Can't extend the wrist, Can't make a fist! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 01-06-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 281
Threads: 74
Thanked 131 Times in 68 Posts
Reputation: 141
Question Can't extend the wrist, Can't make a fist!

Boy falls on outstretched hand; gets humerus fracture and cannot make a fist along with inability to extend wrist.

where is the fracture?

a. supracondylar
b. radial head
c. mid shaft humerus
d. surgical neck
e. anatomical neck
Reply With Quote Quick reply to this message
The above post was thanked by:
1TA2B (01-08-2012), drortho (01-16-2012)



  #2  
Old 01-06-2012
Relid's Avatar
USMLE Forums Scout
 
Steps History: ---
Posts: 57
Threads: 8
Thanked 31 Times in 19 Posts
Reputation: 41
Default

I think it's C.

Symptoms (inability to extend wrist -> wrist drop) indicate injury to the radial nerve which is caused by a fracture of the midshaft of the humerous.

It doesn't explain the fact that the boy can't make a fist though...
But the other answers are inappropriate.
Reply With Quote Quick reply to this message
  #3  
Old 01-07-2012
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
Default

c. mid shaft humerus injury to radial nerve as he cant extend his wrist

FA table page 370
Reply With Quote Quick reply to this message
 
  #4  
Old 01-07-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 93
Threads: 15
Thanked 45 Times in 25 Posts
Reputation: 45
Default

Quote:
Originally Posted by Relid View Post
I think it's C.

Symptoms (inability to extend wrist -> wrist drop) indicate injury to the radial nerve which is caused by a fracture of the midshaft of the humerous.

It doesn't explain the fact that the boy can't make a fist though...
But the other answers are inappropriate.
Yup I agree.. Perhaps the pain from the fall makes it difficult for him to make a fist, I don't know
Reply With Quote Quick reply to this message
  #5  
Old 01-07-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 46
Threads: 3
Thanked 34 Times in 20 Posts
Reputation: 44
Default

What about a supracondylar fracture? After all both the median nerve and radial nerve have to cross the elbow to get to the forearm to innervate wrist flexors/extensors.
Reply With Quote Quick reply to this message
  #6  
Old 01-07-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 281
Threads: 74
Thanked 131 Times in 68 Posts
Reputation: 141
Default

Quote:
Originally Posted by ALittleTeaPot View Post
What about a supracondylar fracture? After all both the median nerve and radial nerve have to cross the elbow to get to the forearm to innervate wrist flexors/extensors.
I was thinking of the same, but then answer is mid shaft of the humerus. CAnnot understand why it cannot be Supracondylar fracture
Reply With Quote Quick reply to this message
  #7  
Old 01-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

Its mid shaft humerus fracture....Radial nerve is in close contact with the bone in the radial groove.
And why its not supracondylar?.....i feel both median and radial nerve are not in close contact in the supracondylar region, located more away from the bone. Hence cant be correct.
lets wait for the exact answer and explanation!!!!!!
Reply With Quote Quick reply to this message
  #8  
Old 01-07-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 46
Threads: 3
Thanked 34 Times in 20 Posts
Reputation: 44
Default

Quote:
Originally Posted by anomali View Post
And why its not supracondylar?.....i feel both median and radial nerve are not in close contact in the supracondylar region, located more away from the bone.Hence cant be correct.
Not sure about that point.

http://www.ncbi.nlm.nih.gov/pubmed/1...ractPlusDrugs1
Reply With Quote Quick reply to this message
  #9  
Old 01-07-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 191
Threads: 8
Thanked 121 Times in 76 Posts
Reputation: 131
Default

Quote:
Originally Posted by ALittleTeaPot View Post
What about a supracondylar fracture? After all both the median nerve and radial nerve have to cross the elbow to get to the forearm to innervate wrist flexors/extensors.
Shaft of the humerus. I will try to explain why its not the supracondylar fracture. If the injury of the radial nerve occurs at or below the level of elbow then there can be partieal extension of wrist possible because branch to Extensor Hallucis longus is given above elbow and the only injury which cn cause complete wrist drop or absent of extension if it occur above the elbow like in this case.
Reply With Quote Quick reply to this message
The above post was thanked by:
doctorFH (01-07-2012)
  #10  
Old 01-07-2012
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 177
Threads: 33
Thanked 86 Times in 16 Posts
Default

I m sure...its C
Reply With Quote Quick reply to this message
  #11  
Old 01-08-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 58
Threads: 0
Thanked 10 Times in 8 Posts
Reputation: 20
Default

C midshaft humerus (radial nerve )
Reply With Quote Quick reply to this message
  #12  
Old 01-08-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 108
Threads: 15
Thanked 23 Times in 14 Posts
Reputation: 33
Default

Quote:
Originally Posted by indigo View Post
Boy falls on outstretched hand; gets humerus fracture and cannot make a fist along with inability to extend wrist.

where is the fracture?

a. supracondylar
b. radial head
c. mid shaft humerus
d. surgical neck
e. anatomical neck
C OR A
Reply With Quote Quick reply to this message
  #13  
Old 01-08-2012
Dr. Mexito's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 662
Threads: 72
Thanked 369 Times in 204 Posts
Reputation: 379
Default C...

Radial nerve... the one to extend the hand.
__________________
"Disease is very old, and nothing about it has changed. It is we who change as we learn to recognize what was formerly imperceptible." JMC
Reply With Quote Quick reply to this message



Reply

Tags
Anatomy-, Musculoskeletal-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
COPD and Wrist Pain, How to manage? step1an USMLE Step 2 CK Forum 5 09-16-2011 12:21 AM
Wrist injury in a suicide attempt ujustgotdoctored USMLE Step 1 Forum 2 08-19-2011 05:03 PM
poor extension of the hand at the wrist usmleman2020 USMLE Step 1 Forum 4 08-05-2011 03:53 PM
Wrist Tendonitis, can I write the patient note? lepidoptera USMLE Step 2 CS Forum 5 06-17-2011 05:28 PM
Fist full of tears theartofbone USMLE Step 2 CS Forum 1 05-04-2010 03:56 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)