Pulled elbow, is it really a joint dislocation ?
Every clinician has seen this: a distressed child, arm hanging by the side, refusing to use it, carried by a panicked parent who simply held their child’s hand to lift him/her a little too firmly. The diagnosis is pulled elbow, also called nursemaid’s elbow. But here’s where things get interesting ; is it truly a pulled elbow?
Strictly speaking, no. In a pulled elbow, the radial head does not dislocate from the radiohumeral joint. What actually happens is a technical change in the ligament: a sudden axial traction/pull on a pronated forearm causes the annular ligament a ligament encircling the radial neck to slip partially over the radial head into the joint. The bones remain in their anatomical positions. There is no radiographic abnormality and no bony displacement, just a trapped ligament.
This explains why a simple supination-flexion or hyperpronation manoeuvre resolves the problem almost instantly, freeing an entrapped ligament not reducing any dislocation.
The condition is self-limiting, responds instantly to closed reduction, and leaves no long-term sequelae.
So the next time a someone calls it a “pulled elbow” we know what we are talking about.