From the Research
To reduce a nursemaid's elbow, the hyperpronation method is recommended as it has been shown to be more effective than the supination-flexion method, with a lower failure rate at the first attempt. This is based on the findings of a systematic review and meta-analysis published in 2017 1, which compared the two most commonly performed maneuvers in the treatment of nursemaid's elbow. The study found that hyperpronation was more effective than supination-flexion, with a risk ratio of 0.34 and a number needed to treat of 4 patients.
The hyperpronation method involves holding the child's arm with their elbow bent at 90 degrees and their palm facing downward, then rotating the forearm downward (pronation) while applying gentle pressure on the radial head with your thumb. This method has been shown to be more effective in terms of success rate and may be less painful compared to the supination-flexion maneuver in children with nursemaid's elbow.
Some key points to consider when reducing a nursemaid's elbow include:
- The child's age and developmental stage, as nursemaid's elbow is most common in children under 5 years old
- The mechanism of injury, as nursemaid's elbow typically occurs when the radial head slips out from under the annular ligament due to a sudden pull on the arm
- The importance of gentle and careful manipulation to avoid causing further injury or discomfort to the child
- The need for prompt medical attention if reduction attempts fail or if pain persists after reduction, as this may indicate a more serious injury.
It's also worth noting that radiographic abnormalities are typically absent in nursemaid's elbows, and prereduction radiographs should only be used to eliminate the possibility of fracture 2. Overall, the hyperpronation method is a safe and effective technique for reducing nursemaid's elbow, and should be considered as the first line of treatment for this common childhood injury.