# Pulled elbow (radial head subluxation) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Nursemaid Elbow - StatPearls (NCBI Bookshelf NBK430777) - https://www.ncbi.nlm.nih.gov/books/NBK430777/ · Pulled elbow - disease-level clinical article (pulled-elbow-full.txt) · Pulled elbow - disease-level clinical article (pulled-elbow-clinical.txt) - Verified date: 2026-08 ## Verified against - Nursemaid Elbow - StatPearls (NCBI Bookshelf NBK430777) - https://www.ncbi.nlm.nih.gov/books/NBK430777/ - Pulled elbow - disease-level clinical article (pulled-elbow-full.txt) - Pulled elbow - disease-level clinical article (pulled-elbow-clinical.txt) ## Treatment metadata - Closed reduction manoeuvre (no drug therapy) - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text PULLED ELBOW (RADIAL HEAD SUBLUXATION) Sources: Nursemaid Elbow - StatPearls (NCBI Bookshelf NBK430777) - https://www.ncbi.nlm.nih.gov/books/NBK430777/ · Pulled elbow - disease-level clinical article (pulled-elbow-full.txt) · Pulled elbow - disease-level clinical article (pulled- elbow-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Caregivers often describe the child's arm being pulled upward by the wrist or the child being swung by the arms, though a specific triggering event may not be recalled - Onset can also follow a fall onto an outstretched arm - The arm can spontaneously reduce before being seen, with the caregiver describing the child refusing to move it and becoming upset at any attempt to touch it [refusing to use a limb] SIGNS - what you find (4) - The child holds the arm extended and pronated, protecting it with the other hand, and generally has no pain unless the arm is manipulated - There may be tenderness over the radial head, with resistance to pronation, supination, flexion, and extension of the forearm - Bruising, redness, swelling, or other signs of trauma are typically absent - Circulation, sensation, and motor function distal to the elbow stay intact even if the child is uncooperative with the exam TESTS (3) - Diagnosis is usually clinical, made by inspecting and palpating the whole arm plus the ipsilateral clavicle for tenderness - Imaging is reserved for suspected fracture or dislocation, visible swelling or deformity, an atypical mechanism, or concern for non-accidental trauma - X-rays are usually normal, though displacement of the radiocapitellar line is sometimes seen IF NOT THIS - what else fits (1) - Elbow fracture, wrist fracture, greenstick fracture, a hand injury, Monteggia fracture, supracondylar fracture, and soft-tissue hand injury are considered Source StatPearls "Nursemaid Elbow" - disease-level clinical article Status traced to the source above 1. CLOSED REDUCTION MANOEUVRE (NO DRUG THERAPY) [1st line] Adult Source Pulled elbow - disease-level clinical article (pulled-elbow-clinical.txt) Why The treatment is a manoeuvre performed in the clinic, and the article states it needs nothing else: closed reduction, done in seconds and with no sedation. No analgesic, splint or sling is named anywhere in it, so none is printed - the reduction is the analgesia. Caution PREPARE THE FAMILY FIRST - the manoeuvre is over quickly, but it hurts while the annular ligament goes back where it belongs. Tell the parents in advance that the child will very likely cry, and that once the elbow is reduced properly the pain should go and the child should be back to normal within a few minutes. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) POSITION - to keep the trauma down and the child comfortable, have the parent hold the child on their lap, and sit yourself facing the child. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) WHICH TECHNIQUE FIRST - two methods are in common use for a subluxed radial head: hyperpronation, and supination with flexion. Hyperpronation succeeds on the first attempt more often, and studies suggest it hurts less. Where it fails, supination with flexion can be tried next. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) HYPERPRONATION, STEP BY STEP - support the child's elbow in one hand and press moderately on the radial head with that same hand. With the other hand, take the wrist and hyperpronate the forearm. A click felt over the radial head usually means it has gone back. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) SUPINATION AND FLEXION, STEP BY STEP - press lightly on the radial head with your thumb, supporting the elbow in the same hand. Take the child's lower forearm in your other hand. Then supinate the forearm and flex it fully, pulling gently as you do. A click, felt or heard, means it worked. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) WHAT SUCCESS LOOKS LIKE - a reduction that works stops the pain at once. Most children start using the arm again within 5-10 minutes, and by 30 minutes 90% have no symptoms at all. It can take a child a couple of minutes to work out that moving the arm no longer hurts. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) Do not judge the attempt in the first sixty seconds. AFTERWARDS - a successful reduction needs no splint and no sling, and the outlook is excellent. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) PREVENT THE NEXT ONE - it can happen again, so instruct the parents to keep away from anything that pulls along the line of the arm: swinging, jerking or lifting the child by the hands, the wrists or the forearms. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) Say it as a sentence the family will repeat: lift the child under the arms, never by the hands. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pulled elbow - disease-level clinical article (pulled-elbow-clinical.txt) Why A pulled elbow is diagnosed on the story of a pull. When the story does not fit, or the arm does not come back, the article stops manipulating and starts imaging. Caution DO NOT MANIPULATE, IMAGE - image the elbow where a fracture or a dislocation is suspected, or where the examination shows swelling or deformity. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) A swollen or deformed elbow is not a pulled elbow. RED FLAG - THE HISTORY THAT DOES NOT FIT: imaging is called for too where the mechanism was not the usual pull along the arm, or where non-accidental injury is a worry. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) An injured arm with no pulling history in a small child is a safeguarding question, not just an orthopaedic one. IF THE ARM STAYS UNUSED - where the child does not get the use of the arm back, imaging for a fracture, or an orthopaedic opinion, may be warranted. Where the child still will not use it after several minutes and the films are normal, put the arm in a sling and refer to an orthopaedic surgeon. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) EXAMINE THE WHOLE LIMB, NOT THE ELBOW - inspect the whole of the affected arm, and the collarbone on that side as well. Palpate the arm from top to bottom, feeling for tenderness over every bone and every joint. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) A NORMAL X-RAY DOES NOT EXCLUDE IT - films are usually normal in a subluxed radial head, though the radiocapitellar line may be seen displaced on a plain film. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) The diagnosis stays clinical: a radial head subluxation can generally be diagnosed at the bedside. (Nursemaid Elbow - StatPearls - NCBI Bookshelf, NBK430777) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)