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9.17 Subluxation of the Head of the Radius (Nursemaid's Elbow)


Presentation

A toddler has received a sudden jerk on his arm causing enough pain that he holds it motionless. Circumstances surrounding the injury may be obvious (such as a parent pulling the child up out of a puddle); or obscure (the babysitter who reports that the child "just fell down"). The patient and family may not be accurate about localizing the injury, and think that the child has injured his shoulder or wrist. The patient is comfortable at rest, splinting his arm with mild flexion at the elbow and pronation of the forearm. There should be no deformity, crepitation, swelling, or discoloration of the arm. There is also no palpable tenderness except over the radiohumeral joint; the child will start to cry with any movement of the elbow.

What to do:

What not to do:

Discussion

This injury is an anterior subluxation of the radial head away from the capitellum through the annular ligament, and occurs almost exclusively among children between 18 months and 3 years of age. On occasion, if the subluxation has been present for several hours, edema, pain, and natural splinting will continue even after reduction, or may prevent reduction.

References:

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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