Shoulder injury

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Stem: Patient involved in an RTA (Road Traffic Accident). Neck and shoulder injury.

What injury do you suspect?

Brachial plexus injury

Mechanism of injury?

Traction injury

Common trunk to be injured?

Upper trunk

C5 nerve will exit in between which 2 vertebra

Between C4 and C5

Where do they exit from? - point at the vertebra (you will be given a vertebra in the exam)

Intervertebral Foramen

C5 and C6 cutaneous supply on human body?

C5: lateral arm
C6: lateral forearm and thumb

Describe sensory deficit in Erb’s & Klumpke palsy?

Erbs (waiters tip) - loss of radial side of arm and forearm
!Klumpke's (claw hand) - loss of sensation over ulnar border of forearm and hand

Identify Rotator cuff muscle? Origin? Insertion? Nerve supply?

Muscle -Origin - Insertion - Action - Innervation - Subscapularis - Ventral scapula (subscapular fossa) Humerus (LT - Lesser Tuberosity) - Internally rotating arm; - Providing anterior stability Upper and lower subscapular nerves
Supraspinatus - Superior scapula (supraspinatus fossa) Humerus (greater tuberosity) - Abducting; Providing stability; - Externally rotating arm Suprascapular nerve
Infraspinatus Dorsal scapula (infraspinatus fossa) Humerus (greater tuberosity) - Providing stability; - Externally rotating arm- Suprascapular nerve
Teres minor Scapula (dorsolateral) Humerus (greater tuberosity) - Providing stability; Externally rotating arm - Axillary nerve

What is the Deltoid muscle origin and insertion?

Origin: lateral clavicle and scapula Insertion: deltoid tuberosity of humerus

How to test it on actor? (Likely referring to a clinical exam/OSCE scenario)

Inability to abduct the shoulder > 15 degrees
Loss of sensation over the badge area

What are the flexors of the elbow and their Nerve supply (Value)? -Name of the nerve in the forearm

Muscle Origin Insertion Action Innervation
Brachialis Anterior humerus Ulnar tuberosity (anterior) - Flexing forearm - Radial (C5-T1) + Musculocutaneous (C5-C7)
Biceps brachii Coracoid (short head); Supraglenoid (long head) Radial tuberosity Relations to bicipital tendon: Medially: Median n. and brachial a. Lateral: Radial nerve - Supination, flexion - Musculocutaneous (C5-C7)
Pronator teres Medial epicondyle and coronoid Mid-lateral radius - Pronating, flexing forearm - Median nerve C5-T1

Name of the sensory nerve in the forearm

Lateral cutaneous nerve of forearm

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sensory distribution of radial median and ulnar nerve

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Rotators of the scapula, origin, insertion & nerve supply?
Upward rotators:

Trapezius
Serratus anterior

Downward rotators:

Rhomboids minor
Rhomboids major
Levator scapulae

Muscle Origin Insertion Action Innervation

Trapezius SP C7-T12 Clavicle, scapula (acromion, SP) -Rotating scapula Cranial nerve XI
Serratus anterior Ribs 1-9Scapula (ventral medial) - Preventing winging Long thoracic nerve
Latissimus dorsi SP T6-S5, iliumHumerus (ITG)-Extending, adducting, internally rotating humerus Thoracodorsal nerve
Rhomboid minor SP C7-T1 Scapula (medial spine) - Adducting scapula Dorsal scapular nerve
Rhomboid major SP T2-T5 Scapula (medial border)- Adducting scapula Dorsal scapular nerve
Levator scapulae Transverse process C1-C4 Scapula (superior medial) - Elevating, rotating scapula C3, C4 nerves

Brachioradialis muscle demonstrate on yourself action

Flex forearm
Nerve Supply (NS):
!Radial nerve

Show C5 reflex

Biceps reflex

Name three muscles supplied by musculocutaneous nerve. Nerve root.
Muscles (BBC):

Biceps brachii
Brachialis
Coracobrachialis

Nerve root:

C5, C6, C7

External rotators of arm

Supraspinatus
Infraspinatus
Teres minor

Axillary nerve cutaneous

Skin to the lower half of deltoid

Axillary nerve muscle supply

Deltoid
Teres minor

Shoulder abductor muscles?

Supraspinatus (0-15)
Deltoid (middle fibres) (15-90)
Trapezius and serratus anterior (over 90): which will require upward rotation of the scapula with lateral rotation of the humerus.

isurg

Shoulder injury