Elbow

Question 1

Elbow instability injury that does not require x-rays

Answer 1

Nursemaid’s elbow

Question 2

Ulnar collateral ligament tear physical exam test

Answer 2

Apply valgus stress to test for pain

Question 3

Ulnar collateral ligament treatment

Answer 3

Surgical (90% success rate) if athlete

Question 4

Best imaging methods for ulnar collateral ligament tears

Answer 4

• MRI arthrography with gadolinium contrast
• Ultrasound

Question 5

How to differentiate ulnar collateral ligament tear from medial epicondylitis

Answer 5

Demographics
- UCL = younger, pitcher
- ME = older, golfer

(can use MRI w/contrast to confirm)

Question 6

How to differentiate septic from non-septic olecranon bursitis on physical exam

Answer 6

Mass will be painful, erythematous, and warm if septic

(can aspirate and send fluid for culture if unsure)

Question 7

Ligament involved in nursemaid’s elbow

Answer 7

Annular ligament

Question 8

Ulnar collateral ligament tear symptoms

Answer 8

• “pop”
• progressive medial elbow pain (with throwing)
• Paresthesia along ulnar nerve

Question 9

Compare and contrast lateral and medial epicondylitis

Answer 9

Both are more degenerative, over time changes.
Ages 40+
NSAIDs won’t help either.

Lateral = tennis elbow
- extensor carpi radialis brevis
Medial = golfer’s elbow
- flexor carpi radialis and pronator teres

Question 10

Vascular exam for elbow dislocations

Answer 10

Modified Allen’s test

Question 11

Three potential causes of olecranon bursitis

Answer 11

• Trauma
• Prolonged irritation
• Infection

Question 12

Elbow dislocation treatment

Answer 12

• Reduction as soon as possible
• Begin ROM 5-7 days post-injury (will become very stiff otherwise)

Question 13

Most common joint dislocated in children

Answer 13

Elbow

Question 14

Two methods to manually reduce nursemaid’s elbows

Answer 14

• Supination + flexion
• Hyperpronation

Question 15

The sail/fat pad sign indicates this

Answer 15

Blood pooling in posterior elbow, likely due to fracture

Question 16

Two fractures that may co-present with elbow dislocation

Answer 16

• Radial head/ coronoid
• Medial epicondyle

Question 17

Are elbow dislocations more often anterior or posterior?

Answer 17

90% are posterior

Question 18

Physical exam test used in lateral epicondylitis that isolates the extensor carpi radialis brevis muscle

Answer 18

Maudsley’s test

(tenderness to palpation over epicondyle is better though)

Question 19

Treatment for epicondylitis

Answer 19

• PT good for long term relief
• Activity modification (rest)

(NSAIDs don’t help)

Question 20

Best physical exam tests for both medial and lateral epicondylitis

Answer 20

Palpate over epicondyles for tenderness

Question 21

In an elbow dislocation patient you suspect neurovascular involvement. How would you test for disruption of the median and ulnar nerves?

Answer 21

Median
- Index finger to thumb strength
- Volar digits 1 + 2 sensation

Ulnar
- Resisted abduction of fingers
- Digits 4 + 5 sensation

Question 22

Most common age for nursemaid’s elbow

Answer 22

Under 5