Upper Limb - Effects of Fall (AQA PDF)

Anatomy of Upper Limb Effects of fall on outstretched hand By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology UPPER LIMB Case Study Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 2 UPPER LIMB Objectives...

Anatomy of Upper Limb Effects of fall on outstretched hand By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology UPPER LIMB Case Study Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 2 UPPER LIMB Objectives: by the end of this lecture the student must understand the following knowledge: ▪ Discuss the effects of Falls on Outstretched hand (while the wrist is extended): 1. Fracture clavicle. 2. Surgical neck fractures of humerus. 3. Fracture mid-shaft of humerus. 4. Fracture distal end of the humerus (Supracondylar fractures). 5. Dislocation of elbow joint. 6. Fracture head & neck of radius. 7. Colles’ fracture. 8. Fracture scaphoid. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk ▪ For any, you must discuss: 1. Causes. 2. Structures which are commonly injured in this fracture September 21, 2023 3 UPPER LIMB Objective # ( 1 ) Fracture of scaphoid ▪ The scaphoid bone is the most frequently fractured carpal bone. ▪ Structure which commonly injured in this fracture is: flexor retinaculum ▪ Pain and swelling in the anatomical “snuffbox” often occurs. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 4 UPPER LIMB Objective # ( 2 ) Colles’ fracture ▪ Is a fracture of the distal end of the radius. ▪ Mechanism of fracture: o The force drives the distal fragment posteriorly and superiorly. o This posterior displacement produces “dinnerfork deformity”. ▪ Structures which commonly injured in this fracture are: 1. Long flexor tendons. 2. Long extensor tendons. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 5 UPPER LIMB Objective Fracture head and neck of radius #(3) ▪ Objective Dislocation elbow joint #(4) Cause: 1. Fall on an outstretched hand. 2. Humerus Direct blow to the lateral ▪ which commonly injured in this fracture are: which fracture are: part of forearm. Structures Structures commonly injured in this side of elbow and upper ▪ of 1. Ulnar nerve. 2. Median nerve. Deep radial Posterior dislocation of elbow joint nerve. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 6 Objective # ( 5 ) Fracture distal end of Humerus UPPER LIMB Supracondylar fractures Medial epicondyle fractures ▪ ▪ Structures which commonly injured in this fracture are: Structures which commonly injured in this fracture are: 1. Ulnar nerve . 1. Injuries to the median, radial, and ulnar nerves. 2. Superior ulnar collateral artery. 2. Damage to or pressure on the brachial artery 3. Inferior ulnar collateral artery. can 4. Anterior ulnar recurrent artery. 5. Posterior ulnar recurrent artery. occur contracture. leading to Volkmann’s ischemic Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 7 UPPER LIMB Humerus Supracondylar fractures Medial epicondyle fractures Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 8 UPPER LIMB Objective # ( 6 ) Fracture mid-shaft of Humerus ▪ Cause: 1) Direct blow on the middle of the arm. 2) Indirect manner by falling on the outstretched hand. ▪ Structures which commonly injured in this fracture are: 1) Radial nerve. 2) Profunda artery. brachii Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 9 Objective # ( 7 ) Fracture Surgical Neck of Humerus UPPER LIMB ▪ Cause: 1) Direct blow on the lateral aspect of the shoulder. 2) Indirect manner by falling on the outstretched hand. ▪ Structures which commonly injured in this fracture are: 1) Axillary nerve. 2) Anterior circumflex humeral artery. 3) Posterior circumflex humeral artery. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 10 Objective # ( 8 ) Fracture clavicle UPPER LIMB Medial fragment ▪ It is the most commonly fractured bone in the body. ▪ The fracture occur at the weakest point, junction of the middle and outer thirds. ▪ After the fracture: a) Lateral fragment: is depressed by the weight of the arm, Deltoid and pectoralis major muscles. b) Medial fragment: is tilted upward by the sternocleidomastoid muscle. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 11 UPPER LIMB sternocleidomastoid Medial muscle fragment Lateral fragment Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk tear in coracoclavicular ligament September 21, 2023 12 Clinical Correlation Injury of Ulnar Nerve UPPER LIMB At Elbow Commonest Cause 1) 1) Fracture medial epicondyle. 2) Cubital tunnel syndrome: compression of ulnar nerve between two heads of flexor carpi ulnaris. Commonest site Behind the medial epicondyle (Cubital tunnel syndrome) (Funny bone) Deformity Muscles paralyzed Ulnar tunnel syndrome (Guyon’s canal): compression of ulnar nerve as it crosses flexor retinaculumn. 2) Cut wounds at the wrist. As it crosses flexor retinaculum (ulnar tunnel syndrome) Claw’s hand All muscles of the forearm & hand that is supplied by ulnar nerve. Which are????? 1) Motor loss At wrist weakness of flexion & adduction of the wrist. 2) weakness of flexion of the fingers. 3) Loss of adduction & abduction of the medial four fingers. Claw hand Muscles of the hand ONLY will be paralysed. Which are? 1) weakness of flexion of the fingers. 2) Loss of adduction & abduction of the medial four fingers. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 13 UPPER LIMB Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 14 UPPER LIMB Clinical Correlation Injury of Median Nerve At Elbow Commonest Cause Commonest site Pronator teres syndrome Carpal tunnel syndrome Compression of the median nerve between two heads of Compression of the median nerve as it crosses the carpal pronator teres Deformity Muscles paralyzed Motor loss At wrist tunnel. Ape hand All muscles of the forearm & hand that is supplied by median nerve. Which are????? 1) weakness of flexion of the wrist. 2) weakness of flexion of the fingers. Ape hand Muscles of the hand ONLY will be paralysed. Which are? ➢ Weakness of the abduction and flexion of the thumb ➢ Loss of the opposition of the thumb. Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 15 UPPER LIMB Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 16 UPPER LIMB Clinical Correlation Injury of Radial Nerve Commonest Cause 1) Intramuscular injection in the triceps brachii 2) Fracture mid-shaft of the humerus. Commonest site In spiral groove. Deformity Wrist drop Muscles paralyzed All the extensors of the forearm. Motor loss Extension of the wrist and elbow. Weakness in Adduction and abduction of the wrist joint. Cutaneous loss All areas supplied by radial nerve, which are? Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 17 UPPER LIMB Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 18 Case Scenario UPPER LIMB A previously healthy 2-year-old boy is brought to the emergency room by his mother because of persistent crying and refusal to move his right arm. The episode began 30 minutes ago after the mother lifted him up by the arms. He appears distressed and is inconsolable. Vital signs are within normal limits. On examination, his right arm is held close to his body in a flexed and pronated position. Which of the following is the most likely diagnosis? A. Proximal ulnar fracture B. Anterior shoulder dislocation C. Supracondylar fracture of the humerus D. Olecranon fracture E. Radial head subluxation Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 19 UPPER LIMB Case Scenario Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 20 UPPER LIMB Case Scenario Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 21 UPPER LIMB Reference • Gray's anatomy for students, 3rd edition. • ISBN: 978-0-7020-5131-9 • Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc. • Chapter 7 Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 22 UPPER LIMB End of Upper Limb Course In M1-Cognition and Action Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 23 UPPER LIMB Lect. 18 - Upper Limb - Effects of fall on outstretched hand By Dr. Hassan Rezk September 21, 2023 24