Ambulatory TSA procedures result in significant cost savings.

Background: Although analyses of the Orthopaedic In-Training Examination (OITE) subspecialty content domains have been performed, few studies have analyzed the levels of evidence (LoEs) for journal articles used as references to create OITE questions. We present an analysis of reference characteristics and question taxonomy for the hand surgery content domain on the OITE. We aim to determine whether level of evidence (LoE) for hand surgery questions have increased over a 15-year period. Methods: All questions and references in the hand surgery content domain on the OITE from 1995-1997 and 2010-2012 were reviewed. The taxonomic classification was determined for each question. Publication characteristics were defined for each reference, and each primary journal article was assigned a LoE. Results: A total of 129 questions containing 222 references met inclusion criteria: 76 questions from 1995-1997 and 53 from 2010-2012. The Journal of Hand Surgery American and European Volumes, Journal of Bone and Joint Surgery American and British Volumes, and theJournal of the American Academy of Orthopaedic Surgeons were the most frequently cited journals overall. Recent examinations were more likely to have Buckwalter T3 complex clinical management questions. There was a statically significant increase in the LoE used to create hand questions on the 2010-2012 compared with the 1995-1997 OITE. Conclusions: Primary journal articles cited on the hand surgery content domain of the OITE frequently included recent publications from both general and subspecialty journals. More recent examination questions appear to test clinical management scenarios. LoE for hand questions has increased over a 15-year period. Our results can be used as a guide to help prepare orthopedic residents for the OITE.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Partial tears of the distal biceps brachii tendon are rare. A complete tear of the distal biceps brachii tendon is readily diagnosed on the basis of history and physical examination and has a well-described clinical presentation of acute pain in the antecubital fossa, localized tenderness, swelling, palpable defect, positive hook test, and weakness in forearm supination and elbow flexion. Partial tears, on the other hand, can present more subtly and remain a diagnostic challenge. We present a novel physical examination technique that utilizes the rotational anatomy of the radius. The patient's forearm is passively supinated and pronated with the elbow flexed to 90° while the examiner firmly palpates the dorsal forearm overlying the radial tuberosity. The tuberosity presents itself beneath the examining fingers only in full forearm pronation. A positive test is indicated by tenderness over the radial (or lateral) aspect of the tuberosity (TILT sign) only in full forearm pronation, and not in supination. We have found this diagnostic test to be 100% sensitive for diagnosing partial distal biceps brachii tendon tears over the last five years during which it has been in use. Representative example cases are presented. A positive TILT sign indicates a diagnosis of partial tear of the distal biceps brachii tendon. This simple diagnostic maneuver could facilitate earlier detection of these injuries. Clin. Anat. 31:301-303, 2018. © 2017 Wiley Periodicals, Inc.

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