A twenty year old male medical student presents one hour after he collided with a telegraph pole while riding his motorcycle at forty-five kilometres per hour. He is right hand dominant. He has a fracture of the right clavicle. He is unable to move his right shoulder or to flex his elbow. The power of finger flexion is reduced. His right hand is cooler than the left and his right radial pulse is reduced. Give a detailed account of how you would use clinical examination to help you define the extent and location of the lesion.

A twenty year old male medical student presents one hour after he collided with a telegraph pole while riding his motorcycle at forty-five kilometres per hour. He is right hand dominant. He has a fracture of the right clavicle. He is unable to move his right shoulder or to flex his elbow. The power of finger flexion is reduced. His right hand is cooler than the left and his right radial pulse is reduced.

  1. Give a detailed account of how you would use clinical examination to help you define the extent and location of the lesion.
  2. Outline what investigations you would initiate following your clinical assessment.
  3. Outline how you would treat this person.
  4. Discuss the role of early exploration and repair of brachial plexus injuries.

 

(30 minutes)

A right hand dominant female surgeon has injured her right thumb skiing earlier in the day. She consults you in the ski lodge later that evening. X-rays are not available. There is swelling and tenderness over the ulnar border of the metacarpo-phalangeal joint.

  1. Discuss how you would examine the patient relating the possible abnormal findings to the anatomy of the affected region.

She wishes to stay at the mountain another week so her family can enjoy the holiday which has just started.

  1. Give a detailed account of the treatment options and expected outcomes depending on the abnormal findings.

 

(30 minutes)

A thirty two year old man presents with a six month history of increasingly severe right sciatica. He has been off work for three months on account of the pain. He has taken non narcotic analgesic and anti-inflammatory medication but has had no other treatment. Prior to the onset of pain he had worked as a construction labourer for fourteen years without a day’s absence due to illness or injury. Imaging reveals a 30% forward shift of L5 on S1 with evidence of pressure on the right nerve root emerging at the L5-S1 level.

  1. Discuss how you would treat this patient.
  2. Discuss how your treatment would differ if the forward shift was 5%.

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