4.1 of 62 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 47-year-old former professional wrestler is helping his friend move some furniture. A large sofa slips from the patient's grip, which causes his elbow to extend. He feels a pop and develops ecchymosis about his antecubital fossa. He discusses his care with a hand surgeon who recommends surgical repair, but the patient is reluctant. Conservative management of this pathology has been shown to result in all of the following EXCEPT?
Lateral antebrachial neuritis
Loss of supination strength
Loss of supination endurance
Loss of flexion strength
Delayed return to activities
Select Answer to see Preferred Response
A 42-year-old man is performing his final deadlift at the annual CrossFit games when he suddenly experiences severe pain in his right arm and is unable to continue. Physical examination is significant for medial brachial ecchymosis, swelling and tenderness over the antecubital fossa, and significantly diminished supination strength. Radiographs are unremarkable and an MRI is shown in Figure A. Given his age and activity level, he is taken for primary surgical repair utilizing a single-incision technique with combined cortical button and interference screw fixation. When the patient returns to clinic, he is found to have experienced the most common neurologic complication associated with this procedure. What is the course of the affected nerve?
Branches distal to the elbow, passing between two heads of pronator teres, running along volar aspect of the flexor digitorum profundus
Dives through the supinator, coursing around the radial neck within the deep compartment of the forearm
Pierces the fascia of the biceps brachii and lays lateral to biceps tendon, deep to the cephalic vein, until emerging and running superficially along the brachioradialis
Runs deep to the brachioradialis and lateral to the radial artery, piercing the fascia of the brachioradialis and becoming superficial within the distal forearm
Runs with brachial artery where it enters the forearm between the pronator teres and biceps tendon, traveling between the flexor digitorum superficialis and profundus
A 44-year-old male sustains the injury shown in Figures A and B. Which of the following statements is true in regards to the treatment for the injury depicted?
Non-surgical management results in improved strength and range of motion
The most common complication related to surgical management is an injury to the terminal branch of the musculocutaneous nerve
Surgical fixation with bone tunnels offers the weakest repair
Surgical fixation with a cortical button offers the strongest repair
Synostosis is the most common complication following a single-incision surgical approach
A 44-year-old left-hand dominant carpenter experienced immediate left elbow pain after trying to stop a heavy object from falling two days ago. Figure A shows a clinical image of the patient upon presentation. Physical exam shows full strength with wrist flexion, wrist extension, and pronation, but notable weakness with supination of the forearm. Sensory exam shows no deficits in the forearm or hand. There is a negative milking maneuver test and a positive hook test. Radiographs are shown in Figure B. What is the next most appropriate step in management?
Sling use as needed for comfort and progressive physical therapy
Allograft reconstruction of the distal biceps tendon
Ulnar collateral ligament reconstruction
Distal biceps tendon avulsion repair
Brachioradialis and ECRB avulsion repair
A patient presents to your office for evaluation of arm pain. Upon evaluation, a diagnosis of rupture of the long head of the biceps tendon is made. Which of the following photographs would best corroborate this diagnosis?
A 28-year-old male sustains a distal biceps rupture while lifting a heavy table and elects to undergo surgical repair using a two-incision technique. What is the most likely neurologic deficit to occur as a complication of this surgical approach?
Intrinsic hand weakness
Numbness of the volar radial three and a half digits
Wrist extension weakness
Numbness to lateral aspect of volar forearm
Inability to flex thumb and index interphalangeal joints
A 40-year-old male was moving his furniture several days ago when he developed anterior forearm pain. On physical exam he is tender just distal to the antecubital fossa. He has decreased strength on supination and elbow flexion when compared to the contralateral side. His MRI is shown in Figures A and B. His injury typically occurs in what portion of the tendon’s distal insertion?
What nerve is injured most commonly during the superficial dissection when repairing a distal biceps rupture through a single incision anterior approach?
Medial antebrachial cutaneous nerve
Lateral antebrachial cutaneous nerve
Superficial radial nerve
Posterior interosseous nerve
A 35-year-old carpenter has pain in the antecubital fossa that is worse with turning a screwdriver. He has undergone non-operative treatment for 6 months without relief. On physical examination his hook test is normal and there is pain and weakness with resisted supination. Radiographs are shown in Figures A-C. A MRI of the right elbow is shown in Figure D. The next most appropriate treatment is?
Exploration of the radial tunnel
Superficial radial neurectomy
Detachment and repair of the biceps tendon
Transfer of the biceps to the brachialis
EMG with nerve conduction study
A patient sustains a distal biceps brachii tendon rupture. If treated non-operatively, the greatest loss of strength would be seen with which activity?
Shoulder forward flexion
Shoulder internal rotation
A 42-year-old male has a suspected distal biceps rupture with a tendon that can be palpated but is painful during the hook test examination. Which of the following is the most appropriate next step?
Operative exploration of distal biceps tendon
Immobilization for three weeks followed by repeat physical examination
Early physical therapy with emphasis on ROM and strengthening