Reduction procedureNCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListCanFamPhysicianv.64(6);2018JunPMC5999240CanFamPhysician.2018Jun;64(6):439–441.PMCID:PMC5999240PMID:29898933Language:English|FrenchPulledelbowinchildrenPronationdouloureuseducoudechezl’enfantSyunsukeYamanaka,MDRanD.Goldman,MDFRCPCAuthorinformationCopyrightandLicenseinformationDisclaimerCorrespondingauthor.Correspondence:DrRanD.Goldman;e-mailac.cb.wc@namdlogrCopyright©theCollegeofFamilyPhysiciansofCanadaThisarticlehasbeencitedbyotherarticlesinPMC.QuestionOurpracticeisseeingchildrenwithrelativelyminorinjuriestotheirelbows,withahistoryof“swinging”themwhentheirhandsarebeingheldtocrosstheroad.Nothingisusuallyfoundonaphysicalexamination.Iknowthatthisislikelya“pulledelbow.”Canwemanagethisintheclinicsettingratherthansendingthefamilytotheemergencydepartment?Whatwouldbethebestcourseofactionintheclinicsetting?AnswerPulledelbow,alsocallednursemaid’selbow,isaradialheadsubluxationcausedbyaxialtractionorasuddenpulloftheextendedpronatedarm,anditisaverycommonphenomenon.Thepracticeofswingingchildrenwhileholdingtheirhandsshouldbeabandoned.Inthecaseofpulledelbow,thechildusuallyavoidsmovingtheaffectedarm,holdingitclosetohisorherbody,withoutconsiderablepain,andnoobviousswellingordeformitycanbeseen.Whileafractureshouldbeexcluded,pulledelbowcanusuallybeidentifiedbasedonthispresentation.Thereductionprocedurecaneasilybedoneintheofficesetting,withan80%successrateandnocomplications.Thehyperpronationmaneuver(holdingtheelbowat90°andthenfirmlypronatingthewrist)toreducepulledelbowhasbeenfoundtobebetterthanasupination-flexionmaneuver(holdingtheelbowat90°withonehand,supinatingandflexingtheelbowrapidlywiththeother)andshouldbeexercisedfirst.When2trialsofreductionareunsuccessful,thechild’sarmshouldbesplintedandthefamilyshouldbesentforfurtherevaluation.QuestionNotrecliniquereçoitdesenfantssouffrantdeblessuresrelativementmineuresaucoude,a