A painful shoulder after a fall

A 9 year old boy, right hand dominant, presented to the emergency department after falling onto an outstretched hand while jumping over a vaulting box during a physical education lesson. He had no notable medical or surgical history. He complained of pain over his upper arm.

Deformity, tenderness, and swelling were obvious at the level of the upper third of the right humerus. Range of motion at the shoulder was limited due to pain. There was no tenderness over the right clavicle or scapula and no other bony injury in the …