Radial head subluxation (nursemaid's elbow), is the most common elbow injury in children. Occurs mostly in children 1-4 years of age.ShareWrittenByJanienneKondrich,MDEditedByMichaelMojica,MDPublishedNovember11,2019TagsOrthopaedics,PediatricsContentsIntroductionAnatomyPresentationExaminationImagingReductionDischargeInstructionsCommentsBacktoTop  RadialHeadSubluxationIntroductionRadialheadsubluxation(nursemaid’selbow),isthemostcommonelbowinjuryinchildren.Occursmostlyinchildren1-4yearsofage.Subluxationreferstoajointthatispartiallyoutofalignment.Dislocationreferstoajointthatiscompletelyoutofalignment(RadialheaddislocationoccursintheMonteggiafracture-dislocation)MechanisminvolvestractionofthearmatthewristwhenAchildisliftedbythewristORWhenacaregivergrabsthearmtopreventthechildfromfallingorpullingaway.AnatomyTheannularligamentsecurestheradialheadtotheulna(A).Inyoungchildrenthisligamentislooselyattachedtotheradius.Withtractiononthedistalradius,aportionoftheannularligamentslipsovertheheadoftheradiusandslidesintotheradiohumeraljointwhereitbecomestrapped(B).By5yearsofagetheannularligamenthasbecomethickerandtighterislesslikelytobedisplaced.PresentationThechildwillimmediatelycomplainofpain.Refusestousetheaffectedarm.Thechildisofteninlittledistressunlessattemptsaremadetomovetheelbow.ExaminationItisbesttohavethepatientsitontheparent’slapwithyousittingacrossfromthemStartbyexaminingtheunaffectedarminordertodevelopthepatient’strustandtoestablishabaselineforhowtheyrespondtoyourexam.Assesstheneurovascularstatusoftheinjuredarm.Theneurovascularexamischallenginginyoungchildrenandshouldberepeated,particularlyaftermanipulationofthearm.Determinethedegreeofperfusionbypalpatingtheradialandbrachialpulsesandassessingcapillaryrefill,warmthandcolorincomparisontotheunaffectedlimb.IfapulseisnotpalpableaDopplerultrasoundcanbeusedtodeterminethepresenceofdistalperfusion.Evaluateboththesensoryandmotorfunctionoftheulnar,medianandradialnerveswhilelimitingmovementoftheelbowasthismayprecipitateorfurtherexac