3-65
Shoulder: Posterior Rare; direct blow to front of Pain and splinting of the As Above
shoulder, translational injury extremity. Arm held at
from falling on outstretched side; near total loss of
arm, ballistic movements ability to rotate externally;
with internal rotation during posterior “fullness” when
convulsion/seizure activity compared with
or electric shock contralateral side
Elbow: Posterior Fall or forceful impact on Foreshortening of the Longitudinal traction fol-
outstretched hand with arm forearm with posterior lowed by anterior transla-
in full extension; generally deformity at the elbow; tion of the forearm relative
posterior and lateral marked pain; rapid to the humerus (technique
displacement of radius and swelling. Ulnar N. injury below); posterior splint
ulna possible from valgus
stretch.
Elbow: Anterior Direct impact on the posterior Fullness/ deformity of Longitudinal traction fol-
forearm with the elbow in antecubital fossa; inability lowed by anterior
flexion. Anterior displace- to flex/extend forearm; translation of the humerus
ment of radius and ulna may have associated relative to the forearm.
brachial artery injury and Apply posterior splint
/or ulnar, median and
radial neuropraxias
Radial head AKA “Nursemaid’s elbow”; Pain, refusal to use arm; Reduce (technique below);
subluxation (RHS) commonly caused by a able to flex and extend place in sling, advise par-
in children sudden jerk or yank on a elbow but unable to fully ents that the problem may
child’s wrist or hand during supinate; may have recur until age five
discipline. minimal swelling and no
visible deformity Be alert
sign/Sx of abuse!
Hand: PIPJ or DIPJ Direct trauma in athletics Obvious, usually dorsal Longitudinal traction to
deformity reduce. Splint in
alumifoam or buddy tape.
X-ray for associated
fractures when able.
Hip: usually posterior Massive impact to knee Hip flexed, adducted, Reduce (as below) if
while hip is flexed and internally rotated, and unable to MEDEVAC
adducted; common dash- shortened; may have STAT.
board injury to front seat associated fracture of
passengers during auto femur; sciatic nerve injury
accidents is common as nerve lies
posterior to joint
Patella: Spontaneous May occur spontaneously Knee flexed; patella Reduce; reduction may
following predictable specific palpable lateral to femoral occur spontaneously;
leg movements in people condyle immobilize with long leg
with loose connective tissues splint or knee immobilizer.
and/or abnormal anatomy; Refer to ortho if possible.
Patella: Traumatic Associated with trauma: Moderate swelling, Reduce gently as above.
“cutting” laterally while tenderness especially Refer for X-rays, possible
sprinting, etc. medial to the patella; arthroscopy and surgical
patella palpable lateral to repair of soft tissue injury
the femur. or fractures
Knee (rare) Direct, massive blow to Dislocation cannot occur Immediate distal neuro/