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A patient has been diagnosed with a fracture to the surgical neck of the humerus. Performing abduction of the arm against resistance is significantly weakened. Which nerve has most likely been injured?

Axillary (correct)

Median

Musculoskeletal

Radial

Damage to the Median nerve in the forearm would result in sensory loss in which area of skin labelled in the diagram below

C (correct)

A Varus deformity of the knee would suggest damage or rupture to which ligament of the knee.

Medial collateral

Lateral collateral (correct)

Anterior cruciate

Posterior cruciate

A 20 year old man sustains a displaced midshaft left humerus fracture in a road traffic accident. On examination, he is unable to extend his wrist and has loss of sensation over the fist dorsal web space. Which of his peripheral nerves has been injured?

Radial nerve Signup and view all the answers

A patient has suspected damage of the deep fibular nerve. To confirm this nerve is damaged, which movement should you ask the patient to perform against resistance?

Dorsiflexion Signup and view all the answers

On the following ultrasound image of the forearm, which muscle is labelled A?

Supinator Signup and view all the answers

How do the following structures contribute to the stability of the glenohumeral joint?

Glenoid labrum - Deepens the glenoid fossa Signup and view all the answers

Why is impingement of the supraspinatus tendon a common sports injury anatomically?

Because its tendon has to pass through a narrow space under the coracoacromial arch Signup and view all the answers

Regarding the nerve and blood supply to the upper limb

Posterior cord = Extensor compartments of arm and forearm C5 root of brachialplexus = Shoulder muscles Median nerve = Flexor compartment of forearm Axillary nerve = teres minor and deltoid muscles Signup and view all the answers

If the nerve labeled A is injured, where might the patient experience sensory loss?

Lateral side of the forearm Signup and view all the answers

At which location on the humerus is the axillary nerve and posterior circumflex humeral artery commonly associated?

Anatomical neck Signup and view all the answers

At which location on the humerus is the radial nerve and profunda brachii artery commonly associated?

Mid-shaft Signup and view all the answers

Regarding the forearm and hand

A = flexion of forearm when half pronated (brachioradialis) B = Flexion or abduction of hand (flexor carpi radialis) C = Pronation of forearm (pronator teres) a = a Signup and view all the answers

<h1>Supinator = Supinate forearm against resistance Flexor digitorum profundus = Hold the proximal interphalangeal joints in extension and ask the patient to flex the distal interphalangeal (fingertips) joints of digits 2 to 5. Brachioradialis = Flexion of elbow against resistance whilst half pronated.</h1> Signup and view all the answers

Why would an injury to the musculocutaneous nerve weaken supination?

Because musculocutaneous nerve innervates biceps which is involved with supination. Signup and view all the answers

Explain the role of the lumbrical muscles in forming a precision grip.

Flexion of the MCP joints and extension of the interphalangeal joints or precision grip Signup and view all the answers

A rock climber is seen in your clinic who has pain at the medial side of the elbow that extends into the anterior compartment of the forearm. They also have weakness with wrist flexion and reduced grip strength. What is the most likely diagnosis?

Golfers elbow/Medial epicondylitis Signup and view all the answers

Name the carpal bones

proximal row: scaphoid, lunate, triquetrum, and pisiform distal row: trapezium, trapezoid, capitate, and hamate Signup and view all the answers

The scaphoid bone is frequently fractured. At which anatomical location can this bone be easily palpated

Within the anatomical snuff box Signup and view all the answers

What is the nerve supply to the lumbrical muscles?

Median nerve supplies the lateral two lumbricals Ulnar nerve supplies the medial two lumbricals Signup and view all the answers

On the following image of the palm of the hand, what action does the adductor pollicis muscle perform and what is its nerve supply?

Action = Adduction of the thumb Nerve supply = Ulnar nerve Signup and view all the answers

The anterior cruciate ligament prevents:

anterior displacement of the tibia on the femur Signup and view all the answers

Regarding the hip and thigh For the rectus femoris, name two movements that it performs.

extension of leg OR flexion of thigh Signup and view all the answers

For the gluteus medius, state two movements it performs

abduction OR medial rotation of thigh Signup and view all the answers

What is NOT a border of the femoral triangle?

abductor longus Signup and view all the answers

Regarding the hip and thigh

What is NOT an example of why the femoral triangle is of clinical importance.

femoral artery for venepuncture Signup and view all the answers

Complete the following table regarding the above X-ray.
Label Name of bone A B C D

D = calcaneus B = talus A = navicular C = cuboid Signup and view all the answers

A 65-year-old female patient is seen in your clinic who has developed a flat foot (pes planus). Which arch has collapsed?

Medial longitudinal arch Signup and view all the answers

You suspect a tendon injury associated with the medial longitudinal arch. Which tendon may have ruptured?

Tibialis posterior tendon Signup and view all the answers

A 40-year-old man comes to you complaining of tingling affecting the index finger and thumb of the right hand. From the history and examination. WHAT is NOT a feature that would suggest a C6 cervical radiculopathy.

Numbness affecting the hand Signup and view all the answers

Name ONE sensory sign that would suggest carpel tunnel syndrome.

Loss of sensation in the lateral 3.5 fingers. Signup and view all the answers

Name ONE motor sign on examination that would suggest carpel tunnel syndrome.

Impairment of the LOAF muscles. Signup and view all the answers

What is compartment syndrome?

Abnormally increased pressure within a specific anatomical region of the leg. Signup and view all the answers

Regarding compartment syndrome What is NOT a clinical sign of acute compartment syndrome

Late sensory loss Signup and view all the answers

Study Notes

Nerve Injuries and Fractures

A fracture to the surgical neck of the humerus can cause weakness in abduction of the arm against resistance, indicating injury to the axillary nerve.
Damage to the Median nerve in the forearm results in sensory loss in the palmar surface of the lateral three and a half fingers.

Knee Injuries

A Varus deformity of the knee suggests damage or rupture to the medial collateral ligament.

Peripheral Nerve Injuries

A patient with a displaced midshaft left humerus fracture, unable to extend their wrist and with loss of sensation over the first dorsal web space, has likely injured the radial nerve.
Damage to the deep fibular nerve can be confirmed by asking the patient to perform toe extension against resistance.

Anatomical Structures

The muscle labelled A on the ultrasound image of the forearm is the flexor digitorum profundus.
The axillary nerve and posterior circumflex humeral artery are commonly associated with the surgical neck of the humerus.
The radial nerve and profunda brachii artery are commonly associated with the radial groove of the humerus.

Glenohumeral Joint

The supraspinatus tendon is susceptible to impingement due to its anatomical location, making it a common sports injury.

Nerve and Blood Supply to the Upper Limb

If the nerve labeled A is injured, the patient may experience sensory loss in the lateral aspect of the upper arm.
The musculocutaneous nerve supplies the lumbrical muscles, and injury to this nerve can weaken supination.

Forearm and Hand

The lumbrical muscles contribute to forming a precision grip.
A rock climber with pain at the medial side of the elbow and anterior compartment of the forearm, with weakness in wrist flexion and reduced grip strength, likely has medial epicondylitis.
The scaphoid bone is frequently fractured and can be easily palpated in the anatomical snuffbox.
The lumbrical muscles are supplied by the median and ulnar nerves.
The adductor pollicis muscle performs adduction of the thumb and is supplied by the ulnar nerve.

Hip and Thigh

The anterior cruciate ligament prevents anterior translation of the tibia.
The rectus femoris performs knee extension and hip flexion.
The gluteus medius performs hip abduction and internal rotation.
The femoral triangle is bounded by the inguinal ligament, adductor longus, and sartorius muscles.

Foot and Ankle

A 65-year-old female patient with a flat foot (pes planus) has collapse of the medial longitudinal arch.
A tendon injury associated with the medial longitudinal arch may involve the posterior tibialis tendon.

Compartment Syndrome

Compartment syndrome is a condition in which the pressure within a closed space increases, compromising the circulation and function of the tissues within that space.
NOT a clinical sign of acute compartment syndrome is paralysis.

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Description

Test your knowledge on identifying nerve injuries associated with a surgical neck fracture of the humerus based on symptoms. Determine which nerve is most likely injured when abduction of the arm against resistance is weakened.