Upper Limb Injuries
by MB, KA & SC
Our Patient…
Mrs B, a 71 year old female, enjoys making pies
for her granddaughters. 2 weeks ago, she fell
forwards onto on an outstretched arm, injuring
her left shoulder in the process. Mrs B
presented to ED with a swollen and tender left
arm with bruising to the chest wall and
proximal humerus. The nerve and blood supply
to the distal left arm was found to be intact.
Figure 1: AP and Axillary view X-rays of the left
humerus
Fig 1: Anatomy of Surgical Neck Fractures
K Wire Fixation
Plate Fixation
In the case of Mrs B, there was no neurovascular
injury however they are extremely common in
cases like this. Some common nerve injuries that
occur in fractures of the surgical neck of the
humerus are outlined below.
Screw Fixation
Reverse Shoulder
Arthroplasty
Figure 2: Formation of an endoanal flap
The principles of fracture management are to reduce,
imobilise and rehabilitate. In the case of Mrs B the plan is to
Figure 2: Dermatomes and Myotomes of the Upper treat her conservatively using a sling in the hope that the
Limb weight of the arm will reduce the fracture. She will be
reassessed in a week and if this method does not appear to
be working other methods (such as surgery) will be explored.
Nerve Injury The advantages of non-operative treatment are: • That they
are non-invasive and so surgery is not required • They are
cheap • No risks of an operation. However • Reduction is not
Axillary nerve always precise • Stability is often inadequate for major
injuries • Mal-union rates are higher in adults • More
Sensory loss outpatient visits and radiographs are required to monitor
O Loss of sensation over lower half of deltoid treatment
muscle
Motor loss
oReduced abduction (15-90°)
oweak flexion, extension, and rotation of shoulder
Radial nerve
Motor loss
O Extension at elbow – paralysis of triceps and
anconeus
O Extension of wrist and fingers – paralysis of
extensors of wrist and all muscles of posterior
Social Implications of Mrs B’s Injuries....
compartment
O WRIST DROP
-Unable to continue her hobby of baking
Sensory loss
-Unable to go on her holiday
O Posterior surface of arm and forearm
-Needs help with ADLs
O Dorsum of hand and dorsal surface of lateral 3½
-Choice of management may cause anxiety
fingers
-Social isolation
-Difficulty with managing her comorbidities
Musculocutaneous nerve
Motor loss
O Paralysis of coracobrachialis, biceps brachii and
brachialis muscles
O Weak flexion of the shoulder
O Weak flexion at the elbow
O Reduced supination
Sensory loss
References
O Loss of sensation over lateral side of forearm http://fitsweb.uchc.edu/student/selectives/Luzietti/Painful_anus_anorectal_anatomy.html
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