A child pulled on the arm and now refuses to use the arm; what is the most likely injury?

A child pulled on the arm and now refuses to use the arm; what is the most likely injury?

• A. Elbow dislocation
• B. Radial head subluxation
• C. Clavicle fracture
• D. Fractured humerus

Answer: (B)

Trauma from pulling on a child’s arm most often causes a radial head subluxation, known as nursemaid’s elbow. The mechanism is a traction force on an extended forearm, which lets the radial head slip partially under the annular ligament while the arm remains painful and reluctant to use. The hallmark is sudden onset of pain with movement and the child often keeps the elbow slightly flexed and the forearm pronated, appearing otherwise well with little or no swelling or deformity. This presentation is classic and makes radial head subluxation the most likely diagnosis in a child who was pulled on the arm and then refused to use it. Other injuries tend to present with more obvious signs. An elbow dislocation usually shows deformity and swelling around the elbow. A clavicle fracture often has visible swelling or a bump over the collarbone and pain with lifting the arm. A fractured humerus typically causes marked pain, swelling, and possibly an abnormal contour of the upper arm. Reduction of the radial head subluxation is quick and can restore motion immediately, typically with a simple maneuver that repositions the radial head under the annular ligament. Imaging may be normal in classic cases, though X-rays are obtained if there’s any doubt or if the mechanism or exam isn’t typical.

Trauma from pulling on a child’s arm most often causes a radial head subluxation, known as nursemaid’s elbow. The mechanism is a traction force on an extended forearm, which lets the radial head slip partially under the annular ligament while the arm remains painful and reluctant to use. The hallmark is sudden onset of pain with movement and the child often keeps the elbow slightly flexed and the forearm pronated, appearing otherwise well with little or no swelling or deformity. This presentation is classic and makes radial head subluxation the most likely diagnosis in a child who was pulled on the arm and then refused to use it.

Other injuries tend to present with more obvious signs. An elbow dislocation usually shows deformity and swelling around the elbow. A clavicle fracture often has visible swelling or a bump over the collarbone and pain with lifting the arm. A fractured humerus typically causes marked pain, swelling, and possibly an abnormal contour of the upper arm.

Reduction of the radial head subluxation is quick and can restore motion immediately, typically with a simple maneuver that repositions the radial head under the annular ligament. Imaging may be normal in classic cases, though X-rays are obtained if there’s any doubt or if the mechanism or exam isn’t typical.