Pulled Elbow
History:
- Age: usually 1 to 4 years old
- In 50%: no history of a "pull" on the arm
Examination:
- not using the affected limb
- elbow in extension and the forearm in pronation
- distressed only on elbow movement
- no swelling, deformity or bruising of the elbow or wrist
- on palpation tenderness is usually absent (remember the clavicle)
- marked resistance and pain with supination of the forearm.
Manipulation during triage or xray may reduce the subluxation.
Differential Diagnosis:
See upper limb non-use guideline
Diagnosis
- Clinically established with a classic history and examination.
- Plain radiographs are indicated when a differential diagnosis is suspected:
- significant tenderness, swelling, bruising or deformity
-
reduction fails
Treatment
- Perform a reduction manoeuvre (see below)
- expect distress and pain
- a click may be felt over the radial head
- review after ten minutes
- if reduction fails, consult with senior medical staff
Reduction manoeuvres
Either of the following methods may be effective
pronation/ flexion manoeuvre
sit the child on the parent's lap
 |
apply pressure over the radial head |
 |
fully pronate forearm and then flex the elbow |
supination/flexion manoeuvre
sit the child on the parent's lap
| |
apply pressure over the radial head |
 |
supinate the forearm |
|
flex the elbow |
