Upper Limb Questions

Question 1

Fracture of the surgical neck of the humerus

Answer 1

• weakness in the ability to aBduct the arm at the shoulder
• some weakness in ability to laterally rotate the arm at the shoulder
• because the axillary artery is lesioned therefore deltoid (aBduct) and teres minor (external rotation) affected

Question 2

Fracture of the hook of hamate

Answer 2

• weakness in the ability to extend the distal phalanges at the IP joints of the ring and little fingers
• wasting of the hypothenar eminence
• because of ulnar nerve lesioned as it passes between the hook of hamate and the pisiform bone in Guyon’s canal

Question 3

midshaft fracture of the humerus

Answer 3

• loss of sensation in skin over the anatomic snuffbox
• wristdrop
• weakness in the ability to extend the thumb at the IP joint or fingers at the PIP joints
• altered sensation in the skin overlying the first dorsal interosseous muscle
• lacerates the profunda brachial artery
• radial nerve lesioned which is used in extension of the thumb (extensor pollicis longus at all joints and extensor pollicis brevis which extends at MP joint)
• think Radial WRistdrop

Question 4

A subluxation of the head of the radius

Answer 4

• weakness in the ability to extend the hand at the wrist

- cutaneous sensation in tact

Question 5

anterior dislocation of the lunate

Answer 5

• altered sensation in skin of the palmar surface of the lateral 3 and a half digits
• flexion still in tact
• atrophy of the muscles of the thenar eminence and paresthesia in the lateral digits
• wrist and finger flexion in tact

Question 6

supracondylar fracture of the humerus

Answer 6

• loss of pronation
• ulnar deviation of the wrist during wrist flexion
• ape hand
• cannot flex the distal phalanx of the thumb at IP joint or fingers at the PIP joint
• altered sensation in the skin overlying the thenar eminence

Question 7

A woman falls of her wrist and loses the ability to EXTEND at the wrist, what fracture is likely to cause this?

Answer 7

• she has lost her ability to extend so it is the radial nerve
• midshaft fractures of the humerus can lesion the radial nerve

Question 8

If a woman loses her ability to extend at the wrist due to a midshaft fracture, what is the likely blood vessel that is lacerated?

Answer 8

-profunda brachial artery

Question 9

A woman complains of pain down the medial aspect of her left arm and hand. She also has a smaller thenar and hypothenar eminence of this side. Her radial pulse is diminished. What neural structure accounts for these symptoms?

Answer 9

• lower trunk of the brachial plexus

- Klumpke’s paralysis from compression of C8 and T1 ventral rami

Question 10

Patient cannot pronate or flex at the middle and index fingers at DIP joints and cannot form the letter “o” with the thumb and index finger. What nerve is compressed?

Answer 10

-anterior interosseous branch of the median nerve

Question 11

Patient cannot extend or spread her fingers. She has a clawing of the ring and little fingers. What spinal cord segment contribute to the nerve that is damaged?

Answer 11

• she has lesioned her ulnar nerve

- spinal cord segments C8 and T1