Elbow Injuries - Radial Head Subluxation (Nursemaids Elbow)

Authors: Melody Glenn, MD, Andrew Little, DO, Mary Haas, MD
Updated: 12/12/2016

Elbow Injuries: Radial Head Subluxation

Radial head subluxation drawing

Classic Presentation

  • Age 1-4 years
  • Occurs by pulling of extended and pronated arm
  • Patient refuses to use arm
  • Elbow in slight flexion/pronation
  • Elbow appears atraumatic
  • No focal elbow tenderness

X-ray Views

  • Xrays rarely indicated
  • Obtain xray if concerned for fracture, unable to reduce elbow, or inability to move arm post reduction

Acute Management

  • Technique: Closed reduction with hyperpronation or supination/flexion approach
  • If concern for supracondylar fracture, do not reduce and obtain xray first.

Follow-Up Timing

  • Routine follow-up with pediatrician