Abos Day #101 A (10/30 & 10/31) Daily Mastery Plan

Front 1

Which is the MC anatomical pattern of the sciatic nerve as it exits the pelvis? 1-As 1 nerve, ant to the piriformis; 2-As 1 nerve, pos to the piriformis; 3-As 2 branches, both ant to piriformis; 4-As 2 branches, 1 ant to piriformis & 1 through the piriformis; 5-As 2 branches, both pos to the piriformis

Back 1

nl anatomy seen in 79% is a single sciatic nerve exiting underneath (passing anterior) to the piriformis, MC variant, seen in 14%, is the sciatic nerve splitting prox to the piriformis w/ 1 branch passing ant to and 1branch passing through the piriformis. FAIR test (flex, add, and IR of hip) can reproduce symptoms.Ans1

Front 2

24yo M is involved in a motorcycle accidt & sustains a R knee inj. PE manuever performed @ 30 deg of knee flex Fig. Which correctly describes the nl anatomic orientation of the region inj in this pt? 1-Popliteus inserts prox to the LCL on the fem; 2-Pos oblique lig ->from the addctr tubercle, just pos and prox to the MCL; 3-Biceps fem inserts pos to the LCL on the fiblr head; 4-Popliteofibular lig inserts lat to the LCL on the fibular head; 5-Deep MCL has both meniscofemoral & meniscotibial lig

Back 2

biceps fem inserts pos to the LCL in Illustrations B & C. long head of the biceps fem 2 main parts. direct arm inserts onto the posterolateral aspect of the fibular head, & ant arm crosses lat to the LCL & inserts on the lat aspect of the fibular head. The short head of the biceps fem has a direct tend insertion onto the sup surface of the fibular head, med pos to the LCL insertion.Ans3

Front 3

Which best describes the anatomic relationships of the LCL in the posterolateral corner? 1-inserts directly ant to popliteofibular lig on fibula & courses deep to popliteus; 2-inserts anterolaterally-> popliteofibular lig on the fibula & courses superfical to popliteus
3-inserts posteromedially to popliteofibular lig on the fibula & courses deep to popliteus; 4-inserts directly pos to popliteofibular lig on the fibula & courses sup-> popliteus; 5-inserts pos & distl to biceps fem tendon on the fibula & courses superficial to popliteus

Back 3

LCL originates on the lateral femoral condyle prox to the insertion of the popliteus, runs superficial to popliteus, and inserts anterolaterally to the popliteofibular lig on the fibula.Ans2

Front 4

Hx;34yo M c/o R knee pain, swelling, and sx of buckling 3 mths p/ being involved in a motorcyle accident. PE: moderate effusion, (+) Lachman, (+)pivot shift, (-) quadriceps active test, and medial sided knee pain w/ a (+) Mcmurray test. Fig A leg ER @ 30 deg of fle, however this deformity corrects with placing the knee @ 90 deg of flex. Fig B shows a standing extremity alignment xray. Figure C shows a sagittal MRI image of the R knee. Appropriate surgical treatment includes EXCEPT:

Back 4

1-(HTO); 2-ACL recon 3- scopic medial partial menisectomy or repair; 4-Posterolateral corner recon;
5-PCL recon:::PCL reconstruction is not indicated in this patient as the physical examination demonstrated a normal quadriceps active test and normal external rotation at 90 degrees of flexion.Ans5

Front 5

While recent studies have failed to demonstrate a significant clinical difference, prox biceps tenodesis compared to tenotomy is felt to possibly result in a lower incidence of which of the following? 1-Arm cramping ; 2-Elbow weak; 3-Elbow stiffness; 4-Shoulder weak; 5-Shoulder stiffness

Back 5

Concern for cosmetic defmty (“popeye” deformity) & mus spasm /cramping has been an argument against performing tenotomy in the past. The long head of the biceps tendon a common source of anterior shoulder pain. Surgical options to tx it include biceps tenodesis by various methods and intraarticular biceps tendon release- tenotomy.Ans1

Front 6

Popliteal Artery Entrapment Syndrome define, how many types? pt c/o? DX

Back 6

A condition characterized by constriction of the popliteal artery by either, adjacent mus, tendons
fibrous tissues, 5 types; Dx-Arteriogram
foot numbness and paresthesias also common
tingling sensation of toes following vigorous exercise, calf cramping following light exercise which improves with vigorous exercise

Front 7

H: 20yo M ftballer c/o knee inj p/ being hit below the knee while blocking. You suspect a (PLC) injury, but are also concerned about a (PCL) tear. Which of (+) PE findings is indicative of a combined PLC & PCL injury? 1-(+) Dial test at 30 deg of flex; 2-Valgus stress test opening @ 0 & 30 deg of flex;3-(+) Pos drawer test; 4-(+) Pivot shift test; 5-(+) Dial test at 30 & 90 deg of flex

Back 7

(PLC) & (PCL) injury is most likely suggested by a positive dial test at 30 & 90 deg of knee flexion.Ans5

Front 8

Which injury patterns is most appropriately managed with an immediate posto PT regimen that includes no active flex but does allow active ext from 90 to 0 deg? 1-Patellar tendon repair; 2- ACL recon 3-ACL recon w/MCL repair; 4-ACL recon w/posterolateral corner repair; 5-PCL recon w/ posterolateral corner repair

Back 8

postop PT = no active flex & active extension from 90 to 0 degrees is most appropriate for a combined PCL and posterolateral corner injury. 1st 4 wks often consist of hinged knee bracing & crutches w/ PWB to allow the posterolateral corner to heal along w/ quadriceps exer (quad sets & SLR). Active knee flex is avoided in the immediate postop period as hamstring contraction has the potential to subluxate the tibia posteriorly and compromise the repair.Ans5