Nursemaid's Elbow PRESENTATION ==> Radial head subluxation is VERY common; most often seen in ages of 1-4 yrs. ==> Arm is held close to the body, elbow flexed and forearm pronated. MANAGEMENT ==> If the history and physical are classic, no X-rays are needed. Obtain x-rays if there is pain to palpation of long bones (rule out Monteggia fx) or the story is not classic. ==> Hold elbow at 90 degrees, then firmly supinate and simultaneously flex the elbow. ==> Place thumb over region of radial head and apply pressure as you supinate. May also need to extend elbow to help screw radial head back in place. POST-REDUCTION ==> Immobilation is not necessary for 1st episode ==> If delayed reduction (>12 hours), place in long arm posterior splint in full supination and elbow @90 degrees http://www.wheelessonline.com/ortho/nursemaids_elbow_radial_head_subluxation
