Which statement best describes nursemaid's elbow and its management?

Which statement best describes nursemaid's elbow and its management?

• A. Dislocation of the elbow requiring surgery
• B. Subluxation of the radial head is common in children under 5; clinical diagnosis; reduction by hyperpronation or supination-flexion without imaging
• C. Fracture of the distal radius requiring immobilization
• D. Tendonitis of the elbow in toddlers

Answer: (D)

Nursemaid’s elbow is a subluxation of the radial head that occurs in young children after a sudden pull on an outstretched arm. It presents with acute elbow pain and the child often holds the arm close to the body with limited ability to supinate, but there is usually no obvious deformity on exam. The diagnosis is clinical; imaging is not required in typical cases unless red flags raise concern for fracture. Management centers on reducing the radial head without surgery. Two effective techniques are hyperpronation of the forearm or supination with flexion of the elbow. Both approaches have high success and allow rapid restoration of use and relief of pain, often immediately after the maneuver. Imaging or immobilization is not routinely needed after a successful reduction. If reduction fails or symptoms persist, reassessment is warranted to exclude other injuries and, if indicated by exam or persistent concern, plain radiographs can be obtained. Educate caregivers that this injury can recur and that gentle handling and avoidance of forceful pulling on a child’s arm can help prevent recurrence.

Nursemaid’s elbow is a subluxation of the radial head that occurs in young children after a sudden pull on an outstretched arm. It presents with acute elbow pain and the child often holds the arm close to the body with limited ability to supinate, but there is usually no obvious deformity on exam. The diagnosis is clinical; imaging is not required in typical cases unless red flags raise concern for fracture.

Management centers on reducing the radial head without surgery. Two effective techniques are hyperpronation of the forearm or supination with flexion of the elbow. Both approaches have high success and allow rapid restoration of use and relief of pain, often immediately after the maneuver. Imaging or immobilization is not routinely needed after a successful reduction.

If reduction fails or symptoms persist, reassessment is warranted to exclude other injuries and, if indicated by exam or persistent concern, plain radiographs can be obtained. Educate caregivers that this injury can recur and that gentle handling and avoidance of forceful pulling on a child’s arm can help prevent recurrence.