Nursemaids Elbow Reduction

Other Names

Illustration of Nursemaid's Elbow

Illustration of Supination & Flexion and the Hyperpronation techniques

• Nursemaids Elbow Reduction
• Supination and Flexion Technique
• Hyperpronation Technique
• Radial Head Subluxation Reduction
• Nursemaid's Elbow Reduction
• Pulled Elbow Reduction
• Annular Ligament Reduction

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Introduction

General

• This page reviews reduction techniques for so-called Nursemaids Elbow
  • This is also known as subluxation of the annular ligament

Anatomy of the Annular Ligament

• Strong, circular ligamentous band that anchors the Radius to the radial notch of the Ulna
• Stabilizes the proximal radioulnar joint while allowing rotation pronation/supination

Indications

• Nursemaids Elbow

Contraindications

• Other diagnosis more likely

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Procedure

Hyperpronation Technique

Supination Flexion Technique

Equipment

• No equipment needed

Preparation

• Child should be present and relaxed
• Parents can help
  • Ideally, child seated in parents lap facing examiner

Hyperpronation Technique

• Preferred and first line maneuver
• Favored over Supination & Flexion
  • Significantly lower first-attempt failure rates (9.4%) compared to supination-flexion (25%)
• Description
  • Stabilize the child's elbow at 90° of flexion with one hand while
  • Grasp the child's hand in a handshake grip with the other
  • Apply firm hyperpronation (rotating the forearm inward, palm facing downward)
  • While maintaining gentle pressure over the radial head with the thumb
  • A palpable or audible click over the radial head typically confirms successful reduction

Supination & Flexion Technique

• Description
  • Stabilize the elbow with one hand while grasping the child's wrist with the other
  • Apply firm supination (rotating the forearm outward, palm facing upward)
  • Then fully flex the elbow so the wrist is directed toward the ipsilateral shoulder
  • While maintaining thumb pressure over the radial head
• First-attempt success rate is lower than hyperpronation at 68–77%

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Aftercare

• Post reduction
  • Child typically has full range of motion within 10-30 minutes
  • Will begin spontaneously moving affected arm
  • Can challenge with item of interest (i.e. bottle, popsicle, etc)
• If unsuccessful reduction, recommend obtain radiographs and consider alternative diagnosis

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Complications

• Alternative diagnosis
• Inability to reduce

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See Also

• Procedures Main
• Elbow Pain Main
• Elbow Anatomy

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