What is it?

Radial head subluxation is a condition where the radial head is pulled partially out of its socket. It usually happens in children below school age, when the forearm is forcibly pulled, as in pulling on a child's arm to prevent him from falling, or swinging with child by holding onto his outstretched hands. It is also called Pulled Elbow and a Nursemaid's Elbow.

This happens because of the peculiar anatomic shape of the radial head, and the weakness of the annular ligament at this age, that allows the radial head to be pulled out.

What are the symptoms?

Typically, a pre-school child had his arm pulled forcibly by accident, following which he will hold his arm by his side in the pronated position, and will be reluctant to use it. He may have some tenderness at the radial head.

What does your doctor do about it?

He often may take an X-ray to rule out any bony injuries, even though radial head subluxation by itself does not give any abnormal findings radiologically.

The doctor reduces the radial head subluxation by holding the arm securely, and supinating the forearm fully. The radial head reduces with a palpable or audible click, following which the child gets complete relief, and almost immediately starts using his arm again. In cases where the treatment was delayed by more than 12 hours, the child may take a little longer to resume use of his arm. In these cases, it may be helpful to rest the arm in a splint or a sling for 24 hours.

What of the future?

In cases of children who are prone to this injury, the parents need to realize it can recur with any kind of forcible pulling of the arm. Care should be exercised to avoid this as much as possible. After the age of 5, recurrence is unlikely.