CHAPTER 28

Nursemaid Elbow (Radial Head Subluxation)

Introduction/Etiology/Epidemiology

• “Annular ligament displacement” is a more appropriate name for this injury than “radial head subluxation” because the ligament moves into the elbow joint rather than the radial head moving away from the articulation.

• With longitudinal traction to the arm, the annular ligament slides over the radial head and becomes trapped between the capitellum and the radial head, stretching or tearing the ligament.

• In infants, the usual mechanism of injury is by rolling over and the extended arm becoming trapped beneath the body.

• In a child, the classic mechanism of injury is pulling an outstretched arm; it can also occur after a fall on an outstretched arm or as a result of a twisting injury. Injury is more likely when the forearm is pronated.

• Young children are more susceptible to this injury because of maturational anatomic differences compared with adults. In young children the annular ligament has a smaller diameter, making it more susceptible to tearing, and the radial head and neck are more oval in shape and narrower, which allows the annular ligament to easily displace (Figure 28-1).

• Represents 15% to 27% of elbow injuries in children younger than 10 years of age

• Peak incidence is between 1 and 3 years of age but has been reported in children as young as 6 months and as old as 10 years

• Slightly more common among girls, and more likely to affect the left side.

Figure 28-1. Nursemaid elbow is a transient displacement of the annular ligament caused by pulling or yank-ing of a child’s arm, usually inadvertently, by a parent or caregiver.

From McInerny TK, Adam HM, Campbell DE, Kamat DM, Kelleher KJ, eds. American Academy of Pediatrics Textbook of Pediatric Care. Elk Grove Village, IL: American Academy of Pediatrics; 2009:2053.

Signs and Symptoms

• The main symptom is refusal to use the upper extremity and/or bend the elbow.

• Pain is reported immediately after the injury and during any attempt to move the elbow.

• Pain is often difficult to precisely locate.

• The child is often in no distress.

•

Related posts:

Miscellaneous Infections Angular Variations: Genu Varum (Bowleg) and Genu Valgum (Knock-Knee) Kyphosis Bone Health Evaluation in the Child Vulnerable to Fracture Compartment Syndrome The Limping Child: General Approach and Differential Diagnosis0

Stay updated, free articles. Join our Telegram channel

Join