msk- upper limb, functional anatomy and clinical applications

Question 1

clavicular fracture

Answer 1

Clavicular fractures often occur from an outstretched hand

Depending on the damage to ligaments, the bone ends may be displaced

4 different types of fracture

Question 2

4 types of clavicular fracture

Answer 2

Type 1 – fracture with no disruption of ligaments – no displacement. Sling for few weeks
Type IIA – fracture medial to the ligaments - ligaments intact
Type IIA - fracture between coracoclavicular ligaments – conoid disrupted, trapezoid intact. Medial fragment of clavicle may elevate
Type III – Fracture through acromioclavicular joint – no displacement – often missed and may cause later on painful osteoarthritis

Question 3

shoulder dislocation

Answer 3

Different types of dislocations - anterior, posterior or inferior.

Anterior dislocation most common – 95% of all dislocations
Seen at all ages but most common in adolescents and young adults
Most common cause – fall on outstretched hand

Even within the anterior dislocations - multiple types – most common one if the subcoracoid dislocation!

Question 4

winged scapula

Answer 4

long thoracic nerve damage

Lesion of the long thoracic nerve - weakness of the serratus anterior muscle –> winging of the scapula.

Scapula is drawn upwards and towards the spine by the unopposed action of trapezius

Lesion by compression of the nerve, trauma, sports-related injuries…

IF severe -limitation of normal elevation of the shoulder because of unstable scapula (not able to appropriately rotate laterally and maintain its position along the chest wall).
Patient may use overactive rhomboid function and trapezius function to compensate.

Question 5

nursemaid elbow

Answer 5

Longitudinal traction applied to the limb – e.g. by pulling the hand of the child when pulled up a curb or when playing (e.g parents making the child swing)

Reduction brings almost immediate and complete relief of pain + child begins to use the elbow again. If the reduction is successful, immobilization is not necessary. The risk of recurrent subluxation is minimal.

Question 6

tennis elbow

Answer 6

lateral epicondylitis
posterior compartment of the forearm), specifically:
Extensor carpi radialis brevis (most involved)
Extensor digitorum
Extensor carpi radialis longus
Extensor carpi ulnaris

symptoms- pain along forearm and elbow
causes- overload injury

Question 7

golfers elbow

Answer 7

Form of tendonitis (swelling/inflammation of tendons)
Medial elbow pain

(anterior compartment of the forearm), specifically:
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor carpi radialis
Pronator teres

symptoms- palm side of forearm, from elbow to wrist
causes- overuse/overloading of tissue. excessive force used to bend the wrist