Reduction of Nursemaid’s Elbow (Radial Head Subluxation)

imagesRadial head subluxation is frequently referred to as “nursemaid’s elbow”


imagesThe annular ligament of the radius displaces into the radiocapitellar articulation (FIGURE 92.1A)


imagesA common injury in children between the ages of 2 and 5 years, after which the annular ligament strengthens and the injury becomes uncommon


INDICATIONS



imagesClinical suspicion of a nursemaid’s elbow based on:


   imagesRefusal to use affected arm


   imagesTypical posture: Affected arm adducted or held at the side, with the elbow slightly flexed and forearm pronated. The child is usually in no distress unless the arm is moved.


   imagesSuggestive mechanism of injury


CONTRAINDICATIONS



imagesGross deformity, swelling, or significant point tenderness suggesting fracture



imagesGeneral Basic Steps


   imagesAnalgesia (if indicated)


   imagesPatient preparation


   imagesReduction


   imagesReevaluation


TECHNIQUE



imagesPatient Preparation


   imagesCaretaker/parent holds child in her/his lap, restraining the unaffected arm


imagesHyperpronation Method (FIGURE 92.1B)


   imagesWith one hand, encircle the elbow with the thumb over the region of the radial head, keeping the elbow flexed at 90 degrees


   imagesWith the other hand, grasp the wrist, and firmly pronate at the wrist


imagesSupination/Flexion Method (FIGURE 92.1C and D)


   imagesWith one hand, encircle the elbow with the thumb over the region of the radial head, keeping the elbow position in some flexion


   imagesWith the other hand, grasp the wrist and apply gentle traction before supination


   imagesIn one motion, supinate the forearm fully and flex the elbow to the ipsilateral shoulder


imagesPostprocedure


   imagesReevaluate child in 10 to 15 minutes to note use of arm. The child will generally regain use of the arm quickly.


   imagesIf the child has not regained use of the arm within 10 to 15 minutes of attempted reduction and no click was detected during procedure, the procedure should be repeated


   imagesRadiography should be performed if the child has not regained use of arm after a reasonable time and no click was detected



images


FIGURE 92.1 A–D: Nursemaid’s elbow. (From Cimpello LB, Deutsch RJ, Dixon C, et al. Illustrated techniques of pediatric emergency procedures. In: Fleisher GR, Ludwig S. Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:1832.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Reduction of Nursemaid’s Elbow (Radial Head Subluxation)
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