Pulled elbow, also known as nursemaid's elbow, occurs when the arm is pulled by longitudinal traction with the forearm in pronation (Figure 1).
The annular ligament is torn at its insertion into the radius (Figure 2). The head of the radius moves distally. When traction is released, the annular ligament becomes trapped into the elbow joint.
This is a very common condition that occurs in children by an adult tugging or pulling the child along by the wrist. This injury occurs due to radial head subluxation (Figure 3). The injury usually occurs in children between 1-4 years of age. The child will refuse to use the arm as if it was paralyzed, and the child will hold the arm slightly flexed and pronated.
The elbow is reduced by flexing the elbow slightly and then supinating the forearm. Usually the elbow is reduced by the X-ray technician as they try to get a true AP view of the elbow by supinating the forearm. A click can be heard when the pulled elbow is reduced and the x-rays are usually negative.
Immobilization is not necessary when treating a pulled elbow. After closed reduction, the child usually moves the elbow very well and will resume normal activity. Recurrence of the injury is rare and irreducible conditions are rare. This condition usually does not require surgery. To avoid a nursemaid's elbow injury, it is always important to warn parents about the risks of pulling their child by the arm.