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Nursemaids Elbow
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Contents
Other Names
- Subluxation of the annular ligament
- Subluxation of the radial head
- Pulled Elbow
- Radial Head Subluxation
Background
- This page to subluxation of the Radial Head from the Annular Ligament, commonly termed 'Nursmaid's Elbow'
History
Epidemiology
- General
- Common
- Most often ages 1 to 4 with average age 28 months (need citation)
Pathophysiology

Illustration of Nursemaid's Elbow[1]
- General
Etiology
- The annular ligament becomes interposed into Radiocapitallar Joint, between the radial head and Capitellum
- In older children (i.e. 5+), thickened, stronger distal attachment of annular ligament prevents subluxation
Pathoanatomy
Risk Factors
- Age (1-4)
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- History
- Mechanism will generally involve a traction force on the affected extremity
- The parent may report a click during the episode
- The child will refuse to move arm, holds elbow in flexion and pronation
- Physical: Physical Exam Elbow
- Pain, tenderness to lateral elbow
- Flexion and extension intact
- Pain when supinating forearm
- Special Tests
Evaluation
Radiographs
- Primary a clinical diagnosis, helpful to exclude other etiologies
- Imaging is not required if the story fits the classic presentation
- Standard Radiographs Elbow
- Typically normal when obtained
- May demonstrate radiocapitellar line slightly lateral to center of capitellum
- Consider imaging if significant MOI, ecchymosis, swelling, age > 5, difficult reduction
Ultrasound
- May be used to help confirm the diagnosis (need citation)
Classification
- N/A
Management
Nonoperative
- Indications
- First line in virtually all cases
- The majority of cases are managed nonoperatively
- Nursemaids Elbow Reduction
- Hyperpronation technique favored over Supination & Flexion
Operative
- Indication
- Chronic, symptomatic subluxations that will not maintain stable reduction
- Technique
- Open Reduction
Rehab and Return to Play
Rehabilitation
- Does not apply due to age
Return to Play
- Does not apply due to age
Complications & Prognosis
Prognosis
- Prognosis is excellent
Complications
- Recurrence
- Rarely, recurrent subluxations
- However one study estimates rate ranges between 27% and 39% (need citation)
See Also
External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Image courtesy of www.childrenshospital.org/, "Nursemaid's Elbow"
- ↑ Macias CG, Wiebe R, Bothner J. History and radiographic findings associated with clinically suspected radial head subluxations. Pediatr Emerg Care 2000; 16(1):22-25.
- ↑ Rudloe TF, Schutzman S, Lee LK, Kimia AA. No longer a "nursemaid's" elbow: mechanisms, caregivers, and prevention. Pediatr Emerg Care 2012; 28(8):771-774.
Created by:
John Kiel on 18 June 2019 01:13:45
Authors:
Last edited:
28 November 2022 00:48:49
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