Clinical Practice Guidelines

Pulled Elbow

  • History:

    • Age: usually 1 to 4 years old
    • In 50%: no history of a "pull" on the arm

    General view of elbowExamination:

    • 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

    Grasping elbow closed apply pressure over the radial head
    over pronationfully pronate forearm and then flex the elbow

     

    supination/flexion manoeuvre

    sit the child on the parent's lap

    Grasping elbow closed apply pressure over the radial head
    Supinatin only supinate the forearm
    Part flexion

    Full flexion

    flex the elbow