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

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


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.


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


  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.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Karl JW, Olson PR, Rosenwasser MP. J Orthop Trauma. 2015;29:e242–4.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Webster BS, Snook SH. J Occup Med. 1994;36:713–7.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Kuye IO, Jain NB, Warner L, et al. J Shoulder Elbow Surg. 2012;21:367–75.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Polinder S, Iordens GI, Panneman MJ, et al. BMC Public Health. 2013;13:531.PubMedPubMedCentralCrossRefGoogle 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.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Buijze GA, Doornberg JN, Ham JS, et al. J Bone Joint Surg Am. 2010;92:1534–44.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Yin ZG, Zhang JB, Kan SL, et al. Clin Orthop Relat Res. 2010;468:723–34.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Bruno M, Weissman B, Kransdorf M, et al. ACR Appropriateness Criteria: acute hand and wrist trauma. 2013.
  12. 12.
    Tiel-van Buul MM, van Beek EJ, Broekhuizen AH, et al. Injury. 1992;23:77–9.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Breitenseher MJ, Metz VM, Gilula LA, et al. Radiology. 1997;203:245–50.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Lohman M, Kivisaari A, Vehmas T, et al. Acta Radiol. 1999;40:615–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Mack MG, Keim S, Balzer JO, et al. Eur Radiol. 2003;13:612–7.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Tibrewal S, Jayakumar P, Vaidya S, et al. Int Orthop. 2012;36:107–10.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Duckworth AD, Ring D, McQueen MM. J Bone Joint Surg Br. 2011;93:713–9.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Khalid M, Jummani ZR, Kanagaraj K, et al. Emerg Med J. 2010;27:266–9.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Blum A, Sauer B, Detreille R, et al. J Radiol. 2007;88:741–59.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Hansen TB, Petersen RB, Barckman J, et al. J Hand Surg Eur Vol. 2009;34:627–30.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Groves AM, Cheow HK, Balan KK, et al. Br J Radiol. 2005;78:791–5.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Foex B, Speake P, Body R. Emerg Med J. 2005;22:434–5.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Fowler C, Sullivan B, Williams LA, et al. Skeletal Radiol. 1998;27:683–7.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Memarsadeghi M, Breitenseher MJ, Schaefer-Prokop C, et al. Radiology. 2006;240:169–76.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Stoneback JW, Owens BD, Sykes J, et al. J Bone Joint Surg Am. 2012;94:240–5.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Micic I, Kim SY, Park IH, et al. Int Orthop. 2009;33:1141–7.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Crosby NE, Greenberg JA. J Hand Surg Am. 2014;39:1408–14.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Stevens KJ, McNally EG. Clin Sports Med. 2010;29:521–53.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Schreiber JJ, Potter HG, Warren RF, et al. J Hand Surg Am. 2014;39:199–205.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Lumsdaine W, Enninghorst N, Hardy BM, et al. Injury. 2013;44:471–4.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Marcheix B, Chaufour X, Ayel J, et al. J Vasc Surg. 2005;42:1230–2.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Carter SJ, Germann CA, Dacus AA, et al. Am J Emerg Med. 2010;28:960–5.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Ayel JE, Bonnevialle N, Lafosse JM, et al. Orthop Traumatol Surg Res. 2009;95:343–51.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Kroner K, Lind T, Jensen J. Arch Orthop Trauma Surg. 1989;108:288–90.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Zacchilli MA, Owens BD. J Bone Joint Surg Am. 2010;92:542–9.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Rowe CR. J Bone Joint Surg Am. 1956;38-A:957–77.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Owens BD, Nelson BJ, Duffey ML, et al. J Bone Joint Surg Am. 2010;92:1605–11.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Wise J, Daffner R, Weissman B, et al. ACR Appropriateness Criteria: acute shoulder pain. 2010. Accessed 1 Aug 2015.
  52. 52.
    Silfverskiold JP, Straehley DJ, Jones WW. Orthopedics. 1990;13:63–9.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Sanders TG, Morrison WB, Miller MD. Am J Sports Med. 2000;28:414–34.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Dumont GD, Russell RD, Robertson WJ. Curr Rev Musculoskelet Med. 2011;4:200–7.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Workman TL, Burkhard TK, Resnick D, et al. Radiology. 1992;185:847–52.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Gyftopoulos S, Bencardino J, Palmer WE. Semin Musculoskelet Radiol. 2012;16:286–95.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Denti M, Monteleone M, Trevisan C, et al. Knee Surg Sports Traumatol Arthrosc. 1995;3:184–6.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Hayes ML, Collins MS, Morgan JA, et al. Skeletal Radiol. 2010;39:1199–204.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Gusmer PB, Potter HG, Schatz JA, et al. Radiology. 1996;200:519–24.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Liavaag S, Stiris MG, Svenningsen S, et al. Scand J Med Sci Sports. 2011;21:e291–7.PubMedPubMedCentralCrossRefGoogle 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.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Oh JH, Kim JY, Choi JA, et al. J Shoulder Elbow Surg. 2010;19:14–20.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Lecouvet FE, Dorzee B, Dubuc JE, et al. Eur Radiol. 2007;17:1763–71.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Omoumi P, Rubini A, Dubuc JE, et al. Eur Radiol. 2015;25:961–9.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Saupe N, White LM, Bleakney R, et al. Radiology. 2008;248:185–93.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Mazzocca AD, Spang JT, Rodriguez RR, et al. Am J Sports Med. 2008;36:1397–402.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Tossy JD, Mead NC, Sigmond HM. Clin Orthop Relat Res. 1963;28:111–9.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Eschler A, Rosler K, Rotter R, et al. Arch Orthop Trauma Surg. 2014;134:1193–8.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Zanca P. Am J Roentgenol Radium Ther Nucl Med. 1971;112:493–506.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Ibrahim EF, Forrest NP, Forester A. Injury. 2015;46(10):1900–5.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Sluming VA. Br J Radiol. 1995;68:1181–4.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Bossart PJ, Joyce SM, Manaster BJ, et al. Ann Emerg Med. 1988;17:20–4.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Schaefer FK, Schaefer PJ, Brossmann J, et al. Eur Radiol. 2006;16:1488–93.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Barnes CJ, Higgins LD, Major NM, et al. J Surg Orthop Adv. 2004;13:69–75.PubMedPubMedCentralGoogle Scholar
  83. 83.
    de Abreu MR, Chung CB, Wesselly M, et al. Clin Imaging. 2005;29:273–7.PubMedCrossRefPubMedCentralGoogle 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.PubMedCrossRefPubMedCentralGoogle 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
    Email author
  • 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

Personalised recommendations