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Reduction of Radial Head Subluxation Medication

  • Author: Gretchen S Lent, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: May 16, 2016
 

Medication Summary

The goal of pharmacotherapy is to treat the pain associated with the procedure.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who experience pain.

Acetaminophen (Tylenol, FeverAll, Aspirin Free Anacin)

 

Acetaminophen is the drug of choice (DOC) for pain in patients with documented hypersensitivity to aspirin or NSAIDs, who have upper GI disease, or who are taking oral anticoagulants.

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Nonsteroidal Anti-Inflammatory Drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Motrin, Advil)

 

Ibuprofen is the DOC for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Gretchen S Lent, MD Attending Physician, Department of Emergency Medicine, Torrance Memorial Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Ryan P Lamb, MD Attending Physician, Ultrasound Coordinator, Mills Peninsula Emergency Medical Associates

Ryan P Lamb, MD is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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Subluxation of radial head occurs after longitudinal traction is placed on pronated extended arm.
In radial head subluxation, subluxated arm is held semiflexed, adducted, and pronated.
Alternative diagnoses to radial head subluxation should be sought if point tenderness or any obvious deformity is present.
Reduction of subluxated radial head: supination-flexion. Technique begins with elbow flexed.
Reduction of subluxated radial head. Shortly after reduction, child resumes using affected arm.
Reduction of subluxated radial head: supination-flexion. Wrist is supinated with elbow still in 90° of flexion.
Reduction of subluxated radial head: supination-flexion. During supination, pressure is maintained on radial head.
Reduction of subluxated radial head: supination-flexion. After supination, elbow is fully flexed.
Reduction of subluxated radial head: supination-flexion. With one hand supinating wrist, other thumb feels click as radial head falls into place on full flexion.
Reduction of subluxated radial head: supination-flexion. Technique begins with supination, followed by full flexion at elbow.
Reduction of subluxated radial head: hyperpronation/forced pronation. With one hand placed distally, arm is hyperpronated while other hand holds elbow steady with thumb on radial head.
Shortly after reduction, child resumes using affected arm.
Reduction of subluxated radial head: supination-flexion. Side view of technique.
Reduction of subluxated radial head: supination-flexion. Front view of technique.
Reduction of subluxated radial head: hyperpronation/forced pronation. Side view of technique.
Reduction of subluxated radial head: hyperpronation/forced pronation. Front view of technique.
Elbow anatomy with annular ligament.
 
 
 
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