Reduction Maneuvers · Hold elbow with non-dominant hand with either thumb or 2nd and 3rd fingers exerting constant gentle pressure over the ...Synonyms:Nursemaid’selbow,Radialheadsubuluxation,ElbowsubluxationAge:Commonly1-4yearsAfter5yearsofage,theattachmentoftheannularligamenttotheneckoftheradiusstrengthensEnlargementoftheproximalradialepiphysiswithgrowthmayalsoimprovestabilityPresentation:Historyofpullmaybeabsentin~50%casesNotusingtheaffectedlimb(Pseudoparalysis)ElbowinextensionandtheforearminpronationDistressedonlyonelbowmovementNoswelling,deformityorbruisingoftheelboworwristOnpalpationtendernessisusuallyabsentMarkedresistanceandpainwithsupinationoftheforearmReductionofpulledelbowproducesimmediaterelief.Itisnecessarytoruleoutothercausesifreductionattemptfailstoproducerelief.X-ray:ruleouteffusion,fractureandtruedislocationCBC,CRP,ESR:ruleoutinfectionPathoanatomy:ReductionManeuversSupinationandFlexionmaneuver(Classicmethod):Followingstepsarecarriedoutinonesmoothmotion1PfenningerandFowler’sProceduresforPrimaryCareE-BookByGrantC.FowlerHoldelbowwithnon-dominanthandwitheitherthumbor2ndand3rdfingersexertingconstantgentlepressureovertheradialheadinmedialdirectionWithdominanthand,applyslightdistaltractionwithsupinationatwrist.Rapidlyraisetheforearmofthechildtowardsarmandflextheelbow>90degrees.ClickmaybefeltattheradialheadPronationandFlexionmaneuver(Hyperpronationmethod):FollowingstepsarecarriedoutinonesmoothmotionHoldelbowasmentioneaboveInsteadofsupinating,hyperpronatethewristwithslightdistaltraction(thismaybeallthatisneeded;continuetonextstepifreductionnotachieved)PerformrapidflexionatelbowClickmaybefeltattheradialheadSomestudieshaveshownhyperpronationmethodtobemoresuccessfulandlesspainfulcomparedtosupinationandflexionmethodinachievingreductionofpulledelbow.Successofreduction:Childshouldbeusingforearmnormallywithin30minutesIfnot,repeatmanipulationcanbeattemptedusingatechniquealternativetothefirstoneX-rayofradialheadsubluxationmaybenormalormayshowincreasedradio-coronoiddi