A mother pulls her 3-year-old child's arm to lift him off the ground. The child now holds the elbow slightly flexed and pronated and refuses to use the arm. There is no swelling or bony tenderness. X-rays are normal. The most likely pathology and correct reduction manoeuvre are:

• A Distal biceps entrapment; hyperextension and supination
• B Radial neck fracture; pronation and extension of the elbow
• C Annular ligament interposition; supination and flexion of the elbow ✓
• D Medial epicondyle avulsion; flexion and supination

Explanation

Pulled elbow (radial head subluxation) occurs when sudden traction causes the annular ligament to slip partly over the radial head in children under 5 years. Reduction is achieved by supination of the fully extended forearm followed by elbow flexion, often with a palpable click. Radiographs are normal, which excludes a radial neck fracture, and the absence of medial tenderness excludes an epicondylar avulsion.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.