Nursemaids Elbow Reduction

Other Names

• Nursemaids Elbow Reduction
• Supination and Flexion Technique
• Hyperpronation Technique

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Background

Illustration of Nursemaid's Elbow

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

Anatomy

• Annular Ligament
  • Strong, circular ligamentous band that anchors the Radius to the radial notch of the Ulna

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Indications

• Nursemaids Elbow

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Contraindications

• Other diagnosis more likely

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Procedure

Illustration of Supination & Flexion and the Hyperpronation techniques

Equipment

• No equipment needed

Preparation

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

Hyperpronation Technique

• Recommended first line technique due to higher first attempt success rate
• Identify radial head and apply medially directed pressure with thumb or index finger
• Examiner supports elbow flexed to 90°
• Hyperpronate the patients forearm with other hand
• Optional: Fully flex elbow while maintaining hyperpronation
• Palpable or audible click may be felt or heard

Supination & Flexion Technique

• Physician places thumb over radial head
• Hold patients arm in supination
• Apply maximum flexion
• Physician will likely heal a palpable click with reduction of the radial head
• Palpable or audible click may be felt or heard

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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

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