term outcomes, worse long term, and poor ts & chondral damage noted at revision

Front 95

Dx: Fixed pOsteriro shoulder dislocation

Back 95

lack of ER

Front 96

Kim lesion:

Back 96

incomplete & concealed avulsion of posteroinferior labrum
+Jerk, + Kim Tests

Front 97

Epidemiology of Geriatric Rotator Cuff dz:

Back 97

~1/3 over 60yo have full thickness tear
~2/3 over 70yo have full thickness tear
sic: if you have one tear, 50% chance its bilateral
Of those with aSx: 50% Sx w/in 3 yrs, 40% of these progressive

Front 98

Social Factor with Poor Prognosis for Subacromial Decompression

Back 98

Pts with workers comp claims

Front 99

Rate limiting factor for recovery from rotator cuff suergy:

Back 99

biologic healing of rotator cuff tendon to humerus: 8-12 weeks minimum

Front 100

Classify Rotator Cuff Tear size:

Back 100

Small: <1cm
Med: 1-3 cm
Large: 3-5 cm
Massive >5 cm or 2 tendons

Front 101

Tx Timeline: Acute Rotator Cuff Tears

Back 101

Repair Early

Front 102

Tx: PASTA:

Back 102

Partial articular supraspinatus tendon avulsion


debridement vs repair = controversial

Front 103

Reverse Shoulder Prosthesis:

Back 103

popular for rotator cuff arthropathy in elderly pts with low fnx demands
requires competaent deltoid, glood glenoid bone stock
more predictable fnx outcomes, but ?high rates of complxns (~40%)

Front 104

Rotator Cuff Arthropathy:

Back 104

Massive rotator cuff tear (ie >5cm or 2 tendons), combined with fixed superior migration of humeral head, and severe glenohumeral arthrosis (loss of congruence)

Front 105

Subscap tears:

Back 105

comma sign on arthroscopy is avulsed SGHL
Tx: surgical, if chronic --> pect transfer

Front 106

Subcoracoid Impingement:

Back 106

<7mm btw humerus and coracoid is abnormal
best evaluation: cross armed CT
Tx: resexn of lateral coracoid process
(open = reattach conjoined tendon, arthroscopic: never detach it)

Front 107

Shoulder:
Internal impingement:

Back 107

Bennet lesion: mineralization of posterior inferior glenoid
indicative of internal impignement from overhead throwing
associated with GIRD: tight posteroinferior capsule/lax anterior capsule: posterosuperior shift of humeral head & internal impingment
Tx: posterior/posteroinferior capsular stretching exercises ie sleeper stretch, & stretching pect minor
Operative: debride labrum, posterior capsular release

Front 108

Dynamic Labral Shear Test:

Back 108

Elbow Flexed to 90*
Forward Flex Shoulder Up to natural limit
Shift out until UE is in coronal plane
Adduct
Positive if pain or click on posterior joint line btw 120 and 90 degrees
86% sensitive, 100% specific for SLAP tear

Front 109

Biceps Tendon Subluxation

Back 109

Most Common Assoc: Subscap Tear
non-op: strengthening & corticosteroids
op: repair of subscapularis, strx, tenotonomy or tenodesis

Front 110

Types of AC seprations:

Back 110

Type I: sprain
II: AC only
III: AC & Coracoclavicular
IV: posterior displacement of clavicle through trapezius muscle (controverial for surg in older/inactive)
V: superior displacement of clavicle (surgical)
VI: inferior displacement of clavicle below conjoined tendon (surgical)

Front 111

Structural Concerns for Ankle ports

Back 111

Anterolateral portal: danger to dorsal intermediate cutaneous branch of superficial peroneal nerve
anteromeial: greater saphenous vein
anterior central: dorsalis pedis
posteromedial: posterior tibial artery
posterolateral: sural nerve

Front 112

MSTS/Enneking System:

Back 112

Arabic numerals for benign lesions.
1 = latent, 2 = active, 3 = aggressive
I: Low Grade
II: High Grade
III: Metastatic
A: Intracompartmental (within cortex)
B: Extracompartmental (beyond cortex)

Hint 112

AJCC Staging System:
I: Low Grade
II: High Grade
III: skip lesions or deep
IV: mets

For I & II: A if <8cm, B if >8cm
For IV: A if mets to lung, B if mets elsewhere

Front 113

AJCC Staging System:

Back 113

I: Low Grade
II: High Grade
III: skip lesions or deep
IV: mets

For I & II: A if <8cm, B if >8cm
For IV: A if mets to lung, B if mets elsewhere

Hint 113

MSTS/Enneking System

Arabic numerals for benign lesions.
1 = latent, 2 = active, 3 = aggressive
I: Low Grade
II: High Grade
III: Metastatic
A: Intracompartmental (within cortex)
B: Extracompartmental (beyond cortex)