Question

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.

please describe more details of Q2,3 thx a lot

Answer 1

1) a) Mrs. lee had undergone proximal humerus fracture. This fracture is characterized by bone damage near surgical neck of humerus.

The humerus extends from shoulder to elbow and the proximal part of humerus articulates with glenoid fossa of scapula. That's why the rotatory movement of shoulder was also affected.

The proximal humerus contains greater tuberosity , lesser tuberosity , articular head and the shaft.

b)The anterior and posterior humeral circumflex arteries branch off of the axillary artery to provide supply to the proximal humerus.

c) The axillary nerve is mainly affected in this injury and depending on the severity of injury the suprascapular nerve might also get affected.

2)Axillary nerve damage will result in paralysis to the deltoid and teres minor muscles. Mrs. Lee will have difficulty performing abduction of the Right limb. Due to Rotator cuff tear the rotatory movement of shoulder would be also a part of problem to mrs. Lee .

3)The axillary nerve also innervates the skin over the lower deltoid and therefore sensation in this region is impaired.The numbness and weakness of the arm is suggestive of axillary nerve injury.