Elbow

Question 1

Pronator Teres Syndrome

Answer 1

Weakness of muscles supplied by median nerve, parasthesia to second and third digits of hand, pain w/ resisted forearm pronation and elbow flexion

Question 2

Anterior Interosseous Syndrome

Answer 2

Weakness of pronator quadratus, unable to make “ok” sign, no sensory changes

Question 3

Posterior Interosseous Syndrome

Answer 3

Pain increased w/ extension of middle finger against resistance, weakness of extensors of the thumb, no sensory loss, functional wrist drop, Arcade of Frohse entrapment sight

Question 4

Cheralgia Parasthetica (handcuff palsy)

Answer 4

Parasthesia and burning pain on dorsum of hand and wrist, fingertips are spared

Question 5

What motion has the greatest loss following elbow dislocation and is most difficulty to regain?

Answer 5

Extension

Question 6

What is the most sensitive test for assessing UCL?

Answer 6

Moving valgus stress test

Question 7

Red flags following closure by primary intention

Answer 7

severe pain and neurologic symptoms

Question 8

Anamolous structure that can be a sight of entrapment for median nerve proximal to elbow

Answer 8

Ligament of Struthers

Question 9

Fat Pad sign at elbow indicates:

Answer 9

Radiographic finding of intra-articular fracture

Question 10

Most common occult elbow fractures in children:

Answer 10

Supracondylar fractures (ex: kid fell on outstretched arm who was in 7th grade and fractured trochlea)

Question 11

Structures in cubital fossa from lateral to medial:

Answer 11

biceps tendon, brachial artery, median nerve

Question 12

Radial Tunnel Syndrome

Answer 12

Entrapment sight can be Arcade of Frohse, pain over lateral humeral epicondyle, can have MILD reduced grip strength but mostly just pain, radial distribution numbness

Question 13

Cubital Tunnel Syndrome

Answer 13

Pain in 4th/5th digits, reduced grip strength, atrophy/weakness of ulnar intrinsic in late stage, ulnar claw in late stage, Wartenburg’s and Froment’s sign

Question 14

Froment’s sign

Answer 14

Flexion of IP of the thumb when trying to grip a piece of paper due to adductor pollicis weakness

Question 15

Wartenburg’s sign

Answer 15

abduction of the 5th finger due to weakness of adducting palmar interosseous muscles (ulnar nerve)

Question 16

a patient presents to the ED and is able to achieve full elbow extension, are radiographs necessary?

Answer 16

No - Elbow extension test can be used to rule out fractures – if they have full extension, you don’t need a radiograph

Question 17

Where is the site that most pediatric elbow fractures occur?

Answer 17

Most pediatric fractures are extra-articular involving the thin bone between the coronoid fossa and olecranon fossa of the distal humerus

Question 18

Difference between AIN and median nerve entrapment?

Answer 18

Median nerve will have sensory issues, AIN will not

Question 19

Patient is sitting with elbow supported and in flexion. Wrist is passively positioned into wrist extension, radial deviation and finger flexion. The tester produces a force into wrist flexion and ulnar deviation.

Answer 19

Cozen’s test - lateral epicondylitis

Question 20

Maudley’s test

Answer 20

3 rd finger resistance test for lateral epicondylitis

Question 21

Handshake Test

Answer 21

Patient perfoms a handshake with the elbow extended and then generates force into supination. Pain is reported at lateral epicondyle. Test is repeated with the elbow flexed to 90. Pain is lessended in flexed position this indicates surgery is not needed. If its the same, surgery is indicated.

Question 22

What are the 3 MOI for a radial head fracture?

Answer 22

Axial load to a pronated forearm
direct blow
hyperflexion

Question 23

Type 1 - 4 radial fracture’s:

Answer 23

1. Undisplaced
2. Large displaces
3. Comminuted
4. Fx with dislocation

Question 24

Patho phys of Heterotopic ossifications

Answer 24

osteogenic precursor cells, inducing agents and permissive enviornment

Question 25

Transient physiological block caused by ichemia without Wallerian degeneration. Nerve architecture is preserved

Answer 25

Neuropraxia

Question 26

Internal architecture of the nerve is preserved but axons are badly damaged and wallerian degeneration occurs

Answer 26

Axonotmesis