- Email: [email protected]
CME questions on the Elbow issue
CME SECTION
CME questions on the Elbow issue 1 Which of the following inserts on the supinator crest of the ulna A B C D E
B C
Annular ligament Brachialis Extensor carpi ulnaris Flexor digitorum profundus Lateral ulna collateral ligament
D E
2 Which of the following statements concerning the posterior interosseous nerve is incorrect A B C
D E
6 Which of the following indications for total elbow replacement is associated with the worst long term outcomes as measured by survivorship of the implant for whatever reason, including infection and loosening
It is at risk in both the Kocher and Kaplan interval approaches to the elbow It should always be identified if supinator is to be detached from the radius Pronation of the forearm moves the point at which the PIN crosses the radius more distally compared to any fixed surface marker laterally The forearm should be fully pronated during lateral approaches to reduce the risk of injury to this nerve The PIN is relatively tethered because it winds around the radial neck, keeping it closely applied
A B C D E
A B C D E
Lateral antebrachial Medial antebrachial Median Radial Ulnar
B C D E
A B C D E
Apply a cast in full flexion and retain in this position for 3 weeks Carry out a further manipulation under sedation Carry out an open repair of the collateral ligaments Explore the elbow to remove interposed soft tissues Splint for a few days then mobilise, repeating radiograph at 1 week
A B C D E
Range of movement 20 e140 with multiple loose bodies
ORTHOPAEDICS AND TRAUMA 30:4
Infection Instability Joint ankylosis Neurological injury New onset heterotopic ossification
9 In direct lateral approaches to the elbow, between what limits, measured from the lateral epicondyle, can it safely be assumed that the radial and posterior interosseous nerves should not be in the operative field
5 Which of the following cases of elbow stiffness would most appropriately be treated by a lateral column procedure A
Haemophilia Post traumatic arthritis Primary osteoarthrosis Rheumatoid disease Seronegative inflammatory polyarthropathy
8 Which of the following complications is most frequently seen after open arthrolysis for significant elbow stiffness
4 After reduction of an acute elbow dislocation with no bony injury on radiographs EUA is stable but post reduction radiographs show slight subluxation, with increased space between the distal humerus and the centre of the olecranon notch of the ulna. What action is appropriate A
Haemophilia Post traumatic arthritis Primary osteoarthrosis Rheumatoid disease Seronegative inflammatory polyarthropathy
7 Which of the following conditions is most likely to be associated with preservation of the ulnohumeral articular cartilage and joint space
3 Which of the following nerves is potentially closest, in mm, to either the anterolateral or proximal anteromedial elbow arthroscopy portals A B C D E
Range of movement from 45 to 120 and impingement pain anteriorly Range of movement from 50 to 130 and anterior loose bodies Range of movement from 50 to 130 with impingement pain posteriorly Range of movement from 70 to 100 of flexion after minimally displaced distal humeral fracture
365
3 cm distal to 6 cm proximal 5 cm distal to 8 cm proximal 7.5 cm proximal to 7.5 cm distal 5 cm proximal to 8 cm distal 3 cm proximal to 6 cm distal
Ó 2016 Published by Elsevier Ltd.
CME SECTION
10 What is the effect of smoking on the risk of distal biceps tendon rupture A B C D E
B C D E
It is protective No effect Risk increased but only in those also taking anabolic steroids Risk increased seven fold in smokers Risk is twice as high in smokers
12 During elbow flexion and extension, which nerve demonstrates the shortest excursion of gliding at the specified site A B C
11 If the triceps is released from the olecranon over the half of its footprint closest to the tip of the olecranon, the fibres originating from which heads of the muscle will be affected A
D E
Lateral
ORTHOPAEDICS AND TRAUMA 30:4
Long Medial Medial and Lateral Medial and Long
366
Median nerve at elbow Median nerve in distal forearm No difference between median and ulnar nerves at either site Ulnar nerve at elbow Ulnar nerve in distal forearm
Ó 2016 Published by Elsevier Ltd.
CME questions on the Elbow issue 1 Which of the following inserts on the supinator crest of the ulna A B C D E
B C
Annular ligament Brachialis Extensor carpi ulnaris Flexor digitorum profundus Lateral ulna collateral ligament
D E
2 Which of the following statements concerning the posterior interosseous nerve is incorrect A B C
D E
6 Which of the following indications for total elbow replacement is associated with the worst long term outcomes as measured by survivorship of the implant for whatever reason, including infection and loosening
It is at risk in both the Kocher and Kaplan interval approaches to the elbow It should always be identified if supinator is to be detached from the radius Pronation of the forearm moves the point at which the PIN crosses the radius more distally compared to any fixed surface marker laterally The forearm should be fully pronated during lateral approaches to reduce the risk of injury to this nerve The PIN is relatively tethered because it winds around the radial neck, keeping it closely applied
A B C D E
A B C D E
Lateral antebrachial Medial antebrachial Median Radial Ulnar
B C D E
A B C D E
Apply a cast in full flexion and retain in this position for 3 weeks Carry out a further manipulation under sedation Carry out an open repair of the collateral ligaments Explore the elbow to remove interposed soft tissues Splint for a few days then mobilise, repeating radiograph at 1 week
A B C D E
Range of movement 20 e140 with multiple loose bodies
ORTHOPAEDICS AND TRAUMA 30:4
Infection Instability Joint ankylosis Neurological injury New onset heterotopic ossification
9 In direct lateral approaches to the elbow, between what limits, measured from the lateral epicondyle, can it safely be assumed that the radial and posterior interosseous nerves should not be in the operative field
5 Which of the following cases of elbow stiffness would most appropriately be treated by a lateral column procedure A
Haemophilia Post traumatic arthritis Primary osteoarthrosis Rheumatoid disease Seronegative inflammatory polyarthropathy
8 Which of the following complications is most frequently seen after open arthrolysis for significant elbow stiffness
4 After reduction of an acute elbow dislocation with no bony injury on radiographs EUA is stable but post reduction radiographs show slight subluxation, with increased space between the distal humerus and the centre of the olecranon notch of the ulna. What action is appropriate A
Haemophilia Post traumatic arthritis Primary osteoarthrosis Rheumatoid disease Seronegative inflammatory polyarthropathy
7 Which of the following conditions is most likely to be associated with preservation of the ulnohumeral articular cartilage and joint space
3 Which of the following nerves is potentially closest, in mm, to either the anterolateral or proximal anteromedial elbow arthroscopy portals A B C D E
Range of movement from 45 to 120 and impingement pain anteriorly Range of movement from 50 to 130 and anterior loose bodies Range of movement from 50 to 130 with impingement pain posteriorly Range of movement from 70 to 100 of flexion after minimally displaced distal humeral fracture
365
3 cm distal to 6 cm proximal 5 cm distal to 8 cm proximal 7.5 cm proximal to 7.5 cm distal 5 cm proximal to 8 cm distal 3 cm proximal to 6 cm distal
Ó 2016 Published by Elsevier Ltd.
CME SECTION
10 What is the effect of smoking on the risk of distal biceps tendon rupture A B C D E
B C D E
It is protective No effect Risk increased but only in those also taking anabolic steroids Risk increased seven fold in smokers Risk is twice as high in smokers
12 During elbow flexion and extension, which nerve demonstrates the shortest excursion of gliding at the specified site A B C
11 If the triceps is released from the olecranon over the half of its footprint closest to the tip of the olecranon, the fibres originating from which heads of the muscle will be affected A
D E
Lateral
ORTHOPAEDICS AND TRAUMA 30:4
Long Medial Medial and Lateral Medial and Long
366
Median nerve at elbow Median nerve in distal forearm No difference between median and ulnar nerves at either site Ulnar nerve at elbow Ulnar nerve in distal forearm
Ó 2016 Published by Elsevier Ltd.