The clinical scenario above describes a nursemaids elbow. This injury occurs commonly in children under 5 years of age as a result of a quick pull on an extended and pronated arm and results in subluxation of the annular ligament. Figure A is a lateral radiograph showing normal ossification pattern in a pediatric elbow, without any obvious fracture or dislocation. A lateral radiograph of a nursemaid's elbow will show a normal collinear relationship between capitulum & central axis of the radius. Reduction typically includes elbow flexion and supination while placing a finger on the radial head to feel the snap of the reducing annular ligament.
Krul et al studied manipulative techniques for reduction of nursemaid elbows. Although elbow flexion with forearm supination is the commonly taught technique for reduction, their review mentioned several studies that showed that forearm pronation during reduction may cause less pain and actually be more effective than supination. They concluded further high-quality studies need to be done on this reduction technique.
Illustration A shows the elbow flexion and forearm supination technique used to reduce the subluxated radial head.
Krul M, van der Wouden JC, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2012 Jan 18;1
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