Upper limb nerve testing in children
Upper‑limb nerve and vascular assessment is mandatory in all paediatric limb trauma and must be documented and repeated. Accurate early recognition, clear documentation and timely escalation reduce the risk of persistent neurovascular deficit - this is particularly important in supracondylar humeral fractures, which commonly associate with anterior interosseous nerve (AIN) and brachial artery injury (NICE NG37; RCEM curriculum).
Clinical priorities
- Provide adequate analgesia and immobilise the limb before examination so that the child can cooperate. Reassess neurovascular status after analgesia and after any manipulation/reduction.
- Perform a focused, time‑stamped neurovascular exam (motor + sensory + vascular) and record findings; repeat at intervals determined by local policy.
- Escalate urgently for vascular “hard signs” (see below). If there is no palpable radial pulse but the hand is well perfused, local policy and NICE NG37 support careful observation with urgent orthopaedic discussion rather than automatic operative exploration.
Anatomical associations to remember
- Extension‑type supracondylar fractures commonly injure the anterior interosseous branch of the median nerve and may compromise the brachial artery.
- Flexion‑type supracondylar fractures more commonly injure the ulnar nerve.
- Radial nerve injury is less common with distal humeral supracondylar fractures but should be tested when fracture pattern or clinical signs suggest it.
Bedside nerve tests - child‑friendly, exam‑focused
Use demonstration, single‑step commands and comparison with the contralateral limb....