eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Joint Reduction, Radial Head Subluxation

Author: Gretchen S Lent, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Apr 2, 2007

Introduction

Radial head subluxation, also known as nursemaid's elbow, is the most common upper extremity injury in infants and young children who present to the emergency department (ED). Reduction of the radial head is easily performed in the ED with few complications.

Subluxation of the radial head is a minor injury in infants and children aged 6 months to 7 years. While subluxation does occur in patients younger than 6 months, peak incidence occurs in children aged 2-3 years, and the injury is rare in children older than 5 years. This injury typically results from a quick pull on a child's arm.


Subluxation occurs after longitudinal traction is...

Subluxation occurs after longitudinal traction is placed on a pronated extended arm.

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Subluxation occurs after longitudinal traction is...

Subluxation occurs after longitudinal traction is placed on a pronated extended arm.


The annular ligament is generally weak in young children. Thus, when longitudinal traction is placed on an extended pronated arm, the radial head may slip into the radiocapitellar articulation, resulting in subluxation. The left arm is more commonly involved, presumably because most caretakers are right-handed. Girls are affected more often than boys.

A child with a radial head subluxation presents in no distress, with the affected arm semiflexed, adducted, and pronated.

The subluxed arm is held semiflexed, adducted, an...

The subluxed arm is held semiflexed, adducted, and pronated.

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The subluxed arm is held semiflexed, adducted, an...

The subluxed arm is held semiflexed, adducted, and pronated.


Parents often note that the child is not using or bending the affected arm. Radiograph findings are often normal, and radiographs are usually not necessary if radial head subluxation is suspected. However, the positioning required to take proper radiographs often reduces the radial head into place. The lateral elbow may have mild tenderness, and attempts to pronate or supinate the arm cause pain. All other range of motion is often permitted. No significant edema or effusion should be found on clinical examination.

Indications

The diagnosis is mostly supported by a child holding the elbow slightly flexed and pronated and a lack of ecchymosis or edema to the affected joint.

Contraindications

  • A diagnosis other than radial head subluxation should be sought if the history includes trauma to the arm, swelling, point tenderness, deformity, or ecchymosis to the patient's elbow.

    Alternative diagnoses should be sought if point t...

    Alternative diagnoses should be sought if point tenderness or any obvious deformity is present.

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    Alternative diagnoses should be sought if point t...

    Alternative diagnoses should be sought if point tenderness or any obvious deformity is present.

  • Patients with known congenital lesions or neurologic deficits require a more detailed evaluation.

More on Joint Reduction, Radial Head Subluxation

Overview: Joint Reduction, Radial Head Subluxation
Treatment & Medication: Joint Reduction, Radial Head Subluxation
Multimedia: Joint Reduction, Radial Head Subluxation
References
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References

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  3. Hay W. Current Pediatrics. 17th ed. New York, NY: McGraw-Hill; 2005.

  4. Hutchinson J. Partial dislocation of the head of the radius peculiar to children. Br Med J. 1886;1:9-10.

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  14. Salter RB, Zaltz C. Anatomic investigations of the mechanism of injury and pathologic anatomy of "pulled elbow" in young children. Clin Orthop Relat Res. 1971;77:134-43. [Medline].

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  18. Tintinalli, Kelen, Stapczynski. Emergency Medicine: A comprehensive Study guide. 6th ed. New York, NY: McGraw-Hill; 2004.

  19. Way L, Doherty G. Current Surgical Diagnosis and Treatment. 11th ed. New York, NY: McGraw-Hill; 2003.

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Further Reading

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Keywords

radial head subluxation, elbow dislocation, elbow injury, nursemaid's elbow, subluxation of the radial head, pulled elbow, upper extremity injury, young children, joint reduction, elbow injury

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Contributor Information and Disclosures

Author

Gretchen S Lent, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; 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.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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