Which position is MOST appropriate for a patient with burns to the axilla, elbow, and volar surface of the hand?

• A. Shoulder in abduction and lateral external rotation
• B. Wrist in extension and digits in slight flexion
• C. Elbow in slight flexion and forearm in supination
• D. Shoulder in extension and lateral external rotation

Answer: (A)

Prioritizing joint position to prevent contractures during burn healing is key. Burns in the armpit area (axilla) put the shoulder at high risk for developing an adduction and internal rotation contracture as scar tissue tightens across the chest and axilla. Keeping the arm in abduction maintains the glenohumeral joint in a lengthened, functional position, and adding some external rotation helps keep the rotator interval and surrounding soft tissues from shortening. This combination best preserves shoulder ROM during healing when burns involve the axilla.

The other positions don’t address this critical risk as effectively. Wrist Extension with fingers in slight flexion targets the hand, not the axilla, and won’t prevent axillary contracture. Elbow slight flexion with forearm in supination does not protect the elbow from flexion contractures and isn’t specifically protective for the axilla. Shoulder extension with external rotation could tension anterior structures and does not counteract the tendency toward adduction from axillary burns.