Anatomy Review

Clavicle
Fracture of the Clavicle commonly fractured, often by indirect force resulting from violent impacts to the outstretched hand during a fall transmitted through the bones of the forearm and shoulder or by falls directly onto the shoulder itself weakest part of clavicle junction of middle and lateral thirds medial fragment is elevated by sternocleidomastoid; lateral fragment is depressed by weight of shoulder and pulled medially by adductor muscles overriding of fragments often incomplete in children greenstick fracture Clavicle is congenitally absent or imperfectly developed in some disorders like cleidocranial dysostosis

Humerus
Fracture of the Shaft of the Humerus results from a direct blow to the arm may injure the radial nerve in the radial groove as it winds around the humeral body paralysis of the elbow, wrist, and digit extensors wrist drop Lateral Epicondylitis also known as elbow tendinitis, golfers elbow, tennis elbow repeated forceful flexion and extension of the wrist strain attachment of common tendon inflammation of periosteum of lateral epicondyle pain felt over lateral epicondyle and radiates down posterior aspect of forearm pain often felt when opening a door or lifting a glass Liable to injury of Humerus bone Axillary nerve at the surgical neck Radial nerve at the radial groove Ulnar nerve behind the medial epicondyle Poor blood supply at the junction of upper and middle 3rd causes non-union of Humerus Head of the Humerus commonly dislocates inferiorly

Radius
Fractures of the Distal Radius (Colles Facture) transverse fracture within the distal 2 cm of the radius most common fracture of the forearm results from forced extension of the hand, usually as a result of trying to ease a fall by outstretching the upper limb distal fragment is displaced dorsally dinner fork (silver fork) deformity * Smith's Facture (reverse Colles) results from a fall or a blow on the dorsal aspect of the flexed wrist and produces a ventral angulation of the wrist

Ulna
elbow dislocation occurs when the bones of the forearm (the radius and ulna) move out of place compared with the bone of the upper arm (the humerus). Common in the fall with outstretched hand Facture of olecranon is common by a FALL ON THE POINT OF ELBOW.

Fracture of coronoid is uncommon

Madelungs deformity is dorsal displacement of lower end of ulna due to retarded growth of the lower end of radius.

Wrist
Fracture of the Scaphoid most common wrist injury (scaphoid most frequently fractured carpal bone) occurs as a result of a fall onto the palm when the hand is abducted pain occurs primarily on the lateral side of the wrist, especially during wrist extension and abduction proximal fragment may undergo avascular necrosis due to its poor blood supply Bennett's fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint Thumb is forced into semiflex and can not be opposed Fist cannot be clenched Reverse Bennetts

Upper Limb General

1. Venipuncture cubital fossa common site for extracting peripheral blood samples, for blood transfusion, and for IV drug administration, and for introduction of cardiac catheters to obtain blood samples from the great vessels or heart chambers median cubital vein or basilic vein usually selected 2. Superficial Ulnar Artery descends superficial to forearm flexor muscles (in ~3% of individuals) pulsations visible and palpable may be mistaken for a vein bleeding or disastrous effects if used for injecting irritating drug 3. Ischemia of the Fingers characterized by intermittent attacks of pallor of the fingers accompanied by paresthesia and pain cause may be due to an underlying disease or an anatomic abnormality if cause is idiopathic (Raynauds disease) treatment: surgery (cervical sympathectomy to dilate the digital arteries)

Nerves
Upper Brachial Palsy other names: Erb palsy, Erb-Duchenne palsy, Duchenne-Erb palsy, Upper Radicular Syndrome usually results from excessive increase in the angle between the neck and the shoulder stretching or tearing of the superior parts of the brachial plexus (C5 and C6 roots or superior trunk) in all cases, paralysis of the muscles of the shoulder and arm supplied by C5 and C6 spinal nerves deltoid, biceps brachii, brachialis, and brachioradialis adducted shoulder, medially rotated arm, extended elbow (waiters tip hand) plus loss of sensation in the lateral aspect of the upper limb Lower Brachial Palsy other name: Klumpkes palsy may occur when the upper limb is suddenly pulled superiorly stretching or tearing of the inferior parts of the brachial plexus (C8 and T1 roots or inferior trunk) most of the small muscles of the hand supplied by the ulnar nerve affected hyperextended metacarpophalangeal joints, inability to flex digits 4 at the DIPs when making a fist, inability to extend IP joints when straightening the fingers clawhand deformity

Nerves
Winged Scapula results from paralysis of the serratus anterior because of injury to the long thoracic nerve, i.e., during radical mastectomy medial border of scapula moves laterally and posteriorly away from the thoracic wall gives scapula appearance of a wing, especially when person leans on the hand or presses the upper limbs against a wall when arm is raised medial border and inferior angle of scapula pull markedly away from thoracic wall arm cannot be abducted above the horizontal because serratus anterior unable to rotate the glenoid cavity superiorly to allow complete abduction of the arm Wrist Drop inability to extend the wrist resulting from injury to the radial nerve paralysis of extensor muscles in the forearm hand flexed at wrist and lies flaccid digits remain flexed at metacarpophalangeal joints IP joints can be extended weakly via lumbricals and interossei (supplied by ulnar nerve)

Nerves
Carpal Tunnel Syndrome results from a lesion that reduces the size of the carpal tunnel, i.e., fluid retention, infection, excessive exercise of the fingers may cause swelling of the long flexor tendons or their synovial sheaths median nerve most sensitive structure in the carpal tunnel and is the most affected clinical manifestations: paresthesia, hyposthesia, or anesthesia of the lateral three and a half digits progressive loss of coordination and strength in the thumb atrophy of thenar eminence apehand deformity treatment: carpal tunnel release partial or complete division of the flexor retinaculum

DR MACU
D= Drop Wrist R = Radial M = Median A = Ape Hand C = Claw Hand U = Ulnar