Elbow
Nursemaid's Elbow
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Nursemaid's Elbow
, Pulled Elbow, Radial Head Subluxation
General
Radial head subluxed beneath orbicular ligament
Epidemiology
Most common between age 1-3 years
Rare after 6 years old
Mechanism
Results from longitudinal traction on hand
Elbow
extended
Forearm
pronated
Often occurs when child lifted by wrist or hand
Symptoms and Signs
Audible snap may be heard with Radial Head Subluxation
Arm is held motionless at side
Slight flexion
Pronation
Adduction
Radial Head tender
Imaging
Elbow XRay
Normal
Management
Reduction
Images
Technique 1
Cup affected elbow with opposite hand
Apply pressure over radial head
Thumb in antecubital fossa
Apply slight longitudinal traction by grasping wrist
Supinate (palm up) and flex (to 90 degrees)
Forearm
Palpable click felt with reduction
Technique 2 (higher efficacy than supination with flexion)
Elbow
held in flexion
Examiner positions thumb over radial head
Hyperpronate
Forearm
Macias (1998) Pediatrics 102(1): e10 [PubMed]
Management
Post-reduction
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
Re-evaluate in 24 hours
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