From the Research
The recommended management for nursemaid elbow in a 1-year-old is prompt reduction using the hyperpronation technique, as it has been shown to be more effective than the supination-flexion technique in recent studies. To perform this maneuver, the forearm is quickly pronated (turned downward) to reduce the subluxation. A successful reduction is often indicated by a subtle click and the child's willingness to use the arm again within minutes. After reduction, no immobilization is typically necessary, and the child can return to normal activities as tolerated. Over-the-counter pain medications like acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) may be given if the child appears uncomfortable, but are often unnecessary once reduction is achieved. Parents should be counseled about the mechanism of injury—typically a pulling force on an extended and pronated arm—to prevent recurrence, which happens in approximately 20-30% of cases. Nursemaid elbow (radial head subluxation) occurs when the annular ligament slips over the radial head, and reduction repositions this ligament to its normal anatomic position.
The hyperpronation technique has been found to be more effective than the supination-flexion technique in several studies, including a 2019 randomized clinical study published in the Indian Journal of Orthopaedics 1, which found that hyperpronation was more successful than supination-flexion as a first attempt (85% vs. 53%). A 2017 systematic review and meta-analysis published in The American Journal of Emergency Medicine also found that hyperpronation was more effective than supination-flexion (risk ratio, 0.34; 95% confidence interval, 0.23 to 0.49) 2.
Some key points to consider when managing nursemaid elbow include:
- The importance of prompt reduction to minimize pain and discomfort
- The use of the hyperpronation technique as the first line of treatment
- The need for parental counseling on the mechanism of injury and prevention of recurrence
- The potential use of over-the-counter pain medications if the child appears uncomfortable after reduction.
Overall, the hyperpronation technique is a simple and effective method for reducing nursemaid elbow in children, and it should be considered the first line of treatment for this condition.