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Anatomy

Upper Limb

Question 100 of 239

A 20 year old patient attends ED having received a gunshot wound to his right arm. Following initial resuscitative measures, it is established that the patient has weakness of flexion and supination of his forearm. Which of the following clinical features is also likely to be seen on further examination:

Answer:

Weakness of flexion and supination of the forearm is likely due to injury of the musculocutaneous nerve which innervates the muscles of the anterior arm. Paralysis of the biceps brachii results in weakness of forearm flexion and supination and paralysis of the brachialis results in weakness of forearm flexion. The musculocutaneous nerve is not involved with movement of the wrist and fingers, but does supply cutaneous innervation to the lateral forearm.

Musculocutaneous Nerve Injury

Anatomy / Upper Limb / Innervation of Upper Limb

Last Updated: 29th January 2019

Table: Clinical Features of Musculocutaneous Nerve Injury

Nerve Musculocutaneous
Mechanism of injury Stab wound in axilla
Motor loss Weakness of flexion and supination of the forearm, weakness of arm flexion
Sensory loss Lateral aspect of forearm

Injury to the musculocutaneous nerve is rare, as it is relatively protected in the axilla.

The most common cause of injury is a stab wound in the axilla.

Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively.

There is loss of sensation over the lateral aspect of the forearm.

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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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