- 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)
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:
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:
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 :)
$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
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
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
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:
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor digitorum superficialis
- Flexor carpi ulnaris
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)
Elbow: flexion
Wrist: pronation
What?
Biceps Brachii tendon (distal attachment to radial tuberosity)
Ulna
Radius (with radial tuberosity)
Sunday, February 11, 2018
Ulnar Collateral, Common Flexor Tendon
Where: medial elbow
What:
Ulnar Collateral Ligament
Humerus
Ulna
Ulnar Nerve
Common Flexor Tendon
What:
Ulnar Collateral Ligament
Humerus
Ulna
Ulnar Nerve
Common Flexor Tendon
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor digitorum superficialis
- Flexor carpi ulnaris
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:
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.
What? Pronator teres (two heads, humerus and ulnar)
Median nn.
This one is especially fascinating and tricky so I illustrated the anatomy first.
Thursday, February 8, 2018
Lateral Elbow: supinators
Where?
What?
Biceps brachii tendon
Supinator
Radius
Radial tuberosity (pink)
How? Motion in suppination
What?
Biceps brachii tendon
Supinator
Radius
Radial tuberosity (pink)
How? Motion in suppination
Wednesday, February 7, 2018
Monday, February 5, 2018
Anterior Elbow MSK Ulltrasound
https://drive.google.com/open?id=1CqnXQGxAWH5frhVLbO_6jZL1-Ses07VM
I'm working on drafts of simple easy to interpret MSK ultrasound guides. Here is elbow!
I'm working on drafts of simple easy to interpret MSK ultrasound guides. Here is elbow!
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Back to MSK today. I was reviewing pathologic cases in the elbow an realized the fun never stops. There are endless iterations of infectio...