ED Pathway for Evaluation/Treatment of Child with a Suspected Extremity Fractures

Vascular Function of Upper Extremity

Pulse Radial, brachial (present, weak, absent) Compare to opposite extremity
Perfusion Capillary refill
Color
Temperature

*Contact Orthopedics immediately for weak or absent pulse perfusion


Motor and Sensory Function Upper Extremity

NERVE MOTOR FUNCTION SENSORY FUNCTION
MEDIAN Wrist flexion, abduction
Thumb, index finger
Palmar thumb, index finger
ULNAR Wrist flexion, adduction
Finger spread
Flexion distal phalanx 5th digit
Ulnar side of 4th digit
5th digit
RADIAL Wrist extension
Supination
Thumb extension
Dorsal web space between thumb, index finger
MUSCULOCUTANEOUS Elbow flexion Lateral forearm

Additional Tests UE Motor Exam

Wrist Extension:
Radial nerve
Wrist Drop
(Radial Nerve injury)
radial nerve normal hand photo radial nerve injured hand photo
Anterior Interosseous Nerve (Branch of Median Nerve)
OK sign:
Thumb IP joint flexion
NOT OK:
Thumb IPJ not flexed
thumb IP joint normal hand photo thumb IP joint damaged hand photo
Posterior Interosseous Nerve (Branch of Radial Nerve)
Thumb extension
radial nerve normal hand photo
Sensory Exam of the Upper Extremity
thumb joints hand photo