Muskuloskeletal Test 2 Elbow Questions & Vignettes

In osteochondritis dissecans, painful cracks form in a joint's articular ___________ and subchondral bone.

cartilage

In osteochondritis dissecans, bone or _____________ float within a joint, causing pain and inflammation.

cartilage fragments

A supracondylar elbow fracture is a fracture of the ________ just above the epicondyles.

distal humerus

Joints affected by osteochondritis dissecans typically display three characteristics:________________, ________________, and _____________..

effusion, tenderness, and crepitus

Nursemaid's elbow is a dislocated elbow joint caused by a sudden pull on an (flexd / extended) (supinated / pronated) forearm.

extended pronated

Lateral epicondylitis (tennis elbow) typically results from repetitive (flexion/extension) ________________ (backhand shots), but can also be idiopathic.

extension

On physical exam, the forearm of a child with nursemaid elbow will be in incomplete (extension/flexion) with the forearm partially pronated.

extension

Physical examination of tennis elbow reveals tenderness over the insertion of the extensor carpi radialis brevis at the lateral epicondyle, pain with resisted wrist (flexion/extension/rotation) , and pain with resisted middle finger extension.

extension

Physical examination of tennis elbow reveals tenderness over the origin of the ___________________ muscle at the lateral epicondyle, pain with resisted wrist extension, and pain with resisted middle finger extension. A. Flexor carpi radialis B. Extensor carpi ulnaris C. Extensor carpi radialis brevis D. Extensor pollicis brevis E. Pronator teres

extensor carpi radialis brevis

Medial epicondylitis is an overuse injury affecting the wrist (extensor / flexor ) tendons that originate in the medial epicondyle. Occasionally the pronator teres and flexor carpi radialis muscle are also injured..

flexor

Medial epicondylititis is an overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle. Occasionally the pronator teres and ___________ muscle are also injured..

flexor carpi radialis

The medial epicondyle is the origin site for the wrist ___________.

flexors

Tennis elbow (lateral epicondylitis) should not be confused with ________________ (medial epicondylitis).

golfer's elbow

Treatment of nursemaid elbow involves ________________.

manual reduction

An X-ray of nursemaid elbow will typically be (normal/abnormal).

normal

Common mechanisms for ______________ injuries include an adult tugging on an uncooperative child or swinging a child by the arms during play.

nursemaid's elbow (radial head subluxation)

Tennis elbow symptoms include lateral epicondyle pain which radiates along the (anterior/posterior) forearm.

posterior

On physical exam, the forearm of a child with nursemaid elbow will be in incomplete extension with the forearm partially (pronated/supinated).

pronated

Medial epicondylititis is an overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle. Occasionally the ______________ and flexor carpi radialis muscle are also injured..

pronator teres

The formal term for nursemaid's elbow is ____________.

radial head subluxation

Children with nursemaid elbow typically present with the complaint of _______________.

refusal to use an arm

Cubital tunnel syndrome is a common form of ________nerve entrapment.

ulnar

Guyon canal syndrome is a form of ________ nerve entrapment.

ulnar

Lateral epicondylitis is a repetitive strain injury of the ________ extensor muscles. A. Forearm B. Upper arm C. Shoulder D. Wrist E. Fingers

wrist

A 69-year-old male presents to his primary care physician for pain in his arm. The patient states that his father recently died of a heart attack which motivated him to join his local gymnasium. After completing a set of weight lifting, he felt a "pop" in his right arm, followed by pain. Since the incident, he has been unable to carry items or lift his arm over his head without difficulty and pain. On physical exam, you note pain with flexion and supination of the forearm. Inspection of the upper extremity reveals edema and ecchymosis. Which of the following is the most likely diagnosis? A. Supraspinatus rupture B. Infraspinatus rupture C. Biceps tendinopathy D. Biceps tendon rupture E. Biceps muscle tear

Biceps tendon rupture

A 24 year old college quarterback reports to the sports medicine clinic complaining of pain over the medial epicondyle of his throwing arm. He also reports slight tinging in his ring and pinky fingers. Physical exam demonstrates a positive valgus stress test. What is the best intial treatment for this patients condition? A. Brace or arm splint followed by 3 months of PT B. Ulnar collateral ligament reconstruction C. Tommy John procedure D. Reassurance and NSAIDS for 2-4 weeks

Brace or arm splint followed by 3 months of PT

A 3-year-old boy is brought to the office because of pain in his left elbow. Father of the patient says that after picking up the boy from day care, he noticed his son was not moving his elbow and complained of pain. Patient is holding his left elbow flexed and pronated. Physical examination shows tenderness over the lateral aspect of the left elbow joint on palpation. Which of the following is the most appropriate next step in management? A. Analgesic B. Closed reduction via pronation and extension C. Closed reduction via supination and flexion D. Orthopedic cast E. Splint

Closed reduction via supination and flexion Closed reduction via supination and flexion is one of the two main methods for reduction in nursemaid's elbow, which is dislocation of the elbow joint caused by a sudden pull on the extended pronated forearm.

A 35 year old male complains of numbness and tingling along the inside of his elbow. He is a roofer and works with a hammer daily. He adds that the pain radiates to his ring finger. Physical exam demonstrates a positive Tinel's sign. What is the most likely diagnosis? A. Ulnar tunnel syndrome B. Cubital tunnel syndrome C. Medial epicondylitis D. Ulnar collateroal ligament tear E. Elbow osteoarthritis

Cubital tunnel syndrome

______________ syndrome is associated with joint dislocation, berry and aortic aneurysms, and organ rupture resulting from improper collagen cross-linking.

Ehlers-Danlos

A 17-year-old girl comes to her primary care provider's office because of easy bruising. She reports having to quit her volleyball team because she has dislocated a joint each season that she has played. Her past medical history is significant for the posterior dislocation of the radial head in her right arm last year. Physical examination shows old ecchymosis along her arms and legs. Which of the following is the most likely diagnosis? A. Chediak-Higashi syndrome B. Ehlers-Danlos syndrome C. I-cell disease D. Kartagener's syndrome E. Menkes disease

Ehlers-Danlos syndrome

A college tennis player complains to her coach that she has constant shooting pain along the lateral aspect of the elbow that radiates down her forearm. Repeated forceful use of which muscle or muscle group is the most likely etiology of her symptoms? A. Pronator teres B. Triceps C. Flexor carpi radialis D. Extensor carpi ulnaris E. Extensor carpi radialis

Extensor carpi radialis

A 27-year-old young man presents to his primary care physician for weakness and tingling in his hand. The patient is an avid bodybuilder and has noticed that his grip strength has gradually worsened in both hands with symptoms worse at the end of a long workout. The patient has a loss of sensation bilaterally over the volar surface of the 4th and 5th digits and over the medial aspect of the volar forearm. There is also notable weakness of finger adduction and abduction. The rest of the patient's physical exam is within normal limits. What is the most likely cause of this patient's condition? A. Brachial plexopathy B. Cubital tunnel syndrome C. Guyon's canal syndrome D. Carpal tunnel syndrome E. Posterior interosseous nerve compression

Guyon's canal syndrome (ulnar tunnel syndrome) This patient is presenting with weakness of grip strength and finger abduction/adduction, as well as a loss of sensation in the distribution of the ulnar nerve (volar surface of the medial forearm and medial two digits), suggesting a diagnosis of cubital tunnel compression. Incorrect Answers: Answer 3: Guyon's canal compression occurs due to compression of the ulnar nerve at the wrist and presents with symptoms distal to this location. Symptoms would include weakness of grip and loss of sensation over the medial two digits; however, this would not explain the loss of sensation over the medial forearm. Answer 4: Carpal tunnel syndrome occurs due to compression of the median nerve as it traverses the carpal tunnel. It presents with weakness and paresthesias of the lateral three digits.

A 35-year-old right-handed male construction worker comes to the clinic because of right elbow pain. Physical examination shows 5/5 muscle strength bilaterally, 2+ radial and ulnar pulses, and intact sensation throughout the right upper extremity. Increased pain at the lateral aspect of his elbow is produced with resisted wrist extension. A plain radiograph of the elbow is normal. Which of the following is the most likely diagnosis? A. Cubital tunnel syndrome B. Elbow osteoarthritis C. Lateral epicondylitis D. Medial epicondylitis E. Olecranon bursitis

Lateral epicondylitis

___________________is a repetitive strain injury of the wrist extensor muscles.

Lateral epicondylitis

A 24 year old college quarterback reports to the sports medicine clinic complaining of pain over the medial epicondyle of his throwing arm. He also reports slight tinging in his ring and pinky fingers. Physical exam demonstrates a positive valgus stress test. What test is diagnostic of the patient's condition? A. CT B. XR C. MRI D. ERC

MRI Patient has an ulnar collateral ligament tear

A 25-year-old man presents to his primary care physician due to elbow pain. He reports that the pain affects his right arm and is located in the right cubital fossa of the elbow. He says that the pain is typically a 3/10 at baseline but increases to an 8/10 when playing badminton or squash. On physical exam, there is tenderness upon palpation of the medial epicondyle, as well as pain with resisted wrist flexion while the elbow is fully extended. What is the most likely diagnosis? A. Cubital tunnel syndrome B. Elbow osteoarthritis C. Lateral epicondylitis D. Medial epicondylitis E. Olecranon bursitis

Medial epicondylitis

_____________________is an overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle. Occasionally the pronator teres and flexor carpi radialis muscle are also injured..

Medial epicondylitis

A 9-year-old boy presents to the emergency room with his mother for severe right elbow and forearm pain after sustaining a fall on to his right arm from the monkey bars. On examination, the affected arm is swollen and tender around his elbow. Radiographs demonstrate a displaced fracture of the proximal ulnar diaphysis and radial head dislocation. What is the most likely diagnosis? A. Monteggia Fracture B. Galeazzi Fracture C. Colles Fracture D. Smiths Fracture

Monteggia Fracture *Dislocation of the radial head

A 54-year-old plumber reports left elbow swelling for the past few months. The swelling has worsened and became more painful over the last week. He works 12 hours a day and spends a lot of time on his knees and elbows when repairing pipelines. On examination, he has no fever. There is a red and tender swelling of the left posterior elbow. What is the most likely diagnosis? A. Cubital tunnel syndrome B. Elbow osteoarthritis C. Lateral epicondylitis D. Medial epicondylitis E. Olecranon bursitis

Olecranon bursitis

A 13-year-old boy presents with left elbow pain. He reports that he cannot specifically localize where the pain is in the left elbow but has noticed it has progressively worsened over the course of 7 months. He also says that elbow swelling typically appears after he does repetive movement. On physical exam, there is mild swelling on the left elbow. With the left elbow in the flexed position with pressure over the capitellum, there is tenderness to palpation. Range of motion of the knee is intact. An anterior-posterior radiograph of the affected elbow demonstrates crescent-shaped radiolucency surrounding subchondral bony fragments. What is the most likely diagnosis? A. Osteoarthritis B. Osteochondritis dissecans C. Rheumatoid arthritis D. Avascular necrosis E. Osteopetrosis

Osteochondritis dissecans

Bone or cartilage fragmentation in _________________ is usually related to repeated joint overloading mechanisms. A. Medial epicondylitis B. Lateral epicondylitis C. Osteochondritis dissecans D. Olecranon bursitis E. Ulnar collateral ligament tear

Osteochondritis dissecans

A 3-year-old boy is brought to the clinic because of left elbow pain. Father of the patient says that after picking up the boy from day care, he noticed his son was not moving his elbow and complained of pain. Patient is holding his left elbow flexed and pronated. Physical examination shows tenderness over the lateral aspect of the left elbow joint on palpation. Which of the following is the most likely diagnosis? A. Elbow dislocation B. Lateral condylar physeal fracture C. Medial condylar physeal fracture D. Radial head subluxation E. Supracondylar humeral fracture

Radial head subluxation

A 2-year-old girl is brought in to the emergency department because of immobility in her left arm for the past 3 hours. She expresses pain at any attempts to move it. Patient is sitting in her father's lap in no acute distress, holding her left arm, and slightly flexed across her belly. Which of the following best explains this patient's condition? A. Ulnar collateral ligament tear B. Medial epicondylitis C. Lateral epicondylitis D. Radial head subluxation E. Olecranon bursitis

Radial head subluxation (Nurse maid's elbow)

A 7-year-old child is brought to the emergency room by his parents in severe pain. They state that he fell on his outstretched right arm while playing with his friends. He is unable to move his right arm which is being supported by his left. On exam crepitus is noted above the elbow upon movement. The child is able to flex and extend his wrist, but this is limited by pain. The child has decreased sensation along his thumb and is unable to make the "OK" sign with his thumb and index finger. What is the most likely diagnosis? A. Midhumerus fracture B. Scaphoid fracture C. Distal radius fracture D. Distal ulnar fracture E. Supracondylar humerus fracture

Supracondylar humerus fracture

__________ is a way to detect irritated nerves. It is performed by lightly tapping over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. A. Tinel's sign B. Valgus stress test C. Varus stress test D. Tennis elbow test E. Golfer's elbow test

Tinel's sign

A 19 year old pitcher for his college baseball team complains of pain over the medial epicondyle of his right arm. He also reports parathesia in the small fingers of the same upper extremity. Physical exam demonstrates a positive valgus stress test. What is the most likely diagnosis? A. Medial epicondylitis B. Lateral epicondylitis C. Osteochondritis dissecans D. Olecranon bursitis E. Ulnar collateral ligament tear

Ulnar collateral ligament tear

The etiology of nursemaid's elbow involves the radial head slipping under the ___________ ligament.

annular

A 38-year-old man comes to the clinic because of pain and tingling at his left elbow and in the fourth and fifth fingers of his left hand for the past two months. He began working as a long-haul truck driver three months ago. Physical examination shows mild atrophy of the hypothenar eminence and intrinsic muscles of the hand. When attempting to pinch a sheet of paper between his left thumb and index fingers, he shows weakness and flexion of the interphalangeal joint of the thumb. When attempting to make a fist with his left hand, the fourth and fifth digits do not flex. Which of the following is the most likely diagnosis is most likely injured? A. Ulnar tunnel syndrome B. Cubital tunnel syndrome C. Medial epicondylitis D. Ulnar collateroal ligament tear E. Elbow osteoarthritis

Ulnar tunnel syndrome (Guyon's canal syndrome) *atrophy at hypothenar eminence - think wrist