Pulled Elbow!

A common occurrence in children, usually between 2 and 5 years of age, is locking of the forearm in pronation or neutral rotation when a segment of the annular ligament is pulled over the edge of the radial head to lie between it and the capitulum. This condition has been termed pulled elbow or nursemaid's elbow. It is produced by a sudden, direct pull on the elevated limb with the elbow extended and the forearm pronated. This may occur when a child falls while his or her hand is being held by an adult. The diagnosis is made on the basis of the history and the characteristic physical findings. The child refuses to use the arm, and the elbow is held slightly flexed. Because of failure to use the arm the condition may be mistaken for a paralysis, such as that caused by injury of the brachial plexus. All movements are of essentially normal range except supination. Attempts to supinate cause pain and a sensation of mechanical blocking.     

Treatment: A very brief manipulation without anesthesia is indicated. With the child's elbow flexed to a right angle, the forearm is supinated quickly while pressure is exerted on the radial head by the operator's thumb. As the malposition is corrected, a definite click is usually felt; after this the child almost immediately resumes use of the arm. If for any reason prompt reduction is not carried out, the displacement will usually undergo spontaneous reduction within a few days.



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