![]() Widened space between the radial head and capitellum.Ultrasound: Findings may include the following.May show displacement of the radiocapitellar line (not sensitive or specific).Consider for nonambulatory infants to exclude differential diagnoses of radial head subluxation.Examination is atypical or reveals significant tenderness to palpation, effusion, or ecchymosis.Mechanism of injury is atypical, significant (e.g., a fall), or unknown.Imaging (typically x-ray) is usually only performed in cases of diagnostic uncertainty or unsuccessful reduction. Imaging is not routinely performed before or after reduction in patients with classic clinical features of radial head subluxation. Patients with recurrent subluxations: Consider arm immobilization.Educate caregivers on how to prevent a recurrence.Neither follow-up nor modifications to normal activity are required.Following successful reduction, the child should have full, pain-free ROM. ![]() Leave the room, ensuring there are toys for the child to play with, and reassess after 10–30 minutes.Supination- flexion maneuver: Supinate the forearm, then immediately flex the elbow.Hyperpronation maneuver: Hyperpronate the forearm (with the elbow extended or flexed at 90 degrees ).Apply pressure to the radial head and perform one of the following maneuvers:.Neither anesthesia nor sedation is required.Radial head subluxation is typically a clinical diagnosis a classic history and examination and successful closed manual reduction confirm the diagnosis. Refer to orthopedic surgery for evaluation within 2 days.Unsuccessful reduction but imaging supports the diagnosis:.Obtain imaging to rule out differential diagnoses of radial head subluxation.Diagnostic uncertainty or unsuccessful reduction.Can be repeated once if the initial attempt is unsuccessful.Successful reduction leads to rapid ( 10–30 minutes ) restoration of pain -free normal ROM.Classic clinical features of radial head subluxation: Proceed directly to treatment.Assess the child's entire arm and clavicle.Most radial head fractures are treated conservatively, with only complex fractures managed surgically. Radial head fractures can cause hemarthrosis, which may be the only visible sign on the elbow x-ray. The reduction can be carried out in an outpatient setting and does not require any immobilization of the elbow or further surgical treatment. Management is usually conservative and involves closed manual reduction of the radial head. Imaging is reserved for cases of diagnostic uncertainty or if treatment is unsuccessful. Diagnosis is usually clinical, based on classic history and examination findings. Clinical signs include painful and limited movement of the upper extremity and guarding, with the arm held in a flexed and pronated position. The injury most commonly occurs in young children after sudden tugging of the outstretched and pronated arm (e.g., if an adult suddenly pulls a child's arm to prevent them from falling). Radial head subluxation (commonly referred to as pulled elbow or nursemaid elbow) refers to the partial dislocation of the head of the radius at the level of the radio-humeral joint.
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