This chapter presents the key facts, clinical presentation, diagnostic testing, treatment of procedures, and prognosis of shoulder and elbow emergencies such as glenohumeral dislocations, scapular fractures, clavicle fractures, sternoclavicular (SC) injuries, acromioclavicular injuries, and proximal humerus fractures. Failure to obtain a lateral projection can result in missing a posterior dislocation in up to 50% of cases. Reductions performed with intra-articular anesthetic injections have been safely performed with equivalent success rates, similar patient comfort, shorter ED length of stays, and lower complication rates. Electromyogram (EMG) testing can be performed at a later date to evaluate suspected nerve injuries. Presence of a posterior SC dislocation should prompt evaluation for associated injuries to the trachea, esophagus, and great vessels, which are in close proximity to the SC joint. Plain radiographs are the preferred test for evaluation of suspected humeral shaft fractures.

Diplopia, visual loss, and pupillary asymmetry are important presentations of neuroophthalmologic emergencies. When evaluating a patient with diplopia, the most important initial step is to determine whether the diplopia is monocular or binocular. Binocular diplopia resolves when either eye is covered. Monocular diplopia usually results from ophthalmologic causes or refractive errors. Binocular diplopia results from ocular misalignment. Diplopia is most pronounced when looking in the direction of the limited extraocular movement regardless of cause. Neuro-ophthalmologic visual loss is divided into prechiasmal, chiasmal, or postchiasmal etiologies. Monocular visual loss indicates a lesion anterior to the chiasm. Pupils are evaluated for reactivity and size in light and dark environments. Anisocoria is defined as unequal pupil size. A significant percent (approximately 20%) of the population has minimal anisocoria without pathology, termed physiological or simple anisocoria. Only physiological anisocoria or Horner's syndrome produce anisocoria with normally reactive pupils.