UMEM Educational Pearls

Category: Pediatrics

Title: Rock Paper Scissors OK ! (submitted by Leen Ablaihed, MBBS, MHA)

Keywords: NV exam, neurovascular, upper extremity injury, orthopedics, hand, fracture, supracondylar (PubMed Search)

Posted: 5/24/2019 by Mimi Lu, MD (Emailed: 8/23/2019) (Updated: 8/23/2019)
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  • The assessment of peripheral nerves in children with upper limb injuries can be challenging. 
  • Neurovascular deficit was not documented in 25% of children presenting with upper extremity injury
  • BOAST (British Orthopedic Association Standards for Trauma) guidelines state that each of the Median, Ulnar, Radial, Anterior Interosseous Nerve exams must be individually documented in any supracondylar fracture
  • Dawson described an easy way to test and document your exam. Have the child play “Rock, Paper, Scissors, Ok”
    • Rock: tests the Median nerve
    • Paper: tests the Radial nerve
    • Scissors: tests the Ulnar nerve
    • Ok: tests the Anterior Interosseous nerve
  • This method increased proper documentation and reduced missed nerve injuries in upper extremity fractures.
  • Dr. Sarah Edwards and Dr. Hannah Lock created an easy infographic in the link below and found near 100% increase in NV documentation in their ED. Their poster won the prize for best infographic at the 2018 Emergency Medicine Educators' Conference (EMEC)
  • https://www.peminfographics.com/infographics/rock-paper-scissors-ok

 

References

  • Dawson AW. Rock-Paper-Scissors. Injury 2003 Jan;34(1):61-3
  • Marsh AG, Robertson JS, Goodman A, Boyle J, Huntly JS. Introduction of a simple guideline to improve neurological assessment of paediatric patients presenting with upper limb fractures.  Emerg Med J. 2016 Apr;(33)4:273-7