part one a 25-year-old male was kicked with an ice skate on the lateral surface
a 25-year-old male was kicked with an ice skate on the lateral surface of his left leg just inferior to the knee while playing in a hockey game. The superficial laceration was treated by the athletic trainer, but the player was unable to continue playing. He complained of pain in the region of the wound with an associated numbness and tingling to the lateral surface of his left leg and the dorsum of his left foot. Upon removal of his skates, the player was unable to dorsiflex his left foot or extend his toes. In an attempt to walk, he experienced a sharp pain to the lateral aspect of his left leg just below his knee with each step. He was sent to the emergency room.
Upon arrival to the emergency room, the physician noted that the patient had an abnormal gait. The patient raised his left foot higher than usual during the swing phase and his foot came down abruptly following heel strike. While the patient sat on the examination table, his left foot assumed a more plantarflexed position when compared to the right. On physical examination, the patient was noted to have subjective tenderness over the head and neck of the fibula and a sensory deficit on the lateral side of the distal part of the left leg, including the dorsum of the foot. An x-ray of the left lower extremity confirmed a fracture of the neck of the fibula. The patient was diagnosed with a left fibular neck fracture with peripheral nerve injury.
1. What nerve is most likely injured in this patient?
2. Describe the anatomical relationship that makes this nerve vulnerable to injury.
3. Discuss the anatomical basis of the loss of sensation an impaired function in the patient’s foot.
4. Describe the compensation mechanism using anatomical structures.
5. Why did the patient experience pain with walking if the fibula is not weight bearing?
A 15-year-old female with a history of depression presents to the emergency room after slashing her wrists with a razor blade. The moderate bleeding from her left wrist was controlled with slight pressure, however, the small spurts of blood coming from the lateral side of her right wrist were more difficult to control. On physical examination, the patient had normal movement and no loss of sensation to her left hand and wrist. Upon examination of the patient’s right hand and wrist, the patient is noted to have a laceration to two superficial tendons and a large nerve. The patient is able to adduct her thumb, but unable to oppose it. She has also lost some fine control of movements of her second and third digits on her right hand. The patient admits to experiencing numbness over the lateral half of her right palm and digits.
1. Why was the patient’s suicide attempt not fatal?
2. Which tendon(s) is/are most likely involved?
3. Which large nerve did the patient cut?
4. What superficial artery has been lacerated?
5. Discuss all of the specific structures affected and the losses of hand/digit function likely to result.
A 52-year-old male underwent surgery for the removal of a malignant tumor from the ight posterosuperior region of the neck. The surgeon performs a radical neck dissection of the region to remove the enlarged lymph nodes. One of the enlarged lymph nodes was in the submandibular triangle, deep to the superior end of the sternocleidomastoid. During his post-operative stay, the patient informed the surgeon that he had difficulty with shrugging his right shoulder and turning his face to the left side against resistance.
1. During the surgical removal of the enlarged lymph node, what nerve was most likely injured?
2. What is the relationship of the nerve from question #1 to the superior end of the sternocleidomastoid? Describe the function and course of this nerve.
3. What lymph node was most likely removed by the surgeon?
4. What areas do these nodes receive lymph from?
5. To which lymph nodes would malignant cells from these nodes likely go if they had metastasized?