Clinical Cases

Question 1

The typical sight of fracture of clavicle is –

Answer 1

Middle third

Question 2

The typical injury at the medial end of clavicle is a – or – dislocation of Sternoclavicular joint

Answer 2

Anterior or posterior

Question 3

Posterior dislocation of clavicle may have impact on what structures?

Answer 3

Impinge on the great vessels of the superior mediastinum and compress or disrupt them

Question 4

In the glenohumeral joint – dislocation occurs most frequently

Answer 4

Anterior

Question 5

Clinically all anterior dislocations are –

Answer 5

Anteroinferior

Question 6

In an anterioinferior dislocation the ________ nerve maybe injured by direct compression of the humeral head on it and the ________ nerves maybe affected due to the lengthening effects of the humerus producing _______ disorder

Answer 6

Axillary

Radial nerve, radial nerve paralysis

Question 7

__________________ dislocations of the Glenn humeral joint is rare and its causes include ____________.

Answer 7

Posterior

Epileptic seizure due to electrocution

Question 8

The two main disorders of the rotator cuff are – and –

Answer 8

Impingement and tendinopathy

Question 9

Of the four muscles that form the rotator cuff the blood supply to – tendon is relatively poor

Answer 9

Supraspinatous tendon

Question 10

The accessory nerve can be evaluated by testing the function of trapezius muscle. how is this generally done?

Answer 10

By asking patients to shrug their shoulders against resistance.

Question 11

Explain the quadrangular space syndrome.

Answer 11

Hyper trophy of the quadrangular space muscles or fibrosis of the muscle edges impinge on the axillary nerve. uncommonly, this produces weakness of the deltoid muscle. Typically, it produces atrophy of the terrace minor muscle, which may affect the control that the rotator cuff muscles exert upon shoulder movement.

Question 12

A tap on tendon of biceps brachii at the elbow is predominantly used to test what?

Answer 12

C6 segment of spinal cord

Question 13

A tap on the tendon of triceps brachii is used to test which nerve?

Answer 13

C7

Question 14

Low BP may be caused by _______ , ____________ or ___________.

Answer 14

High blood loss
Infection
Myocardial infarction

Question 15

Explain how sphygmomanometer is used to measure BP

Answer 15

The sphygmomanometer is a device that inflates a cuff around the mid portion of the arm to compress the brachial artery against the humerus. The cuff is inflated so that it exceeds the normal systolic BP. the clinician places a stethoscope over the brachial artery in the cubital fossa and auscultates for the pulse. as the pressure in the arm cuff of the sphygmomanometer reduces just below the normal systolic blood pressure the thumping sound of the blood becomes audible. As the pressure further drops the thumping sound becomes clearer. once the pressure drops below the diastolic BP the thumping becomes inaudible. so using a range of when the thumping first became audible to when it becomes last audible, the patient’s BP is determined.

Question 16

Low BP may be caused by _______ , ____________ or ___________.

Answer 16

High blood loss
Infection
Myocardial infarction

Question 17

Explain how sphygmomanometer is used to measure BP

Answer 17

The sphygmomanometer is a device that inflates a cuff around the mid portion of the arm to compress the brachial artery against the humerus. The cuff is inflated so that it exceeds the normal systolic BP. the clinician places a stethoscope over the brachial artery in the cubital fossa and auscultates for the pulse. as the pressure in the arm cuff of the sphygmomanometer reduces just below the normal systolic blood pressure the thumping sound of the blood becomes audible. As the pressure further drops the thumping sound becomes clearer. once the pressure drops below the diastolic BP the thumping becomes inaudible. so using a range of when the thumping first became audible to when it becomes last audible, the patient’s BP is determined.

Question 18

The fracture in the mid-shaft of the humerus is most likely to damage _____________ nerve of the arm. What are the symptoms that the patient exhibits if this nerve is damaged?

Answer 18

A fracture in the mid-shaft of the humerus is most likely to damage the radial nerve of the arm. This injury is typical and the nerve should always be tested when such a fracture is reported. The patient’s symptoms usually include wrist drop and sensory changes over the dorsum of the hand.

Question 19

In the arm and forearm, the median nerve is usually not injured by trauma. Why?

Answer 19

Because of its relatively deep position.

Question 20

The most common neurological problem associated with the medial nerve is _____________.

Answer 20

Compression beneath the flexor retinaculum at the wrist (carpal tunnel syndrome).

Question 21

Explain the carpal tunnel syndrome and its clinical significance.

Answer 21

On very rare occasions, a fibrous band may arise from the anterior aspect of the humerus beneath which the median nerve passes. This is an embryological remnant of the coracobrachialis muscle and is sometimes called the ligament or Struthers. Occasionally this ligament may calcify causing the compression of the median nerve and the subsequent weakness of the flexor muscles of the forearm and thenar muscles. Nerve conduction studies will demonstrate the site of nerve compression

Question 22

When a fracture or soft tissue trauma suspected in the elbow joint, what are the tests that the patient is subjected to?

Answer 22

Plain lateral and AP radiograph

Question 23

When a fracture or soft tissue trauma suspected in the elbow joint, what are the tests that the patient is subjected to?

Answer 23

Plain lateral and AP radiograph

Question 24

What is pulled elbow disorder? How is it treated?

Answer 24

Pulled elbow is a disorder that typically occurs in children under 5 years of age. It is commonly caused by a sharp pull of the child’s hand, usually when the child is pulled up a curb. The not-yet-developed head of the radius and the laxity of the anular ligament of radius allow the head to sublux from this cuff of tissue. Pulled elbow is extremely painful, but can be treated easily by simple supination and compression of the elbow joint by the clinician. When the radial head is relocated the pain subsides immediately and the child can continue with normal activity.

Question 25

Epicondylitis in tennis players:

Epicondylitis in golf players:

Answer 25

Tennis players:- pain occurs I;lateral epicondyle and common extensor origin

Golf players:- medial epicondyle and common flexor origin

Question 26

Monteggia’s fracture

Answer 26

Fracture of the proximal 1/3rd of ulna and anterior dislocation of head of radius

Question 27

Galeazzi’s fracture

Answer 27

Fracture of distal 1/3rd of the radius and subluxation (partial dislocation) of the head of ulna(distal part of ulna is called the head of ulna)

Question 28

Colles’ fracture

Answer 28

Fracture + posterior displacement of distal end of radius