A Bullet with a 90-Degree Turn

​"Anything interesting last night?" my colleague asked.​"Yeah, take a look at this. Tell me how this happened." I popped an image up on the screen for the oncoming doc to see.Noting the air in the soft tissue, he guessed, "Shot by someone lying on his back on the ground?""That would explain how the bullet started at the elbow and ended at the clavicle. But if that were true, how did the bullet make a 90-degree turn?" I asked.My colleague shrugged. I didn't know either. After the patient told me what she was doing, I felt foolish that I hadn't tried to put the two points on the same plane. The patient said she was shot while she was putting her arms up in the air.Her exam revealed a wrist drop and inability to extend her thumb. She was able to extend at the elbow, which was consistent with the entrance wound proximal to the lateral epicondyle. She was sent to a trauma center for further evaluation of the gunshot wound and treatment for the radial nerve palsy.Tip to Remember: Radial nerve lesions can be high or low and exhibit a different neurological injury pattern.High (above the spiral groove): Inability to extend at the elbow, wrist, finger, and thumb.Low (below the spiral groove): Preserved elbow extension function, but inability to extend the wrist, finger, and thumb.Low (below the elbow): Preserved elbow and wrist extensions, but inability to extend the thumb (hitchhiker's sign) or fingers.Note: The patient ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs