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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #109

Couple Kid Silhouette Family  - 7089643 / Pixabay

Have a child who is not wanting to move their arm? Are the parents saying that anytime they try to move the arm the child cries in pain? Was there no particular injury the parents can pinpoint outside of possibly holding the child’s hand or lifting them up from the hands or arms? Then you need to be thinking of a nursemaid’s elbow (radial head subluxation)!

Children will have difficulty telling you where it hurts in their arm with this condition, but the pain will be elicited when you try to flex the elbow or pronate the forearm.

This presentation is very common in the pediatric population and is usually easily fixed in the office setting, but you should first obtain an x-ray just to ensure there is nothing more sinister occurring. Here is a tip, oftentimes the x-ray tech will reduce the dislocation due to the necessary views needed for the x-ray. The child will come back from x-ray moving their arm without issue. If this occurs, buy the tech lunch.

If that doesn’t happen though, then reducing the nursemaid’s elbow is very simple to do yourself and DOES NOT need a referral. There are two techniques, either the hyperpronation or the supination/flexion technique. Personally, I like the hyperpronation technique as it is easier. Simply Google these techniques and watch the videos. It is very simple to do if you suspect a nursemaid’s elbow!

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