I. General

  1. Radial head subluxed beneath orbicular ligament

II. Epidemiology

  1. Most common between age 1-3 years
  2. Rare after 6 years old

III. Mechanism

  1. Results from longitudinal traction on hand
    1. Elbow extended
    2. Forearm pronated
  2. Often occurs when child lifted by wrist or hand

IV. Symptoms and Signs

  1. Audible snap may be heard with Radial Head Subluxation
  2. Arm is held motionless at side
    1. Slight flexion
    2. Pronation
    3. Adduction
  3. Radial Head tender

V. Imaging

  1. Elbow XRay Normal

VI. Management: Reduction

  1. Images
    1. ElbowNursemaidsReduction.jpg
  2. Technique 1
    1. Cup affected elbow with opposite hand
    2. Apply pressure over radial head
      1. Thumb in antecubital fossa
    3. Apply slight longitudinal traction by grasping wrist
    4. Supinate (palm up) and flex (to 90 degrees) Forearm
    5. Palpable click felt with reduction
  3. Technique 2 (higher efficacy than supination with flexion)
    1. Elbow held in flexion
    2. Examiner positions thumb over radial head
    3. Hyperpronate Forearm
    4. Macias (1998) Pediatrics 102(1): e10 [PubMed] (or open in [QxMD Read])

VII. Management: Post-reduction

  1. Child uses arm within 10-15 minutes
    1. Immobilization optional (Sling for 1-2 days)
  2. Child fails to use arm after 15 minutes
    1. Obtain Elbow XRay to rule out concomitant Fracture
    2. Elbow XRay normal but child still not using arm
      1. Posterior splint and sling
      2. Re-evaluate in 24 hours

Images: Related links to external sites (from Google)

Ontology: Pulled elbow (C0149977)

Concepts Injury or Poisoning (T037)
ICD9 832.2
ICD10 S53.03
SnomedCT 393609003, 95854004, 417109008
English RADIAL HEAD, SUBLUXATION, NURSEMAID'S ELBOW, PULLED ELBOW, Radial head subluxation, Nursemaid's elbow, subluxation of radial head (diagnosis), subluxation elbow joint radial head, subluxation of radial head, elbow nursemaid, head radial subluxation, elbow nursemaids, elbow nursemaid's, nursemaid's elbow, pulled elbow, subluxation radial head, goyrand's injury, nursemaid elbow, radial head subluxation, Goyrand's injury, Malgaigne's luxation, Nursemaids' elbow, Pulled elbow, Pulled elbow (disorder), Subluxation of radial head (disorder), Subluxation of radial head
Spanish Pulled elbow, codo de las niñeras, lesión de Goyrand, luxación de Malgaigne, luxación del codo (trastorno), luxación del codo, subluxación de la cabeza radial (trastorno), subluxación de la cabeza radial