Upper Extremity Injuries in Adults and Children: Evidence-Based Emergency Imaging

  • Kara Gaetke-Udager
  • Corrie M. Yablon
  • Stefan Puig
Chapter
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)

Abstract

Upper extremity trauma is a common reason for emergency department visits, and a number of upper extremity injuries pose diagnostic dilemmas in the acute setting and for short-term follow-up. Scaphoid fractures are often missed on initial radiographs, which results in unnecessary immobilization before subsequent reimaging. Magnetic resonance imaging (MRI) has the best sensitivity and specificity to evaluate for scaphoid fracture and should be considered in the acute setting. Elbow dislocation can be evaluated with radiographs, but any clinical concern for vascular injury should prompt evaluation with computed tomography angiography (CTA) or angiography. MRI is not necessary in the acute setting after elbow dislocation, but provides excellent soft tissue evaluation to aid in treatment decisions. Radiographs are a necessary first-line study to evaluate glenohumeral dislocation, and sometimes special views can be helpful. While MRI provides excellent soft tissue detail, MR arthrography might be necessary in the subacute setting to evaluate certain sequela of dislocation such as labral, ligamentous, and cartilage injury. Bilateral radiographs with non-weighted and weighted comparisons are needed to evaluate acromioclavicular joint separation. MRI can be useful in distinguishing low- from high-grade acromioclavicular separation, which is important for treatment planning.

Keywords

Scaphoid fracture Elbow dislocation Glenohumeral dislocation Acromioclavicular separation Radiography MRI CT Evidence-based imaging Emergency imaging 

References

  1. 1.
    Ootes D, Lambers KT, Ring DC. Hand (N Y). 2012;7:18–22.CrossRefGoogle Scholar
  2. 2.
    Arora R, Fichadia U, Hartwig E, et al. Pediatr Ann. 2014;43:196–204.CrossRefPubMedGoogle Scholar
  3. 3.
    Karl JW, Olson PR, Rosenwasser MP. J Orthop Trauma. 2015;29:e242–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Webster BS, Snook SH. J Occup Med. 1994;36:713–7.PubMedGoogle Scholar
  5. 5.
    Kuye IO, Jain NB, Warner L, et al. J Shoulder Elbow Surg. 2012;21:367–75.CrossRefPubMedGoogle Scholar
  6. 6.
    Polinder S, Iordens GI, Panneman MJ, et al. BMC Public Health. 2013;13:531.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Schubert HE. Can Fam Physician. 2000;46:1825–32.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Phillips TG, Reibach AM, Slomiany WP. Am Fam Physician. 2004;70:879–84.PubMedGoogle Scholar
  9. 9.
    Buijze GA, Doornberg JN, Ham JS, et al. J Bone Joint Surg Am. 2010;92:1534–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Yin ZG, Zhang JB, Kan SL, et al. Clin Orthop Relat Res. 2010;468:723–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Bruno M, Weissman B, Kransdorf M, et al. ACR Appropriateness Criteria: acute hand and wrist trauma. 2013. https://acsearch.acr.org/docs/69418/Narrative/.
  12. 12.
    Tiel-van Buul MM, van Beek EJ, Broekhuizen AH, et al. Injury. 1992;23:77–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Breitenseher MJ, Metz VM, Gilula LA, et al. Radiology. 1997;203:245–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Dorsay TA, Major NM, Helms CA. Am J Roentgenol. 2001;177:1257–63.CrossRefGoogle Scholar
  15. 15.
    Groves AM, Kayani I, Syed R, et al. Am J Roentgenol. 2006;187:1453–6.CrossRefGoogle Scholar
  16. 16.
    Bretlau T, Christensen OM, Edstrom P, et al. Acta Orthop Scand. 1999;70:504–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Lohman M, Kivisaari A, Vehmas T, et al. Acta Radiol. 1999;40:615–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Mack MG, Keim S, Balzer JO, et al. Eur Radiol. 2003;13:612–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Tibrewal S, Jayakumar P, Vaidya S, et al. Int Orthop. 2012;36:107–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Hunter JC, Escobedo EM, Wilson AJ, et al. Am J Roentgenol. 1997;168:1287–93.CrossRefGoogle Scholar
  21. 21.
    de Zwart AD, Beeres FJ, Kingma LM, et al. J Hand Surg Am. 2012;37:2252–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Duckworth AD, Ring D, McQueen MM. J Bone Joint Surg Br. 2011;93:713–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Khalid M, Jummani ZR, Kanagaraj K, et al. Emerg Med J. 2010;27:266–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Blum A, Sauer B, Detreille R, et al. J Radiol. 2007;88:741–59.CrossRefPubMedGoogle Scholar
  25. 25.
    Hansen TB, Petersen RB, Barckman J, et al. J Hand Surg Eur Vol. 2009;34:627–30.CrossRefPubMedGoogle Scholar
  26. 26.
    Groves AM, Cheow HK, Balan KK, et al. Br J Radiol. 2005;78:791–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Foex B, Speake P, Body R. Emerg Med J. 2005;22:434–5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fowler C, Sullivan B, Williams LA, et al. Skeletal Radiol. 1998;27:683–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, et al. Radiology. 2006;240:169–76.CrossRefPubMedGoogle Scholar
  30. 30.
    Stoneback JW, Owens BD, Sykes J, et al. J Bone Joint Surg Am. 2012;94:240–5.CrossRefPubMedGoogle Scholar
  31. 31.
    O’Driscoll S. Elbow dislocations. In: Morrey B, Sanchez-Sotelo J, editors. The elbow and its disorders. 4th ed. Philadelphia, PA: Saunders/Elsevier; 2009. p. 436–49.CrossRefGoogle Scholar
  32. 32.
    Sheehan SE, Dyer GS, Sodickson AD, et al. Radiographics. 2013;33:869–88.CrossRefPubMedGoogle Scholar
  33. 33.
    Kuhn MA, Ross G. Orthop Clin North Am. 2008;39:155–61, v.Google Scholar
  34. 34.
    Durig M, Muller W, Ruedi TP, et al. J Bone Joint Surg Am. 1979;61:239–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Micic I, Kim SY, Park IH, et al. Int Orthop. 2009;33:1141–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Crosby NE, Greenberg JA. J Hand Surg Am. 2014;39:1408–14.CrossRefPubMedGoogle Scholar
  37. 37.
    Mezera K, Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA, Green DP, Bucholz RW, editors. Fractures in adults. 5th ed. Philadelphia, PA: Lippincott, Williams, & Wilkins; 2001. p. 921–34.Google Scholar
  38. 38.
    Coonrad RW, Roush TF, Major NM, et al. J Shoulder Elbow Surg. 2005;14:312–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Stevens KJ, McNally EG. Clin Sports Med. 2010;29:521–53.CrossRefPubMedGoogle Scholar
  40. 40.
    Schreiber JJ, Potter HG, Warren RF, et al. J Hand Surg Am. 2014;39:199–205.CrossRefPubMedGoogle Scholar
  41. 41.
    Lumsdaine W, Enninghorst N, Hardy BM, et al. Injury. 2013;44:471–4.CrossRefPubMedGoogle Scholar
  42. 42.
    Marcheix B, Chaufour X, Ayel J, et al. J Vasc Surg. 2005;42:1230–2.CrossRefPubMedGoogle Scholar
  43. 43.
    Carter SJ, Germann CA, Dacus AA, et al. Am J Emerg Med. 2010;28:960–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Ayel JE, Bonnevialle N, Lafosse JM, et al. Orthop Traumatol Surg Res. 2009;95:343–51.CrossRefPubMedGoogle Scholar
  45. 45.
    Kroner K, Lind T, Jensen J. Arch Orthop Trauma Surg. 1989;108:288–90.CrossRefPubMedGoogle Scholar
  46. 46.
    Zacchilli MA, Owens BD. J Bone Joint Surg Am. 2010;92:542–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Rowe CR. J Bone Joint Surg Am. 1956;38-A:957–77.CrossRefPubMedGoogle Scholar
  48. 48.
    Hovelius L. Clin Orthop Relat Res. 1982;166:127–31.Google Scholar
  49. 49.
    Bencardino JT, Gyftopoulos S, Palmer WE. Radiology. 2013;269:323–37.CrossRefPubMedGoogle Scholar
  50. 50.
    Owens BD, Nelson BJ, Duffey ML, et al. J Bone Joint Surg Am. 2010;92:1605–11.CrossRefPubMedGoogle Scholar
  51. 51.
    Wise J, Daffner R, Weissman B, et al. ACR Appropriateness Criteria: acute shoulder pain. 2010. https://acsearch.acr.org/docs/69433/Narrative/. Accessed 1 Aug 2015.
  52. 52.
    Silfverskiold JP, Straehley DJ, Jones WW. Orthopedics. 1990;13:63–9.PubMedGoogle Scholar
  53. 53.
    Sanders TG, Morrison WB, Miller MD. Am J Sports Med. 2000;28:414–34.CrossRefPubMedGoogle Scholar
  54. 54.
    Dumont GD, Russell RD, Robertson WJ. Curr Rev Musculoskelet Med. 2011;4:200–7.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Workman TL, Burkhard TK, Resnick D, et al. Radiology. 1992;185:847–52.CrossRefPubMedGoogle Scholar
  56. 56.
    Gyftopoulos S, Bencardino J, Palmer WE. Semin Musculoskelet Radiol. 2012;16:286–95.CrossRefPubMedGoogle Scholar
  57. 57.
    Denti M, Monteleone M, Trevisan C, et al. Knee Surg Sports Traumatol Arthrosc. 1995;3:184–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Hayes ML, Collins MS, Morgan JA, et al. Skeletal Radiol. 2010;39:1199–204.CrossRefPubMedGoogle Scholar
  59. 59.
    Gusmer PB, Potter HG, Schatz JA, et al. Radiology. 1996;200:519–24.CrossRefPubMedGoogle Scholar
  60. 60.
    Liavaag S, Stiris MG, Svenningsen S, et al. Scand J Med Sci Sports. 2011;21:e291–7.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Willemsen UF, Wiedemann E, Brunner U, et al. Am J Roentgenol. 1998;170:79–84.CrossRefGoogle Scholar
  62. 62.
    Palmer WE, Brown JH, Rosenthal DI. Radiology. 1994;190:645–51.CrossRefPubMedGoogle Scholar
  63. 63.
    Magee T. Am J Roentgenol. 2009;192:86–92.CrossRefGoogle Scholar
  64. 64.
    Major NM, Browne J, Domzalski T, et al. Am J Roentgenol. 2011;196:1139–44.CrossRefGoogle Scholar
  65. 65.
    Smith TO, Drew BT, Toms AP. Arch Orthop Trauma Surg. 2012;132:905–19.CrossRefPubMedGoogle Scholar
  66. 66.
    Oh JH, Kim JY, Choi JA, et al. J Shoulder Elbow Surg. 2010;19:14–20.CrossRefPubMedGoogle Scholar
  67. 67.
    Lecouvet FE, Dorzee B, Dubuc JE, et al. Eur Radiol. 2007;17:1763–71.CrossRefPubMedGoogle Scholar
  68. 68.
    Omoumi P, Rubini A, Dubuc JE, et al. Eur Radiol. 2015;25:961–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Saupe N, White LM, Bleakney R, et al. Radiology. 2008;248:185–93.CrossRefPubMedGoogle Scholar
  70. 70.
    Alyas F, Curtis M, Speed C, et al. Radiographics. 2008;28:463–79; quiz 619.Google Scholar
  71. 71.
    Melenevsky Y, Yablon CM, Ramappa A, et al. Skeletal Radiol. 2011;40:831–42.CrossRefPubMedGoogle Scholar
  72. 72.
    Mazzocca AD, Spang JT, Rodriguez RR, et al. Am J Sports Med. 2008;36:1397–402.CrossRefPubMedGoogle Scholar
  73. 73.
    Tossy JD, Mead NC, Sigmond HM. Clin Orthop Relat Res. 1963;28:111–9.PubMedGoogle Scholar
  74. 74.
    Eschler A, Rosler K, Rotter R, et al. Arch Orthop Trauma Surg. 2014;134:1193–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Phillips AM, Smart C, Groom AF. Clin Orthop Relat Res. 1998;353:10–7.CrossRefGoogle Scholar
  76. 76.
    Schlegel TF, Burks RT, Marcus RL, et al. Am J Sports Med. 2001;29:699–703.CrossRefPubMedGoogle Scholar
  77. 77.
    Zanca P. Am J Roentgenol Radium Ther Nucl Med. 1971;112:493–506.CrossRefPubMedGoogle Scholar
  78. 78.
    Ibrahim EF, Forrest NP, Forester A. Injury. 2015;46(10):1900–5.CrossRefPubMedGoogle Scholar
  79. 79.
    Sluming VA. Br J Radiol. 1995;68:1181–4.CrossRefPubMedGoogle Scholar
  80. 80.
    Bossart PJ, Joyce SM, Manaster BJ, et al. Ann Emerg Med. 1988;17:20–4.CrossRefPubMedGoogle Scholar
  81. 81.
    Schaefer FK, Schaefer PJ, Brossmann J, et al. Eur Radiol. 2006;16:1488–93.CrossRefPubMedGoogle Scholar
  82. 82.
    Barnes CJ, Higgins LD, Major NM, et al. J Surg Orthop Adv. 2004;13:69–75.PubMedGoogle Scholar
  83. 83.
    de Abreu MR, Chung CB, Wesselly M, et al. Clin Imaging. 2005;29:273–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Antonio GE, Cho JH, Chung CB, et al. Am J Roentgenol. 2003;180:1103–10.CrossRefGoogle Scholar
  85. 85.
    Hambidge SJ, Davidson AJ, Gonzales R, et al. Pediatrics. 2002;109:559–65.CrossRefPubMedGoogle Scholar
  86. 86.
    Iyer RS, Thapa MM, Khanna PC, et al. Am J Roentgenol. 2012;198:1053–68.CrossRefGoogle Scholar
  87. 87.
    Carson S, Woolridge DP, Colletti J, et al. Pediatr Clin North Am. 2006;53:41–67, v.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kara Gaetke-Udager
    • 1
  • Corrie M. Yablon
    • 1
  • Stefan Puig
    • 2
    • 3
  1. 1.Department of RadiologyMichigan MedicineAnn ArborUSA
  2. 2.Department of Diagnostic, Interventional, and Pediatric Radiology, InselspitalUniversity Hospital Bern, University of BernBernSwitzerland
  3. 3.Department of Radiology and NeuroradiologyKlinik im Park, Hirslanden AGZurichSwitzerland

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