A patient presents with left elbow pain after losing his balance and falling into a wall. The radiologist reads the x-ray as negative. But is there a fracture?
Physical diagnosis of orthopedic injuries receives little attention but is crucial to the practice of emergency medicine.
Check range of motion. The inability to extend the elbow is 73-100% sensitive for a fracture of the elbow. The patient can not fully extend the elbow.
Gently palpate the region. The entire region is tender but this appears to be maximal at the radial head. You palpate the radial head and put the radius through supination and pronation back and forth. This elicits the patient’s pain.
You diagnose a radial head fracture in spite of the negative x-rays. The patient follows up with orthopedic surgery and the radial head fracture is later confirmed.
Take home points:
-Elbow fractures typically restrict range of motion
-The radial head is stressed through supination and pronation
-Gentle palpation can help localize the fracture site