UMEM Educational Pearls

Category: Orthopedics

Title: Nursemaid Elbow

Keywords: nursemaid, elbow (PubMed Search)

Posted: 7/15/2017 by Michael Bond, MD
Click here to contact Michael Bond, MD

Takeaways

Take Home Points:

  1. A radial head subluxation that is common in 1-3 year olds
  2. Often secondary to a longitudinal traction on an extended arm
  3. With a classic story radiographs are not required
  4. The hyperpronation technique has been show to be more effective and less painful in reducing it

 

In-Depth

  • 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