A 2-year old child is spinned around by his father holding his hand. Suddenly the child started crying and did not allow his father to touch his elbow. Which of the following is the likely diagnosis?
Ans. a. Pulled elbow (Ref: Apley 9/e p765)The diagnosis in a 2-year-old child spinned around by his father holding his hand, who starts crying and not allowing his father to touch his elbow is pulled elbow.Pulled Elbow (Nursemaid's Elbow)It is subluxation of radial headQ or more accurately subluxation of the annular (orbicular) ligament, which slips up over the head of radius into the radiocapitellar joint.Mechanism of Injury:Forearm is pronated, elbow is extended and longitudinal tractionQ is applied to the patient's wrist or hand. Such an injury typically occurs when a young child is lifted or swung by the forearmQA child suddenly steps down from a step or off a crub while one of the parents is holding the hand or wrist.Infants (< 6 months) sustain the injury when rolling over in bed with the extended elbow trapped under the body. Clinical Feature: Common in children < 4 years and rare in > 5 yearsQ (because the annular ligament is thicker or stronger)Maximum incidence in 1-3 years age group.The child holds the elbow in slight flexion with the forearm pronated.Supination is limited and voluntarily resisted.Flexion elbow (If could be done) is painless no evidence of effusion and local tenderness is present over radial head and annular ligament.A click may have been heard or felt by a person who pulled it.Diagnosis:Radiographs are normal Treatment:Reduced by flexing the elbow to 90deg and rapidly and firmly rotating the forearm into full supinationQImmobilization is not necessary
Pulled elbow
Supracondylar fracture
Fracture olecranon process
Radial head dislocation
Dislocation of Elbow Joint