II. Types: Soft Tissue Injury
- See Skin Foreign Body
- See Burn Injury
-
Laceration
- Consider open Fracture (some Lacerations originate from the inside)
-
Ligament Sprain
- Injury to ligament or capsule
-
Tendon Strain (Tendinopathy)
- Injury translated at musculotendinous junctions
-
Contusion
- Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue
- Associated complications
- Compartment Syndrome
- Myositis Ossificans
- Local Pressure tissue necrosis
- Morel-Lavallee Lesion
-
Apophyseal Injury (children)
- Secondary ossification sites for tendon insertions, which may be injured with overuse prior to Growth Plate closure
- Examples
III. Types: Fractures
- See Fracture
- See Stress Fracture
- See Epiphyseal Fracture (children)
IV. Types: Nerve Injuries
- General
- Shoulder and Brachial Plexus
-
Elbow and wrist
- Axillary Nerve Injury (e.g. Anterior Shoulder Dislocation, Proximal Humerus Fracture)
- Deltoid motor weakness
- Lateral Shoulder numbness
- Musculocutaneous Nerve Injury (e.g. Anterior Shoulder Dislocation)
- Median Nerve Injury
- Median Nerve Injury at the Elbow
- Median Nerve Injury at the Wrist (Carpal Tunnel)
- Distal Median Nerve injury (e.g. wrist Fracture or dislocation)
- Thumb and Index opposition (OK sign) motor weakness
- Thenar eminence or distal index finger numbness
- Anterior Interosseous nerve injury (Median Nerve branch injury, e.g. Humerus supracondylar Fracture in children)
- Index finger DIP flexion motor weakness
- Radial Nerve Injury (e.g. distal Humerus Shaft Fracture, Anterior Shoulder Dislocation)
- Radial Nerve Injury at the Elbow
- Radial Nerve Injury at the Wrist
- Thumb and finger extension and metacarpophalangeal joint (MCP joint) motor weakness
- Dorsal hand first webspace numbness
- Ulnar Nerve Injury (e.g. Elbow Injury)
- Ulnar Neuropathy at the Elbow (Cubital Tunnel)
- Ulnar Nerve Injury at the Wrist (Ulnar Tunnel)
- Finger abduction motor weakness
- Hypothenar eminence or fifth, small finger numbness
- Axillary Nerve Injury (e.g. Anterior Shoulder Dislocation, Proximal Humerus Fracture)
- Spine
- Buttock and legs
- Sciatica
- Piriformis Syndrome
- Meralgia Paresthetica
- Tarsal Tunnel
- Femoral Nerve Injury (e.g. Public Ramus Fracture)
- Knee extension motor weakness
- Anterior knee numbness
- Obturator Nerve Injury (e.g. Obturator ring Fracture)
- Hip adduction motor weakness
- Medial thigh numbness
- Posterior Tibial Nerve Injury (e.g. posterior Knee Dislocation)
- Toe flexion motor weakness
- Plantar foot numbness
- Superficial peroneal nerve injury (e.g. fibular neck Fracture, posterior Knee Dislocation)
- Ankle eversion motor weakness
- Lateral foot dorsum numbness
- Deep peroneal nerve injury (e.g. fibular neck Fracture, Compartment Syndrome)
- Ankle and toe dorsiflexion motor weakness
- Dorsal foot first and second web space numbness
- Sciatic nerve injury (e.g. posterior Hip Dislocation)
- Superior Gluteal Nerve Injury (e.g. Acetabular Fracture)
- Hip abduction motor weakness
- Upper buttock numbness
- Inferior Gluteal Nerve Injury (e.g. Acetabular Fracture)
- Hip extension motor weakness (at gluteus maximus)
- Lower buttock numbness
V. Types: Regions
- Spine and proximal nerves
- Upper extremity
- Lower extremity
VI. Types: Mechanism
- High velocity injury
- Falls
- Work and chores
- Sports
- Skin and Soft Tissue Injury
VII. History
- See Trauma History (SAMPLE History)
- Background
- Hand dominance (for upper extremity injuries)
- Profession or sports
- History of Present Illness
- Mechanism of injury
- Protective equipment
- Regions of injury
- Past medical history
- Last Tetanus Vaccination (if skin penetration)
VIII. Exam
- See Brief Musculoskeletal Exam
- See Neurologic Exam
- See Trauma Secondary Survey
- See Hand Neurovascular Exam
- Approach: Every Extremity Injury
- Mnemonic: "joint above, joint below, circulation, motor and Sensation, skin and compartments"
- Include examination of joint above and below the involved joint
- Include Sensory Exam, Motor Exam, Reflex Exam and vascular exam (pulses, Capillary Refill)
- Include skin and compartment exam
- Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas
- Upper extremity
- Lower extremity
- Spine
- Spinal Cord Syndrome
- Neck Exam
- Low Back Exam
- Mnemonic
- C3-4-5 keeps the diaphragm alive (Spontaneous Breathing)
- S2-3-4 keeps the stool off the floor (Reflex Defecation Center)
IX. Precautions: Assess for Fracture (Especially in children)
- Ligaments and Tendons are stronger than Growth Plate
- Bone Fractures less often after Growth Plate fusion
X. Complications: Pitfalls
- Injuries with risk of vascular compromise (consider angiography)
- Posterior Knee Dislocation
- Supracondylar Femoral Fracture
- Suprecondylar Humeral Fracture
-
Compartment Syndrome
- Consider Compartment Pressures
-
Epiphyseal Fracture (children)
- Ligaments and Tendons are stronger than Growth Plate
- Bone Fractures less often after Growth Plate fusion
XI. Management
XII. References
- (2018) ATLS, ACS, Chicago, p. 161
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MEDLINEPLUS) |
Of the 206 bones in your body, 3 of them are in your arm; the humerus, radius and ulna. Your arms are also made up of muscles, joints, tendons and other connective tissue. Injuries to any of these parts of the arm can occur during sports, a fall or an accident. Types of arm injuries include Some nerve problems, arthritis, or cancers can affect the entire arm and cause pain, spasms, swelling and trouble moving. You may also have problems or injure specific parts of your arm, such as your hand, wrist, elbow or shoulder. |
| Definition (MSH) | General or unspecified injuries involving the arm. |
| Concepts | Injury or Poisoning (T037) |
| MSH | D001134 |
| SnomedCT | 157673009, 287159005, 212425000, 127278005 |
| English | Arm Injuries, Injuries, Arm, Injury, Arm, Arm Injury, ARM INJ, INJ ARM, Injury arm NOS, injury of upper extremity (diagnosis), injury of upper extremity, Arm Injuries [Disease/Finding], injury arm, arm injury, injury upper extremity, upper limb injury, arm injuries, injury limb upper, extremities injuries upper, extremity upper injury, injuries limb upper, upper extremity injury, Arm Injuries and Disorders, Injury arm NOS (disorder), Injury arm, Arm injury, Injury of upper limb, Injury of upper extremity (disorder), Injury of upper extremity, injury; arm, injury; limb, upper, wound; arm, injury to arm, Injury;arm |
| Swedish | Armskador |
| Czech | paže - poranění, horní končetina - poranění |
| Finnish | Yläraajan vammat |
| Russian | KONECHNOSTI VERKHNEI TRAVMY, КОНЕЧНОСТИ ВЕРХНЕЙ ТРАВМЫ |
| French | Lésions traumatiques du bras, Blessures du membre supérieur, Blessures du bras, Traumatismes du bras, Traumatismes du membre supérieur, Lésions traumatiques du membre supérieur |
| Croatian | RUKA, OZLJEDE |
| Polish | Urazy kończyn górnych |
| Japanese | 腕の損傷, 上肢外傷, 上腕の外傷, 上腕外傷, 腕傷害, 外傷-上肢 |
| Norwegian | Armskader, Skader, arm |
| Spanish | Injury arm NOS, lesión de brazo, SAI (trastorno), lesión de brazo, SAI, Lesiones del Brazo, injuria de las extremidades superiores, lesión traumática de extremidad superior (trastorno), lesión traumática de extremidad superior, lesión traumática de las extremidades superiores (trastorno), lesión traumática de las extremidades superiores, Traumatismos del Brazo |
| Portuguese | Lesões do Braço, Traumatismos do Braço |
| Dutch | letsel; arm, letsel; extremiteit, bovenste, wond; arm, Armtrauma, Armtraumata, Trauma, arm-, Traumata, arm- |
| German | Armverletzungen, Verletzungen, Arm- |
| Italian | Lesioni del braccio |
Ontology: Leg Injuries (C0023220)
| Definition (MSHCZE) | Obecná nebo nespecifikovaná zranění týkající se nohou. |
| Definition (MSH) | General or unspecified injuries involving the leg. |
| Concepts | Injury or Poisoning (T037) |
| MSH | D007869 |
| SnomedCT | 157674003, 393617006, 287160000, 127279002 |
| English | Injuries, Leg, Injury, Leg, Leg injury, INJ LEG, LEG INJ, Injury leg NOS, injury of lower extremity (diagnosis), injury of lower extremity, Leg Injuries, Leg Injuries [Disease/Finding], extremity injuries lower, injury leg, injuries leg, leg injuries, leg injury, lower limb injury, injuries limb lower, disorders injuries leg, Injury leg NOS (disorder), Leg injury (disorder), Injury of lower limb, Injury of lower extremity (disorder), Injury of lower extremity, injury; limb, lower, Leg Injury, injury to leg, Injury;leg |
| Dutch | beenletsel, letsel; extremiteit, onderste, Beenletsel, Beenletsels, Letsel, been-, Letsels, been- |
| French | Lésion de la jambe, Blessures du membre inférieur, Blessures de la jambe, Traumatismes de la jambe, Traumatismes du membre inférieur, Lésions traumatiques de la jambe, Lésions traumatiques du membre inférieur |
| German | Beinverletzung, Beinverletzungen |
| Italian | Traumatismo della gamba, Lesioni della gamba |
| Portuguese | Lesão traumática da perna, Lesões da Perna, Traumatismos da Perna |
| Spanish | Lesión de la pierna, Injury leg NOS, lesión de pierna, SAI (trastorno), lesión de pierna, SAI, Lesiones de la Pierna, injuria de las extremidades inferiores, lesión traumática de extremidad inferior (trastorno), lesión traumática de extremidad inferior, lesión traumática de las extremidades inferiores (trastorno), lesión traumática de las extremidades inferiores, Traumatismos de la Pierna |
| Swedish | Benskador |
| Japanese | ｶｼｿﾝｼｮｳ, 下肢外傷, 下肢損傷, 下腿外傷, 脚部外傷, 外傷-下肢 |
| Czech | končetiny dolní - poranění, Poranění nohy |
| Finnish | Alaraajavammat |
| Russian | KONECHNOSTI NIZHNEI TRAVMY, КОНЕЧНОСТИ НИЖНЕЙ ТРАВМЫ |
| Croatian | NOGA, OZLJEDE |
| Polish | Urazy kończyn dolnych |
| Hungarian | Lábsérülés |
| Norwegian | Benskader, Beinskader |
Ontology: Soft Tissue Injuries (C0037578)
| Definition (MSH) | Injuries of tissue other than bone. The concept is usually general and does not customarily refer to internal organs or viscera. It is meaningful with reference to regions or organs where soft tissue (muscle, fat, skin) should be differentiated from bones or bone tissue, as "soft tissue injuries of the hand". |
| Concepts | Injury or Poisoning (T037) |
| MSH | D017695 |
| SnomedCT | 282026002 |
| English | Injuries, Soft Tissue, Soft Tissue Injuries, Injury, Soft Tissue, Soft Tissue Injury, SOFT TISSUE INJ, INJ SOFT TISSUE, Soft tissue injury NOS, Soft Tissue Injuries [Disease/Finding], injuries soft tissue, soft tissue injury, Injury;soft tissue, injury soft tissue, injuries soft tissues, soft tissue injuries, Soft tissue injuries, STI - Soft tissue injury, Soft tissue injury, Soft tissue injury (disorder) |
| Italian | Traumatismo del tessuto molle, Traumatismo del tessuto molle NAS, Lesioni del tessuto molle |
| Dutch | wekedelenletsel NAO, wekedelenletsel, Letsel, weke delen, Letsels, weke delen, Weke delenletsel, Weke delenletsels |
| French | Lésion des tissus mous SAI, Lésion des tissus mous, Lésions des tissus mous, Traumatismes des tissus mous |
| German | Weichteilverletzung NNB, Weichteilverletzung, Weichteilverletzungen |
| Portuguese | Lesão traumática dos tecidos moles NE, Traumatismos dos Tecidos Moles, Lesão dos tecidos moles, Lesões dos Tecidos Moles |
| Spanish | Lesión traumática de tejidos blandos NEOM, lesión traumática de los tejidos blandos, Lesiones de los Tejidos Blandos, Lesión traumática de tejidos blandos, lesión de tejidos blandos, lesión traumática de los tejidos blandos (trastorno), lesión traumática de partes blandas (trastorno), lesión traumática de partes blandas, Traumatismos de los Tejidos Blandos |
| Japanese | 軟部組織損傷ＮＯＳ, ﾅﾝﾌﾞｿｼｷｿﾝｼｮｳNOS, ﾅﾝﾌﾞｿｼｷｿﾝｼｮｳ, 軟部組織傷害, 軟部組織損傷 |
| Swedish | Mjukdelsskador |
| Czech | měkké tkáně - poranění, Poranění měkkých tkání, Poranění měkkých tkání NOS |
| Finnish | Pehmytkudosvammat |
| Russian | MIAGKIKH TKANEI POVREZHDENIIA, МЯГКИХ ТКАНЕЙ ПОВРЕЖДЕНИЯ |
| Croatian | MEKO TKIVO, OZLJEDE, OŠTEĆENJE MEKIH TKIVA |
| Polish | Urazy tkanek miękkich |
| Hungarian | Lágyrészsérülés, Lágyrészsérülés k.m.n. |
| Norwegian | Skader, bløtdel, Skader, bløtvev, Bløtdelsskader, Bløtvevsskader |
Ontology: Injury of musculoskeletal system (C0272448)
| Definition (NCI) | Damage to the muscles, bones and their supportive structral attachments. |
| Definition (CSP) | damage inflicted on any part of musculoskeletal system as the direct or indirect result of an external force, with or without disruption of structural continuity. |
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 105606008 |
| English | injury musculoskeletal, Injury;musculoskeletal, musculoskeletal injury, injuries musculoskeletal, injury of musculoskeletal system (diagnosis), Injury of Musculoskeletal System, Musculoskeletal Injury, Musculoskeletal injury, Injury of musculoskeletal system (disorder), Injury of musculoskeletal system, Injury musculoskeletal nos |
| Czech | Muskuloskeletální poranění |
| Dutch | skeletspierletsel, Ander letsel bewegingsapparaat |
| French | Lésion musculo-squelettique |
| German | Muskuloskelettale Verletzung |
| Hungarian | Mozgásszervi sérülés |
| Italian | Lesione muscoloscheletrica |
| Japanese | 筋骨格系損傷, ｷﾝｺｯｶｸｹｲｿﾝｼｮｳ |
| Portuguese | Lesão musculosquelética |
| Spanish | Lesión traumática musculoesquelética, injuria del sistema musculoesquelético, lesión traumática del sistema musculoesquelético (trastorno), lesión traumática del sistema musculoesquelético |
