MANUAL MINORS
Pulled elbow, also known as radial head subluxation or nursemaid’s elbow, is a common injury in young children, especially between the ages of 1 and 5, occurring when the radial head partially slips out of its normal position in the elbow joint.
It usually happens when a child’s arm is pulled sharply, such as when they are lifted by the hand or forearm. This injury causes immediate pain, and the child avoids moving the affected arm, which is typically held in a semi-flexed and pronated position (with the palm facing down).
Diagnosis
The diagnosis is based on the typical history of a pulling incident and the child’s presentation, who generally refuses to move the elbow and keeps the arm close to the body. On physical examination, the child experiences pain when attempting to move the elbow, although swelling or deformity is not usually present. X-rays are not required if the history and symptoms are clear, as this is a subluxation, not a fracture.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Supracondylar fracture | Severe pain, deformity, swelling, and complete limitation of movement |
Radial head fracture | Localised pain in the elbow, more common in adults, limited mobility |
Elbow dislocation | Obvious deformity, complete loss of joint alignment |
Synovitis | Swelling and pain in the elbow, without a history of acute trauma |
Olecranon bursitis | Visible inflammation at the back of the elbow, without significant functional limitation |
Emergency Management
Emergency management involves the manual reduction of the subluxation, which is a quick and effective procedure. There are two common techniques:
Supination-flexion technique: The child’s hand is taken, the forearm is supinated (rotating the palm upwards), and the elbow is flexed at the same time.
Pronation technique: The forearm is pronated (palm down) while the elbow is extended.
In most cases, the reduction is successful, and the child regains full movement of the arm almost immediately, with complete relief of pain. Immobilisation or X-rays are generally not necessary.
Definitive Treatment
After a successful reduction, no further treatment is required, and the child can use the arm normally. Parents should be advised to avoid pulling the arm in the future, as this injury tends to recur. If recurrences are frequent, referral to a specialist for further evaluation may be necessary.
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