Clinicoanatomical Problem

Topic Overview

1. Case of Rib Fracture

Problem:
A 45-year-old man sustains blunt chest trauma in a car accident. He has pain on inspiration and tenderness over the lateral chest wall.
Diagnosis: Fracture of ribs (most likely at the angle).
Anatomical Basis:

• The angle of the rib is its weakest part.

• Pain worsens with breathing due to intercostal nerve irritation.

2. Flail Chest

Problem:
A patient presents with paradoxical movement of a segment of the chest wall during breathing.
Diagnosis: Flail chest.
Anatomical Basis:

• Occurs when multiple consecutive ribs fracture at two points, creating a free-floating segment.

• The segment moves inward during inspiration and outward during expiration, impairing ventilation.

3. Costochondritis

Problem:
A young woman complains of sharp pain over the upper chest wall, aggravated by deep breathing but not radiating to the arm.
Diagnosis: Costochondritis.
Anatomical Basis:

• Inflammation at the costochondral or sternocostal junction, commonly of the 2nd to 5th ribs.

• Mimics cardiac pain but is localized and tender to touch.

4. Cervical Rib Syndrome

Problem:
A young woman presents with pain, numbness, and tingling in the medial side of the forearm and hand.
Diagnosis: Cervical rib compressing lower trunk of brachial plexus.
Anatomical Basis:

• Cervical rib arises from C7 and compresses the C8–T1 nerve roots and subclavian artery at the thoracic inlet.

5. Thoracic Outlet Syndrome

Problem:
A patient complains of upper limb weakness and diminished radial pulse on arm abduction.
Diagnosis: Thoracic outlet syndrome.
Anatomical Basis:

• Compression of subclavian artery and brachial plexus between scalenus anterior and cervical rib.

• Leads to ischemic pain and neurogenic symptoms.

6. Sternal Puncture for Bone Marrow

Problem:
A clinician performs a sternal puncture to examine bone marrow in a patient with anemia.
Question: Why is the manubrium chosen?
Answer:

• It is broad, thick, and has cancellous bone rich in marrow.

• The arch of aorta lies posterior to the lower sternum, so upper manubrium is safer.

7. Pott’s Spine (Tuberculosis of Vertebrae)

Problem:
A child presents with a humpback deformity in the upper back and fever.
Diagnosis: Pott’s disease (tuberculous osteomyelitis of vertebrae).
Anatomical Basis:

• Infection destroys vertebral bodies, leading to collapse and anterior wedging.

• Produces gibbus deformity (acute angular kyphosis).

8. Spina Bifida

Problem:
A newborn has a midline swelling in the lower back with cerebrospinal fluid leakage.
Diagnosis: Spina bifida with meningocele.
Anatomical Basis:

• Failure of neural arches to fuse during development.

• May expose meninges or spinal cord.

9. Sternal Foramen during Acupuncture

Problem:
An acupuncturist inserts a needle into a sternal foramen, and the patient develops cardiac tamponade.
Diagnosis: Injury to pericardium through congenital sternal foramen.
Anatomical Basis:

• A sternal foramen may occur due to incomplete fusion of sternebrae, leaving a gap anterior to the heart.

10. Scoliosis and Unequal Shoulder Height

Problem:
A teenage girl presents with lateral curvature of the spine and uneven shoulders.
Diagnosis: Structural scoliosis.
Anatomical Basis:

• Uneven vertebral growth causes lateral and rotational deformity.

• Commonly affects the thoracic vertebrae, altering rib angles and chest symmetry.