The human upper limb is structured for manipulation of objects
in three dimensions. The limb allows for various grasping mechanisms
(precision, power, pinch) in distal regions to be combined with
spatial movements by the proximal regions. Objects are sensed, held
and analyzed or used. They can also be brought to a secondary area
(usually the face) for further analysis or use.
The limb is a module*. The regions* in the
upper limb are extensor or flexor. The two groups are analogous
to those in the lower limb but situated opposite those in its lower
counterpart, due to embryological rotation* (lateral in
the upper limb and medial in the lower).
The regions in the upper limb are grouped in the:
- i) Shoulder girdle (scapula, pectoral, deltoid, axilla)
- ii) Arm (anterior, posterior)
- iii) Elbow (cubital fossa)
- iv) Forearm (anterior, posterior)
- v) Wrist (carpal tunnel, anatomical snuffbox)
- vi) Hand (dorsum, palm, fingers)
Assessment of the limb is made easier by its accessibility compared
to trunk modules, usually providing clear symptoms and signs.
The clavicle* is one of the commonly fractured bones
in the sequence of energy transfer that occurs with a fall on the
outstretched hand or by direct trauma. This is because the shaft
has a sharp negative change in curvature at the junction of the
medial 2/3 and lateral 1/3 (where it most often
The clinical features* are usually typical but vary
- i) Injury factors (high energy, comminution, displacement)
- ii) Patient factors (osteoporosis, previous injuries, co-existing
The x-ray* typically shows an oblique fracture of the
Possible immediate complications include:
- i) Skin break (skin necrosis, ulceration, open fracture)
- ii) Subclavian vessel injury
- iii) Brachial plexus injury (divisions)
Treatment* options depend on the assessment of both
the injury and the patient*.
Possible late complications include:
- i) Poor union*
- ii) Nerve dysfunction (brachial plexus caught in callus)
- iii) Immobility consequences (stiffness ...