Introduction TUBS (Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery) Epidemiology incidence one of most common shoulder injuries 1.7% annual rate in general population demographics have a high recurrence rate that correlates with age at dislocation up to 80-90% in teenagers (90% chance for recurrence in age <20) Pathophysiology mechanism anteriorly directed force on the arm when the shoulder is abducted and externally rotated "on-track" versus "off-track" concept (instability as a bipolar concept) Hill-Sach's defect is "off-track" and will "engage" on the glenoid if size HS defect > glenoid articular track conversely, Hill-Sach's defect is "on track" and will NOT "engage" if HS defect < glenoid articular track GT=0.83D-d (GT = Glenoid Track, D = diameter of inferior glenoid, d = width of anterior glenoid bone loss) may have implications regarding surgical management Associated injuries labral & cartilage injuries Bankart lesion is an avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid. is present in 80-90% of patients with TUBS Humeral avulsion of the glenohumeral ligament (HAGL) occurs in patients slightly older than those with Bankart lesions associated with a higher recurrence rate if not recognized and repaired an indication for possible open surgical repair Glenoid labral articular defect (GLAD) is a sheared off portion of articular cartilage along with the labrum Anterior labral periosteal sleeve avulsion (ALPSA) can cause torn labrum to heal medially along the medial glenoid neck associated with higher failure rates following arthroscopic repair fractures & bone defects Bony Bankart lesion is a fracture of the anterior inferior glenoid present in up to 49% of patients with recurrent dislocations higher risk of failure of arthroscopic treatment if not addressed defect >20-25% is considered "critical bone loss" and is biomechanically highly unstable stability cannot be restored with soft tissue stabilization alone (unacceptable >2/3 failure rate) require bony procedure to restore bone loss (Latarjet-Bristow, other sources of autograft or allograft) recent studies suggest critical bone loss may be as low as 13.5% Hill Sachs defect is a chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim. is present in 80% of traumatic dislocations and 25% of traumatic subluxations is not clinically significant unless it engages the glenoid Greater tuberosity fracture is associated with anterior dislocation in patients > 50 years of age Lesser tuberosity fracture is associated with posterior dislocations nerve injuries Axillary nerve injury is most often a transient neurapraxia of the axillary nerve present in up to 5% of patients rotator cuff tears 30% of TUBS patients > 40 years of age 80% of TUBS patients > 60 years of age Anatomy Glenohumeral anatomy Static (bony anatomy, capsule, labrum, glenoid) and dynamic (rotator cuff, long head of biceps tendon) constraints labrum contributes 50% of additional glenoid depth Anterior static shoulder stability is provided by Anterior band of IGHL (main restraint) provides static restraint with arm in 90° of abduction and external rotation MGHL provides static restraint with arm in 45° of abduction and external rotation SGHL provides static restraint with arm at the side Classification Anteroposterior Translation Grading Scheme Grade 0 • Normal glenohumeral translation Grade 1+ • Humeral head translation up to glenoid rim Grade 2+ • Humeral head translation over glenoid rim with spontaneous reduction once force withdrawn Grade 3+ • Humeral head translation over glenoid rim with locking Sulcus Test Grading Scheme Grade 1 • Acromiohumeral interval <1cm Grade 2 • Acromiohumeral interval 1-2cm Grade 3 • Acromiohumeral interval >2cm Instability Severity Score Variable Parameter SCORE AGE < 20 years 2 > 20 years 0 DEGREE OF SPORTS PARTICIPATION Competitive 2 Recreational/none 0 TYPE OF SPORT PARTICIPATION Contact/forced overhead 1 Other 0 SHOULDER HYPERLAXITY Hyperlaxity (anterior/inferior) 1 Normal 0 HILL SACHS ON AP XRAY Visible on external rotation 2 Not visible on external rotation 0 GLENOID CONTOUR LOSS ON AP XRAY Loss of contour 2 No lesion 0 Clinical Implications Total Possible = 10 An acceptable recurrence risk of 10% with arthroscopic stabilization. < 6 points A score of > 6 points has an unacceptable recurrence risk of 70% and should be advised to undergo open surgery (i.e. Laterjet procedure). > 6 points Presentation Symptoms traumatic event causing dislocation feeling of instability shoulder pain complaints caused by subluxation and excessive translation of the humeral head on the glenoid Physical exam load and shift Grade I - increased translation, no subluxation Grade II - subluxation of humeral head to, but not over, glenoid rim Grade III - dislocation of humeral head over glenoid rim apprehension sign patient supine with arm in 90/90 position positive sign in mid-ranges of abduction is highly suggestive of concomitant glenoid bone loss relocation sign decrease in apprehension with anterior force applied on shoulder sulcus sign tested with patient's arm at side generalized ligamentous laxity assess via Beighton's criteria shoulder specific laxity defined as hyperexternal rotation at side > 85 degress hyperabduction > 120 degrees (Gagey's maneuver) OR > 2+ load shift in 2 or more planes (anterior, posterior, inferior) Imaging Radiographs see imaging of shoulder a complete trauma series needed for evaluation true AP scapular Y axillary other helpful views West Point view shows glenoid bone loss Stryker view shows Hill-Sachs lesion CT scan helpful for evaluation of bony injuries MRI best for visualization of labral tear addition of intraarticular contrast increases sensitivity and specificity Treatment Nonoperative acute reduction, ± immobilization, followed by therapy indications management of first-time dislocators remains controversial risk factors for re-dislocation are age < 20 (highest risk) male contact sports hyperlaxity glenoid bone loss >20-25% reduction simple traction-countertraction is most commonly used relaxation of patient with sedation or intraarticular lidocaine is essential immobilization studies have not shown any benefit of immobilization > 1 week for decreasing recurrence rates some studies show immobilization in external rotation decreases recurrence rates in patients < 40 thought to reduce the anterior labrum to the glenoid leading to more anatomic healing subsequent studies have refuted this finding and the initially published results have not been reproducible physical therapy strengthening of dynamic stabilizers (rotator cuff and periscapular musculature) Operative Arthroscopic Bankart repair +/- capsular shift indications relative indications first-time traumatic shoulder dislocation with Bankart lesion confirmed by MRI in athlete younger than 25 years of age high demand athletes recurrent dislocation/subluxation (> one dislocation) following nonoperative management < 20-20% glenoid bone loss remplissage augmentation with arthroscopic Bankart may be considered if Hills-Sachs "off-track" outcomes results now equally efficacious as open repair with the advantage of less pain and greater motion preservation Open Bankart repair +/- capsular shift indications Bankart lesion with glenoid bone loss < 20-25% revision stabilization following failed arthroscopic Bankart repair without glenoid bone loss >20% humeral avulsion of the glenohumeral ligament (HAGL) can also be performed arthroscopically but is technically challenging Latarjet (coracoid transfer) and Bristow Procedures for glenoid bone loss indications chronic bony deficiencies with >20-25% glenoid deficiency (inverted pear deformity to glenoid) transfer of coracoid bone with attached conjoined tendon and CA ligament Latarjet procedure performed more commonly than Bristow Latarjet triple effect = bony (increases glenoid track), sling (conjoined tendon on top of subscapularis), capsule reconstruction (CA ligament) Autograft (tricortical iliac crest) or allograft (iliac crest or distal tibia) for glenoid bone loss indications bony deficiencies with >20-25% glenoid deficiency (inverted pear deformity to glenoid) revision of failed latarjet Remplissage technique for Hill Sachs defects indication engaging large (>25-40%) Hill-Sachs defect "off-track" Hill-Sachs lesions with <20-25% glenoid bone loss technique posterior capsule and infraspinatus tendon sutured into the Hill-Sachs lesion may be performed with concomitant Bankart repair Bone graft reconstruction for Hill Sachs defects indication engaging large (>40%) Hill-Sachs lesions technique allograft reconstruction arthroplasty rotational osteotomy Historical procedures: Putti-Platt / Magnuson-Stack / Boyd-Sisk all procedures some variation of tightening subscapularis (advancment, plication, etc) led to over-constraint and arthrosis typical presentation of open procedure performed in 1970s-80s, now with presenting complaint of pain and stiffness from glenohumeral OA, especially lack of ER, and signigicant posterior glenoid wear and retroversion Techniques Arthroscopic Bankart repair +/- capsular plication approach shoulder arthroscopic approach technique drive through sign might be present prior to labral repair and capsulorraphy studies support use of ≥ 3 anchors (< 3 anchors is a risk factor for failure) complications recurrence, most often due to unrecognized glenoid bone loss or lack of concomitantly addressing "off-track" HS lesion stiffness, especially in external rotation, further loss of ER may occur with the addition of remplissage axillary nerve injury chondrolysis (from use of thermal capsulorraphy which is no longer used) Open Bankart repair +/- capsular shift approach shoulder anterior (deltopectoral) approach technique subscapularis transverse split or tenotomy open labral repair and capsulorraphy complications recurrence, most often due to unrecognized glenoid bone loss stiffness, especially in external rotation subscapularis injury or failed repair (if tenotomy performed for approach) axillary nerve injury Open Capsular shift approach shoulder anterior (deltopectoral) approach technique inferior capsule is shifted superiorly complications subscapularis injury or failed repair post-operative physical exam will show a positive lift off and excessive ER overtightening of capsule leads to loss of external rotation treat with Z lengthening of subscapularis axillary nerve injury iatrogenic injury with surgery (avoid by abduction and ER of arm during procedure) late arthritis usually wear of posterior glenoid may have internal rotation contracture seen with Putti-Platt and Magnuson-Stack procedures Latarjet and Bristow Procedure approach shoulder anterior (deltopectoral) approach can be performed arthroscopically technique coracoid transfer to anterior inferior glenoid bone defect traditional or congruent arc technique for coracoid graft placement after harvest, coracoid is passed through a split in the distal 1/3 or middle 1/2 subscapularis complications generally higher than arthroscopic or open Bankart, some studies report up to 25% incidence nonunion graft lysis hardware problems stiffness, particularly in external rotation glenohumeral osteoarthritis will rapidly occur with lateral overhang of graft into the joint space nerve injury majority are traction or contusion neuropraxias and resolve spontaneously treat with observation for 3-6 weeks; delayed EMG if deficits persist musculocutaneous nerve is most common occurs during instrumentation around the conjoint tendon axillary nerve also at risk occurs during graft fixation Putti-Platt & Magnuson-Stack (historic) approach shoulder anterior (deltopectoral) approach technique Putti-Platt is performed by lateral advancement of subscapularis and medial advancement of the shoulder capsule Magnuson-Stack is performed with lateral advancement of subscapularis (lateral to bicipital groove and at times to greater tuberosity) complications both lead to decreased external rotation and loading on posterior glenoid which leads to degenerative joint disease (capsulorrhaphy arthropathy) Boyd-Sisk (historic) technique transfer of biceps laterally and posteriorly complications high rate of recurrence Complications Recurrence often due to unrecognized glenoid bone loss treated with a soft tissue only procedure (especially with glenoid bone loss >20-25%) can be due to poor surgical technique (ie, < 3 suture anchors) increased risk with preoperative risk factors including age < 20, male sex, contact/collision sport, ligamentous laxity, and unrecognized glenoid and/or humeral head bone loss (critical bone loss or "off-track" lesion) medical management should be exhausted prior to surgery in patients with seizures, as there is a high recurrence risk even when bony augmentation techniques are used Shoulder pain Nerve injury musculocutaneous (most common) axillary Stiffness especially in external rotation (particularly with Latarjet and additional remplissage) Infection Graft lysis (Latarjet) Hardware complications anchor pull-out (Bankart repair) screw pull-out (Latarjet) Chondrolysis historically due to use of thermal capsulorraphy (now contraindicated) or intra-articular pain pumps (now contraindicated)
Technique Guide CPT Codes: 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Bankart Repair with capsular plication- Arthroscopic Orthobullets Team Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Technique Guide CPT Codes: 23462 Capsulorrhaphy, anterior, any type; with coracoid process transfer Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Latarjet Procedure for Glenoid Deficit - Open Brian R. Waterman Rachel Frank Anthony Romeo Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Technique Guide CPT Codes: 29806, Arthroscopy, shoulder, surgical; capsulorrhaphy 29999 Unlisted procedure, arthroscopy Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Bankart Repair with Remplissage Procedure - Arthroscopic Eric Hohn Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Technique Guide CPT Codes: 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Bankart Repair - Arthroscopic - Dr. Stephen Snyder Eric Hohn Stephen Snyder Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS)
QUESTIONS 1 of 48 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ14.178) Figure A is a glenoid CT 3D reconstruction of a 26-year-old accountant who has recurrent shoulder instability. His first dislocation occurred after a fall while skiing. He has now sustained his third dislocation, which was reduced in the emergency department prior to being sent to your office. What is the most appropriate definitive treatment? Review Topic | Tested Concept QID: 5588 FIGURES: A Type & Select Correct Answer 1 Immobilization in external rotation for 6 weeks 1% (35/3910) 2 Arthroscopic bony Bankart repair 69% (2679/3910) 3 Arthroscopic Remplissage procedure 4% (137/3910) 4 Glenoid augmentation using coracoid transfer 22% (864/3910) 5 Glenoid augmentation using tricortical iliac crest graft 2% (61/3910) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ13.118) A 30-year-old man undergoes arthroscopic Bankart repair for recurrent anterior dislocation. He continues to experience instability postoperatively. Examination reveals a positive apprehension test. Radiographs of both shoulders are seen in Figure A. CT scan of his left shoulder is seen in Figure B. What is the best treatment option? Review Topic | Tested Concept QID: 4753 FIGURES: A B Type & Select Correct Answer 1 Bankart repair 13% (461/3649) 2 Humeral head bone augmentation 2% (56/3649) 3 Remplissage 6% (215/3649) 4 Coracoid autograft 73% (2676/3649) 5 Connolly procedure 3% (108/3649) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ12.9) A 38-year-old former professional football player complains of longstanding left shoulder pain. He admits to multiple previous shoulder dislocations in the past which were treated conservatively with physical therapy. He now complains of symptoms of repetitive instability and a "catching" feeling whenever he abducts and externally rotates his arm. On physical exam he has a positive apprehension test and crepitus in the 90/90 position. A current MRI image of his shoulder is seen in Figure A. Which of the following surgical treatments is most appropriate to address his symptoms? Review Topic | Tested Concept QID: 4369 FIGURES: A Type & Select Correct Answer 1 Superior labrum anterior to posterior (SLAP) repair 5% (292/6382) 2 Open approach for bone grafting of humeral defect with allograft 5% (329/6382) 3 Open repair of humeral avulsion of glenohumeral ligament (HAGL) lesion 4% (286/6382) 4 Remplissage procedure 3% (200/6382) 5 Arthroscopic Bankart repair and Remplissage procedure 82% (5203/6382) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.19) 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. Review Topic | Tested Concept QID: 3442 FIGURES: A Type & Select Correct Answer 1 Humeral avulsion of the glenohumeral ligament (HAGL lesion) stabilization and EMG/NCV studies 2% (66/3709) 2 Immobilization in sling with external rotation and EMG/NCV studies 8% (297/3709) 3 Anterior labral periosteal sleeve avulsion (ALPSA) stabilization 4% (157/3709) 4 Bony Bankart lesion stabilization 85% (3148/3709) 5 Transfer of the infraspinatus tendon and greater tuberosity to the humeral head 0% (11/3709) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.220) A 24-year-old male gymnast is scheduled for arthroscopic repair of the right shoulder. His preoperative MRI is seen in Figure A and the initial arthroscopic examination as viewed from an anterior portal in the lateral decubitus position is demonstrated in Figure B. Based on these images, which of the following diagnoses is correct? Review Topic | Tested Concept QID: 3643 FIGURES: A B Type & Select Correct Answer 1 Partial articular sided thickness rotator cuff tear (PASTA) 4% (169/4498) 2 Anterior labral periosteal sleeve avulsion (ALPSA) 5% (230/4498) 3 Humeral avulsion of the glenohumeral ligament (HAGL) 83% (3743/4498) 4 Glenoid labral articular defect (GLAD) 2% (108/4498) 5 Superior labral anterior posterior lesion (SLAP) 4% (186/4498) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.264) Open anterior shoulder stabilization procedures have failed twice for an active 22-year-old patient. Most recently he had another episode of instability when reaching into the back seat while driving. He has weakness performing the physical exam maneuver shown in Figure A. Images from his MRI are shown in Figures B and C. What is the most appropriate next surgical treatment? Review Topic | Tested Concept QID: 3315 FIGURES: A B C Type & Select Correct Answer 1 Another course of physical therapy 1% (26/2992) 2 Latarjet procedure 16% (492/2992) 3 Lesser tuberosity transfer 7% (196/2992) 4 Pectoralis major transfer 65% (1931/2992) 5 Latissimus dorsi transfer 11% (319/2992) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.77) A 23-year-old man acutely dislocates his shoulder for the first time while kayaking. His shoulder MRI is shown in Figures A and B. He undergoes arthroscopic Bankart repair and re-dislocates his shoulder within 1 month after surgery. What other pathology, besides the Bankart lesion, is likely contributing to this patient's recurrent instability? Review Topic | Tested Concept QID: 3165 FIGURES: A B Type & Select Correct Answer 1 Superior labrum anterior posterior (SLAP) tear 4% (70/1836) 2 Supraspinatus partial articular sided tendon avulsion (PASTA) 2% (42/1836) 3 Humeral avulsion of the glenohumeral ligament (HAGL) 82% (1498/1836) 4 Engaging (>25%) Hill Sachs defect 7% (133/1836) 5 Anterior labral periosteal sleeve avulsion (ALPSA) 4% (78/1836) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.63) A 25-year-old basketball player sustains an anterior shoulder dislocation during a game that is subsequently reduced with traction. A MRI will most likely show which of the following? Review Topic | Tested Concept QID: 3151 Type & Select Correct Answer 1 Supraspinatus tear 1% (39/4303) 2 Humeral avulsion of the glenohumeral ligaments 6% (251/4303) 3 Long head of the biceps tear 0% (9/4303) 4 Superior labrum anterior to posterior tear 7% (304/4303) 5 Anteroinferior labral tear 85% (3672/4303) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ09.133) Which patient would be ideal for an open shoulder reduction and glenoid bone augmentation? Review Topic | Tested Concept QID: 2946 Type & Select Correct Answer 1 25-year-old with first time acute traumatic dislocation 1% (10/1740) 2 78-year-old with a rotator cuff tear arthropathy with superior escape 0% (4/1740) 3 24-year-old with chronic dislocation and large engaging Hill-Sachs lesion 9% (158/1740) 4 30-year-old with an acute bony Bankart fracture-dislocation 9% (163/1740) 5 27-year-old with a chronic anterior dislocation and inverted pear-shaped glenoid 80% (1396/1740) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ09.136) The pathology seen in Figure A is most likely to result from trauma that occurred with the shoulder in which of the following positions? Review Topic | Tested Concept QID: 2949 FIGURES: A Type & Select Correct Answer 1 Adduction, internal rotation 4% (85/2318) 2 Adduction, external rotation 9% (211/2318) 3 Abduction, external rotation 85% (1978/2318) 4 Extension, internal rotation 1% (29/2318) 5 Axial traction in adduction 0% (6/2318) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ09.143) An 18-year-old football player sustains an anterior shoulder dislocation that is reduced on the field. When he presents to the office complaining of posterior pain, you suspect a Hill-Sachs defect. Which of the following is the best radiographic view for identifying a Hill-Sachs defect? Review Topic | Tested Concept QID: 2956 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 3% (75/2536) 2 Figure B 2% (44/2536) 3 Figure C 64% (1635/2536) 4 Figure D 2% (55/2536) 5 Figure E 28% (711/2536) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE08OS.8) What is the most common neurologic problem associated with a simple shoulder dislocation? Review Topic | Tested Concept QID: 6370 Type & Select Correct Answer 1 A neurapraxic brachial plexus injury 1% (2/229) 2 A neurapraxic axillary nerve injury 91% (209/229) 3 A neurapraxic musculocutaneous nerve injury 3% (8/229) 4 A neurotmetic axillary nerve injury 2% (4/229) 5 An axonotmetic musculocutaneous nerve injury 1% (3/229) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ08.45) A patient sustains the injury seen on the radiograph in Figure A. Which nerve is most likely to be injured? Review Topic | Tested Concept QID: 431 FIGURES: A Type & Select Correct Answer 1 Suprascapular 8% (99/1256) 2 Upper or lower subscapular 4% (46/1256) 3 Musculocutaneous 2% (26/1256) 4 Radial 0% (5/1256) 5 Axillary 86% (1078/1256) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.80) An athlete has recurrent anterior shoulder instability despite non-operative treatment including PT and bracing. He is noted to have anterior glenoid bone loss and a coracoid transfer (Latarjet) procedure is recommended. This is believed to improve stability through which of the following mechanism(s)? Review Topic | Tested Concept QID: 741 Type & Select Correct Answer 1 Increasing the glenoid bony support and excursion distance prior to dislocation. 7% (88/1305) 2 The conjoined tendon passing through the subscapularis becomes a supportive sling. 2% (20/1305) 3 Answers 1, 2 and 5 are correct. 58% (760/1305) 4 Both 1 and 2 are correct. 30% (386/1305) 5 The remnant of the CA ligament can be used to aid in repair of the capsular tissues. 3% (40/1305) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.259) What factor has highest risk for recurrent instability following a traumatic anterior shoulder dislocation? Review Topic | Tested Concept QID: 920 Type & Select Correct Answer 1 History of contralateral shoulder dislocation 7% (47/629) 2 Young age (<25-years-old) at time of dislocation 86% (544/629) 3 Dislocation of the dominant shoulder 3% (16/629) 4 Family history of shoulder instability 1% (5/629) 5 History of patella instability 2% (12/629) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.216) A 17-year-old football player sustained an injury to his shoulder. The MRI images are seen in Figures A and B. What is the most likely finding seen at the time of arthroscopy? Review Topic | Tested Concept QID: 877 FIGURES: A B Type & Select Correct Answer 1 Rotator cuff tear 3% (40/1483) 2 SLAP tear 7% (108/1483) 3 Bankart lesion 83% (1226/1483) 4 Glenoid fracture 1% (21/1483) 5 Humeral avulsion of glenohumeral ligaments (HAGL) 6% (82/1483) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.252) What nerve is the most frequently injured in the condition shown in the radiograph? Review Topic | Tested Concept QID: 913 FIGURES: A Type & Select Correct Answer 1 Axillary 96% (589/613) 2 Median 0% (2/613) 3 Musculocutaneous 1% (9/613) 4 Radial 1% (6/613) 5 Suprascapular 0% (2/613) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.130) A 22-year-old basketball player has recurrent instability of the left shoulder. Magnetic resonance imaging is shown in Figures A and B. Which of the following ligaments is injured? Review Topic | Tested Concept QID: 791 FIGURES: A B Type & Select Correct Answer 1 Inferior glenohumeral 83% (1231/1490) 2 Middle glenohumeral 11% (166/1490) 3 Superior glenohumeral 3% (44/1490) 4 Coracohumeral 3% (43/1490) 5 Coracoacromial 0% (1/1490) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.256) What is the most common finding during surgery for traumatic anterior shoulder instability? Review Topic | Tested Concept QID: 267 Type & Select Correct Answer 1 Anterosuperior labral tear 12% (76/628) 2 Anteroinferior labral tear 74% (465/628) 3 Posterosuperior labral tear 1% (9/628) 4 Posteroinferior labral tear 1% (4/628) 5 Hill Sachs lesion 11% (71/628) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.49) A patient undergoes an MRI arthrogram for recurrent shoulder instability. Based on the imaging, the surgeon feels that arthroscopic treatment is contra-indicated and recommends open treatment. What is the most likely diagnosis? Review Topic | Tested Concept QID: 160 Type & Select Correct Answer 1 Glenolabral articular disruption (GLAD) 14% (83/604) 2 Humeral avulsion of the glenohumeral ligament (HAGL) 61% (369/604) 3 Superior labrum tear from anterior and posterior (SLAP) 3% (18/604) 4 Anterior labro-ligamentous periosteal sleeve avulsion (ALPSA) 18% (107/604) 5 Partial articular-sided supraspinatus tendon avulsion (PASTA) 4% (22/604) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.59) A 23-year-old offensive lineman had an arthroscopic anteroinferior labral repair 1 year ago for shoulder instability. He has continued to have recurrent instability. Below is the preoperative MRI from 1 year ago. What is the most likely cause of the recurrent instability? Review Topic | Tested Concept QID: 170 FIGURES: A Type & Select Correct Answer 1 Anteroinferior labral nonunion 3% (17/534) 2 Unrecognized humeral avulsion of the glenohumeral ligament (HAGL) 7% (39/534) 3 Anteroinferior glenoid bone defect 84% (446/534) 4 Engaging Hill Sachs defect 5% (26/534) 5 Untreated SLAP lesion 1% (4/534) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.128) A 19-year-old right hand dominant male high school wide receiver complains of recurrent right shoulder subluxation. Clinical examination is remarkable for a postive apprehension sign and a positive sulcus sign. A T2 coronal MRI is shown below in Figure A. What is the diagnosis? Review Topic | Tested Concept QID: 314 FIGURES: A Type & Select Correct Answer 1 Bankart lesion 7% (65/989) 2 SLAP tear 6% (62/989) 3 Rotator cuff tear 2% (17/989) 4 ALPSA lesion 5% (46/989) 5 HAGL lesion 80% (795/989) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ05.42) A 21-year-old rugby player has recurrent pain and instability of the right shoulder recalcitrant to conservative management. Figure A is an image taken during diagnostic arthroscopy in the lateral decubitus position viewing from the posterior portal with instrument through a rotator interval anterior portal. In addition to the pathology seen in Figure A, what other associated intra-articular condition is most likely present? Review Topic | Tested Concept QID: 78 FIGURES: A Type & Select Correct Answer 1 Rotator cuff tear 3% (17/648) 2 SLAP tear 22% (141/648) 3 Posterior labral tear 9% (60/648) 4 Hill-Sachs lesion 62% (404/648) 5 Buford complex 3% (18/648) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4
All Videos (76) Podcasts (3) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Anterior Instability: My Experience From Across The Pond - Ofer Levy, MD, MCh (Orth) FRCS (OSET 2018) Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 10/18/2019 322 views Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques My Approach to the Evaluation and Treatment of Shoulder Instability With Bone Loss Today and When I Started: What I Have Learned - Evan L. Flatow, MD (OSET 2018) Evan Flatow Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 10/18/2019 213 views Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Non-Operative Treatment for First Time Shoulder Dislocation: Back on the Field - Kevin E. Wilk, DPT, PT, FAPTA (OSET 2018) Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 10/14/2019 319 views Question Session⎪Traumatic Anterior Shoulder Instability (TUBS) Orthobullets Team Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Listen Now 19:10 min 11/5/2019 21 plays Shoulder & Elbow⎪Traumatic Anterior Shoulder Instability (TUBS) Team Orthobullets 4 Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Listen Now 21:37 min 10/21/2019 71 plays Shoulder & Elbow ⎜ Traumatic Anterior Shoulder Instability (ft. Dr. Anthony Romeo) Team Orthobullets (AF) Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) Listen Now 38:34 min 10/18/2019 24 plays See More See Less
Bony Bankart fracture in nondominant shoulder (C101197) Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 7/2/2019 114 3 2 Chicago Sports Medicine Symposium (2016) Recurrent Shoulder Instability Following Arthroscopic Bankart Repair in 21M (C2642) Anthony Romeo Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 7/29/2016 7333 61 17 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Large Engaging Hill Sachs in Chronic Dislocator in 33F (C2425) Bantoo Sehgal Shoulder & Elbow - Traumatic Anterior Shoulder Instability (TUBS) 11/3/2015 669 11 6 See More See Less