II. Definitions
- Nursemaid's Elbow (Radial Head Subluxation)
- Radial head subluxed beneath orbicular ligament
III. Epidemiology
- Most common between age 1-3 years
- Rare after 6 years old
IV. Mechanism
V. Symptoms
- Audible snap may be heard with Radial Head Subluxation
- Typically follows mechanism described above
VI. Signs
- Normal neurovascular exam in classic Nursemaid's Elbow
- Radial Head tender (and may be palpable)
- Arm is held motionless at side
- Slight flexion
- Pronation
- Adduction
VII. Imaging
-
Elbow XRay Normal
- Not required in a classic Nursemaid's Elbow presentation
- Indications for XRay
- Trauma or fall
- Suspected Nonaccidental Trauma
- Elbow localized Bruising or swelling
- Failed reduction (see below)
VIII. Management: Reduction
- Contraindications to Reduction
- Positioning (same for both techniques)
- Caregiver holds child on their lap
- Child's affected elbow at 90 degrees
- Examiner stabilizes affected elbow with their directly opposite hand
- Examiner cups the olecranon in their palm
- Examiners thumb applies pressure at the radial head (with thumb in antecubital fossa)
- Examiner grasps the patient's wrist with their other hand
- Apply slight longitudinal traction with the hand grasping the patient's wrist
- Technique 1: Hyperpronation
- Technique 2: Supination and Flexion
- Signs of successful reduction
- Palpable click felt with reduction
- Child begins using the elbow in the subsequent 15-30 minutes
IX. Management: Post-Reduction
- Perform neurovascular exam
- Child uses arm within 10-15 minutes
- Immobilization optional (Sling for 1-2 days)
- Child fails to use arm after 15 minutes
- Obtain Elbow XRay to rule out concomitant Fracture
- Elbow XRay normal but child still not using arm
- Posterior splint and sling with elbow at 90 degrees
- Re-evaluate in 24 hours
X. References
- Warrington (2023) Crit Dec Emerg Med 37(2): 16-7
- Claudius, Sacchetti and Seiden (January, 2024) EM:Rap
- Macias (1998) Pediatrics 102(1): e10 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
ICD9 | 832.2 |
ICD10 | S53.03 |
SnomedCT | 393609003, 95854004, 417109008 |
English | Radial head subluxation, subluxation of radial head (diagnosis), subluxation elbow joint radial head, subluxation of radial head, elbow strain, elbow nursemaid, head radial subluxation, Strain;elbow, elbow strained, elbow nursemaids, elbow strains, elbow nursemaid's, nursemaid's elbow, pulled elbow, subluxation radial head, goyrand's injury, nursemaid elbow, radial head subluxation, Subluxation of the radial heads, Nursemaid's elbow, Pulled elbow (diagnosis), subluxation joint elbow radial head pulled, Goyrand's injury, Malgaigne's luxation, Nursemaids' elbow, Pulled elbow, Pulled elbow (disorder), Subluxation of radial head (disorder), Subluxation of radial head |
Czech | Nursemaid's elbow |
Dutch | zondagsarmpje |
French | Coude de la bonne d'enfants |
German | Kindermaedchen-Ellenbogen |
Hungarian | Pronatio dolorosa infantum |
Italian | Gomito della bambinaia |
Japanese | ナースメイド肘, ナースメイドヒジ |
Portuguese | Cotovelo da ama-seca |
Spanish | Codo de niñera, codo de las niñeras, lesión de Goyrand, luxación de Malgaigne, luxación del codo (trastorno), luxación del codo, subluxación de la cabeza radial (trastorno), subluxación de la cabeza radial |