Anatomy clinical correlates: Clavicle and shoulder


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Anatomy clinical correlates: Clavicle and shoulder

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Anatomy clinical correlates: Clavicle and shoulder

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Anatomy clinical correlates: Clavicle and shoulder

USMLE® Step 1 questions

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USMLE® Step 2 questions

0 / 9 complete


USMLE® Step 1 style questions USMLE

of complete

USMLE® Step 2 style questions USMLE

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A 44-year-old man presents to his primary care physician with worsening left shoulder pain. He can no longer do bench presses or shoulder presses at the gym due to weakness and pain. The pain is primarily located over the lateral shoulder, is worse at night, and is preventing him from obtaining adequate rest. Past medical history is otherwise unremarkable. He has no history of recent trauma or surgeries to the left shoulder. The patient subsequently undergoes a MRI of the left shoulder, which reveals the following:  

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Which of the following physical examination maneuvers is most likely to yield a positive test, given this patient’s clinical findings?  

Memory Anchors and Partner Content



Viviana Popa, MD

Evan Debevec-McKenney

Ursula Florjanczyk, MScBMC

Our upper limbs are complex structures. They’ve got bones, muscles, fascia, nerves and blood vessels, and everything in between. Our upper limbs are prone to injury however, and oftentimes, even a small injury can have a huge functional deficit as we are so reliant on our upper limbs in everyday life. One of these commonly injured areas is the shoulder region.

Ok, so let’s start by taking a look at the injuries of the clavicle. Because of its subcutaneous position, the clavicle is prone to fractures, which are usually the result of direct or indirect trauma. An example of direct trauma is falling directly on the shoulder. Indirect trauma, however, may occur when falling on an outstretched hand, and the force of impact is transmitted through the bones of the forearm and the arm to the shoulder, which can result in a clavicle fracture. Most of these fractures occur in the middle third of the clavicle, particularly where the middle third meets the lateral third, which is the weakest point of the clavicle.

So with clavicular fractures, the medial fragment is usually pulled up by the sternocleidomastoid muscles, which can be apparent to the naked eye and palpable. At the same time, the trapezius muscle is having trouble holding the lateral fragment up, because of the weight of the limb, so the shoulder drops. And since the two fragments may glide under each other, the clavicle is also shortened. Additional features may signal complications of a clavicle fracture. For example, if the skin above the fracture seems to be tenting, meaning it looks like a tent, that suggests the fracture may become an open fracture in the future, and warrants surgical stabilization.

Alright, now, another thing that can happen in this region is an acromioclavicular dislocation, also called a “shoulder separation”. Just like the name says, the clavicle and acromion process separate, usually because of a direct blow to the shoulder, or a fall landing directly on the shoulder joint. And this may be seen in contact sports, like football, soccer or hockey.


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