Treatment · Perform a reduction manoeuvre (see below) · expect distress and pain · a click may be felt over the radial head · review after ten minutes · if reduction fails ...Stayinformedwiththelatestupdatesoncoronavirus(COVID-19).Findoutmore>>TheRoyalChildren'sHospitalMelbourneHomeAboutNewsCareersShopContactMyRCHPortalAgreatchildren'shospital,leadingthewayHealthProfessionalsPatientsandFamiliesDepartmentsandServicesResearch HealthProfessionals DepartmentsandServices PatientsandFamilies ResearchHomeAboutNewsCareersSupportusContactSearchClinicalPracticeGuidelinesTogglesectionnavigationInthissectionGuidelinesindexCPGinformationFeedbackGuidelinesresourcesParentResourcesRetrievalservicesLocalAntimicrobialGuidelinesEmergencymedicationsRCH  >  HealthProfessionals  >  ClinicalPracticeGuidelines  >  PulledelbowInthissectionGuidelinesindexCPGinformationCitingourguidelinesDisclaimerGuidelinedevelopmentGuidelineDevelopmentProcessFeedbackGuidelinesresourcesParentResourcesRetrievalservicesLocalAntimicrobialGuidelinesEmergencymedicationsPulledelbowPulledelbowHistory:Age:usually1to4yearsoldIn50%:nohistoryofa"pull"onthearmExamination:notusingtheaffectedlimbelbowinextensionandtheforearminpronationdistressedonlyonelbowmovementnoswelling,deformityorbruisingoftheelboworwristonpalpationtendernessisusuallyabsent(remembertheclavicle)markedresistanceandpainwithsupinationoftheforearm.Manipulationduringtriageorxraymayreducethesubluxation.Differentialdiagnosis:See upperlimbnon-useguidelineDiagnosisClinicallyestablishedwithaclassichistoryandexamination.Plainradiographsareindicatedwhenadifferentialdiagnosisissuspected:significanttenderness,swelling,bruisingordeformityreductionfailsTreatmentPerformareductionmanoeuvre(seebelow)expectdistressandpainaclickmaybefeltovertheradialheadreviewaftertenminutesifreductionfails,consultwithseniormedicalstaffReductionmanoeuvresEitherofthefollowingmethodsmaybeeffectivepronation/flexionmanoeuvresitthechildontheparent'slap applypressureovertheradialheadfullypronat