Pulled Elbow

Modern Study Review (AI-Generated)

High-Yield Summary

Pulled elbow, or radial head subluxation, is the most common traumatic elbow injury in young children, typically under age 5. It results from sudden longitudinal traction on an extended, pronated forearm causing the annular ligament to slip and become entrapped between the radial head and capitellum. Prompt recognition and reduction restore function rapidly, with excellent outcomes and minimal complications when managed appropriately.

Key Diagnostic Findings

Anatomy

• Radial head: Proximal radius articulation with the capitellum of the humerus.
• Annular ligament: Encircles the radial head, stabilizing it against the ulna and humerus.
• Mechanism: Longitudinal traction in pronation causes partial radial head subluxation by tearing or slipping of the annular ligament.

Clinical Presentation

• Sudden onset of pain and refusal to use the affected arm after a pulling injury.
• Typically affects children aged 1–5 years; rare after age 5 due to ligamentous strengthening and ossification.
• Arm held slightly flexed and pronated; minimal swelling or deformity.
• No history of direct trauma or fracture.

Imaging

• Usually not required if classic history and exam are present.
• X-rays are indicated to exclude fractures or Monteggia lesions (proximal ulna fracture with radial head dislocation) or congenital dislocation.
• Radiographs typically normal in pulled elbow.

Classification Systems

• No formal classification system is widely used for pulled elbow.
• Diagnosis is clinical, supported by history and physical exam.

Current Gold Standard Treatment

Non-operative

• Reduction maneuver:
• Position elbow at 60–90° flexion.
• Forcefully supinate the forearm while applying pressure over the radial head with the thumb.
• Then fully flex the elbow maximally while maintaining supination.
• Immediate relief of pain and return of function is expected.
• No immobilization required post-reduction; encourage normal use of the arm.
• If unsuccessful, repeat once; persistent cases may require orthopedic referral.

Operative

• Rarely indicated.
• Consider if recurrent subluxations or if reduction fails after multiple attempts.
• Surgical repair of annular ligament or stabilization may be considered in chronic or recurrent cases.

Modern Complications & Outcomes

Complications

Outcomes

• Excellent prognosis with prompt diagnosis and reduction.
• Full return of function typically within minutes to hours.
• No long-term functional deficits expected in uncomplicated cases.
• Education of caregivers reduces recurrence risk.

Classic Clinical Notes

Pulled Elbow

• Probably the most common traumatic elbow injury in children.
• Produced when the arm is pulled in pronation—longitudinal traction in pronation pulls the radial head distally by tearing the annular ligament attachment to the radius. As the traction is released, the annular ligament gets caught between the radial head and capitellum.
• Rare after age 5.

X-ray

• Make sure you are not missing a Monteggia or a congenital dislocation.

Reduction technique:

• The subluxation is then reduced by forcefully supinating the forearm with the elbow in 60-90 degrees of flexion.
• With the forearm forcefully supinated, the elbow is fully flexed maximally.
• The surgeon’s thumb is placed over the radial head and pushes down.

• Watch for the child to begin using the arm.

Last Updated on January 25, 2026 by orthonet