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MSK ultrasound > Elbow Anatomy and Pathology > Flashcards

Elbow Anatomy and Pathology Flashcards

1
Q

The trochlea of the humerus articulates with?

A

Trochlear notch of ulna

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2
Q

The capitellum of the humerus articulates with?

A

Radial head

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3
Q

The olecranon fossa is a large depression on what aspect of the humerus? (anterior or posterior)

A

Posterior surface

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4
Q

What is the distal attachment site of the biceps brachii tendon?

A

Medial aspect of the radius on the radial tuberosity

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5
Q

What bone is longer, radius or ulna?

A

Ulna

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6
Q

What muscle is anterior to the median nerve in the elbow?

A

Pronator teres muscle

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7
Q

How long is the biceps brachii tendon?

A

7 cm long

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8
Q

What portion of the distal biceps tendon most superficial? (short head or long head)

A

Short head = superficial
Long head = deep

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9
Q

The medial approach to scan the biceps tendon in the elbow is also know as what window?

A

Pronator window because you are scanning through the PRONATOR TERES when imaging the distal biceps tendon

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10
Q

What is the most common reason for a RUPTURE in the distal biceps tendon?

A

Weight lifting

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11
Q

What head of the biceps will most likely tear?

A

SHORT head

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12
Q

What is the main difference in appearance of a tear vs. tendinosis?

A

Tear = wavy contour
Tendinosis = NO wavy contour as tendon is still intact

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13
Q

What must you do to determine a partial vs. full thickness tear on ultrasound?

A

Dynamic imaging

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14
Q

What two fossa’s are commonly scanned for joint effusions?

A

Coronoid fossa - which accommodates the coronoid process of the ulna upon elbow flexion

Radial fossa - which accommodates the radial head upon elbow flexion

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15
Q

What pathology creates the “sail sign” on x-ray?

A

When there is a joint effusion at the anterior fat pad at the bottom end of both the coronoid and radial fossa’s

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16
Q

To image the distal end of the biceps brachii in LONG axis, what must the arm position of the patient be?

A

Super-supinated for anterior approach

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17
Q

The common flexor tendon attaches what muscles to what part of the humerus?

A

Attaches the flexor muscles to the MEDIAL epicondyle of the humerus

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18
Q

What are the 3 main flexor muscles of the forearm?

A
  1. Pronator teres
  2. Flexor digitorum
  3. Flexor carpi ulnaris
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19
Q

The UCL attaches what two bones?

A

Ulna and humerus

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20
Q

What part of the UCL is the largest and MOST important? (anterior, posterior, or transverse)

A

Anterior bundle - attaches medial epicondyle to coronoid process of ulna

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21
Q

The ulnar nerve runs in the cubital tunnel on posterior elbow and can be compressed by thickened?

A

Osbourne retinaculum

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22
Q

If the ulnar nerve becomes entrapped, it will swell (proximally or distally)?

A

PROXIMALLY

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23
Q

Describe the movement of the ulnar nerve upon subluxation of the nerve?

A

Ulnar nerve subluxes anteriorly over the medial epicondyle of the humerus upon elbow flexion and extension (it normally passes posteriorly)

24
Q

Golfer’s elbow is also known as?

A

MEDIAL epicondylitis due to repeated trauma of flexor tendons.

25
Q

Golfer’s elbow typically affects what tendons?

A
  1. Superficial flexor tendon
  2. Pronator teres tendon
26
Q

What pathology may be caused by excess or repeated stress — especially forceful wrist and finger motions?

A

Golfer’s elbow/medial epicondylitis

27
Q

A >0.5mm humeral-ulnar joint opening under valgus stress indicates what type of injury?

A

UCL injury

28
Q

What side of the elbow is responsible for flexion and what part is responsible for extension?

A

Flexion - medial side = flexor muscles attach to medial epicondyle

Extension - lateral side = extensor muscles attach to the lateral epicondyle

29
Q

What are the 4 common extensor muscles of the lateral forearm?

A
  1. Extensor digitorum
  2. Extensor digit minimi
  3. Extensor carpi ulnaris
  4. Extensor carpi radialis brevis
30
Q

What extensor muscle is most commonly affected in lateral epicondylitis?

A

Extensor carpi radialis brevis

31
Q

What is the synovial fringe also known as?

A

Plicae

32
Q

How do we image the synovial fringe?

A

Place transducer on lateral elbow - it is between the radial head and capitulum of humerus in a SAG orientation

33
Q

How do we image the annular ligament?

A

Transducer on the lateral edge of elbow crease in a TRV orientation - surrounds the radial head and attaches radius to ulna

34
Q

What is the normal sonographic appearance of the synovial fringe/plicae?

A

Triangular hyperechoic area with a thin hypoechoic border = synovial fluid

35
Q

What is tennis elbow also known as?

A

LATERAL epicondylitis

36
Q

What pathology is most commonly caused by overloading of tendons, usually by repetitive supination of wrist or arm?

A

Tennis elbow/lateral epicondylitis

37
Q

What are the three muscle bellies of the triceps tendon?

A

Long head - on medial aspect
Lateral head - on lateral aspect
Medial head - deep to both long and lateral

38
Q

Where does the tricep tendon insert?

A

Medial aspect of the olecranon process of ulna

39
Q

T or F? Normal bursae of olecranon is not seen on ultrasound

A

TRUE - not seen unless abnormal

40
Q

What pathology relates to “Popeye’s elbow” ?

A

Olecranon bursitis - swelling, pain, erythema (abnormal redness of skin)

41
Q

What is the 2nd most common site for “loose bodies”?

A

Elbow

42
Q

Bone fragments will most often migrate to which site of the elbow?

A

The olecranon fossa which is the deepest depression of the elbow

43
Q

What is the most dependent potential space in the elbow?

A

Olecranon fossa - often find joint effusions here

44
Q

When would you search for bony erosions?

A

In the presence of synovitis and NOT effusions

45
Q

What findings suggest effusion?

A
  1. Displacement of fluid with transducer pressure
  2. NO blood flow
  3. Joint recess collapse with joint movement
  4. Swirling of fluid with pressure
46
Q

What type of joint is the elbow?
A) Synovial pivot joint
B) Synovial hinge joint
C) Plane joint
D) Ball and socket joint

A

B - synovial hinge joint

47
Q

What muscle do you see in the “clamshell” view?
A) pronator teres
B) Extensor pollicis longus
C) Brachialis
D) Distal biceps

A

Brachialis

48
Q

What muscle are we seeing in the “pronator window” when imaging the distal biceps insertion?

A

Pronator Teres

49
Q

What bundle of the ulnar collateral ligament of the elbow is known as Coopers ligament?

A

Transverse ligament - connects the anterior and posterior aspects of the UCL - slide 26

50
Q

What ligament of the elbow is a major stabilizer and protects against Valgus stress?

A

UCL - medial

51
Q

The cubital tunnel retinaculum forms the ‘roof’ of the cubital tunnel. What is the retinaculum also known as?

A

Osborne Ligament - runs from the medial epicondyle to the olecranon process

52
Q

The ulnar nerve runs in the cubital tunnel on posterior elbow, and can be compressed by what types of abnormalities? (4)

A
  1. Thickened Osborne retinaculum
  2. Ganglion
  3. Effusions
  4. Bone spurs
53
Q

Symptoms of cubital tunnel at the elbow include medial elbow pain & sensory loss of what digits?

A

Fingers 4 & 5 - closest to the ulna

54
Q

A snapping sound is heard when your patient flexes and extends their elbow. You are scanning on the medial elbow between the medial epicondyle and olecranon process. What pathology are we assessing?

A

Ulnar nerve subluxation over the anterior aspect of the medial epicondyle

55
Q

How do we differentiate complex fluid vs synovitis?

A

If displacement does NOT occur with transducer pressure = synovitis - warrants a look for bony erosions

If displacement DOES occur = sheath effusion

56
Q

In the elbow, when do we search for bony erosions?

A

If patient has synovitis - DOES not compress with transducer pressure, has color flow, and joint recess does NOT collapse

MSK ultrasound (9 decks)

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