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Questions Answered: 238

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200
38

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Anatomy

Upper Limb

Question 45 of 239

A 79 year old lady tripped on a curb and landed on her outstretched hand. Imaging shows a fracture of the surgical neck of the humerus. Which of the following structures are most likely injured in this type of injury:

Answer:

The axillary nerve and the posterior humeral circumflex artery are most susceptible in this type of injury.

Axillary Nerve Injury

Anatomy / Upper Limb / Innervation of Upper Limb

Last Updated: 24th October 2020

Table: Clinical Features of Axillary Nerve Injury

Nerve Axillary
Mechanism of injury Dislocation of the glenohumeral joint, fracture of the surgical neck of the humerus, trauma or surgery to the shoulder, incorrect use of axillary crutches
Motor loss Loss of abduction of the arm at the glenohumeral joint and weakness of lateral rotation
Sensory loss Lateral arm (regimental badge area)
Signs Atrophy of deltoid – flattened shoulder appearance

Clinical Anatomy

The axillary nerve and associated blood vessels (the posterior circumflex humeral artery and vein) enter the deltoid by passing posteriorly around the surgical neck of the humerus.

Mechanism of Injury

The axillary nerve is most commonly damaged by direct trauma to the shoulder or proximal humerus. Common mechanisms of injury include fracture of the surgical neck of the humerus, shoulder dislocation or iatrogenic injury during shoulder surgery.

Clinical Features

Axillary nerve injury results in:

  • Weakness of abduction (due to paralysis of the deltoid muscle)
  • Weakness of lateral rotation (due to paralysis of the teres minor muscle)
  • Loss of sensation over the 'regimental badge area' on the lateral arm
  • Deltoid muscle atrophy giving a flattened shoulder appearance (in long-standing cases)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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