Humerus Fracture

These are the most common humeral fracture sites and their related injuries.

Rotator Cuff Muscles

 

Remember them with the mnemonic SITS (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis).
Also remember the "Empty can supraspinatus test" used to evaluate this muscle asking the patient to abduct his/her arm to 90 degrees and flex the arm from that position 30 degrees (horizontally) with thumbs pointing to the floor, then apply downward force to his/her arms. This maneuver will elicit pain and weakness on the affected side due to impingement of the supraspinatus tendon (the most commonly affected structure in Rotator cuff Sd) between the acromion and the head of the humerus.

Nerves and Muscles responsible for abduction of the arm:

• Initiates arm abduction (initial 10 degrees) → Supraspinatus muscle <Suprascapular nerve>
• Abduct arm beyond 10 degrees → Deltoid muscle <Axillary nerve>
• Raise arm above horizontal → Serratus ant & Trapezius muscles <Long thoracic & Spinal acc nerves>

Trigeminal Nerve

Conjugate or Lateral Gaze

If the patient has a lesion on the right medial longitudinal fasciculus , upon asking the patient to look towards the left, only the left eye will go to the left while the right eye will be facing towards the examiner (front)

The Wrong Juice

Interesting case: ECG showing wide QRS complexes

That's why we have learned not to trust automatic ECG results...

Here is the script of what happened with this patient: (Source: Movin' Meat... Thanks to ER Dr Shadowfax...)

"The tech, as per protocol, dropped the ECG on my desk within three minutes of its being completed, along with the chart. He was visibly excited. I glanced at the ECG and the triage note. In the standard terse nursing verbiage, it read "CC: Ground Level Fall. Too weak to get out of bed. No injury reported. No other complaints." There was an included prior ECG, which was normal. Today's looked like this: (see ECG above)

"Should I call the cath lab?" the tech asked. We pride ourselves in having the best door-to-dilation time in the region, and it's a key focus of our department protocols that patients with an "Acute MI" or heart attack need to be expedited to the cath lab. The tech had seen the computer interpretation of "ACUTE MI" and was rarin' to go.