MSK Small Group 1

Question 1

The brachialis connects the _______________.

Answer 1

humerus to the ulna

Question 2

The brachioradialis connects the _____________.

Answer 2

humerus to the radius.

Question 3

The _____________ is just medial to the biceps tendon at the elbow.

Answer 3

median nerve

Question 4

True or false: the finger and wrist extensors attach to the lateral epicondyle.

Answer 4

False. The finger extensors attach more distally along the radius.

Question 5

A great way to visualize the brachioradialis is ____________.

Answer 5

to have the elbow flexed to 90ºwith the hand midway between pronation and supination; have the patient flex

Question 6

What three physical exam tests can you do to evaluate for tendonitis?

Answer 6

• Pain with active movement
• Pain with passive movement
• Focal tenderness

Question 7

To do passive stretching, you need to move the joint _____________.

Answer 7

in the opposite way that the tendon contracts; for instance, to stretch the wrist extensors, you flex the patient’s wrist while they are relaxed

Question 8

Remember, when you are testing for pain on activation of a tendon, it’s best to ______________.

Answer 8

have the patient flex against resistance

Question 9

What does the term volar mean?

Answer 9

It is synonymous with anterior when used for the hand (also synonymous with palmar).

Question 10

There are two kinds of rest that MSK doctors recommend: ____________.

Answer 10

immobilization (with splints/braces) and activity modification

Question 11

Why do some doctors use the term tendinopathy as opposed to tendonitis?

Answer 11

The suffix -itis implies an inflammatory process, but in most cases of “tendonitis” there are no inflammatory cells found in or near the tendon. As such, tendinopathy better describes the pathology.

Question 12

What are three ways to reconnect tendon to bone at the end of a surgery?

Answer 12

• They now commonly insert screws into the bone that have little hooks to suture the tendon to.
• You can also use a drill to make a small hole in bone that can be used to anchor tendon to.
• Lastly, if you cut the tendon prior to surgery and leave a little hanging stub, then you can reattach the tendon to it.

Question 13

What are risks of steroid injections?

Answer 13

Clinically relevant:
• Tendon thinning (with possible rupture)
•Skin thinning
• Vascular thinning
(The above three result from decreased collagen crosslinking)
•Local immune suppression
•High glucose (particularly important for diabetics)

Non-clinically relevant:
•Hair loss
•Sweat gland
• Decreased production of melanin (with discoloration)

Question 14

Other than the wrist flexors, what else attaches to the medial epicondyle?

Answer 14

The pronator teres

Question 15

What causes medial epicondylitis?

Answer 15

Golfing (“golfer’s elbow”)

Question 16

What can tear the medial collateral ligament?

Answer 16

Pitching in baseball

Question 17

What is the most common source of medial epicondyle pain?

Answer 17

Ulnar entrapment

Question 18

What is the definition of “ intrinsic muscles of the hand”?

Answer 18

Muscles that have their insertion and origin in the hand

These muscles abduct and adduct the fingers as well as flex the MCP joint.

Question 19

The overall motor function of the median nerve is ____________.

Answer 19

flexion of the wrist, thumb, index finger, and long finger (and the lateral half of the ring finger)

Question 20

What are the two clinically relevant aspects of autonomic innervation of the extremities?

Answer 20

• Sweating

* Vasomotor

Question 21

What connections mediate bicipital flexion of the shoulder?

Answer 21

Coracoid to radius

The humerus to radius mediates elbow flexion.

Question 22

It’s good to check temperature using ________________.

Answer 22

the back of your hand (which is more temperature sensitive)

Question 23

With disruption of autonomic function, you lose what functions?

Answer 23

Vasoconstriction (with subsequent vasodilation) as well as loss of sweating

Question 24

What is a good way to test for denervation of the skin?

Answer 24

Submerge the area in question into water. Denervated skin will not wrinkle.

Question 25

Why does the “claw hand” result from disruption of the ulnar nerve?

Answer 25

The ulnar nerve normally mediates flexion of the MCP, so without that, the fingers are stuck in partial extension.

Question 26

The normal resting state of the hand is _____________.

Answer 26

progressively more flexion from the index finger to the pinky

Question 27

What symptoms are common in carpal tunnel syndrome?

Answer 27

• Burning pain in the wrist in hand
• Nocturnal pain
• Typing can often alleviate the pain, strangely enough

Question 28

What are risks for carpal tunnel?

Answer 28

Obesity, being sedentary, DM, Hypothyroidism

Question 29

What do people often do to relieve carpal tunnel symptoms?

Answer 29

Shake their hands below their waist (to increase the hydrostatic pressure and move fluid around)

Question 30

What is the best way to evaluate for carpal tunnel?

Answer 30

Arms extended, at the level of the heart, with wrists flexed

Question 31

What counts as a positive Tinnel’s test?

Answer 31

Paresthesia

Question 32

Carpal tunnel of pregnancy results from ____________.

Answer 32

edematous synovium of pregnancy

Question 33

_________________ is useful in carpal tunnel. Why?

Answer 33

Steroids

Steroids work to shrink the synovium of the tendon sheaths in the carpal tunnel, so this decreases volume and leads to symptomatic relief.

In other areas of tendinopathy, there is no synovium so steroids won’t work (e.g., cubital fossa).