Stephen J. Schueler, M.D.

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Subluxed Radial Head Reduction

There are two main methods to treat nursemaid's elbow. In general, they should only be performed by trained personnel. The exception is a child with a past history of this problem and a current history highly suggestive of the same condition. In this case, some doctors may instruct a parent to attempt reduction at home.

Pronation Method for Reducing Nursemaid's Elbow
The most common method used to treat this problem is called a pronation technique. Pronation means turning the palm downward.

To perform a pronation reduction on a right-sided nursemaid's elbow:

  • Only perform this reduction if there are no signs of elbow deformity.
  • Gently support the child's right elbow with your right hand, holding the child's elbow at 90 degrees of flexion (elbow should be at a right angle)
  • Hold the child's right hand with your left hand and turn the palm downward (pronation).
  • Straighten the child's elbow keeping the palm down
  • Expect a few seconds of pain, followed by a return to normal after 30-60 minutes
  • The child should be able to reach over his or her head if the treatment was successful.

Supination Method for Reducing Nursemaid's Elbow
The next most common method used to treat this problem is called a supination technique. Supination means turning the palm upward.

To perform a supination reduction on a right-sided nursemaid's elbow:
  • Only perform this reduction if there are no signs of elbow deformity.
  • Gently support the child's right elbow with your left hand, holding the child's elbow at 90 degrees of flexion (elbow should be at a right angle)
  • Hold the child's right hand with your right hand and turn the palm up (supination)
  • Bend (flex) the child's elbow completely, keeping the palm upward so the hand touches the shoulder
  • Expecting a few seconds of pain, followed by a return to normal after 30-60 minutes
  • The child should be able to reach over his or her head if the treatment was successful.

Continue to Subluxed Radial Head Specialist

Last Updated: Dec 21, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Subluxed Radial Head References
  1. Kaplan RE, Lillis KA. Recurrent nursemaid's elbow (annular ligament displacement) treatment via telephone. Pediatrics. 2002 Jul;110(1 Pt 1):171-4. [12093966]
  2. McDonald J, Whitelaw C, Goldsmith LJ. Radial head subluxation: comparing two methods of reduction. Acad Emerg Med. 1999 Jul;6(7):715-8. [10433531]
  3. Shabat S, Folman Y, Mann G, Kots Y, Fredman B, Banian M, Liberman N, Nyska M. The role of sonography in detecting radial head subluxation in a child. J Clin Ultrasound. 2005 May;33(4):187-9. [15856520]
  4. Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am. 1999 Oct;81(10):1429-33. [10535592]
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