476.A 10-year-old boy is brought into your office by his mother. The boy
is supporting his left arm at the elbow by using his right hand because he
thinks he has “broken his arm.” The 10-year-old had been playing tag and
tripped over the curb and landed on the grass, catching himself with his
hands. Upon physical examination you note a slight drooping of the left
shoulder when unsupported, and tenderness over the midclavicular region
butnopalpable fracture or displacement. The jugular notch appears sym-
metrical. The shoulder has normal movement, but the boy is unwilling to
lift his hand above his head because it hurts. Otherwise, hand and arm
movements are relatively normal with normal sensation. You order an AP
and lateral x-rays of the thorax and upper arm because you suspect which
of the following?
a. Colles’ fracture
b. Scaphoid fracture
c. Fracture of the surgical head of the humerus
d. Dislocated sternoclavicular joint
e. Greenstick fracture of the clavicle
477.A 16-year-old girl is brought into your orthopedic office because she
fell off her bicycle while riding down a steep hill. You examine her left arm
and can palpate a displaced midshaft break of her humerus. You note that
she can notextend her wrist, but you do notfeel any distal broken bones.
She has limited ability to extend and abduct her arm at the shoulder. Her
left forearm and hand feel slightly colder than her right arm and you note
she seems to have lost some sensation on the posterior lateral portion of her
left hand, though she says she can feel with all her fingertips. You are con-
cerned that she has damaged which of the following?
a. Axillary nerve
b. Axillary nerve and posterior humeral circumflex artery
c. Radial nerve
d. Radial nerve and deep artery of the arm
e. Median nerve and brachial artery
Extremities and Spine 573