Radial head subluxation: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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==Evaluation== | ==Evaluation== | ||
*Sudden onset | *Sudden onset | ||
*Appropriate history. Sudden pull on extended arm. Swinging the child by adult while playing. | |||
*Absence of edema, focal tenderness, or bruising | *Absence of edema, focal tenderness, or bruising | ||
**If these features are present, consider x-ray and alternative diagnosis | **If these features are present, consider x-ray and alternative diagnosis | ||
Revision as of 12:46, 23 November 2016
Background
- Radial head subluxation due to longitudinal traction on arm
- Annular ligament of radius displaces into radiocapitellar articulation
- Age 1y-5y (peak 2y-3y)
Evaluation
- Sudden onset
- Appropriate history. Sudden pull on extended arm. Swinging the child by adult while playing.
- Absence of edema, focal tenderness, or bruising
- If these features are present, consider x-ray and alternative diagnosis
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Management
- Reduction: Hyperpronation has greater first try success rate (94% vs 69%), but both have similar overall reduction rate[1]
- Hyperpronation Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand hyperpronate patient's wrist
- Supination Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand supinate patient's wrist and flex elbow
- Hyperpronation Technique
- If successful patient will have FROM within 30min
- If unsuccessful after multiple attempts, obtain x-ray
- If negative, immobilize arm in sling, outpatient ortho follow up within 1wk
See Also
References
- ↑ Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. 2009 Jun;16(3):135-8. doi: 10.1097/MEJ.0b013e32831d796a.