Nursing Case Study Elbow Flexion
A 21-year-old female presents to the emergency department with pain in her right arm. She was in class at the local university and was participating in an activity where the professor had the whole class arm-wrestle one another.. During one of the matches, she heard something crack, and her whole arm gave way, followed by excruciating pain. Her x-ray shows the following:
After the physician reviews the x-ray, a directed physical examination should test for the most likely complication of the fracture by evaluating:
A. Elbow flexion
B. Finger extension
C. Upper extremity abduction
D. Weakening of the grip and clumsiness
E. Wrist flexion
Choice “B” is the best answer. The nerve that was most likely injured in this patient is the …show more content…
The median nerve is responsible for the flexor muscles of the forearm (except the flexor carpi ulnaris and the medial half of the flexor digitorum profundus) and the muscles of the thenar compartment and lateral two lumbricals. It is commonly injured with a fracture of the supracondylar humerus. The median nerve roots arise from C5–T1 and stem from the lateral and medial cords of the brachial plexus. Sensory innervation includes the skin of the radial half of the palm and palmar side of the lateral 3-1/2 digits and the nail beds for these digits. Median nerve syndromes include carpal tunnel syndrome (most common upper extremity mononeuropathy caused by compression by the transverse carpal ligament called the flexor retinaculum), pronator teres syndrome, and anterior interosseous neuropathy. A clinical sign may include the lack of ability to abduct and oppose the thumb, which is called “ape-hand deformity.” Prolonged compression or injury to the median nerve at the level of the elbow or upper arm can result in the “hand of benediction,” which is the loss of ability to flex digits two and three at the metacarpophalangeal joints (leaving the 2nd and 3rd digits extended). It should not be confused with the “ulnar claw,” which is exclusively found with ulnar nerve damage and is seen with attempted extension of all the digits (leaving the 4th and 5th digits
After the physician reviews the x-ray, a directed physical examination should test for the most likely complication of the fracture by evaluating:
A. Elbow flexion
B. Finger extension
C. Upper extremity abduction
D. Weakening of the grip and clumsiness
E. Wrist flexion
Choice “B” is the best answer. The nerve that was most likely injured in this patient is the …show more content…
The median nerve is responsible for the flexor muscles of the forearm (except the flexor carpi ulnaris and the medial half of the flexor digitorum profundus) and the muscles of the thenar compartment and lateral two lumbricals. It is commonly injured with a fracture of the supracondylar humerus. The median nerve roots arise from C5–T1 and stem from the lateral and medial cords of the brachial plexus. Sensory innervation includes the skin of the radial half of the palm and palmar side of the lateral 3-1/2 digits and the nail beds for these digits. Median nerve syndromes include carpal tunnel syndrome (most common upper extremity mononeuropathy caused by compression by the transverse carpal ligament called the flexor retinaculum), pronator teres syndrome, and anterior interosseous neuropathy. A clinical sign may include the lack of ability to abduct and oppose the thumb, which is called “ape-hand deformity.” Prolonged compression or injury to the median nerve at the level of the elbow or upper arm can result in the “hand of benediction,” which is the loss of ability to flex digits two and three at the metacarpophalangeal joints (leaving the 2nd and 3rd digits extended). It should not be confused with the “ulnar claw,” which is exclusively found with ulnar nerve damage and is seen with attempted extension of all the digits (leaving the 4th and 5th digits