Upper Limb Trauma
Overview
Upper limb trauma includes injuries from the shoulder girdle to the fingertips. Fractures, dislocations, tendon or ligament damage and wounds may occur together. Treatment depends on alignment, stability, the skin and soft tissues, nerve and blood supply, hand dominance, health and functional needs. Some injuries require urgent reduction or surgery; many can be managed with a sling, splint or cast and structured follow-up.
Injuries assessed
- Clavicle, shoulder and upper-arm fractures or dislocations.
- Elbow fractures, dislocations and ligament injuries.
- Forearm and wrist fractures, including distal radius and scaphoid injuries.
- Hand and finger fractures, joint injuries and tendon lacerations.
- Open wounds, crush injuries, nerve symptoms and complications after previous treatment.
Initial priorities
The first priority is the person’s overall safety, followed by the condition of the skin, circulation and nerves. Open fractures or dislocations, threatened skin, loss of pulse, progressive numbness or severe swelling need urgent hospital assessment. Do not push exposed bone back into a wound.
Rings, watches and tight jewellery should be removed early when a hand or wrist is swelling. A visibly deformed limb should be supported rather than repeatedly manipulated outside an appropriate clinical setting.
Assessment and imaging
Assessment records how the injury occurred, hand dominance, occupation, previous function and relevant medical risks. Examination includes deformity, wounds, tenderness, movement, tendon function, sensation and blood flow.
X-rays are the usual first investigation. CT may define complex joint fractures; MRI or ultrasound may assess selected tendon, ligament, cartilage or occult bone injuries. Imaging must be interpreted with clinical findings.
Non-surgical treatment
Stable, acceptably aligned injuries may be treated with a sling, brace, splint or cast. Some displaced fractures can be realigned without an incision and then monitored with repeat X-rays. Early safe movement of unaffected joints helps limit stiffness and swelling.
Non-surgical care still requires active follow-up. A fracture can lose position, skin can become pressured and stiffness can become established if reviews or rehabilitation are missed.
When may surgery be considered?
Surgery may be recommended for an open injury, unstable or unacceptable alignment, a displaced joint surface, loss of circulation or nerve function, tendon injury, failed treatment without an incision, or an injury unlikely to heal in a useful position.
Treatment may include realignment and fixation with wires, screws, plates, nails or an external frame; tendon or ligament repair; nerve exploration; wound cleaning and removal of damaged tissue; bone grafting; or, for selected unreconstructable injuries, joint replacement or fusion. The least invasive option that can provide reliable treatment is chosen for the specific injury.
Recovery
Bone healing is only one part of recovery. Swelling, scar sensitivity, stiffness and loss of strength can persist after the fracture is united. Hand therapy or physiotherapy may be needed to restore movement and function while protecting healing tissues.
Return to driving, work, lifting and sport depends on the injured structure, stability, pain, medication, strength and ability to control equipment safely. Some severe injuries do not return to pre-injury function despite appropriate care.
Possible complications
- Infection, wound problems or problems with fixation.
- Stiffness, tendon adhesions, weakness or chronic swelling.
- Nerve injury, numbness or complex regional pain syndrome.
- Delayed or failed bone healing, healing in the wrong position, or arthritis after the injury.
- Instability, tendon rupture or need for further surgery.
- Blood clots and medical complications in higher-risk or major trauma.
Seek urgent care
- An open wound over a suspected fracture or exposed bone.
- A ring or tight jewellery that cannot be removed from a rapidly swelling finger or hand.
- A pale, cold or blue hand; absent pulse; or rapidly increasing swelling.
- New or progressive numbness, weakness or inability to move fingers.
- Severe pain that is escalating despite support and prescribed medicine, particularly pain with passive finger movement or a tense swollen forearm.
- Fever, drainage or worsening redness after injury or surgery.
Frequently asked questions
Does every displaced fracture need surgery?
No. The acceptable position depends on the bone, joint involvement, stability, age, function and likelihood of maintaining alignment.
Why are repeat X-rays needed?
Some fractures move after swelling settles. Repeat imaging confirms that alignment remains acceptable during healing.
Why are my fingers swollen when the fracture is at the wrist?
Swelling tracks into the hand. Elevation and regular safe finger movement are important, provided the treating team has not restricted movement.
When can I drive?
Only when you can control the vehicle safely, are not impaired by medication or immobilisation, and meet licensing and insurer requirements.
Can stiffness be permanent?
Yes. Joint injury, prolonged immobilisation, scar and severe soft-tissue damage can leave lasting restriction despite treatment and therapy.
General information
This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.