Comment

Nursemaid's Elbow (Radial head Subluxation): Injury that occurs to young children (under 5 years of age) when someone pulls sharply and upward on their hand or forearm with the elbow fully extended. As a result the annular ligament, which normally wraps around the head of the radius, ends up positioned between the radial head and the humerus. Children will immediately report pain in the affected elbow. After a brief period of time, the pain usually subsides and the child may participate in normal activity, except that they will not move the affected elbow (which may effectively prevent use of the entire arm). They tend to hold the arm close to their body with elbow bent and hand pronated. Inspection of the elbow reveals no deformity, redness or warmth and radiographs (not required) are normal. To correct the problem, the clinician must first gain the child's trust. One hand is placed on the elbow, with the thumb over the radial head. The other gently grasps the patient's hand. This hand is then supinated (turned palm upward) and the elbow flexed. The examiner may feel a click as the annular ligament relocates. There is often a brief period of pain, followed by complete normalization in function. The accompanying videoo nicely demonstrates the arm position assumed by a child with right sided nursemaid's elbow. The pediatrician demonstrates the technique for relocation. See these links for additional information: University of Chicago, School of Medicine Information Sheet.

Image Credit

Charlie Goldberg, M.D.