Clinical Practice Guidelines : Pulled elbow | Pulled elbow reduction

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 applypressureovertheradialheadfullypronateforearmandthenflextheelbow supination/flexionmanoeuvresitthechildontheparent'slap applypressureovertheradialhead supinatetheforearmflextheelbowTweet


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