Elbow MSK

Question 1

Brachialis

Answer 1

C5,6, upper trunk, lateral cord, musculocutaneous nerve

Question 2

brachioradialis

Answer 2

C5,6, upper trunk, posterior cord, radial nerve (below spiral groove)

Question 3

Pronator teres

Answer 3

C6,7, upper and middle trunks, lateral cord, median nerve

Question 4

biceps brachii

Answer 4

C5,6, upper trunk, lateral cord, musculocutaenous nerve

Question 5

triceps

Answer 5

C6,7,8 , all three trunks, posterior cord, radial nerve (innervated above the spiral groove)

Question 6

Anconeous

Answer 6

C6,7,8, all three trunks, posterior cord, radial nerve (innervated above spiral groove)

Question 7

Supinator

Answer 7

C5,6 upper trunk, posterior cord, radial nerve, PIN

Question 8

Pronator teres

Answer 8

C6,7 , upper and middle trunks, lateral cord, median nerve

Question 9

Pronator quadratus

Answer 9

C7,8,T1, middle and lower trunks, medial and lateral cords, median nerve, AIN

Question 10

FCR

Answer 10

C6,7, upper and middle trunks, lateral cord, median nerve

Question 11

FCU

Answer 11

C8,T1 lower trunk, medial cord, ulnar nerve

Question 12

FDS

Answer 12

C7,8, middle and lower trunks, medial and lateral cords, median nerve

Question 13

FDP

Answer 13

C7,8T1, middle and lower trunks, medial cord, AIN/ulnar nerve ..so profound that it requires 2 nerves to innervate it

Question 14

flexor pollicis longus

Answer 14

C8, T1, medial and lateral cords, median nerve

Question 15

osteochondrosis of the elbow

Answer 15

asepitc necrosis of capitellum epiphysis due to poor blood supply

Question 16

osteochondritis dessicans

Answer 16

traction apophysitis of medial epicondyle growth plate

Question 17

Nursemaids elbow

Answer 17

radial head subluxes out of place due to being yanked out of annular ligament; tx reduce it by hyper pronating or supinating while flexing

Question 18

Ulnar collateral ligament sprain

Answer 18

medial elbow pain from excessive valgus stress (ANTERIOR BUNDLE of UCL), physical exam to look for increased laxity, surgery Tommy John if PT fails

Question 19

Radial/Lateral collateral ligament sprain

Answer 19

excess varus force causing lateral elbow pain, worse with VARUS stress testing, RICe, PT, Surgery

Question 20

Lateral epicondylitis

Answer 20

ECRB

Question 21

Cozen test

Answer 21

pain palpating proximal common extensor tendon with resisted extension (using tendon rather than stretching it)

Question 22

Mills test

Answer 22

pain while extending elbow, flexing and radially deviating the wrist (stretch it)

Question 23

Tennis racket adjustment for tx of tennis elbow

Answer 23

increase grip size, decrease string tension to below 55 lbs, play on a slow court (ie clay), correct technique

Question 24

Distal biceps tear

Answer 24

from lifting something very heavy, Hook test, surgery

Question 25

Strongest restraint to valgus stress in the elbow

Answer 25

Anterior bundle of medial collateral ligament.

The medial (ulnar) collateral ligament (also known as the Tommy John ligament due to rupture in throwing athletes) is the primary restraint due to valgus force. Specifically, the anterior oblique band is loose in flexion and taut in extension

Question 26

Shoulder abduction relief sign

Answer 26

Bakody sign

shoulder abduction relief sign or Bakody sign. Individuals with pathology at C5-6 feel relief of their symptoms in this position, which is thought to be due to decreased traction on the C5, C6 nerve roots.

Question 27

Normal Shober test distance

Answer 27

The distance between the 2 points with forward flexion should exceed 15cm in non-affected individuals.

Question 28

Differential for lateral epicondylitis

Answer 28

Patients whose symptoms are consistent with lateral epicondylitis/epicondylosis or “tennis elbow” but who do not respond to conservative treatments should be considered to have a posterior interosseous neuropathy. Mild neural compression of the posterior interosseous nerve may present with proximal and dorsal forearm pain without obvious muscle weakness, wasting, or sensory deficits.

Question 29

A paramedian disc herniation in the lumbar spine has potential to affect the ** nerve roots

Answer 29

traversing

Question 30

Injury to triangular fibrocartilage complex TFCC presentation and work up

Answer 30

This structure is a stabilizer of the distal radioulnar joint and is composed of an avascular articular disc and radioulnar ligament complex. It is often injured with repetitive wrist activities or compressive loads. TFCC tears are best imaged by magnetic resonance imaging (MRI).

Question 31

Ulnar compression at cubital tunnel vs guyons canal

Answer 31

Sensory loss in the 4th-5th digits and along the dorsum of the hand implies an ulnar nerve injury with involvement of the dorsal ulnar cutaneous nerve (DUC). Lesions involving the DUC must be proximal to the wrist and Guyon canal because the DUC branches from the main trunk of the ulnar nerve 5-10cm proximal to the wrist.

Question 32

Panner’s disease

Answer 32

Panner’s disease is usually seen in young boys aged 5 to 12 years. It is felt to be due to an interruption in the blood supply to the epiphysis resulting in initial resorption followed by eventual remodeling of the epiphysis. This condition most commonly occurs in the dominant arm and is found to be due to chronic repetitive trauma, hereditary factors, and certain endocrine disorders.

Question 33

+ fat pad sign mechanism of injury

Answer 33

An elbow hyperextension injury is the most common mechanism of an elbow fracture resulting in a positive fat pad sign on x-ray.