Examination for Some Commonly Missed Dislocations and Upper-Extremity Musculoskeletal Injuries
Symptom | Characteristic History | Physical Finding | Injury |
|---|---|---|---|
Shoulder pain | Seizure Electric shock | Restriction of passive external rotation with the elbow flexed | Posterior shoulder (glenohumeral) dislocation, possibly bilateral |
History of shoulder dislocation, trauma, or overuse in patients > 40 | Inability to maintain a position at 90° of abduction when slight downward pressure is applied (drop-arm test) | Acute complete rotator cuff tear | |
Various mechanisms (eg, pile-on injury in football, direct blow to joint) | Tenderness over the sternoclavicular joint | Sternoclavicular joint injury | |
Most often, fall on the point of the shoulder | Tenderness over the acromioclavicular area | Acromioclavicular strain or disruption (shoulder separation) | |
Wrist pain or swelling | Fall on an outstretched hand | Tenderness over the anatomic snuffbox (located just distal to the radius, between the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus tendons) | |
Various mechanisms | Tenderness over the lunate fossa (in the wrist at the base of the 3rd metacarpal) and pain with axial compression of the 3rd metacarpal | Lunate fracture | |
For other commonly missed injuries, see tables Examination for Some Commonly Missed Fractures and Examination for Some Commonly Missed Soft-Tissue Injuries. | |||