Questions: Upper Arm
A patient presents with pain in the neck, numbness and tingling in the fingers, and a week grip. This presentation suggests thoracic outlet syndrome. Which of the following causes has an embryologic etiology? a. Traumatic injury b. Cardiovascular disease c. Cervical rib d. Pancoast tumor e. Scalene muscle inflammation
Correct Answer = C. A cervical rib is a congenital abnormality that can cause thoracic outlet syndrome because the space that transmits the neurovasculature to the arm is reduced. Other causes listed are not a result of embryologic development.
1A 45-year-old male arrived at the emergency department with injuries to his left elbow after he fell in a bicycle race. Radiographic and MRI examinations show a fracture of the medial epicondyle and a torn ulnar nerve. Which of the following muscles would be most likely to be paralyzed? a. Flexor digitorum superficialis b. Biceps brachii c. Brachioradialis d. Flexor carpi ulnaris e. Supinator
Correct Answer = D. Flexor Carpi Ulnaris Fracture of the medial epicondyle often causes damage to the ulnar nerve due to its position in the groove behind the epicondyle. The ulnar nerve innervates one and a half muscles in the forearm—the flexor carpi ulnaris and the medial half of the flexor digitorum profundus. The nerve continues on to innervate muscles in the hand. The radial n innervates both the brachioradialis and supinator muscles
A 47-year-old woman with breast cancer undergoes a mastectomy with the removal of axillary lymph nodes. Postoperatively, she experiences weakness in extension, medial rotation, and adduction of her arm on the same side. Which nerve was most likely injured iatrogenically in this patient? A. Dorsal scapular B. Long thoracic C. Suprascapular D. Thoracodorsal E. Upper subscapular
D
A child presents to the ER with severe left shoulder pain. child fell off the edge hitting his left shoulder hard on the metal frame. Imaging shows that a portion of bone associated with the shoulder joint has become fractured and then dislocated. Which structure is most likely involved? a. Coracoid process b. Acromion c. Proximal humeral epiphysis d. Distal humeral epiphysis e. Glenohumeral joint
1. C. The child is still undergoing development and at this stage the joint capsule of the glenohumeral joint reinforced by the rotator cuff are stronger than the epiphyseal plate.
A patient presents to the ER with pain in his left shoulder. The patient has not suffered from any accidents or traumatic events. Shoulder has been dislocated. What is the most likely direction in which the dislocation occurred relative to the shoulder joint itself? a. Anterior-posteriorly b. Anterior-superiorly c. Anterior-inferiorly d. Posterior-superiorly e. Posterior-superiorly
1. C; The majority of shoulder dislocations occur in the anterior-inferior direction relative to the glenohumeral joint. Only 4% of dislocations occur posteriorly and 0.5% superiorly. [HRV Note: These values were given by Dr. Mussel during the lecture.] This is the most likely location of injury as the rotator cuff muscles help stabilize the joint in the posterior-superior direction.
A patient presents to the ER complaining of right shoulder pain with edema & point tenderness at the shoulder joint & pain radiating through the upper right portion of the scapula. The shoulder pain has been present for 6 days and is getting worse. Patient's vital are taken and it is found they are running a fever of 101.4. patient is suffering from bursitis caused by an infection. Which portion of the joint is most likely infected? a. Supraspinatus tendon b. Glenohumeral joint capsule c. Subscapular bursa d. Subacromial bursa e. Synovial sheath of biceps brachii
1. D; This infection is most likely to be located in the subacromial bursa. Since the pain is located in the shoulder joint and radiates through the back, this indicates bursitis affecting surrounding muscles/tissues and the location of the pain indicates the supraspinatus muscle. Also, the glenohumeral joint (B) is continuous with the subscapular bursa (C) and the synovial sheath of the biceps brachii (E) - meaning that infection in any of these areas would likely have spread to them all given the time course of the infection. Since the patient has not mentioned pain along the anterior upper part of the arm (indicative of involvement of the synovial sheath of the biceps), the most likely location of the infection is the subacromial bursa (D). Answer A is wrong bs point tenderness is indicated in the shoulder which points to infection within a joint. While the supraspinatus tendon and supraspinatus muscle are going to be affected, they are not the source of the infection given the other clinical clues.
37 yo presents w/ arm laterally rotated, abducted & flexed. This presentation results from which nerve damage? 1. Axillary 2. Dorsal scapular 3. Lower subscapular 4. Spinal accessory 5. Thoracodorsal
5. Thoracodorsal in Lattissimus Dorsi (Medial rot + adduction)
????? A 17-year-old girl fell from her motorcycle and complains of numbness of the lateral part of the arm. Examination reveals that the axillary nerve is severed. Which of the following types of axons is most likely spared (пощадил)? a. Postganglionic sympathetic axons b. Somatic afferent axons c. Preganglionic sympathetic axons d. General somatic efferent axons e. General visceral afferent axons
???? Correct Answer = C. The axillary nerve contains no preganglionic sympathetic general visceral efferent (GVE) fibers, but it contains postganglionic sympathetic GVE fibers. The axillary nerve also contains GSA, GSE, and general visceral afferent (GVA) fibers.
In the process of escaping from T. rex punctures the skin on the medial side of her wrist. A few days later, due to the toxin, an infection is seen spreading up the medial side of her arm along the large cutaneous vein extending from the dorsum of her hand to the medial side of her arm. The vein involved is the: A. Basilic B. Brachial C. Cephalic D. Median cubital E. Ulnar
A. Basilic On the medial side (near the 5th digit) there is the basilic vein. On the lateral side, there is the cephalic vein. SUPERFICIAL The brachial vein runs with the brachial artery-- it is a deep vein that ends at the level of the elbow. The ulnar vein runs with the ulnar artery, draining the ulnar side of the forearm. Neither of these veins are located in superficial tissue. The median cubital vein is a cutaneous vein, but it is short and only found in the median cubital fossa. It provides a connection between the cephalic vein and basilic vein.
A 54-year-old woman presents to the orthopaedic clinic with left shoulder pain localized in the scapular region. A history reveals that her job involves repeated lifting of packages over her head. Physical examination reveals significant weakness in lateral rotation and initiating abduction of her left arm. Which muscle(s) most likely account(s) for the patient's weakness in arm movements? PLUS WHAT NERVE IS AFFECTRED? A. Supraspinatus and infraspinatus B. Infraspinatus and teres minor C. Rhomboid major and rhomboid minor D. Teres major and teres minor
A. Supraspinatus and infraspinatus Nerve: Suprascapular n
An 18-year-old boy involved in an automobile accident presents with an arm that cannot abduct. His paralysis is caused by damage to which of the following nerve? A. Suprascapular and axillar B. Thoracodorsal and upper subscapular C. Axillary and musculocutaneous D. Radial and lower subscapular E. Suprascapular and dorsal scapular
Ab - Del Ser.Ant Supraspinatus A. Suprascapular (supraspinaatus) and axillar (deltoid)
An 18-year-old boy involved in an automobile accident presents with an arm that cannot abduct. His paralysis is caused by damage to which of the following nerves? A. Suprascapular and axillary B. Thoracodorsal and upper subscapular C. Axillary and musculocutaneous D. Radial and lower subscapular E. Suprascapular and dorsal scapular
Ab DeL Serrat.Ant Supraspinaatus A. Suprascapular and axillary
Which of the following structures is indicated by the asterisks in the images? A. Acromion B. Coracoacromial ligament C. Coracoid process D. Subscapular bursa E. Supraglenoid tubercle
Acromion
A 23-year-old man complains of numbness on the medial side of the arm following a stab wound in the axilla. On examination, he is diagnosed with an injury of his medial brachial cutaneous nerve. In which of the following structures are the cell bodies of the damaged nerve involved in numbness located? a. Sympathetic chain ganglia b. Dorsal root ganglia c. Anterior horn of the spinal cord d. Lateral horn of the spinal cord e. Posterior horn of the spinal cord
B. (GSA) = dorsal root ganglia The anterior horn of the spinal cord contains cell bodies of skeletal motor (GSE) fibers, and the lateral horn contains cell bodies of sympathetic preganglionic fibers T1-L2. The posterior horn contains cell bodies of interneurons.
At which of the following sites (A-E) does the torn Supraspinatus muscle attach (refer to the accompanying image)? Pucture A. Acromion B. Greater tubercle of the humerus C. Infraglenoid tubercle D. Lesser tubercle of the humerus E. Supraglenoid tubercle
B. Greater tubercle of the humerus
1. An 18-year-old male is brought to the ER after an injury while playing rugby. Imaging reveals a transverse fracture of the humerus about 1 inch proximal to the epicondyles. Which nerve is most frequently injured by the jagged edges of the broken bone at this location? a. Axillary b. Median c. Musculocutaneous d. Radial Ulnar
B. Median Nerve; A supracondylar fracture often results in injury to the median nerve. Injury to the surgical neck may damage the axillary n. The musculocutaneous n pierces the coracobrachialis m and descends bn the biceps & brachialis mm. It continues into the forearm as the lateral antebrachial cutaneous n. The ulnar nerve descends behind the medial epicondyle in its groove and is easily injured and produces "funny bone" symptoms.
multiple fractures of the humerus. Flexion and supination of the forearm are severely weakened. She also has loss of sensation on the lateral surface of the forearm. Which of the following nerves has most likely been injured? a. Radial b. Musculocutaneous c. Median d. Lateral cord of brachial plexus e. Lateral cutaneous nerve of the forearm
B. Musculocutaneous; The musculocutaneous n supplies the biceps brachii, brachialis, which are the flexors of the forearm at the elbow. The musculocutaneous n continues as the lateral antebrachial cutaneous n, which supplies sensation to the lateral side of the forearm (with the forearm in the anatomic position). biceps brachii is the most powerful supinator m!!!!.
pain and weakness of resisted abduction & forward flexion. pain at rest & at night which is aggravated when patient lays on his right side. His right arm rests in the anatomical position. What is the most likely source of injury? a. Anterior dislocation of humerus from glenohumeral joint b. Inflamed supraspinatus tendon c. Fully torn supraspinatus tendon d. Subacromial bursitis
B: inflamed supraspinatus tendon. A: The patient's arm would be abducted and externally rotated = anterior dislocation C: A fully torn supraspinatus tendon may relieve some of his pain. D: He may be unable to move his shoulder & would present with excessive swelling, redness, bruising or a rash of the affected area.
The supraspinatus tendon is a derivative of which of the following embryological structures? a. Sclerotome b. Syndetome c. Lateral plate mesoderm d. Neural crest cells
B: the syndetome is the embryological structure responsible for creating tendons. A: The sclerotome = vertebral column, ribs & part of the occipital bone. C. The lateral plate mesoderm = the limb buds and bones. Neural crest cells have many derivatives, and in the musculoskeletal system work with occipital somites to form the neurocranium.
A 35-year-old patient has a small but painful tumor under the nail of the little finger. Which of the following nerves would have to be anesthetized for a painless removal of the tumor? a. Superficial radial b. Common palmar digital of median c. Common palmar digital of ulnar d. Deep radial e. Recurrent branch of median
C. Common Palmar digital of ulnar; it comes off the superficial branch of the ulnar nerve and supplies the skin of the little finger and the medial side of the ring finger.
1. After a jarring blow to the left anterior shoulder region, a young field hockey player was told by an examining physician that she had a muscle tear that resulted directly from the superolateral distraction of a fractured coracoid process. Which muscle was torn? A. Deltoid B. Pectoralis major C. Pectoralis minor D. Serratus anterior E. Subclavius
C. Pectoralis minor The deltoid originates from the clavicle, acromion and scapular spine and inserts on the deltoid process of the humerus. Pectoralis major O: from the clavicle, sternum, ribs and I: on the crest of the greater tubercle of the H. Serratus anterior originates on the ribs and inserts on the medial border of the costal surface of the scapula. Subclavius originates on the 1 rib and inserts on the clavicle.
A 52-year-old band director suffered problems in her right arm several days after strenuous field exercises for a major athletic tournament. Examination in the orthopedic clinic reveals wrist drop and weakness of grasp but normal extension of the elbow joint. There is no loss of sensation in the affected limb. Which nerve was most likely affected? a. Ulnar b. Anterior interosseous c. Posterior interosseous d. Median e. Superficial radial
C. Posterior Interosseus. The radial n descends posteriorly between the long & lateral heads of the triceps. It eventually enters the anterior compartment and descends to enter the cubital fossa, where it divides into superficial and deep branches. The deep branch of the radial nerve winds laterally @ radius and runs bn the two heads of the supinator and continues as the posterior interosseous n, innervating extensor muscles of the forearm. Bs this injury does not result in loss of sensation over the skin of the upper limb, it is likely that the superficial branch of the radial nerve is not injured. If the radial nerve were injured very proximally, the woman would not have extension of her elbow. The branches of the radial nerve to the triceps arise proximal to where the nerve runs in the spiral groove. The anterior interosseous n arises from the median n. Injury to the median nerve causes a characteristic flattening (atrophy) of the thenar eminence.
Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection? A. Levator scapulae B. Pectoralis major C. Rhomboideus major D. Serratus anterior E. Subscapularis
D. Serratus anterior, innervated by the long thoracic nerve, draws the scapula forward. If it is denervated, there is no muscle to oppose the motion of the trapezius which is elevating and retracting the scapula. "winged scapula." A winged scapula commonly occurs after an injury to the long thoracic nerve, which runs on the superficial surface of serratus anterior and is particularly vulnerable to trauma. The long thoracic nerve contains contributions from C5, 6, and 7, so remember the saying "C5, 6, and 7 keep the wings from heaven."
A 16-year-old boy sustains a crush injury in the auto body shop in which he is working and now has weakness flexing the metacarpophalangeal joint of the ring finger and is unable to adduct the same finger. Which of the following muscles is most likely paralyzed? a. Flexor digitorum profundus b. Extensor digitorum c. Lumbrical d. Dorsal interosseous e. Palmar interosseous
DAB with a PAD Answer = E. Palmar interosseous. The dorsal & palmar interosseous and lumbrical muscles can flex the metacarpophalangeal joints and extend the interphalangeal joints. The flexor digitorum profundus flexes the DIP joints.
A 41-year-old executive sees her physician because of chronic spasm of the scalene muscles due to stress and depression. The physician determines that she has thoracic outlet syndrome. The scalene muscle spasms most likely affect which region of the brachial plexus? a. Terminal Branches b. Cords c. Divisions d. Trunks e. Roots
E The roots of the brachial plexus pass bn the anterior and middle scalene muscles. Spasm of these muscles can cause entrapment of the roots of the plexus. The trunks, divisions, cords, and terminal branches occur distally to this region, so they are incorrect
Scapulohumeral rhythm does NOT involve movement of the following joint: a. Glenohumeral joint b. Scapulothoracic joint c. Acromioclavicular joint d. Sternoclavicular joint e. Suprascapular joint
E. The suprascapular joint does not exist. Joints that work together to produce scapulohumeral rhythm: 1. glenohumeral joint 2. scapulothoracic joint 3. acromioclavicular joint 4. sternoclavicular joint.
A 7-year-old boy falls from a tree house and is brought to the EM department of a local hospital. On examination, he has weakness in rotating his arm laterally bs of an injury of a nerve. Which of the following conditions is most likely to cause a loss of this nerve function? A. Injury to the lateral cord of the brachial plexus B. Fracture of the anatomic neck of the humerus C. Knife wound on the teres major muscle D. Inferior dislocation of head of humerus E. A tumor in the space in shoulder region
Lat - Del In Teresa Minor The answer is D. Inferior displacement of the head of the H may damage the axillary nerve, which arises from the posterior cord of the brachial plexus, runs through the quadrangular space accompanied by the posterior humeral circumflex vessels around the surgical neck of the H. supplies the deltoid and teres minor, which are lateral rotators of the arm.
A 17-year-old boy is injured. fracture of the surgical neck of his H and bleeding from the point of the fracture. Following the accident, the boy has weakness in rotating his arm laterally. Which of the following muscles are paralyzed? A. Teres major and teres minor B. Teres minor and deltoid C. Infraspinatus and supraspinatus D. Supraspinatus and subscapularis E. Teres major and infraspinatus
Lat Del In Teresa Minor B. Teres minor and deltoid
A 27-year-old man was admitted to the ER after an automobile collision in which he suffered a fracture of the lateral boarder of the scapula. Six weeks are the accident, physical examination reveals weakness in medial rotation and adduction of humerus. Which nerve was most likely injured? A. Lower subscapular B. Axillary C. Radial D. Spinal accessory E. Ulnar
MeD Larisse, teres Major, Subscapularis ADD Larisse, Teresa Major A.
A 27-year-old man was admitted to the emergency department after an automobile collision in which he suffered a fracture of the lateral boarder of the scapula. Six weeks are the accident, physical examination reveals weakness in medial rotation and adduction of humerus. Which nerve was most likely injured? A. Lower subscapular B. Axillary C. Radial D. Spinal accessory E. Ulnar
MeD Larisse, teres Major, Subscapularis ADD Larisse, Teresa Major A. The lower subscapular n (C5-C6) + USS. It innervates the subscapularis and teres major muscles. Axillary n (C5-C6) --> deltoid & teres minor mm = lateral rot. Radial n, posterior cord --> triceps brachii & anconeus m in the arm. spinal accessory n --> trapezius m, which elevates and depresses the scapula.
An MRI examination reveals an injury to the medial cord of the brachial plexus. Which of the following spinal nerve levels would most likely be affected? a. C5, C6 b. C6, C7 c. C7, C8 d. C7, C8, T1 e. C8, T1
Medial Cord + Lateral Cord give rise to MEDIAN nerve e. C8, T1
***** A patient bleeding from his shoulder secondary to a knife wound is in fair condition because there is vascular anastomosis around the shoulder. Which of the following arteries is most likely a direct branch of the subclavian artery that is involved in the anastomosis? a. Dorsal scapular artery b. Thoracoacromial artery c. Circumflex scapular artery d. Transverse cervical artery e. Suprascapular artery
Mnemonic: 'VIT C and D' Vertebral artery Internal thoracic artery Thyrocervical trunk Costocervical trunk Dorsal scapular artery Mnemonic: 'VIT C and D' Answer A
Picture of Shoulder dislocation (glenohumeral joint)
Most common inferior shoulder dislocation (glenohumeral joint)
A 22 year-old-man comes into the ER after a game of football with a prominent acromion and a superiorly-moved clavicle. What is the primary joint that has been affected? A. Acromioclavicular joint B. Scapulothoracic joint C. Glenohumeral joint D. Sternoclavicular joint
The answer is A. The acromioclavicular joint is responsible for the signs of shoulder separation that the patient is exhibiting. When the glenohumeral joint is dislocated, the humeral head is affected and is dislocated downwards. The sternoclavicular joint is rarely ever damaged itself bs of its strength, but force transmitted through it can result in a clavicle fracture, which would lead to a sagging limb.
*** A 12-year-old boy walks in; he fell out of a tree and fractured the upper portion of his humerus. Which of the following nerves are intimately related to the humerus and are most likely to be injured by such a fracture? a. Axillary and musculocutaneous b. Radial and ulnar c. Radial and axillary d. Median and musculocutaneous e. Median and ulnar
The answer is C. axillary n passes posteriorly @ the surgical neck of the H; radial n lies in the radial groove of the middle of the shaft of H. The ulnar nerve passes behind the medial epicondyle, and the median nerve is vulnerable to injury by supracondylar fracture of the humerus, but these nerves lie close to or in contact with the lower portion of the humerus. The musculocutaneous n is not in direct contact with the humerus.
**** Following this accident, the damaged n causes difficulty in abduction, extension, and lateral rotation of his arm. Cell bodies of the injured nerve involved in movement of his arm are located in which of the following structures? A. Dorsal root ganglion B. Sympathetic chain ganglion C. Anterior horn of the spinal cord D. Lateral horn of the spinal cord E. Posterior horn of the spinal cord
The answer is C. The (injured) axillary n (deltoid m) contains GSE fibers whose cell bodies are located in the anterior horn of the spinal cord, and supply the deltoid and teres minor muscles. The axillary nerve also contains GSA and GVA fibers, whose cell bodies are located in the dorsal root ganglia, and sympathetic postganglionic fibers, whose cell bodies are located in sympathetic chain ganglia. The lateral horn of the spinal cord between T1 - L2 contains cell bodies of sympathetic preganglionic fibers. The posterior horn of the spinal cord contains cell bodies of interneurons
***A 21-year-old patient has a lesion of the upper trunk of the brachial plexus (Erb-Duchenne paralysis). Which of the following is the most likely diagnosis? a. Paralysis of the rhomboid major b. Inability to elevate the arm above the horizontal c. Arm tending to lie in medial rotation d. Loss of sensation on the medial side of the arm e. Inability to adduct the thumb
The answer is C. A lesion of the upper trunk of the brachial plexus results in a condition called "waiter's tip hand," in which the arm tends to lie in medial rotation because of paralysis of lateral rotators and abductors of the arm.
A man is unable to hold typing paper between his index and middle fingers. Which of the following nerves was likely injured? a. Radial nerve b. Median nerve c. Ulnar nerve d. Musculocutaneous nerve e. Axillary nerve
The answer is C. DAB with a PAD The ulnar nerve is the "heavy lifter of the hand." To hold a typing paper, the index finger is adducted by the palmar interosseous muscle and the middle finger is abducted by the dorsal interosseous m. Both of these muscles are innervated by the ulnar nerve.
A 21-year-old woman who is an athlete dislocated her glenohumeral joint. However, after 1 week the physician noted that the woman had lost strength when she attempted internal rotation of her arm at the shoulder. This finding was most likely caused by a tear in which of the following muscles? A. Infraspinatus B. Pectoralis minor C. Subscapularis D. Supraspinatus E. Teres minor
The answer is C. Internal rotation is the primary function of subscapularis muscle (LSS &USS nn); The infraspinatus, teres minor = external rotators supraspinatus = abductor of the arm from 0 to 15 degrees. pectoralis major = flexor, adductor, medial rotator
A rock climber falls on his shoulder, resulting in the lesser tubercle chipping off of the humerus. Which of the following structures would most likely have structural and functional damage? A. Supraspinatus muscle B. Infraspinatus muscle C. Subscapularis muscle D. Teres minor muscle E. Coracohumeral ligament
The answer is C. The subscapularis m inserts onto the lesser tubercle of the humerus. The supraspinatus, infraspinatus, and teres minor muscles insert onto the greater tubercle of the humerus. Coracohumeral ligament attaches to the greater tubercle.
he has very limited abduction of his left shoulder and flexion of his left elbow. On observation, the left shoulder is medially rotated. His forearm is pronated, and his elbow is extended. Which of the following muscles is most likely paralyzed in this patient? a. Flexor carpi ulnaris b. Flexor digitorum superficialis c. Latissimus dorsi d. Teres minor e. Trapezius
The answer is D. This patient most likely has an Erb palsy, which is characterized by the "waiter's tip" damage to the C5 and C6 nerve roots. Of the choices, the teres minor is innervated by the axillary nerve (C5, C6) and therefore likely to be paralyzed in this patient. The flexor carpi ulnaris is innervated by the ulnar nerve (C7, C8) and is not affected in an Erb palsy. The flexor digitorum superficialis is innervated by the median n (C7, C8, T1) The latissimus dorsi is innervated by the thoracodorsal nerve (C6, C7, C8) and is not affected in an Erb palsy. The trapezius is innervated by the spinal accessory nerve (cranial nerve XI) and is not affected in an Erb palsy.
A 38 year old homebuilder was involved in an accident and is unable to supinate his forearm. Which of the following nerves are most likely damaged? a. Suprascapular and axillary b. Musculocutaneous and median c. Axillary and radial d. Radial and musculocutaneous e. Medial and ulnar
The answer is D. The supinator and biceps brachii mm responsible for supination of the forearm. These muscles are innervated by the radial and musculocutaneous nerves.
A 29-year-old woman is examined in the ER after falling from her balcony. Radiographic examination reveals that she has suffered a broken clavicle, with associated internal bleeding. Which of the following vessels is most likely to be injured in clavicular fractures? A. Subclavian artery B. Cephalic vein C. Lateral thoracic artery D. Subclavian vein E. Internal thoracic artery
The answer is D. The subclavian vein traverses bn the clavicle and first rib and is the most superficial structure to be damaged following a fracture of the clavicle. The subclavian artery runs posterior to the subclavian vein, and though it is in the appropriate location, it would likely not be damaged bs of its deep anatomic position.
A 47-year-old female tennis professional is informed by her physician that she has a rotator cuff injury. Her physician explains that over the years of play, a shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the following ligaments is the physician most likely referring? A. Acromioclavicular ligament B. Coracohumeral ligament C. Transverse Scapular ligament D. Glenohumeral ligament E. Coracoacromial ligament
The answer is E. The coracoacromial ligament contributes to the coracoacromial arch, preventing superior displacement of the head of the H. Bs this ligament is very strong, it will rarely damage; instead, the ligament can cause inflammation or erosion of the tendon of the supraspinatus muscle as the tendon passes back and forth under the ligament. The acromioclavicular ligament, connecting the acromion with the lateral end of the clavicle, is not in contact with the supraspinatus tendon. The coracohumeral ligament is located too far anteriorly to impinge upon the supraspinatus tendon. The glenohumeral ligament is located deep to the rotator cuff muscles and would not contribute to injury of the supraspinatus muscle. The transverse scapular ligament crosses the scapular notch and is not in contact with the supraspinatus tendon.
Which of the following mm is most likely torn in this patient? Picture 1. Deltoid 2. Infrasoinatus 3. Supraspinatus 4. Teres Major 5. Teres Minor
The arrow in the MRI indicates the supraspinatus tendon as it passes inferior to the acromion and superior to the humeral head before it attaches to the greater tubercle of the humerus. A Supraspinatus
A 32-year-old man is admitted to the ER following a fall directly on his right shoulder with the arm abducted. He experienced pain and swelling of his shoulder immediately after the fall. Physical examination shows a "step deformity" (refer to the asterisk in the following image). A. Clavicle fracture B. Shoulder separation (acromioclavicular joint) C. Shoulder dislocation (glenohumeral joint) D. Sternoclavicular joint separation
The dislocation of the acromioclavicular joint makes the acromion more prominent with the clavicle moving superiorly. The answer is B. Shoulder separation.
A patient comes to ER complaining of the numbness over the lateral aspect of the forearm. Injury is to a terminal branch of the brachial plexus. Which from below you would suspect to be diminished? (more than 1 are correct): a. flexion of forearm b. flexion of arm c. pronation of forearm d. supination of forearm e. extension of forearm
a,b,d
fracture of the lateral border of the scapula. Six weeks after the accident, physical examination reveals weakness in medial rotation and adduction of the humerus. Which nerve was most likely injured? a. Lower subscapular b. Axillary c. Radial d. Spinal accessory e. Ulnar
a. Lower subscapular n It innervates the subscapularis and teres major muscles
A 35-year-old male wrestler is admitted to the ER with excruciating pain in his right shoulder and proximal arm. During physical examination, the patient clutches the arm at the elbow with his contralateral hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the following conditions is the most likely? * H = humerus A. The head of the H is displaced anteriorly B. The head of the H is displaced posteriorly C. The head of the H is displaced inferiorly D. The head of theH is displaced superiorly E. The head of the H is displaced medially
acromioclavicular dislocation = shoulder separation The answer is C. The head of the humerus is displaced inferiorly bs in that location it is not supported by rotator cuff muscle tendons or coracoacromial arch. It is also pulled anteriorly (relative to the tendon of the triceps brachii) beneath the coracoid process by pectoralis and subscapularis muscles.
A 23-year-old college quarterback is admitted to the ER. Physical examination reveals he is unable to move his right (throwing) arm and must support it with his left hand. Radiographic examination of his shoulder is performed to diagnose the patient (refer to the accompanying images). What is the patient presenting with?
anterior shoulder dislocation of glenohumeral joint