Sports Medicine

Front 1

What do local edema or intra-articular edema suggest in the setting of acute joint injury?

Back 1

Local edema suggests ligamentous or tendinous injury extra-articular, and intra-articular edema suggests hemarthrosis or tendinosis due to a ligament tear intra-articular

Front 2

localized, rapid onset edema in a joint suggests what?

Back 2

extra-articular ligament or tendon injury

Front 3

delayed, global edema of a joint suggests what?

Back 3

intra-articular injury of a ligament or tendon.

Front 4

What is the gold standard for physical exam finding of a MCL tear?

Back 4

Valgus stress applied to the knee at 30deg flexion. Valgus stress applied at full extension tests posterior capsule, cruciates, POL

Front 5

What is the grading system for MCL tears?

Back 5

Grading- I-no opening at fibular head II-some opening but endpoint felt, III- no endpoint

Front 6

How should MCL tears be treated?

Back 6

Low grade MCL tears should be treated conservatively. High grade MCL tears should be evaluated for a concurrent ACL tear (which should be treated surgically, if needed), but the MCL tear should still be treated conservatively

Front 7

What direction does the ACL run? What direction does the PCL run?

Back 7

Antero-medially. Postero-laterally

Front 8

What injuries (contact and noncontact) typically cause ACL tears? Which is more common?

Back 8

Contact injuries involve hyperextension or valgus stress. Noncontact injuries involve deceleration and rotation. Noncotact is more common.

Front 9

What is the typical history of a cruciate injury?

Back 9

Feeling a pop or tear, instability and inability to continue playing. Swelling typically occurs within 12 hours (often delayed somewhat)

Front 10

What is the proper way to test an ACL injury?

Back 10

Laxity in anterior, posterior, varus, valgus and rotation. Specifically, it is the Lachman and pivot shift.

Front 11

What is the proper way to perform a Lachman? What is the grading scheme?

Back 11

Anterior force applied to tibia in 20-30deg flexion. Grade I- <5mm Grade III- >10mm, a or b- firm endpoint or no endpoint, respectively.

Front 12

What is the proper way to perform a pivot shift? What is the grading scheme?

Back 12

Preferably under anesthesia. Beginning with leg abducted and knee in full extension, valgus, axial and internal rotation load is applied and the knee is slowly flexed. The movement is seen as the lateral plateau begins in subluxation and then reduces with further flexion. Grade 0- no pivot shift, Grade I with smooth glide with reduction, Grade II- abrupt reduction and grade III- momentarily lock in subluxation.

Front 13

What is the "unhappy triad" or "football triad"?

Back 13

ACL tear, MCL tear and meniscus tear (lateral slightly more than medial).

Front 14

In the setting up ACL injury, what factors determine healing in meniscus tears?

Back 14

Medial meniscus tears are more likely to non-heal or progress with conservative therapy than lateral meniscus tears.

Front 15

When is ACL reconstruction recommended?

Back 15

In young patients, active in high level sports involving cutting and pivoting, or in patients with a high degree of laxity. Additionally, KT-1000 displacement >5mm than normal (opposing knee), inability to perform one hop test, inability to regain normal gait at 40 days (John Wayne test).

Front 16

What medical conditions are associated with tendinopathies?

Back 16

metabolic (DM, hyperparathyroidism, osteomalacia, gout, uremia) iatrogenic (steroid and flouroquinolone), chronic disease (renal, SLE, RA)

Front 17

What is the proper initial evaluation of patellar tendonopathy?

Back 17

Physical exam for bogginess and pain. Plain radiographs to evaluate for traction osteophytes, tendon calcification or patellar abnormalities.

Front 18

When conservative managment fails, what is the proper way to evaluate patellar tendonopathy?

Back 18

U/S and MRI may be used after 3 months of conservative therapy to evaluate for intertendinous degerneration which may be amenable to operative therapy.

Front 19

What is conservative therapy for patellar tendonopathy?

Back 19

Cessation of inciting activity, NSAIDs, ice and active rest, with immediate initiation of stretching and isometric strengthening.

Front 20

What type of disease are Osgood-Schlatter and Sinding-larsen-Johansson diseases? how do they occur?

Back 20

Osteochodroses. They develop as part of disordered endochondral ossification of a previously normally developing epiphysis (vigorous athletics while the axial and appendicular skeleton is still developing, especially during a growth spurt)

Front 21

What structure is the most important in preventing patellar dislocation?

Back 21

The medial patellofemoral ligament (MPFL). It is almost universally disrupted in lateral patellar dislocation.

Front 22

What other factors might predispose to a patellar dislocation?

Back 22

High patella, increased q-angle, systemic hypermobility

Front 23

What is the clinical history of a patellar dislocation?

Back 23

Two "clunks," first felt with injury (rotation on valgus, flexed knee and planted foot, direct blow) and then with extension of leg.

Front 24

What special physical exam test evaluates patellar dislocation?

Back 24

The patellar dislocation test, where lateral force is applied to the patella with the knee in 20 deg flexion.

Front 25

What other knee injuries are commonly associated with patellar dislocation?

Back 25

chondral and osteochondral injuries of the patella: avulsion of the medial patella due to stretched MPFL or of the medial femoral epicondyle.

Front 26

What operative techniques are available for patellar dislocation?

Back 26

Repair/reconstruct (medial retinaculum), release (lateral retinaculum to acheive balance) and realign

Front 27

What does pain localized to the inguinal crease, radiating laterally suggest?

Back 27

Intra-articular hip pain

Front 28

What does lateral hip pain suggest?

Back 28

Trochanteric bursitis

Front 29

What does pain above the inguinal crease suggest when referring to "hip pain"?

Back 29

Pain from abdominal structures, most likely athletic hernia.

Front 30

What does midline pain suggest, when referring to "hip pain"?

Back 30

Pain from symphyseal structures, e.g. osteitis pubis

Front 31

What nerve roots innervate the hip joint capsule, and which has the greatest contribution? What peripheral nerves are these?

Back 31

L2-S1 innervate the hip joint, predominantly L3. This plexus forms the sciatic, femoral and obturator nerves.

Front 32

What nerve, which innervates the hip joint, may cause referred pain in a distal joint? What is the distal joint?

Back 32

The obturator nerve also innervates the knee, and hip pain may cause referred knee pain.

Front 33

What are the three types of snapping hip syndrome?

Back 33

External, internal and intra-articular.

Front 34

What is the proposed mechanism for external snapping hip syndromes? What physical exam findings support the diagnosis?

Back 34

External SHS is the most common and is due to thickened IT band or glut maximus over the greater trochanter. Tenderness over greater trochanter and positive ober test

Front 35

What is the proposed mechanism for internal snapping hip syndromes? What physical exam findings support the diagnosis?

Back 35

Internal SHS is due to the iliopsoas over the iliopectineal eminence or femoral head. Medial thigh and inguinal crease pain, snap with movement from flexed, abducted and ER hip to extended, adducted and IR hip.

Front 36

What is the proposed mechanism for intra-articular snapping hip syndromes?

Back 36

Intra-articular is due to labral tears, loose bodies or osteochondral defects.

Front 37

What are the 5 phases of muscle strain rehabilitation?

Back 37

I- RICE (48-72hr)
II- regain ROM with passive ROM, heat, ultrasound (3-7d)
III-Increase strength, flexibility, endurance (1-3wk)
IV- Increase strength and coordination (3-4wks)
V- Sports specific training and return to sport

Front 38

What three physical exam tests are used to help diagnose a labral tear?

Back 38

Obrien's, Biceps Load II and Crank Test

Front 39

How is the o'brien's test performed?

Back 39

Shoulder flexed (90), adducted (30) and internally rotated (max), load applied to humerus downward, pain in posterior shoulder and relieved when externally rotated and load applied.

Front 40

How is the crank test performed?

Back 40

Shoulder abducted (160) and elbow flexed (max), axial load applied and shoulder moved (McMurray's for the shoulder).

Front 41

How is the Bicep Load II test performed?

Back 41

Shoulder adducted (120), elbow flexed (90), force applied to forearm to extend elbow.

Front 42

What physical exam tests are used to evaluate the biceps tendon?

Back 42

Palpation of the bicipetal groove, as well as the Speed's and Yergason's tests

Front 43

How is the speed's test performed?

Back 43

Arm flexed (90) and adducted (90, pointing straight forward) with thumbs up, load applied downward on the humerus

Front 44

How is the yergason's test performed?

Back 44

Shoulder adducted to body, elbow flexed. Pain with resisted supination. This test is questionable in its sensitivity.

Front 45

What physical exam tests are used to evaluate rotator cuff injuries?

Back 45

Belly lift (resisted internal rotation), resisted external rotation, the full can test and the drop-arm test.

Front 46

How is the full can test performed?

Back 46

Shoulder abducted (90) and flexed forward to 30 degrees with thumb upwards, load applied downward to humerus.

Front 47

What physical exam tests are used to evaluate an AC joint injury?

Back 47

Palpation, O'brian's, Scarf or cross-arm and compression test

Front 48

How is the compression test performed?

Back 48

The clavicle and scapular spine are compressed.

Front 49

How is the cross-arm test performed?

Back 49

The shoulder is fully adducted to the opposite shoulder with internal rotation, and the AC joint is palpated.

Front 50

What physical exam tests are used to evaluate shoulder instability?

Back 50

Apprehension and relocation test, Sulcus test and shuck test.

Front 51

How is the apprehension and relocation test performed?

Back 51

With the patient supine at the edge of the exam table, the arm is abducted to 90 and the elbow flexed to 90. Load applied to the posterior of the humerus and the arm is externally rotated. The relocation test is the relief of apprehension when load to the humerus is shifted to the anterior of the humerus.

Front 52

How is the sulcus sign test performed?

Back 52

Load applied inferiorly to the humerus, inspect for a sulcus just proximal to the humeral head.

Front 53

How is the shuck test performed?

Back 53

The scapula is grasped by the coracoid and scapular spine, the arm is abducted (90) and "shucked" back and forth.

Front 54

What physical exam tests are used to evaluate an impingement?

Back 54

Neer's and Hawkin's

Front 55

What is the most common direction of hip dislocations? How do these patients present?

Back 55

Posterior. After trauma, with the leg flexed, adducted and interior rotated.

Front 56

What is the proper management of a hip dislocation?

Back 56

Reduction under paralytic sedation with immediate test of ROM and a CT to evaluate for loose bodies. Bed rest immediately, partial weight bearing at 2 days, full weight bearing at 2 weeks, return to activities at 6 weeks. Radiographs every 6 months for 2 years to evaluate for avascular necrosis.

Front 57

How do x-rays, bone scans and MRIs compare in terms of sensitivity and specificity when evaluating stress fractures?

Back 57

X-rays are highly specific but not sensitive, Bone scans are highly sensitive but not specific, and MRIs are both highly sensitive and specific.

Front 58

What is the typical clinical presentation of a femoral neck stress fracture?

Back 58

long distance runner, recruit or ballet dancer with gradual onset of groin pain in the setting of increased training. Nighttime pain is common. Physical exam reveals pain at extremes of motion, particularly internal rotation.