• often fractured by indirect force
• weakest part are its middle and lateral third
• sternocleidomastoid muscle elevates the medial bone fragment

• 1st long bone to ossify- intramembranous ossification
• endochondral ossification- end of clavicle passes through carilaginous phase
• 2ndary ossification center ossifies 18-25 and completely fuses ar 25-31 yrs of age- last epiphysis of a long bone to fuse

result of severe trauma

usually accompanied by fractured ribs

most involve the protruding subcutaneous acromion

little treatment is involved

Fractures of the Surgical neck- common in elderly, axillary nerve damage can occur

transverse fractures of the shaft of humerous- result from direct blow to arm

supracondylar fracture- distal part of humerus near the supracondylar ridges

fracture radial groove- radial nerve; fracture distal hum- median nerve; fracture medial epicondyle-ulnar nerve

most common fracture of the forearm

complete fracture of the distal 2 cm of radius

results in distal fragment communicated, ulnar styloid process avulsed, results in diner fork hand

results from a fall with the hand abducted

pain occurs on lateral side of wrist

can lead to avascular necrosis of the proximal fragment of scaphoid and from this produce degenerative joint disease

may result in nonunion of the fractured bony parts due to traction from the attached muscles

ulnar nerve may be injured

ulnar artery may also be injured

fracture of distal phalanx- usually comminuted

fractures of proximal and middle phalanges- result of crushing or hyperextension injuries

due to injury of the long thoracic nerve

medial border moves laterally and posteriorly away from thoracic wall

arm cannot be abducted above horizontal position

to draw blood or inject a soln

median cubital vein is commonly used

Results in: atrophy of deltoid

rounded shoulder contour dissapears

loss of sensation over lateral sipe of the proximal part of the arm

to test deltoid- arm is abducted, against resistance, starting at 15 degrees

produces instability to glenohumeral joint

rupture or tear to supraspinatus tendon is most common

degenerative tendinitis of the rotator cuff is common in the elderly

allow for collateral circulation

if a problem with axillary artery flow, flow in the subscapular artery can be reversed

abrupt surgical ligation does no allow for adequate collateral circulation

wound in proximal part is dangerous due to air emboli

note: when arm is fully abducted vein lays in front of artery

lymphangitis- inflammation of lymphatic vessels

humeral nodes are generally involved first

warm red streaks of the limb

most common site for metastases of breast cancer

Prefixed Brachial Plexus

Postfixed brachial Plexus

superiormost root of the plexus is C4 and the inferiormost is C8

superior C6 and inferior T2- inferior trunk may be compressed by first rib

erb-duchenne palsy- lam hangs by the side medial rotation

upper limb- adducted shoulder, medially rotated arm, extended elbow lateral aspect loss of sensation

injury to inferior part of brachial plexus

claw hand results

enables surgeons to operate on the upper limb without using a general anesthetic

results from wear and tear on inflammed tendon

torn from attachment to supraglenoid tubercle

gives a "Popeye" deformity

relaxed limb: pronated and partially extended

examiner's thumb placed on biceps tendon anf tapped with reflex hammer

normal response- involuntary contraction of the biceps, confirms integrity of C5 and C6 cord segments

results in: paralysis of the coracobrachialis, biceps, brachialis

flexion of the elbow and supination of forearm is weakened

loss of sensation on lateral surface of the forearm

Volkmann ischemic contracture

results from occlusion or laceration of brachial artery

is contraction of the fingers and sometimes the wrist

Best place is near the middle of the arm

may be clamped distal to the inferior ulnar collateral artery without producing tissue damage

ischemia of the elbow and forearm results from clamping the artery proximal to the deep artery of the arm for an extended periord

Tennis Elbow

pain felt over lateral epicondyle and radiates over posterior surface of the forearm

appears most common on dorsum of wrist

swelling referred to as ganglion

can compress the median nerve by narrowing the carpal tunnel

results from sudden severe tension on a long extensor tendon my avulse part of its attachment to the phalanx

person unable to extend the distal interphalangeal joint

results in progressive shortening, thivkening, and fibrosis of the palmar fascia and palmar aponeurosis

pulls 4th and 5th fingers into partial flexion

swelling is generally on the dorsum side where the fascia is thinner

fascial spaces determine the extent and direction of pus flow

important to know that the superficial palmar arch is at the same level as the distal extremity of the common flexor sheath

wounds along the thenar eminence may injure the recurrent branch of the median nerve to the thenar muscles

marked by cyanosis and paresthia and pain

Raynaud Syndrome- unkown cause

inflammation of the tendon and synovial sheath

infection usually confined to infected digit

infection spreads from digits depending on connection with common flexor sheath

results from: lesion that significantly reduces that size of the tunner or increase in size of structures that pass through it

median nerve is most affected

sensation issues may arise in lateral 3 and a half digits

Friction of the APL and EPB tendons resulting is fibrous thickening of sheath and stenosis of the osseofibrous tunnel

causes pain in the wrist that radiates proximally to the forearm and distally to the thumb

trigger finger/ snapping finger

FDS and FDP tendons enlarge proximal to tunnel and person passively tries to extend the finger a snap is audible

usually occur in forearm and wrist

wrist lacerations of nerve result in impairment of the 2nd and 3rd fine control movements

laceration at elbow results in loss of flexion of proximal and distal  interphalangeal joints of 3nd and 3rd digit

1) posterior to the medial epicondyle of the humerus

2) In the cubital fossa formed by the tendinous arch connecting the humeral and ulnar head of the FCU

3) the wrist

4) the hand

manifest by hypoesthesia in the medial and one half fingers and weakness of one intrinsic hand muscle

4th and 5th finger clawing may occur, ability to flex is unaffected

Wrist drop is the primary clinical manifestation

severance of the deep branch- inability to extend thumb and the metacarpophalangeal joints to the other digits, loss of sensation does not occur

generally injured in repetative use of upper limb

degenerative tendinitis of the rotator cuff

attrition of the supraspinatus tendon also occurs

complete tear person cannot initiate abduction

AC joint is weak and easily injured by direct blow

AC dislocation also called shoulder separation

when AC and coracoclavicular ligament tear shoulder sep from clavicle and falls

most often in young adults

excessive extension and lateral rotation of the humerus

Inflammation and calcification of the acromial bursa result in pain, tenderness, and limitation of movement of the glenohumeral joint

depostion of calcium in the supraspinatus tendon may irritate the overlying subacromial bursa

painful arc syndrome

"frozen shoulder"

adhesive fibrosis and scarring between the inflamed capsule of the glenohumeral joint, rotator cuff, subacromial bursa, and deltoid

difficulty abducting the arm

results from excessive friction between the triceps tendon and the olecranon

pain is severe during flexion of the forearm because of pressure exerted on the inflammed subtendinous olecranon bursa by the triceps tendon

epiphysis for the medial epicondyle may not may not fuse with distal end of the humerus until up to age 20

traction injury of the ulnar nerve is a complication of the abduction type of avulsion of the medial epicondyle

may occur when children fall with their elbows flexed

distal end of the humerus is driven through the weak anterior part of the fibrous layer of the joint capsule as the radius and ulna dislocate posteriorly

injury to ulnar nerve may occur