“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.”

-Kailash Satyarthi


Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not use his arm.


There are two well-described methods for reduction: (1) supination followed by flexion and (2) hyperpronation. For the supination and flexion method, the clinician supinates the forearm fully and then flexes at the elbow.


Image from www.orthobullets.com.
Image from www.orthobullets.com.


For the hyperpronation method, the elbow is held at 90 degrees, and the wrist is then hyperpronated.


Image from www.orthobullets.com.
Image from www.orthobullets.com.


In both cases, a “click” is usually felt. Here is a video showing the methods by Larry Mellick:



A few different studies support higher success rates with hyperpronation (see references below). Try the hyperpronation method first for your next Nursemaid’s elbow!




Bek, Dogan, et al. “Pronation versus supination maneuvers for the reduction of ‘pulled elbow’: a randomized clinical trial.” European Journal of Emergency Medicine 16.3 (2009): 135-138.


Gunaydin, Yahya Kemal, et al. “Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid’s elbow cases.” The American journal of emergency medicine 31.7 (2013): 1078-1081.


Gupta, Nachi, and Jeff Nusbaum. “Rosh Review Hits The Airwaves…The Best Emergency Medicine Board Review Is Now In Audio.” Audio blog post. Roshcast. N.p., 11 Oct. 2016. Web. 31 Jan. 2017. <https://www.roshreview.com/blog/rosh-review-hits-the-airwaves-the-best-emergency-medicine-board-review-is-now-in-audio>.


Hughes, Michael. “Nursemaid’s Elbow.” Ortho Bullets. N.p., n.d. Web. 31 Jan. 2017. <http://www.orthobullets.com/pediatrics/4012/nursemaids-elbow>.


Krul, Marjolein, et al. “Manipulative interventions for reducing pulled elbow in young children.” The Cochrane Library (2012).


Macias, Charles G., Joan Bothner, and Robert Wiebe. “A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations.” Pediatrics 102.1 (1998): e10-e10.


Wu, Fred, and Michelle Lin. “Quick Trick: Hyperpronation of Nursemaid’s Elbow.” Emergency Physicians Monthly. N.p., n.d. Web. 31 Jan. 2017. <http://epmonthly.com/article/quick-trick-hyperpronation-of-nursemaids-elbow>.


Main image from kidshealth.org.

July 2024