Injuries of Upper limb

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Injuries of the
Upper limb
Dr Naveed Khalid

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Anatomic snuff box
 Triangular deepening on the radial, dorsal side of the hand
 The medial border (ulnar side)
 Extensor pollicis longus Tendon.
 The lateral border (radial side)
 Extensor pollicis brevis tendon
 Abductor pollicis longus tendon
 Floor
 Scaphoid
 Trapezium
 Content
 Radial Artery

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Fracture of the clavicle
 Fall on the shoulder or outstretched hand
 During delivery through the birth canal of a baby who is breech
presentation

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 Its fracture occurs most commonly at the junction of its medial
and lateral thirds
 This results in Upward displacement of the medial fragment and
downward displacement of the lateral fragment

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 It may cause injury to the brachial plexus (lower trunk)
 Fatal hemorrhage from damage to the subclavian artery
 Thrombosis of the subclavian vein may occur

10. Fracture of Humerus

11. Site Nerve Artery
1 Surgical Neck Axillary nerve Posterior humeral circumflex artery
2 Shaft Radial nerve Profunda brachii artery
3 Supracondylar Median nerve Brachial artery
4 Medial Epicondyle Ulnar nerve Ulnar collateral artery

13. z
Colles Fracture
 Distal radius fracture in which the distal fragment is displaced
(tilted) posteriorly
 Produces a characteristic bump described as dinner fork
deformity because the forearm and wrist resemble the shape of
a dinner fork.
 May cause damage to the median nerve
 If the distal fragment is displaced anteriorly, it is called a reverse
Colles fracture (Smith fracture).

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Fracture of the scaphoid
 Due to Fall on the outstretched hand
 Deep tenderness felt in anatomical snuffbox
 Damages the radial artery and can cause
avascular necrosis of the bone and
degenerative joint disease of the wrist

18. z
Fracture of the hamate
 Leads to Injury of structures close to the hook of hamate
 Ulnar Nerve
 Ulnar Artery

20. Glenohumeral dislocation (subluxation)

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Glenohumeral Dislocation
 Occurs usually in the anteroinferior direction because of the lack
of support by tendons of the rotator cuff
 Damages the Axillary nerve

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Lateral Epicondylitis
 Also known as tennis elbow
 Chronic inflammation or irritation of the origin (tendon) of the
extensor muscles of the forearm from the lateral epicondyle of
the Humerus
 Due to repetitive extension at elbow joint

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Lateral Epicondylitis
 Also known as tennis elbow
 Chronic inflammation or irritation of the origin (tendon) of the
extensor muscles of the forearm from the lateral epicondyle of
the Humerus
 Due to repetitive extension at elbow joint

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Medial Epicondylitis
 Also known as golfer’s elbow
 Painful condition caused by a small tear or an Inflammation or
irritation in the origin of the flexor muscles of the forearm from
the medial epicondyle
 Due to repetitive flexion at elbow joint

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Radial head Subluxation
 Occurs in toddlers when the child is lifted
by the wrist
 It is caused by a partial tear (or loose) of
the annular ligament and thus the radial
head slips out of position

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Cubital tunnel
 Space of the dorsal medial elbow which allows passage of the ulnar nerve around
the elbow
 Transmits
 Ulnar Nerve
 Posterior ulnar recurrent artery

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Cubital tunnel syndrome
 Compression on the ulnar nerve in the cubital tunnel behind the
medial epicondyle (funny bone)
 Causes numbness and tingling in the ring and little fingers

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Carpal tunnel syndrome
 Due to Compression of the median nerve
 Reduced size of the osseofibrous carpal tunnel
 Results from
 Inflammation of the flexor retinaculum or
 Arthritic changes in the carpal bones or
 Inflammation or thickening of the synovial sheaths of the flexor tendons

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 Leads to pain and paresthesia (tingling, burning, and
numbness) in the hand in the area supplied by the median nerve
and may also cause atrophy of the thenar muscles in cases of
severe compression.

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Injury to brachial plexus
 Axillary nerve
 Weakness of lateral rotation and abduction of the arm
 Musculocutaneous nerve
 Weakness of supination and flexion of forearm
 Loss of sensation on the lateral side of forearm

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Radial nerve palsy
 Injury to the posterior cord is caused by the pressure in the
axilla
 Crutch palsy
 Saturday night palsy
 Resulting in the paralysis of the arm
 It results in the loss in function of the extensors of the arm,
forearm, and hand
 Produces a wrist drop

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MEDIAN NERVE PALSY
 Loss of opposition of the thumb, and flexion of the lateral two
interphalangeal joints
 It also produces a characteristic flattening of the thenar
eminence, often referred to as the ape hand.

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Ulnar nerve palsy
 The ring and little fingers are Hyperextended at the metacarpophalangeal
joints and flexed at the interphalangeal joints.
 It results in loss of abduction and adduction of the fingers and flexion of the
metacarpophalangeal joints because of the paralysis of the palmar and
dorsal interossei muscles and the medial two lumbricals.
 It also produces wasting of the hypothenar
 Results in claw hand

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Injury to the long thoracic nerve
 Caused by a stab wound or during radical mastectomy or
thoracic surgery.
 It results in paralysis of the serratus anterior muscle and inability
to elevate the arm.
 It produces a winged scapula in which the vertebral (medial)
border of the scapula protrudes away from the thorax

55. z
Erb–Duchenne paralysis
 Upper trunk injury (C5-C6 roots)
 Birth injury during a breech delivery or a violent displacement of
the head from the shoulder such as might result from a fall from
a motorcycle or horse
 It results in a loss of abduction, flexion, and lateral rotation of the
arm, producing a waiter’s tip hand, in which the arm tends to lie
in medial rotation resulting from paralysis of lateral rotator
muscles.

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 Thank you