Approach to common musculoskeletal injuries (pediatrics) Quiz: Ace Your Exams

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A 12-year-old boy presents to the emergency department after a fall off a bicycle. The patient struck a pothole and landed directly on his left shoulder. Pain is reported over the anterior left shoulder, radiating up the neck and down the left arm. Parents at bedside report the patient is otherwise healthy and does not take any daily medications. Temperature is 37°C (98.6°F), heart rate is 106/min, blood pressure is 110/65 mmHg, respiratory rate is 18/min, and oxygen saturation is 99% on room air. The patient appears uncomfortable but in no acute distress. Examination of the left shoulder reveals point tenderness at the acromioclavicular (AC) joint. The patient can flex and extend the elbow with minimal pain. Radial pulse is 2+, capillary refill is less than 2 seconds, and sensation is intact. Which of the following is the best next step in diagnosis?

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Radiograph of the left humerus

Computed tomography (CT) of the left shoulder

Radiograph of the left shoulder

Arthrocentesis of the left shoulder

Magnetic resonance imaging (MRI) of the left shoulder