II. General

  1. Radial head subluxed beneath orbicular ligament

III. Epidemiology

  1. Most common between age 1-3 years
  2. Rare after 6 years old

IV. Mechanism

  1. Results from longitudinal traction on hand
    1. Elbow extended
    2. Forearm pronated
  2. Often occurs when child lifted by wrist or hand

V. Symptoms and Signs

  1. Audible snap may be heard with Radial Head Subluxation
  2. Arm is held motionless at side
    1. Slight flexion
    2. Pronation
    3. Adduction
  3. Radial Head tender

VI. Imaging

  1. Elbow XRay Normal

VII. Management: Reduction

  1. Images
    1. ElbowNursemaidsReduction.jpg
  2. Technique 1
    1. Cup affected elbow with opposite hand
    2. Apply pressure over radial head
      1. Thumb in antecubital fossa
    3. Apply slight longitudinal traction by grasping wrist
    4. Supinate (palm up) and flex (to 90 degrees) Forearm
    5. Palpable click felt with reduction
  3. Technique 2 (higher efficacy than supination with flexion)
    1. Elbow held in flexion
    2. Examiner positions thumb over radial head
    3. Hyperpronate Forearm
    4. Macias (1998) Pediatrics 102(1): e10 [PubMed]

VIII. Management: Post-reduction

  1. Child uses arm within 10-15 minutes
    1. Immobilization optional (Sling for 1-2 days)
  2. Child fails to use arm after 15 minutes
    1. Obtain Elbow XRay to rule out concomitant Fracture
    2. Elbow XRay normal but child still not using arm
      1. Posterior splint and sling
      2. Re-evaluate in 24 hours

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Pulled elbow (C0149977)

Concepts Injury or Poisoning (T037)
ICD9 832.2
ICD10 S53.03
SnomedCT 393609003, 95854004, 417109008
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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