What is the procedure for radial head subluxation (nursemaid's elbow) reduction?

From the Research

Nursemaid elbow reduction is best performed using the hyperpronation technique, which is more effective and less painful than the traditional supination-flexion method. To perform this procedure, hold the child's hand as if you're going to shake it, then quickly pronate the forearm by turning the palm downward while applying gentle pressure to the radial head with your thumb. You'll typically feel or hear a click when the annular ligament slips back into place. The child will usually regain normal elbow function within minutes, demonstrating successful reduction by willingly using the affected arm. This injury, also called radial head subluxation, commonly occurs in children under 5 years when sudden traction is applied to an extended and pronated arm, causing the annular ligament to slip over the radial head. After reduction, no immobilization is needed, and parents should be educated about avoiding pulling on the child's arm. If the first attempt fails, a second attempt can be made, but persistent symptoms warrant radiographic evaluation to rule out fracture or other pathology.

Key Points

• The hyperpronation technique is the most effective method for reducing nursemaid's elbow, with a success rate of 66% compared to the supination-flexion method 1.
• The hyperpronation technique is also less painful than the supination-flexion method, with a lower risk of failure at the first attempt 2, 3.
• The mechanism of injury is usually sudden traction on the arm, and the diagnosis is typically made clinically without the need for diagnostic images 4, 1.
• After reduction, parents should be educated about avoiding pulling on the child's arm to prevent recurrence, and no immobilization is needed 2, 5.

Reduction Technique

To perform the hyperpronation technique, follow these steps:

• Hold the child's hand as if you're going to shake it
• Quickly pronate the forearm by turning the palm downward
• Apply gentle pressure to the radial head with your thumb
• Feel or hear a click when the annular ligament slips back into place

Post-Reduction Care

• No immobilization is needed after reduction
• Parents should be educated about avoiding pulling on the child's arm to prevent recurrence
• If the first attempt fails, a second attempt can be made, but persistent symptoms warrant radiographic evaluation to rule out fracture or other pathology 2, 5.