Gross Anatomy Exam 2 Injuries

Question 1

Fracture at the clavicle

Answer 1

• common in children, indirect blow FOOSH, direct fall on shoulder
• SCM elevates medial clavicle, traps unable to hold up, coracoclavicular ligament prevents AC dislocation
• no nerve damage

Question 2

Transverse Fracture of shaft

Answer 2

• results from direct blow
• deltoid will carry proximal fragments laterally
• radial nerve is at risk of damage

Question 3

Spiral Fracture of Shaft

Answer 3

• indirect result of FOOSH
• overriding of fractured end, foreshortening
• radial nerve is at risk of damage

Question 4

Intercondylar Fractures

Answer 4

• results in a severe fall on flexed elbow
• may separate condyle from shaft completely
• may damage median or ulnar nerves

Question 5

Fracture of Radius or Ulna

Answer 5

• usually from severe injury, can be independent, Colle’s fracture distal 2cm of radius, common in adults 50+ and females, slip and FOOSH
• ulnar styloid often avulsed, distal fragments of radius is displaced posteriorly, posterior angulation happens in the forearm, dinner fork deformity
• no nerve damage and it heals well because of great blood supply to are

Question 6

Fracture to Scaphoid

Answer 6

• most commonly fractured carpal, fall on hand when ABD, fracture goes across narrow part of scaphoid
• pain on lateral side during ext. and ABD, radiograph shows fracture 10-14 days later, healing is slow b/c of bad BS, avascular necrosis, may need surgical fusion
• no nerve damage, bad blood supply

Question 7

Separated Shoulder

Answer 7

• AC joint is weak and easily injured by direct blow, contact sports, FOOSH
• severe when both acromioclavicular ligament and coracoclavicular ligaments tear, from CC log to shoulder falls, acromion passes inf. to clavicle
• no nerve damage

Question 8

Injury to Axillary Nerve (C5-6)

Answer 8

• fracture of surgical neck, dislocation go GH joint, compression by crutches, intramuscular injection
• deltoid atrophy becomes flattened, ABD of 15-90 affected
• Axillary nerve damaged, loss of sense to part of pros arm, superior lateral brachial cutaneous n.

Question 9

Rotator Cuff Injury

Answer 9

• injury or disease can be the cause, continued use of limb above horizontal
• may tear 1 or more SITS, produces instability of GH joint, supraspinatous most commonly injured, more avascular near acromion, no ability to ABD the first 15 degrees
• no real nerve damage

Question 10

Injury to Long Thoracic Nerve

Answer 10

• nerve takes superficial course lying on serratus anterior, knife fight, mastectomy or weapon directed at thoracic
• medial border of scapula moves lat and posteriorly, away from thoracic wall when hand is pressed against wall, winged scapula, arm can’t ABD past 90 b/c scap rot.
• no sensory loss

Question 11

Brachial Plexus Lesions (Upper

Answer 11

• caused by pathology, trauma or compression, roots or trunks can be hurt
• proximal muscles can have complete or incomplete paralysis and ability to feel pain

Question 12

Brachial Plexus Lesions (Lower)

Answer 12

• caused by pathology, trauma or compression, roots or trunk can be hurt,
• distal muscles are affected and can have paresis, paralysis or ability to feel pain

Question 13

Lower Brachial Plexus Injury

Answer 13

• much less common, when upper limb is pulled superiorly
• injures inferior trunk (8-T1) Klumke Palsy, may avulse roots, claw hand, unopposed action of extensors
• sensory loss to medial part of dorsum of hand by dorsal branch of ulnar n. AND medial 1/2 digits of palmar surface by Palmar branch and Palmar digital branches of Ulnar

Question 14

Upper Brachial Plexus Injury

Answer 14

• injury from increased angle b/w neck and shoulder, horse throws body, baby with shoulder dystocia
• streches or tears C5-6 nerve roots and superior trunk, Erb-Duchenne Palsy = paralysis of shoulder and arm, waiters tip position, can’t ADD, MR or ext arm
• sensory loss to superior lateral cutaneous n AND lateral antebrachial cutaneous n.

Question 15

Bursitis of Elbow

Answer 15

• falls on elbow or from infection of the skin covering olecranon, repeated excessive pressure causes inflammation
• subcutaneous olecranon bursitis, students elbow
• no nerve damage

Question 16

Dislocation of Elbow Joint

Answer 16

• fall on hand when elbow flexed, hyperextension, blows that drive ulna posterior and posteriolateral
• radius and ulna dislocate posteriorly, ulnar collateral is often torn, head of radius, coronoid or olecranon may fracture
• Ulnar nerve damaged, numbness in little fingers and weakness of flex and ulnar deviation

Question 17

Biceps Tendonitis

Answer 17

• long head of biceps brachia as it moves in IT grove, sports involving throw or raquet, repetitive micro trauma, tight narrow IT groove
• produces tenderness/pain and crepitis (crackling sound)
• no nerve damage

Question 18

Rupture of Tendon of Long head of BB

Answer 18

• occurs in 35+, wear and tear inflamed tendon in IT groove, overhead movements and forceful flexion
• tendon torn from supraglenoid tubercle, associated with a pop and snap, results in popeye deformity
• no nerve damage

Question 19

Injury to Musculocutaneus Nerve (C5-7)

Answer 19

• rare injury but from knife fight
• arm flexors, shoulder flex weakened, flex of elbow is weakened, supination of forearm weak
• sensory loss to lateral surface of forearm by lateral ante brachial cutaneous n.

Question 20

Injury to Radial Nerve (C5-8)

1st type

Answer 20

• most commonly injured n., symptoms depend on level
• to radial superior to origin of its branches to triceps, improper crutches, saturday night palsy, post dislocation of GH joint
• wrist drop, inability to ext wrist and digits at MP joints, wrist assumes flexed position
• sensory loss to inferior lateral arm, posterior arm, forearm, dorsum of hand and lateral fingers by the lower brachial cutaneous, post brachial cutaneous and ante brachial cutaneous, superficial radial nerves

Question 21

2nd type of Radial Nerve Injury

Answer 21

• injury to radial groove, only weakens the triceps, fracture to humeral shaft
• only medial head of triceps is affected, posterior forearm compartment affected, wrist drop
• sensory loss to dorsum of hand and lateral fingers, superficial radial nerve

Question 22

Medial Epicondylitis

Answer 22

-inflammation of common flexor tendon, golfers elbow
-overuse of flexors that require gripping
-pitchers, golfers and rock climbers
_RICE to recover

Question 23

Injury to Median Nerve (C6-T1) at Elbow

Answer 23

• fracture of lacerations at supracondylar ridge, loss of flex. of IP in 1-3 digits, weakened flex of PIP in 4 and 5, weakened flex of MP at 2 and 3, thenar muscles function is lost, Hand of Benidiction
• sensory loss to lateral 2/3 of palm and palmar side of radial 3 1/2 digits

Question 24

Impingment of Median nerve at AIN

Answer 24

-flexor digitorum profundus and flexor pollicis longus are affected
attempt to make an okay sign results in a pinch posture

Question 25

Pronators Syndrome

Answer 25

• nerve entrapment impingement syndrome, compression of median nerve by pronator teres, often happen during pregnancy
• pain and tenderness at proximal aspect of forearm, Hyperesthemia of central palm and palmar aspects of radial 3 1/2 digits, weakness with flexion and pronation of forearm

Question 26

Injury to Ulnar Nerve

Answer 26

27% of nerve lesions effect ulnar n.

• posterior to medial epicondyle, cubital tunnel, at the wrist and in the hand
• power to ulnar deviate is gone, wrist flexion is impaired, cant make a fist, IP joints cent extend, claw hand
• sensory loss to medial aspect of palm and dorsum of hand as well as medial 1 1/2 digits