A 26-year-old woman was involved in a head-on automobile collision
while wearing a seat belt. In
the Emergency Room she was alert and complained of some tingling in
the left arm. The physical
exam was normal except for a decreased sensation in her left arm. The
only other pertinent finding
was a lipstick imprint on her clothes over her left breast. A C-spine
series revealed locked facets at
C5 and C6 with dislocation of the vertebral body. She was successfully
treated with traction. "Under
normal circumstances, touching the lips to the upper left breast is an
almost impossible feat for most people; lipstick on the
breast indicates that the posterior
column of the cervical spine opened enough to
provide the neck mobility needed to accomplish that feat."
Emergency Medicine, Oct., 1989, p.46. Inspection of the trauma
patient's clothing is an important principle of physical examination
that
may provide valuable clues regarding the nature and location of the
patient's injuries.