Daily Bolus of LR: Nursemaid’s Elbow Reduction

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June 2, 2011 by dailybolusoflr

Nursemaid's Elbow

This condition, found in children typically under the age of 6, arises when the annular ligament subluxes over the head of the radius.

* Two methods of reduction can be used: supination and flexion or hyper-pronation.
* New studies are looking like the hyper-pronation may be more effective than the old standard of supination and flexion.. (Bek D et al. Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial European Journal of Emergency Medicine. 2009, 16(3), 135-8)

Children typically present with a history of having their arm pulled upward and (imagine your child running into the street while you are still standing on the sidewalk) and subsequently refusing to use the arm.

* Please watch the youtube video below for a demonstration of both methods at work.
* Many practitioners will try one and if not successful, try the other.
* It is also important to rule out injury and if history suggests acute trauma, obtain imaging.

http://www.youtube.com/watch?v=-0ROu4hCXwQ

<http://www.youtube.com/watch?v=-0ROu4hCXwQ>–
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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