A mother pulls her 3-year-old son up by one arm. The child cries and then holds the limb pronated, slightly flexed at the elbow, refusing to use it. There is no swelling or bony tenderness. What is the correct reduction manoeuvre?

• A Hyperextension of the elbow followed by forceful pronation
• B Longitudinal traction with the shoulder abducted to 90 degrees
• C Traction with the elbow extended, then hyperpronation of the wrist
• D Supination of the forearm followed by flexion of the elbow ✓

Explanation

Pulled elbow is subluxation of the radial head through the annular ligament in a child under 5 years. Reduction is achieved by supination of the forearm followed by elbow flexion, classically with the examiner's thumb over the radial head to feel a click. Hyperextension is the mechanism of injury, not the treatment, and the shoulder position in option B plays no role in reducing the annular ligament.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.