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Questions Answered: 26
Final Score 46%
12
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Anatomy
Upper Limb
Question 112 of 180
A 28 year old man is brought to ED with a severely painful arm after being involved in a collapsed scrum during a rugby match. An x-ray of his arm is shown below. Which of the following nerves is most commonly injured in this type of injury:
(Image by Hellerhoff (Own work) [CC BY-SA 3.0 , via Wikimedia Commons)
Answer:
The x-ray shows an anterior shoulder dislocation - the axillary nerve is the most commonly injured nerve in this type of injury where it wraps around the surgical neck of the humerus.Shoulder Joint Dislocation
Anatomy / Upper Limb / Shoulder
Last Updated: 8th May 2022
Dislocation of the shoulder joint most commonly occurs in an anterior direction.
Clinical Features
- Severe shoulder pain
- All movements limited and painful
- Affected arm supported by unaffected arm
- Loss of normal contour of deltoid (flattened shoulder)
- Step-off deformity at acromion (with palpable gap inferior to acromion)
- Humeral head palpable anteriorly and below the coracoid process
Anterior Shoulder Dislocation. (Image by Hellerhoff [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons)
Complications
Common complications of anterior shoulder dislocation include:
- Axillary nerve damage (paralysis of the teres minor and deltoid with weakness of lateral rotation and abduction, and loss of sensation over 'regimental badge' area on lateral arm)
- Posterior humeral circumflex vessel damage
- Bankart lesion (avulsion of the glenoid labrum at the insertion of the inferior glenohumeral ligament)
- Rotator cuff damage
- Shoulder joint instability
- Injury to brachial plexus
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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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