#ortho see also [[paediatric elbow]] > [!key points] > - **subluxation of the radial head** > - annular ligament slips over the proximal part of the radial head > - clinical diagnosis with history and exam > - common injury in toddlers 1-4 years > - in 50% no history of a "pull" to the arm # clinical features - not using affected limb - elbow in extension and the forearm in pronation or supination - no swelling, deformity, or bruising to elbow or wrist - absence of tenderness on palpation - resistance and pain with supination of the forearm - not much pain at rest # investigations - XR if significant tenderness, swelling, bruising, or deformity or if reduction fails - DDx [[upper limb non-use]] # treatment - analgesia - reduction - if the reduction is successful, the child should be pain free and able to move the arm normally in 5-30 min, including being able to reach for an object above the head - in cases where reduction is felt to be successful, but the injury is greater than 12 hours old, it may take 1-2 days to use the arm again # Reduction ## hyperpronation manoevre - support elbow with one hand with gentle pressure from your thumb over the radial head (to palpate a 'click' on successful reduction) - fully pronate forearm ![[Pasted image 20230826154434.png]] ## supination / flexion manoevre - support the elbow with one hand with gentle pressure from your thumb over the radial head to palpate click on reduciton - supinate the forearm - flex the elbow ![[Pasted image 20230826154525.png]] ![[Pasted image 20230826154535.png]]