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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A minor league baseball player presents with deteriorating pitch velocity and control in addition to worsening elbow soreness. His MRI is shown in Figure A and based on this he decides to proceed with surgery. Which of the following medial ulnar collateral reconstruction techniques would give this athlete the best chance to return to sport?
Modified Jobe technique and ulnar nerve submuscular transposition
Classic Jobe technique and ulnar nerve in situ release
Classic Jobe technique and ulnar nerve transposition
Docking technique and ulnar nerve in situ release
Modified Jobe technique and medial epicondylectomy
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Which of the following statements most accurately describes the anatomy and kinematics of the elbow medial ulnar collateral ligament (UCL)?
Anterior band of the anterior bundle exhibits an isometric strain pattern through elbow range of motion (ROM)
Anterior band of the anterior bundle exhibits an isokinetic strain pattern through elbow ROM
Posterior band of the anterior bundle exhibits an isometric strain pattern through elbow ROM
Posterior band of the anterior bundle exhibits an isokinetic strain pattern through elbow ROM
Anterior band of the posterior bundle exhibits an isometric strain pattern through elbow ROM
A 21-year-old college baseball pitcher presents with right elbow pain. He reports that his pitching velocity and accuracy has been decreasing. On physical exam, he has a positive moving valgus stress test. His lateral radiograph is shown in Figure A. Which of the structures in Figure B is likely injured?
A collegiate javelin thrower presents complaining of medial elbow pain that is affecting her performance. Her imaging is seeing Figure A. Which ligament is likely affected, what arc of motion does it contribute stability, and where does it insert anatomically?
Anterior oblique bundle of the ulnar collateral ligament, 30-120 degrees of flexion, sublime tubercle
Posterior oblique bundle of the ulnar collateral ligament, greater than 90 degrees of flexion, sigmoid notch
Posterior oblique bundle of the ulnar collateral ligament, 30-120 degrees of flexion, sublime tubercle
Anterior oblique bundle of the ulnar collateral ligament, greater than 90 degrees of flexion, sigmoid notch
Anterior oblique bundle of the ulnar collateral ligament, 0 degrees of flexion, sublime tubercle
A 28-year-old Olympic water polo athlete complains of vague medial sided elbow pain that has progressively worsened with a noticeable loss of velocity on his shot. Which of the following correctly matches the throwing phase (Figure A) with the injured structure on the MRI (Figure B).
B and 2
C and 2
B and 3
D and 1
C and 3
A 31-year-old right handed pitcher felt a pop in his throwing elbow during a game. He is diagnosed with a rupture to the medial ulnar collateral ligament complex of the elbow. During which phase of the overhead throwing cycle did this pitcher most likely sustain his injury?
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.
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
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?