Arm Injury

• Injuries to the arm (shoulder to hand)
• Injuries to a bone, muscle, joint or ligament
• Excluded: muscle pain caused by too much exercise or work (overuse). Covered in Arm Pain.
• Excluded: finger injury only. See that care guide.

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 lifting a child by the wrist or hand. It can also be caused by suddenly pulling a child toward you. 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.

Pain Scale

• 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
• Collarbone is painful and can't raise arm over head
• Can't open and close the hand normally
• Skin is split open or gaping and may need stitches
• Cut over knuckle of hand
• Age less than 1 year old
• Cut or scrape and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• Severe pain and not better 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

Contact Doctor Within 24 Hours

• Very large bruise or swelling
• Pain not better after 3 days
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Injury limits sports or school work
• Pain lasts more than 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
• Minor cut or scrape

Care Advice for Minor Arm Injuries

1. 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.
2. 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.
3. Small Cut or Scrape Treatment:
   • Use direct pressure to stop any bleeding. Do this for 10 minutes or until bleeding stops.
   • Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.
   • Gently scrub out any dirt with a washcloth.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage. Change daily.
4. 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.
5. 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.
6. Rest the Arm:
   • Rest the injured arm as much as possible for 48 hours.
7. 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.
8. 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 triangle-shaped bandage. Many first aid kits have a triangle 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 higher 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.

• Keep the hand and wrist from moving 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.

Notes:

• 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.