Clinical anatomy of

upper limb
Dr. Sachin Shembekar
Fracture of Clavicle
• Most common
fracture in
Road Traffic
Accidents
(RTA).
• Occurs mostly
in the middle
of the shaft.
• Figure of 8
bandage is
used for
treatment.
 Dislocation of Head of Humerus
• Shoulder is most commonly dislocated joint in the
body. It may be anterior, posterior or inferior.
• Anterior dislocation is most common
Fracture of Surgical Neck of Humerus
Causes damage to axillary nerve & posterior
circumflex humeral artery.
Fracture Shaft of Humerus

Causes damage
to radial nerve
passing through
spiral groove.
 Dislocation of Elbow
• Posterior elbow dislocation is most common.
• Produced by a fall on the outstretched hand with
the elbow slightly flexed.
• The olecranon process of ulna shifts posteriorly
and the elbow is fixed in slight flexion.
Subluxation of Head of Radius
• Sudden powerful jerk on
the hand of a child may
dislodge the head of the
radius from the grip of
the annular ligament
known as subluxation of
radiual head.
• Also known as pulled
elbow, slipped elbow,
toddler elbow or
nursemaid’s elbow.
• Seen in <4 years of age.
Madelung’s Deformity
Definition: Madelung’s deformity is dorsal
subluxation of the lower end of the ulna, due to
retarded growth of the lower end of radius.
Fracture of Base of First Metacarpal
Bennett Fracture: It is an Rolando Fracture: It is
intraarticular oblique an intraarticular Y-shaped
fracture that separates the fracture of the base of the
palmar ulnar aspect of the 1st metacarpal with the
1st metacarpal base from the detachment of several
remaining 1st metacarpal fragments (typically 3)
 Winging of Scapula
Prominence of medial border of scapula on pushing
something due to paralysis of Serratus Anterior
Muscle resulting from injury to Long Thoracic Nerve
Erb’s Palsy : Policeman’s Tip Hand
or Porter’s Tip Hand
Klumpke’s Palsy : Claw Hand
Wrist Drop – Radial Nerve Injury
 Olecranon Bursitis
• Inflammation of bursa over olecranon process
• Also called as student’s elbow or miner’s elbow
 Tennis Elbow
Pain over lateral epicondyle due to excessive use
of muscles attached to the lateral epicondyle.
 Golfer’s Elbow
Pain over medial epicondyle due to excessive use of
muscles attached to the medial epicondyle.
Ulnar Claw Hand
Hand of Benediction
 Duputren’s Contracture
Ring finger is most commonly incolved
 Dawbarn’s Test
• This test is done for Subacromial Bursitis
• Procedure – Patient is seated comfortably. Apply
pressure just below acromion process, and note
for any pain or tenderness. Then abduct the arm
upto 90 degree.
• Positive Dawbarn sign – Pain in the subacromial
region disappears with the abduction of arm
indicating subacromial bursitis.
Negative Dawbarn’s Sign
Positive Dawbarn’s Sign
Exams for Carpal Tunnel Syndrome
 Ape Thumb Deformity
Patient cannot move the thumb away from the
rest of the hand due to paralysis / wasting of
thenar muscles due to median nerve injury.

Normal
thenar Wasting of
eminence thenar
muscles
 Pen Test
• This test is done for testing the function of
Abductor Pollicis Brevis which is supplied by
Median Nerve in hand.
• Procedure – The patient lies his hand flat on a
table with his palm facing upwards. The patient is
asked to abduct his thumb to touch the
examiner’s pen which is held above it.
• In case of injury to median nerve or paralysis of
abductor pollicis brevis patient is unable to touch
the his thumb to the examiner’s pen.
 Book Test
• This test is done for testing Adductor Pollicis which
is supplied by Ulnar Nerve.
• Procedure – Patient is asked to grasp a book or a
paper or a card firmly between the thumb & index
finger with both hands. After that examiner tries to
pull the object out of the patient’s hand.
• In ulnar nerve palsy, patient will suffer difficulty in
maintaining a hold. The flexor pollicis longus muscle
of the thumb tries to compensate for this loss of
power to maintain the grip pressure by
flexing/bending the thumb’s tip at the interphalangeal
joint. Therefore, this sign is known as ‘froment’s
sign’ or ‘book test’
 Card Test
• This test is done for testing Palmar Interossei
which is supplied by Ulnar Nerve.
• Procedure – a card is inserted between two
extended finger’s and the patient is asked to
grasp it between the fingers while the clinician
gently tries to pull the card
• In case of weak palmar interossei, it is easy to
pull out the card.
 Egawa’s Test
• This test is done for testing Dorsal Interossei
(Abductors) of middle finger which is supplied
by Ulnar Nerve
• Procedure – With the hand kept flat on a table
palmar surface down, the patient is asked to
move his middle finger sideways
• In case of weak dorsal interossei, patient is
unable to move his middle finger properly.