Nursemaid’s Elbow

Not typically necessary for reduction

Consider acetaminophen (15 mg/kg) or ibuprofen (5–10 mg/kg) as needed.

The thumb is placed in the region of the radial head for palpation and the exertion of mild pressure (anterior to posterior).

The child's forearm is gently but firmly rotated into full supination.

The elbow is then flexed to 90 degrees by holding the child's forearm above the wrist and stabilizing the humerus and elbow with the other hand to prevent rotation of the shoulder. If any resistance is met, one should continue flexing the elbow to the point of maximal flexion.

As reduction is achieved, a palpable and sometimes audible “click” can be felt in the region of the radial head.

This maneuver will typically achieve instantaneous reduction of the radial head and sometimes instant relief of pain.

Consider a hyperpronation maneuver if supination/flexion fails.

The child should typically be observed for 15 min for a return of full function and use of the affected arm.

If function has not normalized in 15 min, a repeated attempt at reduction is recommended.

In some studies, the delay until normal use of the arm is achieved is longer when there has been a delay in treatment from the time of injury.

If there is no evidence of recovery after several reduction attempts, the diagnosis must be reconsidered.

Immobilization is not necessary for the 1st occurrence of subluxation.

If reduction is delayed for more than 12 hr following injury, an attempt is made to support the limb with a sling for 10 days with the elbow in 90 degrees of flexion and the forearm in full supination, but most toddlers discard the sling within minutes.

For cases of multiple recurrences of nursemaid's elbow, some clinicians recommend a trial of immobilization of the upper limb in an above-elbow cast for 2–3 wks after evaluation by a pediatric orthopedist.