Urgent or Emergency Care?
If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.
Help Me Decide
- Injuries to the arm (shoulder to fingers)
- Injuries to a bone, muscle, joint or ligament
- Excluded: Muscle pain caused by too much exercise or work (overuse). Covered in Arm Pain.
Types of Arm Injuries
- Fractures. Fractures are broken bones. A broken collarbone is the most common broken bone in children. It's easy to notice because the collar bone is tender to touch. Also, the child cannot raise the arm upward.
- Dislocations. This happens when a bone is pulled out of a joint. A dislocated elbow is the most common type of this injury in kids. It's caused by an adult quickly pulling or lifting a child by the arm. Mainly seen in 1 to 4 year olds. It's also easy to spot. The child will hold his arm as if it were in a sling. He will keep the elbow bent and the palm of the hand down.
- Sprains. Sprains are stretches and tears of ligaments.
- Strains. Strains are stretches and tears of muscles (such as a pulled muscle).
- Muscle Overuse. Muscle pain can occur without an injury. There is no fall or direct blow. Muscle overuse is from hard work or sports (such as a sore shoulder).
- Muscle bruise from a direct blow
- Bone bruise from a direct blow
- Skin Injury. Examples are a cut, scratch, scrape or bruise. All are common with arm injuries.
- Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
- Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
- Severe: The pain is very bad. It keeps your child from doing all normal activities.
Call 911 Now
- Serious injury with many broken bones
- Major bleeding that can't be stopped
- Bone is sticking through the skin
- You think your child has a life-threatening emergency
Go to ER Now
- Can't move the shoulder, elbow or wrist at all
- Looks like a broken bone (crooked or deformed)
- Looks like a dislocated joint
- Large deep cut that will need many stitches
Call Doctor or Seek Care Now
- Can't move the shoulder, elbow or wrist normally
- Can't open and close the hand normally
- Skin is split open or gaping and may need stitches
- Cut over knuckle of hand
- Age under 1 year old
- Severe pain and not improved 2 hours after taking pain medicine
- You think your child has a serious injury
- You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
- Very large bruise or swelling
- Pain not better after 3 days
- You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
- Injury limits sports or school work
- Dirty cut and no tetanus shot in over 5 years
- Clean cut and no tetanus shot in over 10 years
- Pain lasts over 2 weeks
- You have other questions or concerns
Self Care at Home
- Bruised muscle or bone from direct blow
- Pain in muscle (from minor pulled muscle)
- Pain around joint (from minor stretched ligament)
Care Advice for Minor Arm Injuries
- What You Should Know About Minor Arm Injuries:
- During sports, muscles and bones get bruised.
- Muscles get stretched.
- Here is some care advice that should help.
- Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain.
- Use as needed.
- Cold Pack for Pain:
- For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
- Put it on the sore muscles for 20 minutes.
- Repeat 4 times on the first day, then as needed.
- Reason: Helps the pain and helps stop any bleeding.
- Caution: Avoid frostbite.
- Use Heat After 48 Hours:
- If pain lasts over 2 days, put heat on the sore muscle.
- Use a heat pack, heating pad or warm wet washcloth.
- Do this for 10 minutes, then as needed.
- Reason: Increase blood flow and improve healing.
- Caution: Avoid burns.
- Rest the Arm:
- Rest the injured arm as much as possible for 48 hours.
- What to Expect:
- Pain and swelling most often peak on day 2 or 3.
- Swelling should be gone by 7 days.
- Pain may take 2 weeks to fully go away.
- Call Your Doctor If:
- Pain becomes severe
- Pain is not better after 3 days
- Pain lasts more than 2 weeks
- You think your child needs to be seen
- Your child becomes worse
Care Advice for Minor Arm Injuries
To put on a sling you first need to have a triangular bandage. Many first aid kits have a triangular bandage.
- Find the two ends of the triangle that are farthest apart. These are the ends that you will tie around the neck.
- Lay the arm down the middle of the triangle.
- Take the two ends of the triangle that are farthest apart and tie them behind the neck (a square knot is best, but any knot will do).
- Make sure the wrist is at a level heigher than the heart.
- Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.
- Immobilize the hand and wrist by placing them on a rigid splint (see drawing).
- Tie several cloth strips around hand/wrist to keep the splint in place. You can use a roll of gauze or tape instead of cloth strips.
- You can make a splint from: a wooden board, magazine folded in half, folded-up newspaper, cardboard, or a pillow.
- If you have no splinting materials, then support the injured arm by resting it on a pillow or folded up blanket.
- After putting on the splint, apply a cold pack or an ice pack (wrapped in a towel) to the area.
RICE is a way to remember the steps for taking care of a sprain, strain, or bruise. There are four things you should do:
- REST the injured part of your body for 24 hours. Can return to normal activity after 24 hours of rest if the activity does not cause severe pain.
- Apply a cold pack or an ICE bag (wrapped in a moist towel) to the area for 20 minutes. Repeat in 1 hour, then every 4 hours while awake.
- Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If numbness, tingling, or increased pain occurs in the injured part, the bandage may be too tight. Loosen the bandage wrap.
- Keep the injured part of the body ELEVATED and at rest for 24 hours. For example, for an injured ankle, place that leg up on a pillow and stay off the feet as much as possible.
The information contained in these topics is not intended nor implied 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.
Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.
Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
- You can have a conversation with your child's doctor.
- Your child's doctor can perform a physical examination and any necessary tests.
- Your child could have an underlying medical problem that requires a physician to detect.
- If your child is taking medications, they could influence how he experiences various symptoms.
If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!
And when in doubt, call your child's doctor NOW or go to the closest emergency department.
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Pam Wilson, MD
Physical Medicine & Rehabilitation - Pediatric, Pediatrics, Physical Medicine & Rehabilitation