A 12-Year-Old With Urinary Retention Who Can't Grasp Objects

Liana Meffert; Daniel Miller, MD


April 18, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 12-year-old boy presents to the emergency department with bilateral arm pain and notable weakness and numbness that he describes as feeling "fuzzy." The patient reports that approximately 2 weeks ago, he fell off his bicycle and landed on his right arm. He had no head trauma or loss of consciousness as a result of the accident. Since his accident, he has experienced worsening right arm pain, which now extends to his back and left arm and does not radiate.

An initial radiograph of the right arm showed no fractures. When left arm pain later developed, cervical and lumbar spine radiographs were ordered, which were negative for spine fracture but raised concern for acromioclavicular joint injury, with an elevation of the distal clavicle relative to the acromion.

Last night, the patient was awakened by the pain; this morning, he was unable to grasp objects. His mother brought him to the emergency department. On a review of systems, he notes that yesterday, he began having trouble emptying his bladder. He does not report any recent confusion, dizziness, headaches, nausea, or emesis. His mother has been treating him at home with ibuprofen and acetaminophen, without much relief.


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