Sonographic Finding of a Pulled Elbow

Sohn, Youdong; Lee, Yusung; Oh, Younjae; Lee, Wonwoong

doi:10.1097/pec.0000000000000299

Cited by 11 publications

(6 citation statements)

References 8 publications

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“…We also collected ultrasonographic images of both elbows to compare affected and unaffected elbows. We conducted ultrasonography according to our previous study [ 6 ]. This was performed as follows: the child was held on the parent’s lap while the parent was seated opposite the ultrasound operator.…”

Section: Methodsmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

“…Recently, we introduced a method to diagnose pulled elbow through new ultrasonographic findings [ 6 ]. This study determines the accuracy of ultrasonography in the diagnosis of pulled elbow as a follow-up to our previous investigation.…”

Section: Introductionmentioning

confidence: 99%

New, specific ultrasonographic findings for the diagnosis of pulled elbow

Lee

Sohn

2014

Clin Exp Emerg Med

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“…Early ultrasonographic studies of the nursemaid's elbow almost all focused on the anterior joint with a longaxis view to assess the morphology of the annular ligament and supinator muscle. [25][26][27][28][29] The J-sign, a change in the shape of the supinator muscle and annular ligament, and enlargement of the anterior synovial fringe were found. 27,28 However, these findings may be based on detecting secondary changes in the joint.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of Dynamic Ultrasonography in Nursemaid’s Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid’s Elbow

Tsai¹,

Chiang

2023

Journal of Pediatric Orthopaedics

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Background: Nursemaid's elbow is a common musculoskeletal disorder among children under 5 years of age. However, diagnostic imaging to confirm a nursemaid’s elbow diagnosis is still unavailable. Through the use of a high-frequency ultrasound probe, we determined the etiology and possible pathophysiology of nursemaid’s elbow. Methods: Thirteen consecutive patients with the clinical suspicion of nursemaid’s elbows were examined. A high-frequency linear array 6 to 24 MHz hockey stick transducer was used to detect small changes (partial eclipse signs) of the radial head in the axial view before and after manipulation. Results: All patients in this study had a successful reduction. A partial eclipse sign was found in all patients before reduction and disappeared after successful reduction. Conclusion: These pathologic features detected through high-frequency ultrasonography suggest the role of the escaped posterior synovial fringe in the pathogenesis of the nursemaid’s elbow. The specific finding of a “partial eclipse sign” could be a useful additional clue leading to the correct diagnosis of the nursemaid’s elbow and may help avoid the unnecessary reduction in patients who do not have a “partial eclipse sign”. Level of Evidence: Level II, diagnostic studies.

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“…В случае сомнения в диагнозе, а также для оценки целостности анулярной связки ряд авто ров рекомендуют ультразвуковое исследование (УЗИ) локтевого сустава [32][33][34]. На основании этого метода в проспективном исследовании H.S.…”

Section: клиника диагностика и дифференциальная диагностикаunclassified

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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Sonographic Finding of a Pulled Elbow

Cited by 11 publications

References 8 publications

New, specific ultrasonographic findings for the diagnosis of pulled elbow

New, specific ultrasonographic findings for the diagnosis of pulled elbow

The Usefulness of Dynamic Ultrasonography in Nursemaid’s Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid’s Elbow

Current views on radial head subluxation

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