From the Research
The correct management for this patient is hyperpronation of the forearm, as it has been shown to have a higher success rate in reducing radial head subluxations compared to supination and flexion. This child is presenting with classic signs of nursemaid's elbow (radial head subluxation), a common pediatric injury that typically occurs when a child's arm is pulled longitudinally. The clinical presentation is characteristic: the child holds the affected arm slightly flexed and pronated, refuses to use it, and shows no significant tenderness on examination.
Key Points to Consider
- The reduction technique involves hyperpronation of the forearm, which typically results in an immediate return of function as the annular ligament slips back into place over the radial head.
- This maneuver is both diagnostic and therapeutic.
- Radiography is unnecessary in typical cases with this classic presentation and no signs of trauma or tenderness.
- The condition resolves quickly with proper reduction, and the child usually regains full use of the arm within minutes, making orthopedic consultation, splinting, or traction unnecessary interventions that would only delay appropriate care.
Evidence-Based Recommendation
The most recent and highest quality study, published in 2025 1, compared the effectiveness of supination/flexion and hyperpronation maneuvers in the management of radial head subluxation in children. The study found that the hyperpronation maneuver had a significantly higher first-attempt success rate compared to the supination/flexion maneuver. Therefore, hyperpronation is the recommended initial treatment option for managing radial head subluxations in children.