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Anatomy

Upper Limb

Question 165 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:

By Hellerhoff (Own work) [CC BY-SA 3.0 , via Wikimedia Commons

(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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