Reduction. A child presenting with features typical of Radial Head Subluxation should undergo prompt reduction. Unless a fracture is suspected (as evidenced by ...Nursemaid'sElbowHome/AboutSAEM/Academies,InterestGroups,&Affiliates/CDEM/ForStudents/CDEMCurriculum/PedsEMCurriculum/Nursemaid'sElbow Objectives RecognizethetypicalpresentationofRadialHeadSubluxationUnderstandthepathogenesisofRadialHeadSubluxationUnderstandtheapproachtoreductiontechniquesutilizedinpresentationsofRadialHeadSubluxationCasePresentationA28montholdfemalepresentstotheEmergencydepartmentinthecareofhermother. Thepatient’smotherreportsthatseveralhoursearliersheandherdaughterwereholdinghandsonanafternoonwalk. Asherchildstumbledtowardthecurbofasidewalk,themotherquicklypulledthepatientupbythehandandwristtoavoidafalloffthesidewalkandintothestreet. Themotheradmitsthatherdaughterwasmomentarilyliftedintotheairbeforebeingplacedbackdownontoherfeet. Sincetheevent,thepatienthasbeenunwillingtomoveherleftarmforanyreason. Sheresistsanyattemptofthemothertomanipulateormoveherarm. Themotherisconcernedthatshemayhaveinjuredherdaughter’swrist.IntroductionNursemaid’sElbow,moreaccuratelyreferredtoasRadialHeadSubluxation,isaninjuryuniquetothepediatricpatient. Itisthemostcommonelbowspecificinjuryinthepediatricpopulation. Ittypicallyoccursinchildren6monthsto3years. Ithasbeenreportedupthroughpre-teenyearsbutisrarepast4yearsofage. RadialHeadSubluxationoccurswhentheannularligamentslipsawayfromtheradialhead,becomingentrappedwithintheradiohumeraljoint(figure1). Thetypicalmechanismofinjuryincludesaxialtractiononapronatedforearmasoccursduringplayorduringcommonactivitiesofdailyliving.ExamWhileallchildrenwithRadialHeadSubluxationdemonstratelimitedtonomovementoftheaffectedarm,theactualpositionofthearmmaybevariable. Fullextensionattheelbow,aslightlyflexedelbow,oranelbowflexedto90degreesmaybeobserved. Theextremityisheldclosetothebodywiththeforearmmostcommonlypronated. Acompleteexaminationoftheupperextremityisindicatedstartingproximall