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A 28-year-old professional baseball pitcher sustains a complete rupture of his ulnar collateral ligament. He is neurovascularly intact on exam. Which of the following surgical reconstruction techniques has been shown to result in the lowest complication rate and best patient outcome?
Splitting of flexor-pronator mass, figure-of-8 graft fixation.
Splitting of flexor-pronator mass, docking graft fixation.
Splitting of flexor-pronator mass, docking graft fixation, ulnar nerve transposition.
Detachment of flexor-pronator mass, figure-of-8 graft fixation, ulnar nerve transposition.
Detachment of flexor-pronator mass, docking graft fixation, ulnar nerve transposition.
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A 19-year-old male complained of right elbow pain 4 months ago after pitching in a collegiate baseball game. He underwent a period of rest and forearm strengthening and now has recurrence of pain during a throwing interval program. A MRI is shown in Figure A. What is the next most appropriate step in management?
Open ECRB tendon release and removal of the diseased tendon with repair of the tendon remnant
Arthroscopic debridement of lesion and osteotochondral autograft transplant from ipsilateral knee
Excision of the diseased tendon and reattachment of the origin of the flexor-pronator muscle group to the medial epicondyle
Open reconstruction of the ligament using ipsilateral palmaris longus tendon
Diagnostic elbow arthroscopy, removal of posteromedial olecranon osteophytes and débridement of chondromalacia
A 22-year-old collegiate pitcher sustains a medial collateral ligament (MCL) rupture of his throwing elbow requiring surgical reconstruction. Anatomic restoration of the MCL is desired to maximize function. Which of the following best describes the kinematics of the native MCL?
Anterior bundle becomes tight in flexion and lax in extension
The posterior bundle demonstrates the greatest change in tension from flexion to extension
Posterior bundle becomes lax in flexion and tight in extension
Posterior bundle is isometric
The posterior bundle is isometric, but the anterior is not
A 25-year-old professional baseball pitcher complains of medial elbow pain during the early acceleration phase of throwing. He has lost 10 mph on his fastball. Radiographs of the elbow are provided in Figure A. EMG studies demonstrate no entrapment of the ulnar nerve. Which of the following physical exam maneuvers will most strongly confirm the correct diagnosis?
Evaluating for pain with resisted wrist flexion
Testing for Froment's sign
Evaluating for pain with Hawkins impingement test
Evaluating for pain with moving valgus stress test
Performing the lateral pivot shift test
All of the following protect the elbow from valgus loads during the throwing cycle EXCEPT?
Flexor-pronator muscle contraction
Reduced fastball velocity
Increased glenohumeral internal rotation torque
The greatest stress on the medial ulnar collateral ligament of the elbow occurs during which phase of throwing?
Which of the following is the primary stabilizer to resist valgus stress in mid-flexion of the elbow?
Anterior oblique ligament of the medial ulnar collateral ligament
Posterior oblique ligament of the medial ulnar collateral ligament
Flexor-pronator muscle mass
A professional pitcher reports pain localized to the medial aspect of his throwing elbow. History reveals that he was pitching in a playoff game and heard and felt a pop in his elbow. MRI reveals a complete ulnar-sided avulsion of the medial collateral ligament (MCL). Examination reveals valgus instability and ulnar nerve involvement. What recommendations should be made based on the patient’s desire to return to sport?
Rest, followed by physical therapy
Splinting in 15 degrees of flexion
Arthroscopic debridement, followed by bracing in full extension for 4 weeks
During which phase of the overhead throwing cycle is a baseball pitcher most likely to rupture the medial ulnar collateral ligament complex of the elbow?