Abos Day #100 B (10/28 & 10/29) Daily Mastery Plan

Front 1

p/open pec maj transfer to addrs chronic subscap insuff, which movements would show weakness if an iatrogenic nerve inj occurred dur'g the pec transfer? 1- Elbow flex; 2-Elbow extnsn; 3-Shoulder ER; 4-Shoulder add; 5-Shoulder abd

Back 1

open pec maj tendon transfer for chronic subscap deficiency, the musculocu Nrv is most at risk, Injury to this nerve would lead to weakness in elbow flex, due to its innervation of the biceps and brachialis muscles.Ans1

Front 2

75yo Hx:retired carpenter x 2 yrs increasg L shoulder pain & intermittent swelling in Fig, R-hand dom, avid bowler, denies constitutional sx; PE=80 deg of active ford flex, 170 deg of pass ROM. Palpation reveals subcutaneous fluid w/no distinct mass; xray in Fig B. What is the next step in managmnt? 1. Bx & ref to ortho oncologist; 2-Rev TSA; 3-Arthrocentesis w/ aspirate submitted-> cell count & diff; 4-Conventional unconstrained TSA; 5-C spine MRI r/o syrinx

Back 2

1-Dx= RC arthropathy, best option listed, a rev TSA, hemiarthroplasty would also be an appropriate tx.
2-Fig= geyser sign =recurrent effusions with the synovial fluid free to commun b/t the glenohumeral jt & subacromial bursa from RC arthropathy. 3-pseudoparalysis = active elevation of <90° (b/c of an unstable glenohum fulcrum NOT pain) w/full passive ROM.Ans-2

Front 3

collegiate swimmer develops med winging of the scapula. If the EMG & nerve conduction studies= abn, the nerve roots to be involved are? 1-C7, C8, T1; 2-C6, C7, C8; 3-C5, C6, C7; 4-C4, C5, C6;5-C3, C4, C5

Back 3

long thoracic nerve which holds the scapula to the chest wall and prevents the inferior angel of the scapula from migrating medially. It is innervated by the long thoracic nerve (C5,6,7).Ans3

Front 4

Hx: 21yo M training to become a professl mixed martial artist c/oweakness w/forwd flex R arm. 4 mths ago, he sustained several blows & kicks R UE, torso, flank during consecutive training sessions. PE: deformity shown Fig A. Which muscles labeled in Fig B is deficient & leading to his sx? 1-A; 2-B; 3-C; 4- D; 5-E

Back 4

dx=med scapular winging, 2^ long thoracic nerve palsy & serratus anterior deficiency, shown w/ the letter D, A - Trapezius; B - Teres maj; C - Latissimus; E - Infraspinatus.Ans4

Front 5

Early rev TSA designs (before the Grammont-style prosthesis) had a high failure rate due to early loosening of the glenoid component. What biomechanical feature accounted for this problem? 1- Glenoid component did not have a neck; 2-Hum component too horizontal; 3-Centr of rotation too lat;
4-Center of rotation too ant; 5-Center of rotation too inf

Back 5

Early reverse ball-and-socket designs failed because their center of rotation remained lateral to the scapula, which limited motion and produced excessive torque on the glenoid component, leading to early loosening.Ans3

Front 6

MRI shoulder in pt w/chronic quadrilateral space synd is most likely to show ? 1-Inc intra-capsular vol; 2-Loss of intra-capsular vol; 3-Fatty atrophy of the infraspinatus; 4-Fatty atrophy of the teres minr; 5. Fatty atrophy of the latissimus dorsi

Back 6

Quadrilateral space syndrome involves dysfunction of the axillary nerve, perhaps by entrapment or compression, resulting in the functional denervation of the teres minor.Ans4

Front 7

Which of the following pts is the optimal candidate for a latissimus dorsi transfer? 1-36yo laborer w/ massive RCT & assoc supraspinatus atrophy; 2-67yo non-laborer w/ RCT arthropathy & pseudoparalysis; 3-34yo laborer w/ massive RCT & thoracodorsal nerve palsy
4-63yo w/ supraspinatus RCT & subacromial imping; 5- 37yo non-laborer w/ extensive chondrolysis following a RC repair & indwelling pain catheter placement for postop pain

Back 7

this procedure is predicated on restoring an active ER (subscap) & flex moment at the glenohumeral joint, as these motions constitute the primary functional deficits for this configuration of massive cuff tear (SS &SubScap) younger adult pt w/an irreparable posterosuperior RTC, lack of advan glenohumeral DJD, has an intact subscapularis func to stabilize the hum head p/ latissimus transfer, & maintains some active forw elevtn, dysfunctional subscapularis is a relative contraindication did poorly.Ans1

Front 8

Which patient has the best indication for latissimus dorsi transfer? 1-55yo M w/ RCT arthropathy & prox hum migration; 2-85yo M w/irreparable posterosuperior RCT & 60 deg of forwd elevtn & 0 deg of active ER @ his side; 3-45yo M w/ complete irreparable suprasp & subscap tears w/ 90 deg of active forwd elevation; 4-50-yo M w/ large irreparable posterosuperior RCT w/ 100 deg of forw elev & -10 deg of ER; 5-35yo w/ an acute traumatic complete posterosuperior RCT w/ 0 deg of active ER

Back 8

this procedure is predicated on restoring an active ER (subscap) & flex moment at the glenohumeral joint, as these motions constitute the primary functional deficits for this configuration of massive cuff tear (SS &SubScap) younger adult pt w/an irreparable posterosuperior RTC, lack of advan glenohumeral DJD, has an intact subscapularis func to stabilize the hum head p/ latissimus transfer, & maintains some active forw elevtn, dysfunctional subscapularis is a relative contraindication did poorly.Ans4

Front 9

What technical error leads to scapular notching after reverse total shoulder arthroplasty? 1-Sup placement of the glenoid component; 2-Retroverted placement of the glenoid component; 3-Inf placement of the glenoid component; 4-Overtensioning of the soft tissue envelope; 5-Inf tilt of the glenoid component

Back 9

Superior placement of the glenoid component during reverse shoulder arthroplasty can lead to scapular notching. This is the most common radiographic complication following the procedure. Illustration A shows this radiographic finding.Ans1

Front 10

Hx:24yo pt c/omplains of vague R shoulder pain. On PE weakness w/ ER. EMG findings are consistent w/ quadrilateral space syndrome. Along with the deltoid, what other muscle is affected? 1-Teres maj;2-Teres minor; 3-Pec maj; 4-Supraspinatus; 5-Subscapularis

Back 10

axillary nerve -> quadrilateral space on its path to innervate the teres minor & deltoid and provide sensation to the lateral arm. syndrome is caused by compression of the pos hum circumflex artery and axillary nerve or one of its major branches in the quadrilateral space. For flex and/or abduction and ER of the humerus aggravate the sx.Ans2