A 21 year male with fracture surgical neck humerus presented with regimental badge sign and difficulty in abduction, most likely to be injured
**Core Concept**
The axillary nerve is a branch of the posterior cord of the brachial plexus, responsible for innervating the deltoid and teres minor muscles. It also provides sensory innervation to the skin over the deltoid region. Injury to this nerve can lead to weakness or paralysis of shoulder abduction.
**Why the Correct Answer is Right**
The regimental badge sign is a clinical indicator of axillary nerve injury, which involves a sensory loss over the deltoid region in the shape of a regimental badge. This occurs due to the sensory branches of the axillary nerve being damaged. Additionally, the patient's difficulty in abduction is likely due to the weakness of the deltoid muscle, which is primarily innervated by the axillary nerve. The axillary nerve is particularly susceptible to injury in fractures of the surgical neck of the humerus, as the nerve passes closely to the surgical neck.
**Why Each Wrong Option is Incorrect**
**Option A:** Ulnar nerve injury would primarily affect the flexor muscles of the forearm and the intrinsic muscles of the hand, leading to symptoms such as claw hand and weakness in grip strength. This does not match the patient's symptoms of difficulty in abduction and regimental badge sign.
**Option C:** Klumpke's paralysis involves injury to the lower trunk of the brachial plexus, resulting in weakness or paralysis of the intrinsic muscles of the hand and forearm. This does not match the patient's symptoms of difficulty in abduction and regimental badge sign.
**Option D:** Supraclavicular nerve injury would primarily affect the skin over the supraclavicular region, leading to sensory loss. This does not match the patient's symptoms of difficulty in abduction and regimental badge sign.
**Clinical Pearl / High-Yield Fact**
In orthopedic trauma, it is essential to assess the neurovascular status of the affected limb, as nerve injuries can often be associated with vascular injuries. A thorough neurovascular examination can help identify potential complications and guide management.
**✓ Correct Answer: B. Axillary nerve injury**