Take Home Points:
- A radial head subluxation that is common in 1-3 year olds
- Often secondary to a longitudinal traction on an extended arm
- With a classic story radiographs are not required
- The hyperpronation technique has been show to be more effective and less painful in reducing it
Additional Information
- Due to a tearing of annular ligament attachment to radial neck, with detatched portion trapped between subluxed raidal head and capitellum
- children refuse to use affected arm and hold in a flexed pronated position
- Xrays are generally unnecessary unless history and physical are not consistent with nursemaid's elbow, symptoms for greater than 12 hours, or reductions attempts are unsuccessful
- Traditionally, reduce by supination of forearm with elbow in 90' of flexion
The Hyperpronation Method: This reduction technique for a nursemaid's elbow (radial head subluxation) has been found to have better first attempt success than classic supination/flexion technique and less painful. (Pediatrics July '98).
- Support the elbow with a finger on the radial head, and forcefully hyperpronate. You do NOT need to flex the elbow.
Click here to see a video of the technique https://youtu.be/-0ROu4hCXwQ?t=1m15s