Upper Limb

Question 1

Reference: Orthobullets.com

What is ‘nursemaids elbow’? MOI? EPi?

Answer 1

Subluxation radial head (tear of annular ligament into radio-capitellar jt) -caused by longitudinal traction applied to extended arm -1-4yo

(Orthobullets = OB)

Question 2

Reference: Orthobullets.com

Signs/Symp of Radial Head Sublux

Answer 2

-tends to hold elbow in slight flexion w forearm pronated +/- pain /tenderness localized to lateral aspect of the elbow.

Question 3

Reference: Orthobullets.com

SUPRACONDYLAR # -% elbow inj -peak age -OT?

Answer 3

41% 7YO Majority

Question 4

Reference: Orthobullets.com

RADIAL HEAD Sublux -% elbow inj -peak age -OT?

Answer 4

28% 3yo rare

Question 5

Reference: Orthobullets.com

LAT CONDYLAR PHYSEAL # -% elbow inj -peak age -OT?

Answer 5

11% 6yo most

Question 6

Reference: Orthobullets.com

MED EPI-CONDYLAR APOPHYSEAL # -% elbow inj -peak age -OT?

Answer 6

8% 11YO minority

Question 7

Reference: Orthobullets.com

RADIAL HEAD+NECK # -% elbow inj -peak age -OT?

Answer 7

5% 10yo minority

Question 8

Reference: Orthobullets.com

ELBOW DISLOCATIONS -% elbow inj -peak age -OT?

Answer 8

5% 13yo rare

Question 9

Reference: Orthobullets.com

MED CONDYLAR PHYEAL # -% elbow inj -peak age -OT?

Answer 9

1% 10yo rare

Question 10

Reference: Orthobullets.com

2 techniques to reduce R.H.Sublux? Better one?

Answer 10

1.SUPINATION–>FLEX 2. HYPER-pronation (better)

–>2x attempts, usu back to N w/in 10mins, otherwise WHAT ELSE?

Question 11

Reference: Orthobullets.com

Describe the SUPINATION–>FLEX reduction technique for R.H.Sublux…

Answer 11

-manually supinating forearm + flex elbow past 90 degrees of flexion

–> while holding the arm supinated the elbow is then maximally flexed SO THAT WRIST IS DIRECTED TO IPSILATERAL SHOULDER

–>during this maneuver physician’s thumb applies pressure over the radial head

–>palpable click is often heard with reduction of the radial head

Question 12

Reference: Orthobullets.com

Describe the Hyperpronation reduction technique for R.H.Sublux

Answer 12

-hold childs elbow @90d in one hand

–> firmly pronate wrist WHILST

–> EXTENDING elbow

Question 13

Reference: Orthobullets.com

recurrence of Rad.Head Sublux?

Answer 13

5% to 39% of cases, but generally ceases after 5 yo

Question 14

Reference: Orthobullets.com

F/up of R.H.Sublux?

Answer 14

• immob not necessary
• only req if not normal ~1wk
• avoid traction