Upper Limb - Arm + forearm

Question 1

What is biceps tendinopathy?

Answer 1

Inflammation of the long head of the biceps tendon

Question 2

What symptoms suggest biceps tendinopathy?

Answer 2

1. Anterior shoulder pain radiating to the elbow
2. Worsened by shoulder flexion, forearm pronation, and elbow flexion

Question 3

What might a snapping sensation indicate?

Answer 3

Subluxation of the tendon

Question 4

What is a key sign of a bicep tendon tear?

Answer 4

‘Pop-eye’ sign and extensive bruising

Question 5

A pop-eye sign is seen where?

Answer 5

1. Proximal long head of the biceps tendon (more common)
2. Distal biceps tendon (less common but dramatic)

Question 6

What investigation is used for bicep tendinopathy?

Answer 6

Ultrasound scan (USS)

Question 7

‘There’s significant weakness + pain at the elbow, especially after lifting’

This suggest what?

Answer 7

Distal rupture

Question 8

‘there’s a bulge but minimal weakness’

Answer 8

proximal long head

Question 9

A 19-year-old is brought into the emergency department by ambulance from the gym. He reports attempting to ‘curl’ over 20kg of weight with his right arm when he felt intense pain at his right elbow with almost immediate weakness in his right arm. On examination of the arm, there is marked swelling at the elbow joint, there is also a prominent bulge in the anterior upper arm and the patient is extremely weak in flexion although supination is preserved

What is the most likely injury?

Answer 9

Long head of biceps rupture

Question 10

A 45-year-old male presents to the GP after noticing a prominent bulge over his right biceps which appeared suddenly 1 day ago. There is no pain and there is no limitation to his movements. He is a frequent weight-lifter and has a history of injury to his shoulder 5 years ago

What is the most possible diagnosis?

Answer 10

Proximal bicep tendon rupture

Question 11

What is the most common type of proximal humerus fracture?

Answer 11

Surgical neck fracture

Question 12

What is the typical cause of proximal humerus fracture?

Answer 12

Low-energy falls, especially in osteoporotic bone

Question 13

What are the key symptoms of a proximal humerus fracture?

Answer 13

Pain, swelling, and decreased motion

Question 14

What is a significant concern in the clinical exam for those with a proximal humerus fracture?

Answer 14

Axillary nerve injury—check neurovascular status

Question 15

How are simple proximal humerus fractures managed?

Answer 15

Conservatively with a collar and cuff
= ORIF or joint replacement in severe cases

Question 16

What causes a humeral Shaft Fracture?

Answer 16

1. Direct trauma to the arm (eg, RTC) results in transverse or comminuted fractures
2. Fall resulting in oblique, or spiral fractures if rotational

Question 17

What are the symptoms and signs of a humeral Shaft Fracture?

Answer 17

Symptoms
1. Pain
2. Extremity weakness

Signs
1. Preoperative/pre-reduction neurovascular exam is critical

2. Examine and document the status of radial nerve pre and post-reduction
3. Radial nerve injury - neurovascular examination!!

Question 18

What commonly causes fractures of the radius and ulna shafts?

Answer 18

Direct or indirect trauma to the forearm

Question 19

What are the 4 types of fracture patterns seen in radius and ulna shaft fractures (forearm fractures) ?

Answer 19

1. Monteggia
2. Galeazzi
3. Nightstick fracture
4. Greenstick fracture

Question 20

What is a Monteggia fracture?

Answer 20

A fracture of the proximal third of the ulna with dislocation of the proximal head of the radius

= (1) Fall on an outstretched hand with forced pronation

(2) Needs prompt diagnosis to avoid disability

Question 21

What is a Galeazzi fracture?

Answer 21

A fracture of the distal third of the radius with dislocation of the distal radioulnar joint

= Direct blow

Question 22

What is a nightstick fracture?

Answer 22

An isolated fracture of the ulnar shaft, usually from a direct blow

Question 23

What is a greenstick fracture and who typically gets it?

Answer 23

An incomplete fracture of a long bone that bends and cracks instead of breaking completely

= common in children due to flexible bones

Question 24

What causes radial nerve palsy?

Answer 24

1. Wrist drop ( the inability to extend the wrist, stays flexed and downwards) = classic sign of radial nerve palsy
2. Inability to extend elbow and fingers
3. Sensory loss over the posterior arm, forearm, and dorsum of lateral 3½ fingers
   = matches radial nerve distribution

Therefore a humeral shaft fracture

Question 25

What are the 3 different radical nerve injuries?

Answer 25

1. Axillary 2. Midshaft Humerus 3. Forearm

Question 26

Describe radial nerve injury the axillary

Answer 26

= Crutch palsy (1) Motor loss: Elbow extension (triceps), wrist and finger extension (wrist drop). (2) Sensory loss: Posterior arm, forearm, dorsum of hand, lateral 3½ fingers Very high radial nerve injury

Question 27

Describe radial nerve injury at the humerus

Answer 27

= Fracture (1) Motor loss: Wrist and finger extension (wrist drop) thumb extension (2) Sensory loss: Posterior forearm, dorsum of the hand, lateral 3½ fingers High radial nerve injury

Question 28

Describe radial nerve injury at the forearm

Answer 28

= Posterior Interosseous Nerve (1) Motor loss: Finger/thumb extension. (2) Sensory: No sensory loss. Low radial nerve injury

Question 29

A 34-year-old contractor has fallen off some scaffolding at work onto his right arm, and you suspect a mid-shaft humeral fracture. What would test the nerve most at risk in this situation?

Answer 29

Extend the wrist

Question 30

In a mid-shaft humerus fracture, which structure is most at risk of injury

Answer 30

radial nerve

Question 31

A surgical neck fracture damages what?

Answer 31

Axillary nerve and posterior circumflex humeral artery