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