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Intervention with Hankin
A 20 yo female soccer player arrives at the ER using her right hand to hold her left arm
close to hr boy. She said that during practice, she was tripped by another player and fell
to the ground on her left shoulder. During physical examination, you observe that the
patient’s left arm is adducted and medially rotated, the elbow extended, and the forearm
pronated; there is loss of sensation from the lateral forearm. Which muscles are
affected by this injury and explain the medially rotated arm?
1. Posterior deltoid-teres minor-infraspinatus
2. Posterior deltoid-teres major-infraspinatus
3. Anterior deltoid-teres minor-infraspinatus
4. Anterior deltoid-teres major-infraspinatus
The opposite muscles aren’t working: flexors, lateral rotators, abductors. Lost sensation
in the lateral forearm means the injury may be the lateral cutaneous nerve of the
forearm. Question asking for the lateral rotators= teres minor, infraspinatus, and
posterior deltoid. Note: supraspinatus initiates abduction.
17 yo weight lifter comes in with a bad shoulder. 2 weeks before, he’d been benchpressing 300 lbs and the weight left him. He felt an electric shock in his left shoulder. He
wasn’t able to abduct his left arm from anatomical position to 90 degrees, but can
maintain position of 90 degree abduction if the limb is placed in that position. Which
nerve has been damaged.
1. Suprascapular
2. Dorsal scapular
3. Axillary
4. Upper subscapular
5. None of the above
Axillary supplies deltoid and teres minor. Suprascapular is the answer since it helps
initiate abduction for deltoid to kick in.
54 yr old male brought into the ER after a motor accident. Sensory deficit of C8 and T1
dermatomes are present. Which nerve carries sensory fibers from the affected
dermatomes.
1. Long thoracic
2. Medial cutaneous nerve of the forearm
3. Lateral cutaneous nerve of the forearm
4. Deep branch of ulnar
5. None of the above
The deep branch of ulnar is all motor. Answer is the medial cutaneous nerve of the
forearm. Page 182 of notes
Patient comes to the ER with a stab wound that penetrates the axilla. Pt exhibits
pronounced neurological deficits including: lack of cutaneous sensation over the wrist
dorsal interosseous muscle, inability to extend the wrist and elbow; abduction of
shoulder can be initiated but not completed. The part of the brachial plexus that was
damaged was the:
1. C7 root of the brachial plexus
2. Middle trunk of the brachial plexus
3. Posterior cord of the brachial plexus
4. Radial nerve
5. None of the above
Superficial branch of the recurrent radial nerve supplies the first interosseous. Radial
nerve supplies the extensors. Suprascapular nerve of the supraspinatus arises from the
superior trunk thus plexus is still okay here since the axilla has been penetrated.
Inability to complete abduction means the deltoid isn’t function thus axillary nerve also
isn’t function. Answer= posterior cord of the brachial plexus.
Different question: All extensor carpi muscles insert at metacarpals. Only flexor carpi
ulnaris attaches to a bone (pisiform). The opponens muscles are deep so they cannot
attach to the pisiform.
During shoulder surgery on a 56 yo woman, the vascular bundle along the medial
border of the scapular is damaged. Which artery will most likely compensate for the
blood supply to the scapula that was lost during this procedure.
1. Dorsal scapular
2. Suprascapular
3. PCH
4. Lateral thoracic
5. Thoracodorsal
Anastomoses allows for collateral circulation. Blood vessels that make up the vascular
bundle include the dorsal scapular. They supply rhomboids, levator scapulae.
Circumflex scapular which is a branch of subscapular also does. Suprascapular is only
answer available here. PCH and ACH supply the humerus. Lateral thoracic which is a
branch of axillary supplies serratus anterior. Thoracodorsal, a brunch of subscapular,
supplies latissimus dorsi.
52 yr old band director suffered problems in her right arm several days after strenuous
field exercises. Physical exam in the orthopaedic clinic reveals wrist drop and weakness
of grasp but normal elbow extension. There is no loss of sensation in the affected limb.
Which nerve is most likely affected?
1. Ulnar
2. Anterior interosseous
3. Posterior interosseous
4. Median
5. Superficial radial
The extensor aren’t working due to wrist drop. This means it has to do with extension
(therefore not 1, 4, or 5). Anterior interosseous is a branch of median nerve. Posterior
interosseous is almost equivalent to the deep branch of the radial nerve (which is all
motor and dives into the supinator). It becomes posterior interosseous after coming
from the supinator muscle.
A 22 yo woman is admitted to the ER in an unconscious state. The nurse takes a radial
pule to determine the heart rate of the patient. This pulse is felt lateral to which tendon.
1. Palmaris longus
2. Flexor pollicis longus
3. Flexor digitorum profunuds
4. Flexor carpi radialis
5. Flexor digitorum superficialis
Flexor pollicis longus is too deep to palpate from the surface. 2 and 5 are deeper.
Palmaris longus is more medial thus flexor carpi radialis is the answer.
A 24 yo man is admitted with a wound to the palm of his hand. Physical exam reveals
that he: (1) cannot touch the pads of his fingers with his thumb, (2) can grip a sheet of
paper between all fingers, and (3) has no loss of sensation from the skin of his hand.
Which nerve has most likely been injured?
1. Deep branch of ulnar
2. Anterior interosseous
3. Median (in the hand)
4. Recurrent median
5. Deep branch of radial
Opponens pollicis supplied by recurrent median is damaged. The ability to grip a sheet
means the interosseous muscles are functioning (the 3 middle fingers) thus ulnar nerve
is functional= deep branch of the ulnar since it’s the motor nerve. All the sensory
branches in the hand are fine therefore median is fine. Anterior interosseous is deep
forearm. Deep branch of the radial in not the answer thus the answer is median nerve.