Radial head subluxation (Nursemaid elbow)

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Radial head subluxation (Nursemaid elbow)

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USMLE® Step 1 style questions USMLE

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A 4-year-old girl is brought to the emergency department for acute onset left elbow pain. She was playing in her sandbox when her parent pulled her by the arm to take her inside. Vitals are within normal limits. Examination reveals a young girl who keeps her hand in a pronated and extended position. Any manipulation of the arm causes the girl to cry. There is no swelling or deformity. The physician hyperpronates the forearm, resulting in a click with immediate cessation of pain and resumption of the patient using her arm. Which of the following best describes the etiology of this patient’s condition?  

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Summary

Radial head subluxation, also known as nursemaid's elbow, is a dislocation of the elbow joint caused by a sudden pull on the extended pronated forearm, such as by an adult tugging on an uncooperative child or by swinging the child by the arms during play. The injury is most common in children between the ages of 1 and 4. Symptoms can include pain and swelling in the elbow, inability to supinate the forearm, as well as a decreased range of motion. Treatment involves a close reduction of the subluxation, and usually the prognosis is good.

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