Season 6 Case 34
Oh no. Not Peds!
History: 3 year old not moving arm
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Answer: Nursemaid’s elbow
Nursemaid’s elbow (aka pulled elbow) is subluxation of the radial head from the capitellum and interposition of the annual ligament into the radiocapitellar joint.
As I have found digging into the details of many of my cases, there isn’t 100% agreement on the radiographic findings except for the fact that no imaging should be required. But if performed, it should be normal or show subluxation of the radial head from the capitellum but NOT frank dislocation.
To examine alignment we use the “radiocapitellar line” which when drawn through the center of the radial neck longitudinally and should intersect the capitellum on all views.
Here we see it pretty close to intersecting the capitellum consistent with a component of subluxation but not true dislocation. Speaking with the clinician revealed a classic history and physical exam and following manual manipulation (flexed supination with mild pressure), they felt the reduction and the patient was up an running around the room almost instantly.