UMEM Educational Pearls

Category: Orthopedics

Title: Nursemaid's elbow

Keywords: Elbow, dislocation, instability (PubMed Search)

Posted: 11/13/2021 by Brian Corwell, MD (Updated: 12/7/2021)
Click here to contact Brian Corwell, MD

The classic mechanism for nursemaids elbow is axial traction on a pronated forearm and extended elbow.

The force allows a portion of the annular ligament to slip over the radius.

Consider this diagnosis with other mechanisms of injury especially if the exam is not suggestive of fracture.

Suspect in a patient in minimal distress with arm held semi flexed and pronated.

 

A recent retrospective study looked at other mechanisms of injury.

 

69 subjects with a median age of 2.5 years

The most common mechanisms of injury were fall (57%), direct hit to the elbow (16%), and rolling over (7%).

Some studies note the left elbow is more commonly involved but this is likely due to most guardians being right-handed, thereby holding the child’s left hand

 

References

Li N, Khoo B, Brown L, Young T. Nonaxial Traction Mechanisms of Nursemaid's Elbow. Pediatr Emerg Care. 2021 Jun 1;37(6)