Pulled Elbow

What is Pulled Elbow?

Pulled Elbow or “Nursemaids Elbow” is common in young children between 1 and 6 years of age. It is due to the annular ligament of the radial head becoming stretched and entrapped. There is usually a history of a pull on the affected arm, such as when a child tries to run off in a different direction when walking with the hand held by a parent.Sometimes the incident is unobserved or thought to be too trivial to have caused any injury. The child typically allows the arm to hang loosely by their side in a pronated position. They are usually undistressed unless the arm is moved.

Clinical Features

• The parents come with complaint of the child not using the affected limb
• here is usually a history of a pull on the affected arm, such as when a child tries to run off in a different direction when walking with the hand held by a parent. Although there may not be history of pull in half the cases
• Inspection: The child keeps the elbow in extension and the forearm in pronation and is distressed only on elbow movement. Usually there is no swelling, deformity or bruising of the elbow or wrist
• Palpation: tenderness is usually absent
• Movements: marked resistance and pain with supination of the forearm.

Diagnosis

• Clinically established with a classic history and examination.
• X rays are unnecessary if there is a typical history and no visible swelling or deformity. If the child has a pulled elbow the X ray is normal. The child may have normal use of the arm on return from radiology since positioning by the radiographer may solve the problem.
• Plain radiographs are indicated when a differential diagnosis is suspected:
  • significant tenderness, swelling, bruising or deformity
  • reduction fails

Treatment

The treatment consists of reducing the ligament back to its original position