While fireman Fred is fighting a fire in a building, part of t...

Question

While fireman Fred is fighting a fire in a building, part of the ceiling collapses, and a beam strikes him on his left shoulder. He is rescued, but has a great deal of pain in his shoulder. He cannot move his arm properly, especially in the anterior direction. His clavicle is not broken, and his humerus is intact. What is the probable nature of Fred’s injury?

Accepted Answer

Welcome back everyone. Our next question says Mike, a professional rugby player was involved in a high intensity match during a tackle, he collided forcefully with an opponent and landed awkwardly on his left side. Immediately after the impact, Mike experienced intense pain and a noticeable deformity in in his left chest area, he was unable to move his left arm without severe discomfort and noticed swelling and bruising over the inter injured sight. Mike is likely to have sustained a fracture in his a scapula b clavicle c humorous or D jugular notch. So let's think about the symptoms. Our problem tells us he's likely to have sustained a fracture, which would make sense with swelling bruising and intense pain. After some sort of incident that might be expected to cause this. The deformity is seen in the left chest area which would indicate that the bone is somewhere in that region. The bones actually been displaced, causing this deformity, but he's also unable to move his left arm. So we're thinking about that joint. So between the deformity in the chest and unable to move his left arm or without severe discomfort, we would be thinking about the joint area of the shoulder. So let's think about the bones that make this up to determine which is most likely to have been fractured. Just putting a very, very rough diagram here. And we would be thinking about most likely the choice B clavicle in my drawing, the clavicle is in red. It's that flat bone and it bridges the bone of the scapula which forms the socket part of the ball and socket joint of the shoulder and then it connects the scapula with the sternum, which I've drawn in blue. So I have the scapula in black on the left side with this bridge of the clavicle and red in the middle and the sternum and blue on the right. And this would make sense. An injury to the clavicle is going to affect the ability of the arm to move within that joint. You can see the socket area of the scapula, this rounded area and of course, the humorous, the ball part of the humus will be fitting right in there. So if the clavicle has been broken, to the extent that it's actually sticking out the ability of the joint to move freely is definitely going to be affected. In addition, the clavicle is the one of the most frequently or actually, I should say the most frequently fractured bone in the human body, especially if he's been involved in an intense high contact sport like rugby, definitely the most likely possibility and of course, you have the deformity scene in the left chest. When the clavicle fractures, it almost always fractures outward, which is actually very fortunate because the jugular vein lies right underneath it. And we would definitely have problems if jagged, broken bone edges were projecting towards the jugular vein. So you would expect to see with a fractured clavicle, this deformity where the bone might be jutting out. So all of these signs here definitely indicate a fracture of the clavicle. Let's look at our other answer. Choices. Choice A is scapula. And as we said, the difficulty in moving the left arm would indicate some sort of effect on the shoulder joint. However, you wouldn't see the deformity in the chest in case of fracturing the scapula, the scapula is the shoulder blade and it's found in the back. So you wouldn't expect to see that visible deformity in the front with a fractured scapula. It's also less common to be fractured although it can be injured. So choice a not our correct answer to C is the humerus. And of course, that's the upper arm bone that goes into the scala Mike did have difficulty moving his arm. But since the humerus is bounded on either side by the shoulder joint and then the elbow joint, we'd expect to also see difficulty or limited movement in the shoulder and the elbow. And more importantly, you expect to see swelling and bruising in the upper arm. Um Whereas with Mike, we're seeing a deformity visibly in the chest. So that's why we wouldn't expect it to be a fracture to the humerus. And finally, choice d the jugular notch, um The jugular notch is just this depression in the upper sternum. And I'll put a little red arrow here to show it on my diagram. So at the very top of the sternum, it's easily felt uh at the bottom of your neck. But this wouldn't be something you would fracture. It's a little notch in the bone. You wouldn't describe yourself as having a fracture of the jugular notch. So choice the, not a correct answer. So again, with this description of Mike, having been involved in a rugby game falling on his left side and then experiencing intense pain, noticeable deformity in the chest area, unable to move his left arm with swelling and bruising. Where is this fracture? Likely to be? Choice? B the clavicle? I'll see you in the next video.

Key Concepts

Shoulder Anatomy

Rotator Cuff Injuries

Shoulder Dislocation

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