Tuesday, February 27, 2018

Two Head Biceps

Anatomy Lesson today. This will preempt some shoulder MSK ultrasound anatomy.  A few key take aways I want to demonstrated before tomorrow:


  • Biceps Brachii has two heads: long and short. Short head is Superficial. Long head is Deep.
  • Long head (Biceps) goes under the Subscapularis Tendon on its way to the head of the Humerus. The short head runs over the Subscapularis muscle on it's way tot he coracoid process (Scapula)

Saturday, February 24, 2018

Radial Neck Fracture

Back to MSK today.

I was reviewing pathologic cases in the elbow an realized the fun never stops. There are endless iterations of infection, cancer, effusion that will result in similar pathologies. Rather than draw each, I thought I'd articulate a few ultrasound highlights that indicate underlying process:

  • Bony irregulars: osteochondral growth, intra-articular bodies, osteoid osteomoa, infection
  • Synovial hypertrophy: synovial fold syndrome, chondromatosis, seronegative spondyloarthropathies, rheumatoid arthritis
  • Nerve compression
  • Displaced fat pad
That being said, there is one that is particulary fascinating I will illustrate: fracture on ultrasound

What: 
Radius
Brachioradialis muscle body
Capitellum (humerus)

Where? Radial neck, the interface between radius and humeral capitellum

Note: bony step off with hypoechogeneic underlying bone. Also notice soft tissue effusion surrounding site. 

Thursday, February 22, 2018

Student Debt Calculation: How Much To Prevent Ballooning Interest?

Today is a departure from MSK medicine and a delve into finance. Particular that of personal finance. I'm a newly minted doctor in residency. I have an average loan debt. Today is a calculation into how much I need to contribute to prevent the principal balance exploding before making an attending salary. I graduated with $220,000 in debt. I attended a state allopathic school as an in-state student. I lived moderately conservative: no new car, small apartment, and no vacations. I did eat out more than I'd recommend in hindsight. I had a family gift of $20,000.

$220,000 is a lot of money. But I regularly hear about doctors that defer payment with a final balance of $350,000 to $500,000. A strange ratio game I always play is "is my annual salary greater than my debt?" I'm sure there's a formal and recommended income-to-debt ratio number, but 1:1 is my comfort level. So the question today is:

What annual payments are required to keep my debt at the same level?

Here's my balance




To protect my privacy, I blanked out my savings / checking accounts. They amount to around $15,000. I have one credit car that I'd like to tear up shortly. More on that later. But for the meantime it has a $5 balance.

So here's my balance: $222,322

My interest rate is: 5.625%

This means every year 5.625% of my balance is then added to my balance. The next year then 5.625% of the new balanced is added to my balance.



As you can see, things get out of hand quickly with the magic of compound interest.

I decided to figure out how much I can contribute every year to keep the number around $222,322. I'm not in the place to eliminate my debt, but I'm not able to prevent it from exploding. I'm a medical resident, so you know my salary is around $45,000 to $55,000.

The way I can prevent this is pay $12,505 every year before it capitalizes (capitalization means it gets added into the principal. Capitalization is what happens at the end of each arrow in the picture above.

My current required payments under my income plan is $331 per month. Of note, there is a 6 month deference available for new graduates. What a joke.  I understand one month to allow for moving, but anything beyond that is just a chance for interest accumulation. I didn't take this deal and started paying the day I had a paycheck

So how close does the required $331 get me to preventing my balance from exploding?

$331 x 12 months = $3,972.

This is nowhere close to $12,505 (8,533 short).

How much should I contribute?

$12,505 / 12 = $1,042 per month.

On a resident's salary that is around 30% of my take home pay.

Can I do it?

Stay tuned :)






















Monday, February 19, 2018

Pathologic Effusion in Posterior Elbow

Where?
Posterior Saggital Elbow


What?
Triceps Muscle
Triceps Tendon
Posterior Fat Pad (forgive "Bad" written below)
Trochlea (Humerus)
Olecranon (Ulna)
Pathologic Joint Effusion



Sunday, February 18, 2018

Posterior Elbow, Triceps

Where?
What?
Humerus (Trochlea)
Ulna (Olecranon)
Fat Pad
Triceps Muscle
Triceps Tendon
Hyaline Cartilage

Friday, February 16, 2018

CET and LCL

Where?
What?
Humerus (lateral epicondyle)
Radius (head)
Annular ligament
Radial Collateral Ligament
Common Extensor Tendon
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digiti minimi
  • Extensor carpi ulnaris 


Thursday, February 15, 2018

Medial Epicondyle, triceps, ulnar nerve

Where? Medial Epicondyle

What?
Humerus (medial epicondyle)
Triceps Brachii (with septum) muscle
Ulnar nerve
Common Flexor Tendnn:




Monday, February 12, 2018

Distal Biceps Brachii Tendon

Where?
Elbow: flexion
Wrist: pronation

What?
Biceps Brachii tendon (distal attachment to radial tuberosity)
Ulna
Radius (with radial tuberosity)


Saturday, February 10, 2018

Common Flexor Tendon, Ulnar Collateral Ligament, Medial Elbow

Where: Medial Elbow
What?
Humerus (Trochlea + Medial Epicondyle)
Ulna
Ulnar Collateral Ligament
Common Flexor Tendon
Common Flexor Muscles:
  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis
  • Flexor carpi ulnaris



Friday, February 9, 2018

Anterior Elbow Fossa: Pronator Teres + Median Nerve

Where? Anterior elbow joint recess @ distal end.


What? Pronator teres (two heads, humerus and ulnar)
Median nn.

This one is especially fascinating and tricky so I illustrated the anatomy first.





Here is a look at the appearance under ultrasound. Note the belly of muscle in short axis: no fibrillar structures. The median nn. is in short.



Thursday, February 8, 2018

Lateral Elbow: supinators

Where?
What?
Biceps brachii tendon
Supinator
Radius
Radial tuberosity (pink)

How? Motion in suppination



Wednesday, February 7, 2018

Biceps Brachii Tendon

What: Biceps Brachii Tendon

Where: 



Appearance (straightforward, not requiring mnemonic)


MCP Joint Follow-up

The answer was #1! Notice how ruddy the volar plate, extensor tendon appeared. For learning, I will start with the normal. Here is th...