Acta Orthop. 2013 Apr;84(2):178-83. Epub 2013 Feb 15.
Spontaneous Osteonecrosis of the Knee (SONK)
Does Alendronate have any role in treatment of SONK?
A 15-year-old female who is an avid runner has started developing increasing pain along her right leg. She indicates that the pain has developed in the past few months and has progressed in the past few weeks to where she cannot tolerate weightbearing on the limb. She runs approximately 10 miles per day and is set on a collegiate running career. She notes that her menses began at age 11, but she has not had a menstrual cycle for 3 months presently. She denies sexual activity. On examination, she is exquisitely tender over the right tibia at the level of the middle to distal third. Radiographs are seen below in Figure A and Figure B. Which of the following should be included as part of this patient’s management?
Observation with continuation of physical activity
Discontinuation of running with weightbearing in CAM walker
Intramedullary nailing of the tibia
Casting of the affected lower extremity
Discussion of eating habits and training regimens
can we say amenorrhea for only 3 months and she already has a stress reaction which need management not just discussion
In biomechanical testing, which of the following tissues has the highest maximum load to failure?
Quadruple semitendinosus and gracilis tendons
Bone-patellar tendon-bone with a width of 10 mm
Bone-quadriceps tendon with a width on 10mm
Tibialis tendon allograft
Native anterior cruciate ligament (ACL)
On the 2016 OITE it asked which ACL graft type has the most tensile stiffness -- the answer was BTB (not quadrupled hamstring). How is this different from the max load to failure?
I think the medial/lateral labeling on the hamstring tendons is wrong. Else I need to go back to med school and forget about the recertification test! Which is beginning to seem like a great idea!!https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/semitendinosus-and-semimembranosus/
Most surgeons prefer to avoid or limit which of the following exercises in the initial post-operative rehabilitation following ACL reconstruction?
Seated leg extensions
Straight leg raises
Active range of motion
Closed chain exercises
Could someone clarify or specify "Quadriceps sets?" From a gym user's perspective, seems like closed chain leg press and open chain seated leg extensions are both "Quad sets."
At what range of motion do seated leg extension exercises place the greatest amount of stress on the anterior cruciate ligament?
0 to 30 degrees
30 to 60 degrees
60 to 90 degrees
90 to 120 degrees
flexion greater than 120 degrees
Confusing discussion: "a posterior shear force (PCL stress) was generated throughout the entire range with maximal shear occurring from 85° to 105° of flexion. During knee extension, there is an anterior shear force (ACL stress) from 38° to 0° and a posterior shear force from 40° to 101°". Is the posterior shear throughout the entire range or from 101 to 40? Is this the entire range of flexion and extension or just flexion?
Which of the following is the most common anatomical pattern of the sciatic nerve as it exits the pelvis?
As a single nerve, anterior to the piriformis muscle
As a single nerve, posterior to the piriformis muscle
As two branches, both anterior to piriformis muscle
As two branches, one anterior to piriformis and one through the piriformis muscle
As two branches, both posterior to the piriformis muscle
Dr. Syed, the anatomical model shows the specimen from posteriorly. The sciatic nerve is exiting below the muscle, indicating that the nerve is anterior to the piriformis.
r u sure sciatic nerve is anterior to the muscle in the illustration ? plz clarify
piriformis , sciatic nerve anatomical anomaly
piriformis , sciatic nerve anatomical anomalies
Diagnostic arthroscopy of the shoulder in a normal individual
This video the steps of a diagnostic arthroscopy of the shoulder in a patient with normal anatomy.Chad Smalley MDCenter for Sports Medicine and OrthopaedicsChattanooga, TNAbboud JA, Ricchetti ET, Tjoumakaris F, Ramsey ML. Elbow arthroscopy: basic setup and portal placement. J Am Acad Orthop Surg. 2006 May;14(5):312-8. Level of Evidence: 5 - Other. [PMID]16675625[/PMID]
very nice , thanks a lot.
A 35-year-old carpenter has pain in the antecubital fossa that is worse with turning a screwdriver. He has undergone non-operative treatment for 6 months without relief. On physical examination his hook test is normal and there is pain and weakness with resisted supination. Radiographs are shown in Figures A-C. A MRI of the right elbow is shown in Figure D. The next most appropriate treatment is?
Exploration of the radial tunnel
Superficial radial neurectomy
Detachment and repair of the biceps tendon
Transfer of the biceps to the brachialis
EMG with nerve conduction study
Tad dubious to suggest partial tears should be converted to full tears and repair, when this is based upon case series with no control arms. The natural history of partial tears is likely to be fairly benign and surgical repair may not give any benefit beyond placebo.
A 72-year-old man reports progressive pain and restriction of motion in his left shoulder. His active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation. Based on his radiograph shown in Figure A and physical exam, where is glenoid wear most likely to exist?
I guess Im a little confused. The stem states that his shoulder exam motion is restricted to Active and Passive ROM of 90 FF and Neutral ER. Does that mean there is 0 degrees abd, IR, ext, etc. or does that mean there are no limitations in those Ranges. Secondly, in practice who is gonna guess at where the deficit is anyway---get an axillary view and find out. No one ever took a patient to shoulder surg with just one X-ray and a best guess!! Not a great question for a recertification test after 32 years in practice!
A 34-year-old competitive weightlifter presents with increasing pain during bench pressing. His physical exam demonstrates slight weakness in external rotation. Radiographs are unremarkable. His MRI findings are seen in Figure A. Treatment should include which of the following?
Refrain from weightlifting for a minimum of 6 weeks
Physical therapy with rotator cuff strengthening
Suprascapular cyst decompression
Infraspinatus rotator cuff repair and acromioplasty
Spinoglenoid cyst decompression with posterior labral repair
Wow!!! I don't really see a clearly defined labral tear, though certainly bench pressing may lead to one. 34 yo is not really young in competitive sports, though in his mind he might think he is going to be the best ever. Pain is "slight", weakness is "mild" and the last time I checked 6 weeks isn't a lifetime, and I don't know many people paying the bills off their competitive weightlifting winnings. So, if after 6 weeks of rest, rehab and post stretching he's still hurting, then surgery. He will probably have to see a psych from watching his chest shrink 1 1/2 inches during that time, but it will probably make him a better man at 35 anyway!! Just saying
Proximal tibial cyst in a 41M (C2763)
41 / M - A 41 year old male presents with complaints of pain, limited ROM, and instability of his left knee.
The patient states that he was kicked in the knee a few months ago and developed pain in the medial compartment. He had no complaints of pain in his knee before this traumatic episode.
In August, 2016 he underwent left knee arthroscopy - torn meniscus.
In September, 2016 - re-arthroscopy - revealed a medial meniscal flap.
How would you manage this patient?
Multidirectional Shoulder Instability (MDI)
Sorry, that was supposed be for question 7 on MDI on instability QRD: 7319
Medial Scapular Winging Educational Video
Educational video describing the cause of winging of the scapula and treatment methods for this deformity. Medial winging of the scapula is a result of injury or impingement of the long thoracic nerve.
The x-ray looked like he had already had an anterior inferior bony procedure performed. To me it even looked like he had something removed from the tip of the coracoid. I supposethat is the Bennett lesion, but with the changes on the coracoi, why couldn't it be a worn out transfered bone block? All the history said was that he had a previous procedure that failed. The clunk could be from his shoulder dislocating in the mid range, while the bone block is inferior.
Int Orthop. 2016 Mar;40(3):519-24. Epub 2015 Jul 2.
A 22-year-old collegiate football player has immediate onset of left shoulder pain after a tackle. He reports a history of multiple subluxations in the past, but this is the first time he had to "pop" his shoulder back into place. On examination 3 days later, he has weakness in the deltoid. CT axial image is displayed in Figure A. Which of the following is the MOST appropriate next step in management.
Humeral avulsion of the glenohumeral ligament (HAGL lesion) stabilization and EMG/NCV studies
Immobilization in sling with external rotation and EMG/NCV studies
Anterior labral periosteal sleeve avulsion (ALPSA) stabilization
Bony Bankart lesion stabilization
Transfer of the infraspinatus tendon and greater tuberosity to the humeral head
Dr. Johnston - you are correct. There are significant rates of axillary nerve injuries with shoulder dislocations, but these are generally non-symptomatic and aren't diagnosed, except in EMG related studies. The differences in percentages are in the clinical and EMG findings, as you mention. There are varying rates quoted in the literature, depending on the studies performed in each analysis. Here's two examples below, in fact.Prevalence of associated injuries after anterior shoulder dislocation: a prospective study.Atef A, El-Tantawy A, Gad H, Hefeda MInt Orthop. 2016 Mar. doi: 10.1007/s00264-015-2862-z. pii: 10.1007/s00264-015-2862-z. 40. (3). :519-24PMID: 26133290 (Link to Abstract)Injuries associated with traumatic anterior glenohumeral dislocations.Robinson CM, Shur N, Sharpe T, Ray A, Murray IRJ Bone Joint Surg Am. 2012 Jan 4. doi: 10.2106/JBJS.J.01795. 94. (1). :18-26PMID: 22218378 (Link to Abstract)