While walking, a post-menopausal grandmother falls off a curb and lands hard on

Question

While walking, a post-menopausal grandmother falls off a curb and lands hard on her outstretched right arm. Her physicians diagnose a fracture of the bone which forms the only bony connection between the upper limb and the axial skeleton. They also note damage to the joint between the fractured bone and the axial skeleton. They perform surgery to realign the bone at the fracture to allow proper healing and they use a titanium plate to permanently secure the fractured bone to the axial skeleton at the injured joint. However, they are particularly concerned because her bone mass is quite low and due to her advanced age, she also has low osteoblast activity.

Using the above passage, following her surgery, which of the following activities would be most affected?

Brushing her teeth with her right hand

Eating with her right hand

Buttoning her shirt with her right hand

Scratching her left shoulder with her right hand

Explanation / Answer

Technically the upper limb is connected to the axial skeleton by the shoulder girdle which comprises of 2 bones : clavicle and scapula.

Since it says the patient acquired the factored due to fall on outstretched hand we will assume that the fracture is a clavicular one.

The joint connecting the clavicle to the sternum ( axial skeleton) is the sternoclavicular joint. That is the joint which has been displaced in the patient. Movements of this joint are:

Depression and elevation of the shoulder

Rotation of the shoulder

In the actions given , only the last one involves elevation of the shoulder joint. Eating , brushing and buttoning can be achieved without it. Hence scratching the opposite shoulder will be most difficult

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