WEAKNESS OF THE UPPER EXTREMITY FOLLOWING A HUMERAL HEAD FRACTURE

PURPOSE: Complications can occur following fractures of the humeral head. The purpose of this case report is to discuss a patient who had weakness and pain following a fall resulting in a humeral head fracture and to demonstrate the contribution of electrophysiologic testing in management of the patient's problem. DESCRIPTION: The patient was a 76-year old woman who fell sustaining a fracture of the humeral head. The resulting pain and weakness failed to respond to conservative treatment including physical therapy. The patient was referred to a hand surgeon for the persistent weakness in her upper extremity. The hand surgeon requested nerve conduction studies (NCV) electromyography (EMG). Following a second period of conservative care, repeat NCV & EMG studies were requested. OBSERVATIONS: The hand surgeon, after receiving these studies, performed a surgical exploration of the patients' median nerve at the level of the elbow. The patient's course of treatment following this surgical intervention led to a desirable outcome of improved function and pain relief. CONCLUSIONS: The patient presented an unusual challenge in terms of determining the causes of her weakness in the upper extremity. The electrophysiologic testing helped in determining the cause of these problems and contributed positively to the patients' overall management.