The Basics of Reducing Radial Head Subluxation (Nursemaid's Elbow)

Radial Head Subluxation (Nursemaid's Elbow):

  • Age Range: 6 months to 7 years old (usually 2-3 years old)
  • Mechanism: Sudden, longitudinal traction on arm with elbow extended
  • Annular ligament of radius displaces into radiocapitellar articluation
  • Two Reduction Techniques: Supination Technique and Hyperpronation Technique

Supination Technique:

  • Hold childs elbow at 90 degrees with one hand
  • Supinate the patient's extremity at the wrist
  • Flex the supinated wrist towards the patient's shoulder
  • Feel for reduction of radial head with hand on elbow.

Hyperpronation Technique:

  • Hold patient's elbow at 90 degrees
  • Firmly pronate at wrist until reduction is complete
  • Consider investingating for occult fractures if patient does not resume normal use of extremity within 30 minutes after reduction.

1) Hopkins-Mann C, Ogunnaike-Joseph D, Moro-Sutherland D. Chapter 143C. Pediatric Procedures: Nursemaids' Elbow Reduction. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.