{"id":7345,"date":"2025-08-18T00:01:00","date_gmt":"2025-08-18T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7345"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-2-ck-question-of-the-day-elbow-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Elbow pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\/#References\" >References\u00a0<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today, we\u2019re examining a clinical case of a 4-year-old child in the ER with elbow pain. What&#8217;s the the likely cause?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 4-year-old boy is brought to the emergency department by his mother to be evaluated for elbow pain. He was forcefully pulled onto the curb by his mother after inadvertently stepping into the street. The patient has refused to move his right arm since the incident. Vitals are within normal limits. Physical examination shows an irritable child holding his right upper limb with his left hand. The affected elbow is flexed and the forearm pronated. There is no visible erythema, swelling, or deformity. There is limited range of motion on physical examination. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following structures is most likely involved in this patient\u2019s condition?\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Biceps tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Annular ligament<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lateral epicondyle tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Medial epicondyle tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Interosseous membrane of the forearm<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Annular ligament<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Biceps tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Biceps tendon rupture typically occurs in older adults secondary to forceful extension of the elbow on a fully contracted biceps muscle. Patients may hear or feel a \u201cpopping\u201d sensation. There is often a visible \u2018Popeye deformity&#8217; in the mid-upper arm reflective of the shortened biceps brachii. Limited range of motion at the elbow joint as seen in this patient would not be expected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lateral epicondyle tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Lateral epicondyle tendonitis can cause pain and tenderness at the lateral elbow. However with this condition there is full range of motion of the elbow joint.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Medial epicondyle tendon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Medial epicondyle tendonitis can cause pain and tenderness at the medial epicondyle. However with this condition there is full range of motion of the elbow joint.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Interosseous membrane of the forearm<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The interosseous membrane of the forearm is a connective tissue that lies between the radius and ulna. It is usually affected in patients with a radius or ulna fractures following a fall on an outstretched hand.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"970\" height=\"544\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/Radial-Head-Subluxation-and-Dislocation-2.png\" alt=\"RADIAL HEAD SUBLUXATION AND DISLOCATION\nForearm is pronated\nClinical Features:\n* Crying\n* Refuse to use arm\n* Pain\nAnular Ligament\nRadial Head (not fully formed)\nPartial dislocation &quot;Pulled Elbow&quot;\" class=\"wp-image-7348\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/Radial-Head-Subluxation-and-Dislocation-2.png 970w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/Radial-Head-Subluxation-and-Dislocation-2.png?resize=300,168 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/Radial-Head-Subluxation-and-Dislocation-2.png?resize=768,431 768w\" sizes=\"auto, (max-width: 970px) 100vw, 970px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Radial head subluxation (i.e. nursemaid\u2019s elbow) <\/strong>is a common injury in young children (1-4 years of age). It is the most common upper extremity injury in infants and young children presenting to the emergency department. It is typically caused by <strong>axial traction on an outstretched, pronated forearm<\/strong>. With sudden traction on the distal radius,<strong> the annular ligament <\/strong>slips over the head of the radius at the level of the radiohumeral joint, where it becomes <strong>entrapped<\/strong>.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Children with radial head subluxationIt typically present holding the injured arm in a flexed and pronated position and refusing to move it. Patients present with sudden, acute pain of the affected arm. Notably, <strong>pain does not always localize to the elbow<\/strong> and there is typically <strong>no swelling<\/strong>,<strong> bruising<\/strong>,<strong> or deformity<\/strong> of the arm. The diagnosis is clinical and most patients can be managed with closed manual <strong>reduction<\/strong> by either hyperpronation of the forearm (preferred) or supination of the forearm with flexion of the elbow.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Radial head subluxation (i.e. nursemaid\u2019s elbow) <\/strong>refers to a displacement of the annular ligament over the head of the radius and entrapment of the annular ligament in the radiohumeral joint. It results from axial traction on an outstretched pronated forearm, typically<strong> <\/strong>in a child &lt;5 years of age.\u00a0\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Anterior_cruciate_ligament_injury\">Anterior cruciate ligament injury<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Welch, R., Chounthirath, T., &amp; Smith, G. A. (2017). Radial head subluxation among young children in the United States associated with consumer products and recreational activities. Clinical Pediatrics, 56(8), 707-715.\u00a0<\/li>\n\n\n\n<li>Rudloe, T. F., Schutzman, S., Lee, L. K., &amp; Kimia, A. A. (2012). No longer a \u201cnursemaid\u2019s\u201d elbow: mechanisms, caregivers, and prevention. Pediatric emergency care, 28(8), 771-774.\u00a0<\/li>\n\n\n\n<li>Hill, C. E., &amp; Cooke, S. (2017). Suppl-8, M6: Common Paediatric Elbow Injuries. The open orthopaedics journal, 11, 1380.\u00a0<\/li>\n\n\n\n<li>Boutis K (2020). Pediatric orthopedic emergencies. Tintinalli J.E., &amp; Ma O, &amp; Yealy D.M., &amp; Meckler G.D., &amp; Stapczynski J, &amp; Cline D.M., &amp; Thomas S.H.(Eds.), Tintinalli&#8217;s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/06\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-4438\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/06\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/06\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis by Elsevier today! Access your\u00a0<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>\u00a0and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Test your Step 2 CK knowledge on a common pediatric elbow injury. Which structure is affected in a child presenting with pain, limited motion, and forearm pronation?<\/p>\n","protected":false},"author":202,"featured_media":7347,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,45],"tags":[1333,1335,829,1334,1329,1332,1328,1331,1330,671],"class_list":["post-7345","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2","tag-annular-ligament","tag-child-trauma","tag-elbow-pain","tag-forearm-injury","tag-nursemaids-elbow","tag-orthopedic-emergencies","tag-pediatric-elbow-injury","tag-pediatric-emergency","tag-radial-head-subluxation","tag-usmle-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0Elbow pain - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-elbow-pain\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Elbow pain - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Test your Step 2 CK knowledge on a common pediatric elbow injury. 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