Nursemaid elbow or Pulled Elbow, as is commonly called, most commonly occurs in children aged 1-4 years. The usual history is a child been lifted or pulled by the wrist, followed by pain and loss of active forearm rotation.
The forearm is usually flexed 15-20 degrees at the elbow, and the forearm is partially pronated. Often, the weight of the affected arm is supported with the other hand. The patient resists supination/pronation as well as flexion/extension of the forearm.
Axial traction is the most common cause of nursemaid elbow.
Ultrasonography has been used as a noninvasive modality to assess for annular ligamentous injury and displacement of the radial head from the capitellum. It has also been used to assess progress of treatment for patients with recurrent subluxations.
Once diagnosed, the radial head can be easily relocated using simple manoeuvres. The patient should be able to completely supinate the forearm, after a successful reduction.
Age younger than 2 years and a delay of more than 4 hours before treatment have been associated with failure to use an affected arm within 30 minutes. An important part of the management is educating parents about the risk of reoccurrence.
The forearm is usually flexed 15-20 degrees at the elbow, and the forearm is partially pronated. Often, the weight of the affected arm is supported with the other hand. The patient resists supination/pronation as well as flexion/extension of the forearm.
Axial traction is the most common cause of nursemaid elbow.
Ultrasonography has been used as a noninvasive modality to assess for annular ligamentous injury and displacement of the radial head from the capitellum. It has also been used to assess progress of treatment for patients with recurrent subluxations.
Once diagnosed, the radial head can be easily relocated using simple manoeuvres. The patient should be able to completely supinate the forearm, after a successful reduction.
Age younger than 2 years and a delay of more than 4 hours before treatment have been associated with failure to use an affected arm within 30 minutes. An important part of the management is educating parents about the risk of reoccurrence.
