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.
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Gaetke-Udager, K., Yablon, C.M., Puig, S. (2018). Upper Extremity Injuries in Adults and Children: Evidence-Based Emergency Imaging. In: Kelly, A., Cronin, P., Puig, S., Applegate, K. (eds) Evidence-Based Emergency Imaging. Evidence-Based Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-67066-9_29
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