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Nursemaids Elbow Reduction

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Other Names

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


Illustration of Nursemaid's Elbow[1]
  • This page reviews reduction techniques for so-called Nursemaids Elbow
    • This is also known as subluxation of the annular ligament




  • Other diagnosis more likely


Illustration of Supination & Flexion and the Hyperpronation techniques[2]


  • No equipment needed


  • 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[3]
  • 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


  • 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


  • Alternative diagnosis
  • Inability to reduce

See Also


  1. Image courtesy of www.childrenshospital.org/, "Nursemaid's Elbow"
  2. Image courtesy of SAEM.org, "Nursemaid's Elbow"
  3. Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. 2009 Jun;16(3):135-8. doi: 10.1097/MEJ.0b013e32831d796a.
Created by:
John Kiel on 25 November 2019 20:05:31
Last edited:
28 November 2022 00:51:43