Which technique is best for reducing a pulled elbow?
The triage nurse comes to tell you that s/he has a toddler with a pulled elbow in triage. You want to reduce it straightaway and send the child home, high-fiving the whole family on their way out. You wonder which reduction technique is most likely to be successful...
Pulled elbow is a painful condition of acute onset, resulting in sudden loss of function in the affected limb of a child. The mechanism of injury is often a sudden pull on the ipsilateral hand/forearm (e.g. parent pulling the child up a kerb, or even the child pulling its hand away impulsively), resulting in subluxation of the radial head. Pulled elbow can also be caused by a fall or twist. Typically, the child will suddenly cry out in pain and then refuse to use their arm. A snap or click may be heard. The arm is held slightly flexed and twisted inwards, without any bruising or swelling. Pain may be felt at the shoulder or wrist as well as the elbow[5,6].
Two main reduction techniques are described: supination-flexion (the traditional method) and hyperpronation.
Krul M, van der Wouden JC, Kruithof EJ, van Suijlekom-Smit LWA, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database of Systematic Reviews 2017, Issue 7
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