72.15 Pulled elbow (young children)

This common injury is the result of lifting up a child by one arm, or swinging him around on it. Many minor and otherwise undiagnosed injuries are probably pulled elbows. The head of a child’s radius has no well defined neck, so that if it is pulled distally, it can be gripped by the annular ligament.

A child with a pulled elbow holds his hand in neutral, he refuses to use his arm, and he cannot rotate his wrist. Sometimes, the head of his radius is tender. His X–rays are normal. The differential diagnosis of a fracture of the neck of his radius.

Figure 72.22: PULLED ELBOW. A, shows the mechanism of pulled elbow, and B, the method of manipulating it.

Treatment is usually easy. Hold his hand in one of your hands as if you were shaking hands, and cup his elbow in the palm of your other hand. Suddenly supinate his arm and at the same time quickly push his hand towards his elbow, while pushing on the head of his radius with your thumb. This will usually free the head of his radius from the annular ligament. Sometimes, even extending his elbow to take an X–ray does the same. He will cry loudly, but he will usually be able to move his arm. If this fails, do nothing. He will usually recover completely in a few weeks; if he does not, refer him.