Radial Head Subluxation (Nursemaid Elbow)



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Radial Head Subluxation (Nursemaid Elbow)

Patient with normal range of motion?

Give follow up advice. No sling needed

Treat appropriately

Have child sit in parents arms and sit across and face child

Treat appropriately

Grip distal forearm and while maintaining gentle traction, hyperpronate the forearm

Grip distal forearm and while maintaining gentle traction, fully supinate and flex the elbow in one motion

Support child's elbow within your palm with a small amount of pressure on radial head with one finger

Inclusion Criteria
  • Clinically diagnosed radial head subluxation
Exclusion Criteria
  • None

X-ray Elbow, 3 view

Concerning history for fracture?

Determine optimal reduction technique

Radial head subluxation is also referred to as a nursemaid's elbow, pulled elbow, or annular ligament displacement. It usually occurs primarily in children 1 - 4 years old (peak 2 -3 years), but has been reported both younger and older. Girls have a higher incidence as does the left arm over the right.

The most common cause of the subluxation is from sudden traction placed on the distal radius causing the annular ligament to slip over the head of the radius and trapping it in the radiohumeral joint. This occurs most frequently when axial traction is placed on a pronated forearm as when an adult pulls a child quickly by one arm or is swung by the arm. Although this is the classic story it is only present 50 percent of the time.

As the child develops the annular ligament becomes thicker and is much less likely to be displaced causing the subluxation (around 5 years of age).

Consider repeat attempt at reduction 1 -2 times

Sling arm and follow up with orthopedics

X-ray Elbow, 3 view



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