Upper limb - Specific breaks, lesions and conditions (MSK)

Question 1

Winged scapula

Answer 1

Caused by:

• damage to the serrates anterior muscle (usually around the medial border)
• Damage to the long thoracic nerve that innervates this muscle
• Causes scapula to protrude in an abnormal position

Question 2

Colles fracture

Answer 2

• Most common fracture of the radius
• Fall on an outstretched hand to catch yourself
• Dinner forked shape

Question 3

Smiths fracture

Answer 3

• Compression on the dorsum on the hand (reverse of colles)
• Distal fragment of the radius is displaced superiorly

Question 4

Monteggia’s fracture

Answer 4

• Forearm fracture
• Proximal shaft of the ulna is fractured and the head of the radius dislocates anteriorly

Question 5

Galezzas fracture

Answer 5

• Forearm fracture
• Fracture of the distal radius with the with the ulna head dislocating at the distal radio ulnar joint

Question 6

Wrist drop

Answer 6

• Unable to extend the wrist of fingers
• Due to damage of radial nerve
• Cause by mid shaft of humerus lesion causing extension at the elbow to be affected, numbness at posterior forearm and dorsum of hand

Question 7

Golfers elbow

Answer 7

• Damage to the muscles and tendons that cause flexion of forearm and fingers
• Often seen In golfers
• Pain around the common flexor origin of medial epicondyle

Question 8

Tennis elbow

Answer 8

• Wrist extensor muscles and tendons are damaged
• Causing pain at common extensor origin of lateral epicondyle
• Seen in tennis players

Question 9

Dupuytrens contracture

Answer 9

• Thickening of the palmar aponeurosis by collagen over secretion by fibroblasts (specialised fascia under skin)
• Triangular structure
• Inability to flex middle or small fingers (GD)

Question 10

Ruptured biceps brachii

Answer 10

• Long head or distal insertion rupture
• Pop eye sign
• Older patients more common due to wear and tear of tendons

Question 11

Humerus fracture

Answer 11

• From proximal to distal - Axillary, radial, median nerve damage
• Surgical neck of humerus = Axillary nerve
• Further down the shaft = radial

Question 12

Erb’s palsy

Answer 12

• Upper lesion of the brachial plexus (C5-C6)
• Excessive displacement of the head to the opposite side or dropping of the shoulder on the same side
• Can occur in infants during difficult delivery or in adults due to impact
• Presents with loss of motion and numbness around the shoulder, reduced flexion at the elbow and inability to bring food to mouth
• Arm adducted and internally rotated

Question 13

Klumpke’s palsy

Answer 13

• Lower brachial plexus injury (C8-T1)
• Can be during delivery or when adults fall onto something
• Less common injury that leads to loss of sensation or movement of wrist and hand and unable to move fingers

Question 14

Claw hand

Answer 14

• Following a medial epicondyle fracture, damaging the ulnar nerve (distal) or median nerve (medial)
• can initially cause hand of benediction
• affecting flexor digitorum profundas

Question 15

greens stick

Answer 15

Bone not full snapped

• Often occurs in children

Question 16

Boxers fracture

Answer 16

• Punching wall or someone
• Fractures the 5th metacarpal

Question 17

Spiral humerus fracture

Answer 17

• In adults usually due to trauma such as a fall

*In kids often by non-accidental injury