Basildon EM Handbook 2018

Pulled elbow

March 2018 | by EMauthor

•Aka subluxation of the radial head

•Peak incidence is 1 – 4 years

•There is typically a clear history of the child arm being pulled followed by inability to use the arm, the child is usually not in pain unless the elbow is moved

•The child typically hold the arm partly flexed at the elbow in full pronation

•A gentle approach is essential in examining the child, the shoulder, wrist and hand are examined 1st, if they normal then a gentle attempt to move the elbow will elicit pain. A dose of oral calpol and or ibuprofen before the examination can be of help

•If the history, age of the child, and examination suggest a pulled elbow, x-ray is not needed, only x-ray if the diagnosis is in doubt

•Reduction is easy, inform the parent about the diagnosis, the mechanism of the injury and that the procedure may temporarily upset the child. Place the thumb over the radial head and quickly supinate and fully flex the elbow while applying gentle pressure over the radial head. Reduction is often accompanied by a click.

•The child will be temporarily upset but usually regain the use of the arm in 10-15 minutes

•If the child is not using the arm after this manoeuvre, reassure the parents and arrange review in 3 days

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