A mother pulls her 2-year-old child up by one arm while lifting him. The child cries and then refuses to use the arm, holding it in slight flexion and pronation. There is no swelling or bony tenderness at the elbow. The structure responsible and the correct reduction manoeuvre are:

• A Interposition of the brachialis tendon; forced flexion and rotation
• B Torn radial collateral ligament; pronation and extension
• C Subluxation of the ulnohumeral joint; hyperextension traction
• D Annular ligament slip around the radial head; supination and flexion ✓

Explanation

Radial head subluxation (pulled elbow) occurs when longitudinal traction tears or displaces the annular ligament, allowing a portion of it to slip between the radial head and capitellum. Reduction is achieved by supinating the forearm and flexing the elbow while pressing over the radial head, often with a felt click. Pronation and flexion also works, but pronation with the elbow extended does not reduce it. The child typically uses the arm within minutes of successful reduction.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.