Pediatric emergency medicine trisk 0869 0869
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within the bicipital groove. Pressure may produce exquisite tenderness in this
area, so palpation should be gentle; if uncertainty about a finding of tenderness
exists, a comparison with the examination of the uninjured side is helpful. Finally,
the proximal humeral shaft and the scapula are palpated.
During the neurologic evaluation, it is important to test sensation over the
deltoid muscle (to assess axillary nerve damage after shoulder dislocation) and
over the lateral proximal forearm (to assess musculocutaneous nerve damage).
Next, examine the patient’s active and passive range of motion (see Fig. 43.7 ).
Internal and external rotation can be observed easily in a child by asking the
patient to touch behind the neck (external rotation) and lower back to the inferior
tip of the opposite scapula (internal rotation).
