A mother pulls her 3-year-old child up by one outstretched arm. The child then holds the limb pronated and slightly flexed and refuses to use it. There is no swelling or deformity. The anatomical basis of this condition and the standard reduction manoeuvre are:

• A Tear of the annular ligament; hyperextension and traction of the elbow
• B Dislocation of the proximal radioulnar joint; pronation and extension
• C Subluxation of the annular ligament over the radial head; supination and flexion of the elbow ✓
• D Fracture of the radial neck; immobilisation in an above-elbow cast

Explanation

Pulled elbow (nursemaid's elbow) occurs when longitudinal traction on a pronated extended arm lets the immature annular ligament slip partly over the radial head. Reduction is by supination of the forearm followed by rapid full flexion of the elbow, usually with a palpable click and immediate return of function. No imaging is needed before reduction when the history is typical. Recurrence is possible until the ligament matures, and parents should be advised against axial traction.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.