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Nursemaid's elbow
From WikEM
(Redirected from Radial head dislocation)
Contents
Background
- Radial head subluxation due to longitudinal traction on arm
- Annular ligament of radius displaces into radiocapitellar articulation
- Age 1y-5y (peak 2y-3y)
Clinical Features
- Sudden onset of pain and unwillingness to use affected elbow/arm
- Typical history = sudden pull on extended arm (e.g. swinging the child by arms while playing, pulling child back from walking into intersection, etc)
- Generally there is no edema, focal tenderness, or bruising
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
Radiograph-Negative
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Septic bursitis
- Biceps tendon rupture/dislocation
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- Generally clinical diagnosis
- Imaging not required before attempting reduction
Management
Reduction
Hyperpronation has greater first try success rate (94% vs 69%), but both have similar overall reduction rate;[1] consider doing both techniques at once in quick succession
- Hyperpronation Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand hyperpronate patient's wrist
- Supination Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand supinate patient's wrist and flex elbow
Post-Reduction
- If successful patient will have return of full range of motion within 30min
- If unsuccessful after multiple attempts, obtain x-ray and consider alternative diagnoses (e.g. Salter-Harris fracture)
Disposition
- Discharge if successful reduction and return of use of arm
See Also
References
- ↑ Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. 2009 Jun;16(3):135-8. doi: 10.1097/MEJ.0b013e32831d796a.
