Mississauga Chiropractor Presents: Pulled Elbow

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Here’s another Blog from a Mississauga Chiropractor…

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A pulled elbow is a temporary displacement of the radial head from the annular ligament.  Pain is due to a pinched annular ligament.  This is an extremely common traumatic injury in preschool children

 

Demographics:

a)      Age: up to 5 years old; peak incidence is 2-3 years old (usually toddlers) – rare after age 5

 

Causes:

a)      Sudden traction on the forearm/hand with the elbow extended & forearm pronated (often when a parent is lifting a child over a curb, or in/out of a shopping cart

b)      Lax, weak annular ligament; radial head is still small at this age

 

History:

a)      Adult or sibling lifts/swings child by the arm

b)      Child has no history of trauma, but suddenly refuses to use their arm

c)      Child presents with pain/apprehension/guarded; injury is less severe than the symptoms may indicate (child’s anxiety is often greater than pain)

d)      Child’s forearm is pronated with elbow slightly flexed & unwilling to move or straighten the arm

e)      Child’s injured foream may be supported/protected by the opposite hand

 

Management:

a)      Home Care:  Protect & immobilize the affected extremity

b)      Manipulation to reduce the displacement if child is under 4 years old

  1. Elbow is stabilized over the cubital fossa – distal forearm is quickly distracted & supinated.  Supination is key (combined Supination with flexion)
  2. A palpable and sometime audible click will indicate reduction
  3. Often immediate relief & restored function after manipulation

c)      Refer if child is over 4 years old or if manipulation fails

d)      Ice to numb the pain (24-48 hours)

e)      Excellent prognosis

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