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CASE 3 A 23-year-old male reports that during a game of hoops (basketball), he tripped while driving the ball to the basket, and fell on his outstretched right hand with the palm down. Two days later, he phoned his anatomist father and related that his right wrist was painful. Later that day, he visited his father, who noted that the wrist was slightly swollen and tender but without deformity. He instructed his son to extend the right thumb, thereby accentuating the anatomical “snuffbox,” which is extremely tender to deep palpation. His father advised him to get his hand and wrist x-rayed.
⯈ What is the most likely diagnosis? ⯈ What is the most likely anatomic defect?
ANSWERS TO CASE 3:
Wrist Fracture Summary: A 23-year-old male trips while playing basketball and suffers trauma to the right wrist. The wrist is slightly swollen, tender, but not deformed. However, deep palpation of the anatomical snuffbox elicits extreme tenderness. • Most likely diagnosis: Wrist fracture • Most likely anatomical defect: Fracture of the narrow middle portion of the scaphoid carpal bone
CASE 2 A 32-year-old man is involved in a motor vehicle accident. He used three-point restraints and was driving a sedan. The driver of a pickup truck ran a stop sign while going at approximately 45 mi/h (mph) and broadsided (T-boned) the patient’s vehicle on the driver’s side. The patient has multiple injuries, including a displaced fracture of the left humerus. He complains of an inability to open his left hand and loss of sensation to a portion of his left hand.
⯈ What is the most likely diagnosis? ⯈ What is the likely mechanism of the injury? ⯈ What portion of the left hand is likely to have sensory deficit?
ANSWERS TO CASE 2:
Radial Nerve Injury Summary: A 32-year-old man is involved in a motor vehicle accident that causes a displaced fracture of the left humerus. He has motor and sensory losses to his left hand. • Most likely diagnosis: Injury to the radial nerve as it spirals around the humerus, resulting in an inability to extend the wrist or fingers and loss of sensation of the hand • Likely mechanism: Stretch or crush injury to the radial nerve as it spirals around the midshaft of the humerus • Likely location of sensory deficit: Radial (lateral) side of the dorsum of the hand and dorsum of the thumb and index and middle digits
CASE 1 A 32-year-old woman delivered a large (4800-g) baby vaginally after a somewhat difficult labor. Her prenatal course was complicated by diabetes, which developed during pregnancy. At delivery, the infant’s head emerged, but the shoulders were stuck behind the maternal symphysis pubis, requiring the obstetrician to execute maneuvers to release the infant’s shoulders and complete the delivery. The infant was noted to have a good cry and pink color but was not moving its right arm.
⯈ What is the most likely diagnosis? ⯈ What is the most likely etiology for this condition? ⯈ What is the likely anatomical mechanism for this disorder?
ANSWERS TO CASE 1:
Brachial Plexus Injury Summary: A large (4800-g) infant of a diabetic mother is delivered after some difficulty and cannot move its right arm. There is shoulder dystocia (the infant’s shoulders are stuck after delivery of the head). • Most likely diagnosis: Brachial plexus injury, probably Erb palsy (Duchenne- Erb paralysis) • Most likely etiology for this condition: Stretching of the upper brachial plexus during delivery • Likely anatomical mechanism for this disorder: Stretching of nerve roots C5 and C6 by an abnormal increase in the angle between the neck and the shoulder