Will an X-ray Show Nursemaid's Elbow?
No, x-rays will not show nursemaid's elbow (radial head subluxation) because it is a soft tissue injury involving subluxation of the radial head beneath the annular ligament, not a bony abnormality. 1
Why X-rays Are Typically Normal
Nursemaid's elbow is a clinical diagnosis based on history (pulling mechanism on outstretched arm) and physical examination (child refuses to use affected arm, holds it in pronation) rather than imaging findings 1, 2
Standard radiographs cannot visualize the pathology because the injury involves displacement of soft tissue structures (annular ligament and possibly posterior synovial fringe) rather than bone displacement or fracture 3
X-rays are primarily useful to exclude other diagnoses such as fractures, dislocations, or osseous pathology when the clinical presentation is atypical or reduction attempts fail 4, 5
When Imaging May Be Considered
Atypical Presentations Requiring Imaging
Failed reduction attempts after typical manipulation maneuvers should prompt radiographic evaluation to rule out fracture or true dislocation 5
Unclear mechanism of injury (such as falls or trauma rather than classic pulling injury) warrants plain films to exclude occult fractures 4
Persistent symptoms after reduction or inability to use the arm normally after manipulation requires imaging workup 5
Advanced Imaging Options
High-frequency ultrasound (6-24 MHz) can detect the "partial eclipse sign" showing the escaped posterior synovial fringe before reduction, which disappears after successful reduction 3
MRI with sedation can demonstrate entrapment of the annular ligament in the radiocapitellar joint in atypical cases where reduction is unsuccessful, and can confirm successful reduction 5
Clinical Approach
The diagnosis is made clinically without imaging in typical cases. Proceed directly to reduction using supination-flexion or hyperpronation techniques without obtaining x-rays 1, 2
Order radiographs only when: