No Longer a “Nursemaid’s” Elbow

Rudloe, Tiffany; Schutzman, Sara A.; Lee, Lois K.; Kimia, Amir A.

doi:10.1097/pec.0b013e3182624906

Cited by 23 publications

(14 citation statements)

References 7 publications

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“…The diagnosis of pulled elbow depends on history of mechanism and physical examination [ 3 ]. Reduction may be attempted without radiographs if clinical presentation is typical of a pulled elbow [ 7 , 10 ]; however, in case of an unclear mechanism of injury, unnecessary radiographs are often taken [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

New, specific ultrasonographic findings for the diagnosis of pulled elbow

Lee

Sohn

2014

Clin Exp Emerg Med

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ObjectiveAmong infants and preschool children with complaint of upper extremity immobility, pulled elbow, also known as nursemaid’s elbow or radial head subluxation is the most common cause presenting to pediatric emergency departments. However, proper tools to diagnose pulled elbow remain limited. We conducted a study to determine the feasibility of ultrasonography in diagnosing pulled elbow.MethodsInfants and preschool children presenting to an urban emergency department with the complaint of upper extremity immobility between April and July 2013 were enrolled. The following ultrasonographic information was recorded: (1) whether there was a change in the shape of the supinator muscle, (2) whether there was an annular ligament in place, and (3) whether there was an enlargement of the synovial fringe. We used the affected arms’ ultrasonographic images as the study group and opposite arms’ ultrasonographic images as the control group.ResultsWhen we diagnosed pulled elbow using ultrasonographic findings (i.e., the annular ligament was not in place), we found the following results: sensitivity, 64.9% (95% CI, 47.5% to 79.8%); specificity, 100.0% (95% CI, 90.5% to 100.0%); positive predictive value, 100.0% (95% CI, 85.8% to 100.0%); and negative predictive, 74.0% (95% CI, 59.7% to 85.4%).ConclusionA pulled elbow can easily be confirmed by ultrasonography when the annular ligament is displaced.

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Section: Discussionmentioning

confidence: 99%

New, specific ultrasonographic findings for the diagnosis of pulled elbow

Lee

Sohn

2014

Clin Exp Emerg Med

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“…Interestingly, spontaneous reduction of ALD was reported for 16% of the children in our study. Rudloe et al reported that spontaneous reduction of ALD was observed in 9.5% of patients, with a further 8% reduction achieved during imaging studies . Children with ALD face an increased risk for recurrence.…”

Section: Discussionmentioning

confidence: 99%

Parental questionnaire study showed that annular ligament displacement was common in three‐year‐old children and almost a half had reoccurring episodes

Kimura¹,

Taketani

Kurozawa

2018

Acta Paediatrica

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“…По данным крупного поперечного исследования K. Pirruccio et al, выполненного по национальным базам данных за 2001-2017 гг., удельный вес ПГЛ в группах у детей в возрасте до 1 года составил 7 % (ДИ 6,0-8,8 %), от 1 года до 2 лет -33,5 % (ДИ 32,1-35,0 %), от 2 до 3 лет -35,1 % (ДИ 33,7-36,6 %), от 3 до 4 лет -15,6 % (ДИ 14,4-16,8 %), от 4 до 5 лет -5,7 % (ДИ 5,0-6,3 %), от 5 до 6 лет -2,1 % (ДИ 1,7-2,5 %) от 6 до 7 лет -0,7 % (0,4-1,0 %), в возрасте 7 лет -незначительное количество [2]. В большинстве научных работ отмечено преобладание девочек (57-60 %) [2,4,11,14], однако, по данным проспективного исследования F. Heydari et al, в 53 % случаев ПГЛ наблюдалось у мальчиков [10]. Левая рука повреждается чаще правой (60-61 %) [4,10,11].…”

Section: эпидемиологияunclassified

“…Основной и классический механизм ПГЛ заключается в резкой тракции за запястье или кисть при разогнутом локтевом суставе и пронированном предплечье [3,14]. Основу повреждения составляют смещение и интерпозиция в плечелучевом суставе анулярной связки, которая в норме окружает головку и шейку лучевой кости и удерживает головку напротив головчатого возвышения плечевой кости.…”

Section: этиология и патогенезunclassified

“…Rudloe et al, включавшем 3170 пациентов за 1995-2009 гг., тракционный механизм травмы также преобладал и составил 63,0 %. В 19,0 % случаев механизм травмы не был известен [14]. По данным ретроспективного исследования P. Toupin et al, включавшего 427 пациентов за двухлетний период, тракционный механизм ПГЛ наблюдался у 62,8 %, падение -у 18,2 %, выкручивание руки в локтевом суставе -у 4 % пострадавших [23].…”

Section: этиология и патогенезunclassified

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Current views on radial head subluxation

Petrushin

Леонидович²,

Bragina

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Backgrоund. Radial head subluxation is the most common injury in young children and accounts for 2.6% of the total population in this age group. In 39%82% of cases, the mechanism of injury is the traction of the arm, but subluxation can occur during a fall and in other circumstances; in 19%51% of cases, the mechanism of injury is unknown. Aim. The purpose of this study is to generalize and arrange the available literature and data and present current views on the prevalence, etiology, pathogenesis, diagnosis, and treatment of radial head subluxation in children. Materials and methods. A literature search was performed using the PubMed, PubMed Central, Google Scholar, CNKI-Scholar, Cyberleninka, and eLibrary databases. The sample of sources was mainly limited to 20002019. Results. The cause of subluxation is the displacement of the annular ligament and its interposition in the humeroradial joint. It is determined by a number of features of the elbow joint anatomy in young children. Diagnosis of radial head subluxation is based on history and clinical data; radiography and ultrasonography are used to obtain a clear clinical picture and to exclude fractures. The mainstay of treatment is a closed reduction, which is conducted via two methods as follows: supinationflexion and hyperpronation. According to modern research data, preference is given to the hyperpronation method; it is more effective in terms of number of reduction attempts, is technically simpler and, possibly, less painful. Generally, immobilization after effective reduction is not required as the function of the elbow joint is fully restored. A consequence of radial head subluxation is recurrence, which occurs in 5%46% of cases. A factor associated with recurrence is being less than two years of age. The prophylaxis of radial head subluxation is aimed at preventing forceful arm traction in children under three years of age and involves educating the parents or caregivers in the symptoms of subluxation to prevent late admission. Conclusions. Radial head subluxation is found in young children and is mainly diagnosed clinically. The treatment consists of a closed reposition, and the prognosis for restoring limb function is favorable.

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No Longer a “Nursemaid’s” Elbow

Abstract: Radial head subluxation mechanisms can be classified into subcategories, which may be caregiver and even patient gender specific. Provider awareness regarding these mechanisms may help target education and prevention.

Cited by 23 publications

References 7 publications

New, specific ultrasonographic findings for the diagnosis of pulled elbow

New, specific ultrasonographic findings for the diagnosis of pulled elbow

Parental questionnaire study showed that annular ligament displacement was common in three‐year‐old children and almost a half had reoccurring episodes

Current views on radial head subluxation

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