UMEM Educational Pearls

Category: Pediatrics

Title: Hyperpronation

Keywords: Pediatrics, Hyperpronation, Radial Head Subluxation, Nursemaid (PubMed Search)

Posted: 5/21/2010 by Reginald Brown, MD (Updated: 5/22/2010)
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Hyperpronation: 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.  (Pediatrics July '98).  Support the elbow with a finger on the radial head, and forcefully hyperpronate.  

  • Technique may be less painful as well.  
  • Reexamine after five minutes, and normal function should be returned
  • 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
  • Supination/Flexion may be attempted after two failed hyperpronation attempts 


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