MCQs – Upper Extremity/Elbow 2

MCQs-UE/elbow 2
epicondylitis from PIN entrapment can be difficult – one of the clues may be pain/discomfort with pronation/supination – this is supposedly more indicative of PIN entrapment. Theoretically, lateral epicondylitis should not move!

– entrapment of the musculocutaneous nerve as it emerges between biceps and brachialis as the lateral antebrachial cutaneous nerve can cause sensory deficit in the forearm – beware in the throwing athlete!

– in a 16 year old, treat the Monteggia fracture like an adult – ORIF ulna, reduce the radial head.

– be wary of necrotizing fasciitis in a post-op wound (?!?!) – they need urgent extensive fasciotomies and excision of involved tissue. Because the infection often does not involve the muscle like gas gangrene, you may get away with just doing fasciotomies and excision rather than amputation.

– silicone implants: 2 acceptable uses: staged tendon reconstruction (Hunter rods), MCP arthroplasty. THAT’S IT!

– some have advocated using a silicone implant for the distal ulnae in caput ulnae syndrome – I’m not sure if this is still acceptable. Do not use silicone as a lunate replacement, radial head replacement, or in the PIP joints (these are better off fused).

– for elbow dislocation: vascular injury in about 7%; recurrence is UNCOMMON (stiffness is more common); the mechanism is usually hypersupination with axial load and some valgus.

– if treating a humeral shaft fracture with functional bracing – plan on using it for 8 weeks. Watch out for varus angulation.

– remember the acceptable alignment of closed treatment of humeral shaft: 20 AP angulation, 30 of varus, 3 cm of shortening. These are probably more acceptable midshaft and higher than in the distal shaft.

– the most compelling reason to operate on cubitus varus is COSMESIS

– for most significant compound injuries to the forearm, try to plate the fractures rather than x-fix

– remember the indications for ORIF of humeral shaft fractures
– open
– vascular injury
– segmental
– bilateral
– floating elbow (ipsilateral forearm)
– multi-trauma
– head injury
– unacceptable alignment – 20 AP, 30 varus, 3 cm short
– pathologic
– iatrogenic nerve injury following reduction

– at 3-4 month after radial nerve injury – do EMG’s and consider your options – if there is some reinnervation, then wait, if not, then explore

– median nerve compression in the forearm – lacertus fibrosis, pronator teres, fibrous arch of FDS, abberant vessels; ligament of Struthers can compress the nerve but is in the ARM, not forearm.

– distal biceps tendon rupture: common in MALES 30-50; previous steroid use; causes decreased supination strength; and can be detected on MRI; it is usually the dominant extremity
– when doing radial nerve palsy tendon transfers – don’t take both the FCU and FCR (take one or the other)

– the best indication for total elbow replacement is in the rheumatoid patient – their functional demands are the least!

– the elbow joint is not completely a hinge joint.

– hard to know if tension band alone vs tension band with intramedullary screw is better – I’d think the latter, but it has been biomechanically been shown to be about equal.

– 3 week old lateral condyle fracture – fix in situ.

– best treatment for Mason II fracture radial head – probably FIX it (current thinking is to check to see if there is mechanical block, then decide with that). By being a Mason II it implies 2 mm of displacement or more, so it implies that you should probably ORIF it.

– for longitudinal injuries: distal ulnar pain may occur if there is proximal radial migration greater than 1 cm resulting in DRUJ incongruity.

– for a dislocated elbow that is out for more than 7 days – probably unlikely to get it reduced closed (definitely not after 3 weeks). You need to do an open reduction and release the contractures and get it back in. Be ready to reconstruct ligaments and use a hinge external fixator.

– the only really good indication for excising a radial head is if it is a