Upper limb injuries are a frequent presentation in primary care and minor injury units, particularly in active children. Falls, sports activities, and playground incidents commonly result in fractures, sprains, and soft tissue injuries. While many of these injuries are minor and can be managed conservatively, primary care providers must be adept at recognising serious injuries requiring urgent referral.
Common Upper Limb Injuries in Children
1. Clavicle Fractures
Clavicle fractures are one of the most common paediatric fractures, typically resulting from falls onto the shoulder or outstretched hand.
Assessment:
- Tenderness and swelling over the clavicle
- Visible deformity or bruising
- Pain with arm movement
Management:
- Most cases require a simple sling for comfort
- Referral for orthopaedic assessment if the fracture is significantly displaced or tenting the skin
2. Supracondylar Fractures of the Humerus
These fractures are common in children aged 5–7 years and usually result from a fall onto an outstretched hand.
Assessment:
- Pain and swelling around the elbow
- Reduced range of motion
- Neurovascular assessment is essential (look for compromised circulation or nerve injury)
Management:
- Immediate referral to secondary care for X-ray and orthopaedic evaluation
- Avoid excessive manipulation to prevent vascular injury
3. Radial Head Subluxation (Nursemaid’s Elbow)
A common injury in toddlers caused by a sudden pull on the arm, leading to subluxation of the radial head.
Assessment:
- Child refuses to use the affected arm, holding it in a pronated position
- Minimal swelling or bruising
- No significant tenderness on palpation
Management:
- Reduction can be performed in primary care using the hyperpronation or supination-flexion method
- Immediate pain relief and restored function confirm successful reduction
- If symptoms persist, consider X-ray to exclude fractures
4. Distal Radius Fractures
These are among the most frequent childhood fractures, occurring from falls onto an outstretched hand.
Assessment:
- Pain, swelling, and possible deformity at the wrist
- Tenderness over the distal radius
- Neurovascular examination to rule out complications
Management:
- Immobilisation with a splint or cast
- Referral for orthopaedic assessment in displaced or angulated fractures
5. Scaphoid Fractures (Rare but Important)
Although rare in younger children, scaphoid fractures can occur in adolescents and are often missed due to subtle symptoms.
Assessment:
- Snuffbox tenderness is a key finding
- Pain with wrist movement, especially radial deviation
- X-ray may not always show fractures initially—consider MRI if symptoms persist
Management:
- Immobilisation in a thumb spica splint
- Referral for orthopaedic review if suspicion remains high
Improving Assessment and Management in Primary Care
Key Principles:
- Thorough history and examination: Mechanism of injury often provides diagnostic clues.
- Early neurovascular assessment: Crucial in elbow and forearm injuries.
- Appropriate use of imaging: X-rays are essential for suspected fractures, but clinical suspicion should guide management.
- Timely referral: Recognising when specialist input is needed can prevent complications.
Enhance Your Skills with Specialist Training
To improve your confidence in diagnosing and managing childhood injuries, consider enrolling in the Minor Injuries in Children (1-18 years of age) Course by PDUK. This course covers:
- Effective assessment techniques
- Identification and management of common paediatric injuries
- Practical skills for primary care and minor injury settings
Click here to learn more and book your place.
Conclusion
Primary care clinicians play a vital role in the early assessment and management of paediatric upper limb injuries. A structured approach, incorporating thorough history-taking, clinical examination, and appropriate referral pathways, ensures optimal patient outcomes. By staying updated with best practices and further training, healthcare providers can enhance their skills in managing these common childhood injuries effectively.
References
Davies, R. and Roberts, C. (2021) ‘Paediatric fractures: common presentations and management strategies’, British Journal of General Practice, 71(703), pp. 45-50. doi:10.3399/bjgp21X714785.
Ferguson, J., Nicol, M. and Perry, D. (2022) ‘Emergency management of paediatric upper limb injuries in primary care’, Archives of Disease in Childhood – Education & Practice, 107(4), pp. 201-206. doi:10.1136/archdischild-2021-322470.
