Source / episode info

• **Episode:**619
• **Title:**DIP Ep 619: USMLE MSK Series (Elbow, Neck, Back)
• **Published:**2025-08-13
• Source:Episode page

One-liner

This episode reviews high-yield musculoskeletal topics including the differential diagnosis of elbow pain (Cubital Tunnel Syndrome, epicondylitis), differentiating cervical myelopathy from radiculopathy based on UMN/LMN signs, and recognizing red flags for low back pain such as cauda equina syndrome or spinal stenosis.

High-yield summary

• Elbow: Cubital Tunnel Syndrome involves compression of the ulnar nerve; Lateral Epicondylitis (Tennis Elbow) is due to wrist extension overuse; Medial Epicondylitis (Golfer's Elbow) is due to wrist flexion overuse.
• Olecranon Bursitis: Painful mass at the posterior elbow, but it does not cause restricted range of motion (ROM). Aspirate if signs of infection or crystal deposition are present; never inject steroids.
• Spinal Cord vs Nerve Root: Myelopathy involves spinal cord compression and presents with mixed UMN/LMN signs; Radiculopathy involves nerve root compression and typically presents with predominant LMN signs and dermatomal pain radiating down the limb.
• Lumbar Spine Red Flags (Need Imaging): Suspect imaging if there are signs of cauda equina syndrome (bowel/bladder dysfunction, saddle anesthesia), suspected infection (IV drug use, UTI spread), or malignancy compression.
• Spinal Stenosis: Characterized by neurogenic claudication, which is worsened by standing/extension and relieved by sitting down or leaning forward ("shopping cart sign").

Learning objectives

• Differentiate between lateral epicondylitis (Tennis Elbow) and medial epicondylitis (Golfer's Elbow) based on pain location and associated muscle groups.
• Apply clinical reasoning to distinguish myelopathy from radiculopathy using patterns of upper vs. lower motor neuron deficits.
• Identify the classic physical exam findings that differentiate spinal stenosis (neurogenic claudication) from lumbar strain or herniated disc.
• Recognize "red flag" symptoms in low back pain requiring urgent imaging (e.g., cauda equina syndrome, signs of infection/malignancy).
• Understand appropriate conservative management for most musculoskeletal complaints and when advanced intervention is necessary.

Board exam buzzwords