Method 1: · With the elbow semi-flexed, grasp the forearm with one hand, and place the thumb of your other hand over the lateral aspect of the elbow. · Supinate the ...Youarehere»Home»Forhealthprofessionals»EmergencyDepartmentGuidelines»PulledelbowForhealthprofessionalsEmergencyDepartmentGuidelinesCAHSClinicalDisclaimerChildren'sAntimicrobialManagementProgramClinicalPracticeGuidelinesReferralstoPCHPostgraduateMedicalEducationPulledelbowDisclaimerTheseguidelineshavebeenproducedtoguideclinicaldecisionmakingforthemedical,nursingandalliedhealthstaffofPerthChildren’sHospital.Theyarenotstrictprotocols,andtheydonotreplacethejudgementofaseniorclinician.Clinicalcommon-senseshouldbeappliedatalltimes.Theseclinicalguidelinesshouldneverbereliedonasasubstituteforproperassessmentwithrespecttotheparticularcircumstancesofeachcaseandtheneedsofeachpatient.Cliniciansshouldalsoconsiderthelocalskilllevelavailableandtheirlocalareapoliciesbeforefollowinganyguideline. ReadthefullPCHEmergencyDepartmentdisclaimer.AimToguidestaffwiththeassessmentandmanagementofchildrenwhopresentwithapulledelbow.KeypointsApulledelbowiswherethereispartialsubluxationoftheradialhead,withtheorbicularligamentslippingofftheendoftheradius.Thisisacommoninjuryintoddlers2-3yearsofage(reportedagerange=6months-7years).AssessmentThehistoryiscentraltothediagnosisThechildisoftenundistressed,butreluctanttousethearm,andcriesifthearmismovedThechildusuallyholdstheaffectedarmmotionless,inamid-pronepositioninfrontofthechest,keptstillbytheoppositehand.HistoryAsuddenlongitudinalpulloraxialtractiononthearmofaninfantortoddler,whilethearmisextendedTypically,theinjurymayoccurwhenaparentsgrabsachildbythearmasthechildisrunningawayorfallingorbeingswungaroundbythearms(“whizzydizzy”)Ifthehistoryistypical,andexaminationfitswiththediagnosis,thenX-RayisnotnecessaryIfthehistoryorexaminationarenottypical,thenX-Raysshouldbedonetoexcludeotherinjuriesbeforeattemptingtomanipulatethearm.ExaminationTheremaybemildfocaltendernessovertheradialhead,butgener