Pediatric emergency medicine trisk 3439 3439

Clinical assessment. In the setting of a suspected clavicle fracture, the physical
examination should include both the shoulder and the arm to evaluate for possible
vascular or brachial plexus injury. Visual inspection and palpation of the clavicle
for deformity or crepitus should indicate the location of the fracture. Examination
for an AC injury should include visual inspection for localized bruising and
swelling as well as palpation of the joint during flexion and extension of the
shoulder and distraction of the arm as it is placed in adduction. If the injury is not
severe and/or the diagnosis is uncertain, the Bell–van Riet test for isolated AC
joint pathology is felt to be the most sensitive. For this test, the affected arm is
passively raised in full adduction to 90 degrees and crossed in front of the patient
toward the contralateral shoulder while maintaining full extension. The patient
then attempts to elevate the arm against resistance. If this maneuver results in
focal pain at the AC joint and inability to maintain the arm in the adducted and
elevated position, this likely indicates an unstable AC joint.