Should Your Child See a Doctor?

Arm Injury

Definition

  • Injuries to arm (shoulder to fingers)
  • Injuries to a bone, muscle, joint or ligament

Types of Arm Injuries  

  • Fractures (broken bones). A broken collarbone (clavicle) is the most common fracture of childhood. Easy to recognize because the collar bone is tender to touch and the child is unwilling to raise the arm upward.
  • Dislocations (bone out of joint). A pulled elbow is the most common dislocation of childhood. It's caused by an adult suddenly pulling or lifting a child by the arm. Mainly 1 to 4 year olds. Easy to recognize because the child holds his arm as if it were in a sling with the elbow bent and the palm down.
  • Sprains - stretches and tears of ligaments
  • Strains - stretches and tears of muscles (e.g., pulled muscle)
  • Muscle overuse injuries from sports or exercise
  • Muscle bruise from a direct blow
  • Bone bruise from a direct blow

Pain Severity Scale  

  • MILD: doesn't interfere with normal activities
  • MODERATE: interferes with normal activities or awakens from sleep
  • SEVERE: excruciating pain, unable to do any normal activities, incapacitated by pain

When to Call Your Doctor for Arm Injury

Call 911 If…

 
  • Your child has a serious injury with multiple fractures
  • Your child has major bleeding that can't be stopped
 

Call Your Doctor Now (night or day) If

  • You think your child has a serious injury
  • Looks like a broken bone or dislocated joint
  • Swollen elbow or any large swelling
  • Skin beyond the injury is pale or blue
  • Skin is split open or gaping and may need stitches
  • Age under 1 year old
  • Bicycle spoke or washing machine wringer injury
  • Pain is SEVERE (and not improved after 2 hours of pain medicine)
  • Unable to move arm or shoulder normally (especially if someone pulled on the arm)
  • Young child and cries when you try to move the shoulder (collarbone fracture suspected)
  • Joint nearest the injury can't be moved fully (opened and closed)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Pain not improved after 3 days
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Pain lasts over 2 weeks
 

Parent Care at Home If

  • Bruised muscle or bone from direct blow
  • Pain in muscle (probably from mild pulled muscle)
  • Pain around joint (probably from mild stretched ligament)
 

Home Care Advice for Minor Arm Injuries

  1. Reassurance: Bruised muscles or bones can be trated at home.
    • Pain: For pain relief, give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage Table.) Ibuprofen is more effective for this type of pain.
    • Local Cold: For bruises or swelling, apply a cold pack or ice bag wrapped in a wet cloth to the area for 20 minutes per hour. Repeat for 4 consecutive hours. (Reason: reduce the bleeding and pain)
    • Local Heat: After 48 hours, apply a warm wet washcloth or heating pad for 10 minutes 3 times per day to help absorb the blood.
     
  2. Expected Course: Pain and swelling usually peak on day 2 or 3. Swelling is usually gone by 7 days. Pain may take 2 weeks to completely resolve.
  3. Call Your Doctor If:
    • Pain becomes severe
    • Pain is not improving after 3 days
    • Pain lasts over 2 weeks
    • Your child becomes worse
     

References

  1. Benjamin HJ, Mjannes JM, Hang BT. Getting a grasp on hand injuries in young athletes. Contemp Pedatr. 2008;25(3): 49-63.
  2. Brenner JS and the Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119(6):1242-1246.
  3. Carson S, Woolridge D, Colletti J, Kilgore K. Pediatric upper extremity injuries. Pediatr Clin North Am. 2006;53(1):41-68.
  4. Clark E, Plint A, Correll R, et al. A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics. 2007;119:460-467.
  5. England SP and Sundberg S. Management of common pediatric fractures. Pediatr Clin North Am. 1996;43:991-1011.
  6. Feter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18:341.
  7. Hennikus WL, Shaw BA, Gerardi JA. Elbow injuries. Contemp Pediatr. 1999;16:155-177.
  8. Huurman WW and Ginsburg GM. Musculoskeletal injury in children. Pediatr Rev. 1997;18(12):429-440.
  9. Koutures CG. An overview of overuse injuries. Contemp Pediatr. 2001;18(11):43-70.
  10. Meckler GD, Spiro DM. Radial head subluxation. Pediatr Rev. 2008;29:e42-e43.
  11. Waanders NA, Hellerstein E, Ballock RT. Nursemaid's elbow: Pulling out the diagnosis. Contemp Pediatr. 2000;17(6):87-96.  

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/14/2010

Last Revised: 9/13/2010 6:14:33 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.