Question

Case Scenario

Mrs Lee is a 60 years old woman. She is the housewife and lives with his husband and son in the public estate. Last week, she went to the wet market for buying food and groceries. She slipped fall on the street. Her right upper arm and armpit region were hit on the kerb. She went home and massage the armpit and upperarm immediately with massage oil. However pain over upper arm and armpit were still. At evening severe bruising was noted over upper arm and also the axilla. Mrs Lee was admitted to A&E department. She complaint numb over upper arm and could not move her wrist. Her X-ray indicated fractures over proximal part of humerus and she was sent to the ward for further treatment. The examination showed that her shoulder movement was limited due to pain elicited and muscle weakness. Numbness was also noted over upper arm, forearm and dorsum of the right hand. Sensory test showed that diminished sensation, only pain sensation was intact. She had weakness in wrist movement. Right hand grip was normal. Please answer according to the following guidance:

1. According to Mrs Lee condition, please indicate the structures that were involved in this accident? a) List out the fracture sites along the humerus with Mrs Lee presentation and the bony landmarks. b) List out the artery (arteries) and vien (veins) involved in this accident c) List out the nerve (nerves) that would be invloved in this accident

2. What is/are movement limitation that Mrs Lee would come across and please explain the reason underneath.

3. Please describe the sensation issue of Mrs Lee and explain the type/mode of injury resulting in present condition.

Answer 1

1. Mrs Lee had a slip fall and hit her upper arm and axilla which led to fracture of proximal part of humerus.
a. Mrs Lee had a fracture at the proximal part of humerus. The proximal part of humerus consists of anatomical neck, surgical neck, greater tuberosity abd lesser tuberosity.
b. The axillary vein and artery pass through the axilla. Injury to proximal humerus results in injury to axillary artery and axillary vein.
c. The radial nerve is injured due to fracture of proximal humerus.
2. The patient will experience movement loss at the shoulder and wrist joint. Loss of movement at shoulder occurs due to pain and muscle weakness at the shoulder site and damage to radial nerve. Wrist extension is lost due to damage to radial nerve.
3. The radial nerve is responsible for sensory functions of upper arm, forearm and dorsum of hand. The patient has sustained a radial nerve injury due to fracture of proximal humerus which is the reason for lost sensations.This type of injury is known as peripheral nerve injury. First degree of nerve injury caused by compression of nerve is known as neuroprexia. Second degree of nerve injury caused by partial cut to the nerve is known as axonotmesis. Third degree of nerve injury caused by complete cut to the nerve is called neurotmesis.