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HWN Suggests

Nursemaid's Elbow

There are two preferred techniques for reduction of a radial head subluxation. The method I start with is to support the patient's elbow and forearm and gently supinate the forearm while flexing the elbow and applying gentle pressure over the radial head. A “pop” sensation will often be felt as the radial head reduces. The other technique that can be used is to hyper-pronate the forearm while maintaining the elbow in a flexed position. Both of these techniques have a high success rate. Typically, the child will start using the arm again, but it may not be immediate. I will typically reassess the patient about 10-15 minutes post-reduction to ensure they are using their arm normally again. If…

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 How to Fix A Dislocated Elbow

Radial head subluxation is the displacement of the annular ligament, and what does this mean? With any dislocation, it involves some tweaks & pops to get bones back into place! We hope you enjoy this video over this interesting procedure.

Articles of Interest

Nursemaid’s Elbow

Never has there been a more anachronistic name for such a common malady. Hailing from the time when the wealthy had female domestic workers who cared for children within their large household, this outmoded eponym describes a common orthopedic condition that impacts young children. I’ll cast my vote for calling it “pulled elbow” like they do in Australia – because it describes when happens when the radial head subluxes from its usual position nestled in the annular ligament. This episode discusses the diagnosis and management of this can’t miss condition, that I suspect our residents and students aren’t seeing as much as they should.

Quick Trick: Hyperpronation of Nursemaid’s Elbow

The proposed maneuver involves one hand holding the elbow at 90 degrees of flexion and the other hand holding the wrist. The wrist is then hyperpronated to complete the reduction.

Medical Student Pearl

Some research has indicated that the hyperpronation maneuver may be more effective and less painful for the patient, so it may be worth attempting this maneuver first.

Newport: Nursemaids Elbow

How to reduce? There are two methods: extension/supination and “forced” or hyperpronation.

Nursemaid's Elbow Reduction Methods

Data from those trials suggested that hyperpronation resulted in less failures at ?rst attempt than the supination-?exion, and although there was limited data, there was no obvious difference in adverse events or pain between the two techniques.

Nursemaid’s Elbow Reduction

Either hyperpronate the forearm or supinate followed by immediate flexion. If you are doing the supination-flexion technique, there should be slight traction. You should feel a click when it reduces.

Nursemaid’s Elbow – feel like Mr. Miyagi

The Hyperpronation technique has literature that seems to favor it as being easier to do, more successful initially, and less discomfort for the child (again, the child often starts with the arm already partially in pronation).

Tricks of the Trade: Nursemaid elbow reduction

A 2009 paper by Bek et al.1 describes a method of pronation instead of supination. The proposed maneuver involves one hand holding the elbow at 90 degrees of flexion and the other hand holding the wrist. The wrist is then hyperpronated to complete the reduction.

Resources

SAEM

Two reduction techniques described and commonly utilized in clinical practice include Hyperpronation and Supination/Flexion. While there is an abundance of literature evaluating the two methods, no one technique has been proven superior over the other, indicating that both constitute a reasonable approach an initial reduction attempt.