A radial head subluxation that is common in 1-3 year olds
Often secondary to a longitudinal traction on an extended arm
With a classic story radiographs are not required
The hyperpronation technique has been show to be more effective and less painful in reducing it
Answer
Due to a tearing of annular ligament attachment to radial neck, with detatched portion trapped between subluxed raidal head and capitellum
children refuse to use affected arm and hold in a flexed pronated position
Xrays are generally unnecessary unless history and physical are not consistent with nursemaid's elbow, symptoms for greater than 12 hours, or reductions attempts are unsuccessful
Traditionally, reduce by supination of forearm with elbow in 90' of flexion
The Hyperpronation Method: This reduction technique for a nursemaid's elbow (radial head subluxation) has been found to have better first attempt success than classic supination/flexion technique and less painful. (Pediatrics July '98).
Support the elbow with a finger on the radial head, and forcefully hyperpronate. You do NOT need to flex the elbow.
