Lecture #110: Intro to Orthopedics of Upper Extremity

What are common mechanisms of midshaft humeral fractures?

Direct blow, fall, or collision causing trauma to the humeral shaft.

Which nerve is most commonly injured in a midshaft humeral fracture?

The radial nerve, which runs along the humeral shaft.

Which artery is at risk in a midshaft humeral fracture?

The deep brachial artery.

What are key motor deficits in radial nerve injury from midshaft fracture?

Loss of elbow extension, wrist extension, and finger extension resulting in wrist drop.

What sensory deficits occur with radial nerve injury?

Loss of sensation over the posterior arm, posterior forearm, and dorsal hand.

What is wrist drop?

Inability to extend the wrist due to radial nerve injury leading to flexed resting position.

What condition mimics radial nerve injury from midshaft fracture?

Saturday night palsy due to compression of the radial nerve.

What fracture is associated with axillary nerve injury?

Surgical neck fracture of the humerus.

What are findings of axillary nerve injury?

Loss of shoulder abduction beyond 15 degrees and decreased sensation over the lateral shoulder.

What artery is associated with surgical neck fractures?

The posterior circumflex humeral artery.

What fracture is associated with median nerve injury?

Supracondylar humeral fracture.

What are motor deficits in median nerve injury at the elbow?

Loss of wrist flexion and thumb opposition.

What sensory deficits occur with median nerve injury?

Loss of sensation over the lateral three and a half digits on palmar and dorsal sides.

What serious complication can occur after supracondylar fracture?

Compartment syndrome leading to Volkmann contracture.

What is Volkmann contracture?

Permanent flexion deformity of the wrist and fingers due to ischemia and muscle necrosis.

What causes Volkmann contracture?

Increased compartment pressure compressing the brachial artery and causing ischemia of flexor muscles.

What is the clinical presentation of Volkmann contracture?

Wrist and fingers held in flexion with inability to passively extend.

What nerve damage worsens Volkmann contracture?

Median nerve injury contributing to flexor compartment dysfunction.

What fracture is associated with ulnar nerve injury?

Medial epicondyle fracture.

What are motor deficits in ulnar nerve injury?

Decreased flexion of the fourth and fifth digits and radial deviation of the wrist during flexion.

What sensory loss occurs in ulnar nerve injury?

Loss of sensation over the fifth digit and medial half of the fourth digit.

What is the typical mechanism of medial epicondyle injury?

Direct trauma to the medial elbow.

What pediatric elbow injury results from pulling on the arm?

Radial head subluxation also known as nursemaid’s elbow.

What is the mechanism of radial head subluxation?

Longitudinal traction on the arm causing displacement of the radial head.

What is the typical presentation of nursemaid’s elbow?

Child holds arm slightly flexed and pronated with refusal to use it.

What are common elbow conditions included in clinical evaluation?

Fractures, dislocations, bursitis, ligament injuries, and nerve entrapments.

What is the ulnar collateral ligament important for?

Stabilizing the medial elbow during valgus stress.

What condition is associated with repetitive forearm use at the elbow?

Epicondylitis including lateral and medial types.

What is lateral epicondylitis?

Inflammation of wrist extensor tendons causing pain at the lateral elbow.

What is medial epicondylitis?

Inflammation of wrist flexor tendons causing pain at the medial elbow.

What are common wrist injuries discussed in upper extremity evaluation?

Scaphoid fractures, lunate injuries, and distal radius fractures.

Why are scaphoid fractures clinically significant?

Poor blood supply increases risk of avascular necrosis.

What is a boxer’s fracture?

Fracture of the fifth metacarpal typically from punching an object.

What is trigger finger?

Locking of a finger due to tendon sheath inflammation.

What is mallet finger?

Inability to extend the distal phalanx due to extensor tendon injury.

What is carpal tunnel syndrome?

Compression of the median nerve at the wrist causing numbness and tingling in the first three digits.

What is Guyon’s canal syndrome?

Compression of the ulnar nerve at the wrist affecting the fourth and fifth digits.

What is De Quervain tenosynovitis?

Inflammation of thumb tendons causing pain with movement and grasping.

What are the six Ps of compartment syndrome?

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia.

What is the definitive treatment for compartment syndrome?

Emergent fasciotomy to relieve pressure and restore blood flow.

What is the importance of recognizing neurovascular injury in fractures?

Early identification prevents permanent damage and guides urgent management.

What is the clinical importance of understanding fracture patterns?

It helps predict associated nerve and vascular injuries.