Common Upper‑Limb Minor Injuries
This section summarises the high‑yield upper‑limb injuries seen in the emergency department: distal radius fractures, carpal bone fractures and carpal dislocations, metacarpal and phalangeal fractures, and simple finger dislocations. Focus is on rapid recognition, safe initial ED management (analgesia, immobilisation, reduction), key complications to exclude, imaging strategy for occult injuries, and clear triggers for specialist referral in line with NICE NG38 and ED practice guidance.
Core principles (assessment and initial management)
Perform a focused, documented assessment before any manipulation.
- History: mechanism (FOOSH, direct blow, twisting), limb dominance, occupation, anticoagulation, osteoporosis, time since injury.
- Examination: document distal neurovascular status (pulses, capillary refill); sensory testing in median, ulnar and radial distributions; two‑point discrimination or light touch if available; and motor/tendon function (finger flexion/extension, thumb opposition).
- Re‑document neurovascular and motor findings after any reduction or procedure.
- Inspect for open wounds, skin compromise, deformity, compartment pressure signs and acute median‑nerve symptoms (particularly with perilunate/lunate injuries).
- Analgesia and anaesthesia: provide appropriate analgesia before manipulation. Options include oral/IV analgesia, inhaled nitrous oxide, procedural sedation, local haematoma block or ultrasound‑guided regional block depending on local expertise (see RCEM resources).
- Immobilise painful or deformed injuries promptly (short‑arm backslab, scaphoid splint) while arranging imaging and definitive care.
- Before discharge, ensure clear written and verbal safety‑netting and arrange fracture‑clinic or specialist follow‑up (NICE NG38).