Abstract
Pulled elbow is a disorder commonly observed in children in routine medical practice, Pulled elbow or nursemaid’s elbow is a radial head subluxation caused by a sudden pull on the extended pronated forearm.; however, when the circumstances involved in the injury are unknown, difficulty has been encountered in differential diagnosis whether it is a bone fracture or pulled elbow. One of the reasons involved has been the unavailability of diagnostic imaging in confirming the diagnosis of the pulled elbow. Nursemaid’s elbows are indistinguishable from healthy elbows on radiograph. This article reviews the key issues to be considered while assessing these patients with real time musculoskeletal ultrasonography.
Keywords: Pulled elbow, Nursemaid’s elbow, musculoskeletal ultrasonography.
References
- Alka Sudhir Karnik, Alpana Karnik, Alpana Joshi. Ultrasound Examination of Pediatric Musculoskeletal Diseases and Neonatal Spine. The Indian Journal of Pediatrics: June 2016, Volume 83, Issue 6, pp 565–577
- Ultrasound of Pediatric Musculoskeletal Disease: From Head to Toe. Seminars in Ultrasound, CT and MRI: Volume 32, Issue 2, April 2011, Pages 142-150
- James Teh. Ultrasound in Paediatric Trauma Pediatric Skeletal Trauma: pp 39-58
- FarukGüngör, TaylanKılıç. Point-of-Care Ultrasonography to Assist in the Diagnosis and Management of Subluxation of the Radial Head in Pediatric Patients: A Case Series. Ultrasound in Emergency Medicine https://doi.org/10.1016/j.jemermed.2017.01.049
- Eismann, Emily A. MS; Cosco, Emily D.; Wall, Eric J. Absence of Radiographic Abnormalities in Nursemaid’s Elbows. Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 426–431 doi: 10.1097/BPO.0000000000000126
- Schutzman SA, Teach S. Upper-extremity impairment in young children. Ann Emerg Med: 1995;26:474–9. [PubMed]
- Diab HS, Hamed MM, Allam Y. Obscure pathology of pulled elbow: dynamic high-resolution ultrasound-assisted classification J Child Orthop: 2010;4:539–43. [PMC free article] [PubMed]
- Kosuwon W, Mahaisavariya B, Saengnipanthkul S, Laupattarakasem W, Jirawipoolwon P. Ultrasonography of pulled elbow: J Bone Joint Surg Br. 1993;75:421–2. [PubMed]
- Kraus R, Dongowski N, Szalay G, Schnettler R. Missed elbow fractures misdiagnosed as radial head subluxations. Acta Orthop Belg: 2010;76:312–5. [PubMed]
- Choung W, Heinrich SD. Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid’s elbow). J Pediatr Orthop: 1995;15:454–6. [PubMed]
- Macias CG, Wiebe R, Bothner J. History and radiographic findings associated with clinically suspected radial head subluxations. Pediatr Emerg Care: 2000;16:22–5. [PubMed]
- Snyder HS. Radiographic changes with radial head subluxation in children. J Emerg Med: 1990;8:265–9. [PubMed]
- Scapinelli R, Borgo A. Pulled elbow in infancy: diagnostic role of imaging. Radiol Med: 2005;110:655–64. [PubMed]
- Sacchetti A, Ramoska EE, Glascow C. Nonclassic history in children with radial head subluxations. J Emerg Med: 1990;8:151–3. [PubMed]
- Rudloe TF, Schutzman S, Lee LK, Kimia AA. No longer a “nursemaid’s” elbow: mechanisms, caregivers, and prevention. Pediatr Emerg Care: 2012;28:771–4. [PubMed]
- Dohi D. Confirmed specific ultrasono-graphic findings of pulled elbow. J Pediatr Orthop: 2013;33:829–31. [PubMed]
Corresponding Author
Dr Sharat Agarwal
Professor (Associate), Orthopaedics & Trauma,
North Eastern Indira Gandhi Regional Institute of Health & Medical sciences (NEIGRIHMS),
Shillong (India)-793018
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone- +91-9436336213