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RMSK overall > Elbow RMSK > Flashcards

Elbow RMSK Flashcards

1
Q

Prominent recess/FOSA of elbow

A

coronoid and radial fossa anteriorly and olecranon fossa posteriorly

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2
Q

Where are the fat pads located

A

in each joint recess. it is intracapsular but extrasynovial

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3
Q

Medial elbow joint stabilizers

A

UCL- 3 components anterior , posterior and oblique

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4
Q

Which is the most important medial stabilizer

A

anterior bundle

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5
Q

Lateral elbow stabilizer

A

LCL complex

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6
Q

what are the components of the lateral elbow stabilizer

A

radial collateral ligament, annular ligament, small accessory radial collateral ligament and LUCL

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7
Q

Brachialis inserts to

A

Ulna BRU!!!

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8
Q

Biceps brachii inserts where?

A

radial tuberosity

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9
Q

what kind of insertion is biceps brachii

A

dual insertion… short head is more superficial and inserts distally on radial tuberosity

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10
Q

triceps inserts to

A

olecranon process

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11
Q

which muscles compose the superficial layers of the distal triceps?

A

lateral and long head

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12
Q

shorter head of triceps and deeper

A

medial head

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13
Q

Where can you find the anconeus

A

between olecranon process and lat epicondyle

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14
Q

Medial compartment of elbow

A

common flexor tendon ( FCR, PL, FCU, FDS) all originating from medial epicondyle

FDP- NOT INCLUDED

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15
Q

Lateral compartment of elbow structures?

A

ECRB, ED, EDM, ECU all from lateral epicondycle

Not including ECRL- since it is more proximal

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16
Q

Where is origin of ECRL

A

proximal to lateral epicondyle

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17
Q

Space between olecranon process of ulna and Medial epicondyle is bridged by what ligament

A

bridged by the cubital tunnel retinaculum ( osborne ligament)

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18
Q

True cubital tunnel

A

between two heads of flexor carpi ulnaris and deep to arcuate ligament

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19
Q

WHere does median nerve course through sa elbow muscular landmark?

A

between ulnar and radial headfs of pronator teres

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20
Q

Radial nerve course from humerus .. which muscles does it pass from elbow to forearm

A

posterior aspect of humeral shaft then distally and laterally beneath the brachioradialis.. deep branch courses under supinator and superficial branch beneath BR into forearm

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21
Q

Commonly missed in elbow scan

A

anterior joint recess. ulnar collateral ligament, LCL complex, radial head and annula recess, capitellum, posterior joint recess, olecranon bursa

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22
Q

vascular Landmark of biceps brachii tendon

A

lateral to brachial artery

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23
Q

Two different superficial nerves of anterior elbow and landmarks

A

lateral antebrachial cutaneous nerve- lateral and superficial ..( continuation of musculocutaneous nerve) to BT, radial nerve- superficiial and deep

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24
Q

Lacertus fibrosus location

A

superficial to biceps tendon

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25
Q

Views for distsal biceps tendon

A

usual anterior aproach.. lateral to brachial artery

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26
Q

Other views for distal biceps tendon

A

Medial approach v1 ( move medial until brachial artery seen then angle lateral toward center of elbow. + heel toe maneuver + slight flexion )

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27
Q

Another medial approach v2

A

SAX then LAX once footprint is seen

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28
Q

3rd method for distal biceps

A

Pronator window approach- elbow flexed… transducer over medial epicondcle and elbow flexed… viewing at coronal plane , move towards wrist and slightly anterior to visualize radial tuberosity

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29
Q

structures to evaluate on posterior elbow

A

joint recess, triceps, soft tissues over olecranon, trochlea, capitellum, olecranon fossa, cartilage

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30
Q

superficial layer of triceps brachii posteriorly comprised of which heads

A

long and lateral heads

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31
Q

deeper layer of triceps represent

A

medial head of triceps

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32
Q

lateral structures ( tendon, ligament, bony landmarks)

A

common extensor tendon, LCL complex, raidal head, annula recess, capitellum, radial collateral ligament

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33
Q

foorptint origin of common extensor tendon

A

proximal 46% of bone surface.. a bony ridge may be seen at the ending.

34
Q

structure to remember near the radiocapitellar joint

A

meniscus like synovial fold called the POSTEROLATERAL PLICA

35
Q

differentiate the radial collateral and the lateral ulnar collateral ligament

A

RCL adjacent to CET… LUCL.. oblique and inserts to crista supinator of ulna

36
Q

Which recess in elbow most sensitive for joint fluid accumulation

A

posterior olecranon recess

37
Q

Complex fluid in elbow appearance

A

hypoechoic to hyperechoic

38
Q

heterogeneous fluid indicates?

A

hemorrhage or infection

39
Q

findings that suggest complex fluid

A

compressibility, redistribution or motion of contents, lack of internal flow on color doppler

40
Q

findings suggestive of synovial hypertrophy

A

non compressibility

flow on color doppler

41
Q

What causes synovial hypertrophy

A

infection, RA, inflammatory arthritis, intra-articular osteoid osteoma

42
Q

synovial pathology with calcified hyperechoic foci

A

pigmented villonodular synovitis… if synovial chondromatosis there will be hyperechoic foci

43
Q

Common sites for intra-articular bodies

A

olecranon, coronoid, annula recess

44
Q

synovial fold syndrome

A

adjacent to radial head it is heterogeneous thickener or elongated

45
Q

Evaluate for articular hyaline cartilage where

A

over capitellum and look for osteochondral abnormaloty

46
Q

olecranon bursa location

A

superficial to olecranon process of ulna, must FLOAT

47
Q

findings suggestive of gout

A

hyperechoic synovial hypertrophy with internal hyperechoic foci

48
Q

findings suggestive of a full thickness tear

A

anechoic or hypoechoic tendon fiber disruption, tendon retraction with refraction shadowing

49
Q

distal biceps tendon tear of only one head will be classified as

A

partial thickness tear

50
Q

dynamic evaluation of full tear

A

proximal segment will show little or no movement with pronation to neutral

51
Q

dynamic evaluation of partial tear

A

somve movement is seen equal to amount of rotation

52
Q

appearance of DOMS

A

focal or diffuse hyperechoic area of the involved muscle with possible enlargement ( triceps, biceps, brachiorad)

53
Q

partial thickness tear triceps 4 considerations

A

Observe superficial layer of tendon,
Usually combined lateral and long head attachments,
May have fractured displaced osteophyte 2-4cm retraaction of avlused bone

54
Q

Lateral epicondylitis most common tendon

A

most common carpi radialis brevis ( most anterior and most common)

55
Q

findings of lat epic

A

tendinosis >4.2mm if common extensor tendon with possible hyperechoic calcification and adjacent bone irregularity

56
Q

Poor prognosis for lat epicondylitis

A

size of intasubstance common extensor tendon tear and radial collateral ligament inclusion- poor outcome

57
Q

what stabilizes the medial elbow joint?

A

Ulnar collateral ligament ( APO) anterior posterior and oblique

58
Q

Insertion of the anterior bundle

A

sublime tubercle

59
Q

full thickness tear appears

A

complete fiber discontinuity, variable anechoic, hypo echoic isoechoic fluid and hemorrhage.. difficult to distinguish from partial

60
Q

dynamic evaluation of elbow for ulnar collateral ligament tear criteria for joint gapping and requirements for surgery?

A

during valgus stress joint gapping >1mm difference- UCL tear req. surgery… if 2.5mm full thickness tear

61
Q

Are all calcifications pathologic in UCL?

A

can be asymptomatic with baseball players

62
Q

Lateral elbow stabilizers and ligaments?

A

radial collateral ligament , annular ligament, LUCL.

63
Q

Criteria for cubital tunnel syndrome

A

> 9mm2 or ratio of >2.8

64
Q

Where does the ulnar nerve dislocate

A

medially and anteriorly over the medial epicondyle and reloates with extension

65
Q

snapping triceps syndrome

A

includes medial head of triceps and also ulnar nerve.. so 2 snaps.

66
Q

anconeus epitrochlearis muscle incidence? and possible pathology

A

normal variant in 23% can cause ulnar nerve compression.. diagnosed in extension

67
Q

Median entrapment sites

A

distal humerus- ligament of Struthers (supracondylar process). antecubital region- pronator syndrome, distally AIN from fibrous bannds of anomalous muscles

68
Q

Radial nerve pathologies

A

spiral groove syndrome - wrist drop and sensory but spared triceps function

69
Q

Humeral shaft injury

A

can injure radial nerve from enlargement to transection

70
Q

Spiral groove compression

A

Saturday night palsy

71
Q

Radial tunnel syndrome location and distribution and manifestation?

A

between two heads of supinator..

Proximal lateral forearm pain in present without motor abnormalities

72
Q

Posterior interosseous nerve syndrome clinical manifestation

A

painless lack of finger and thumb extension without wrist drop. imaging is enlargement of radial nerve deep branch just proximal to entrance between two heads of supinator

73
Q

causes of PIN syndrome

A

Arcade of Froshe,
fibrouse bands,
leash of henry.

74
Q

The deep branch of radial nerve normally flattens as it enters supinator meaning

A

not nerve compression

75
Q

Peripheral nerve sheath tumors echo characteristics?

A

schwanoma and neurifibroma appear as defined hypoechoic mass with low-level internal echoes. may havei ncreased through transmission

76
Q

Inflammatory epitrochlear lymph node

A

enlarged, oval shape, normal echogenic hilum and hilar vascular pattern..

77
Q

Malignant epitrochlear lymph node

A

round with absence of echogenic hilum, thickening of hypoechoic cortex and peripheral or mixed vascularity

78
Q

Lateral flexion approach- can view full thickness tear of BT

A

elbow 90 degress, transducer is placed transverse to radius and at the beginning of radial head.. go distally till you see the supinator at level of radial tuberosity

79
Q

Dorsal flexed pronation view good for what ?

A

can see distal biceps and good position for injection

80
Q

Medial flexion view can view what structure?

A

can see BT more proximally can see bicipitoradial bursa if enlarged

RMSK overall (4 decks)

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