Name of the Procedure:

Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation

Summary

This procedure, often called a nursemaid's elbow reduction, involves manually repositioning a dislocated radial head in a child's elbow. It is a common and straightforward method to correct the elbow joint without the need for surgery.

Purpose

The procedure addresses a condition known as radial head subluxation or nursemaid's elbow, which occurs when the radial head slips out of its normal position. The goal is to quickly and safely return the radial head to its proper place, alleviating pain and restoring normal arm function.

Indications

• Sudden arm pain and inability to use the arm in a child, usually after a pulling injury.
• Tenderness and reluctance to move the affected arm.
• Confirmation of radial head subluxation through clinical evaluation, often without the need for imaging.

Preparation

• Minimal preparation is typically required.
• Parents or guardians may be asked to comfort and reassure the child.
• No specific fasting or medication adjustments are necessary.
• Brief medical history and physical examination to confirm the diagnosis.

Procedure Description

1. The child is positioned comfortably, often sitting on a guardian's lap.
2. The healthcare provider gently supports the child's arm.
3. Two common techniques may be used:
   • Supination and flexion: The forearm is turned palm-up and bent at the elbow.
   • Hyperpronation: The forearm is turned palm-down and rotated internally.
4. A palpable click or pop may be felt as the radial head repositions.

Duration

The manipulation typically takes only a few seconds to a minute.

Setting

The procedure is performed in an outpatient clinic, emergency room, or doctor's office.

Personnel

• Usually performed by a physician, such as a pediatrician, emergency room doctor, or an orthopedic specialist.
• A nurse may assist with positioning and comforting the child.

Risks and Complications

• Minimal risks when properly performed.
• Rare complications may include residual pain or re-subluxation, which can be managed with additional intervention.
• Very rare risk of incorrectly diagnosing another elbow injury, such as a fracture.

Benefits

• Immediate relief of pain and restoration of arm movement.
• High success rate with a simple, non-invasive technique.
• Typically, children regain normal use of the arm almost immediately after reduction.

Recovery

• No specific post-procedure care required.
• Parents should monitor the child for recurrence of symptoms.
• Follow-up is rarely necessary unless symptoms persist or recur.

Alternatives

• Alternative treatment may include imaging studies to confirm diagnosis, though typically not needed.
• If reduction is unsuccessful, further evaluation by a specialist may be necessary.
• Surgical intervention is extremely rare and only considered in complicated cases.

Patient Experience

• The child may experience brief discomfort during the manipulation.
• Comfort measures include a gentle environment and reassuring presence of parents.
• Pain resolves almost immediately after successful reduction, leading to rapid return of normal arm use.