Pulled elbow

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A pulling the elbows , also known as the radial head subluxation , is when the ligament that wraps around the radial head slips. Often a child will hold their arms against their body with the elbows slightly bent. They will not move the arm because it causes pain. Touching the arm, without moving the elbows, is usually not painful.

A pulled elbow usually results from a sudden pull on the long arm. This can happen when lifting or swinging the child by the arm. The underlying mechanism involves the annular slippage of the ligaments of the head of the fingers followed by the ligaments trapped between the fingers and the humerus. Diagnosis is often based on symptoms. Xray can be done to override other problems.

Prevention is to avoid potential causes. Treatment is by subtraction. Moving the forearm down to the palm down position by straightening the elbow seems to be more effective than moving it to the position of the palm of the hand followed by bending the elbow. After a successful reduction, the child will return to normal within a few minutes. Interesting elbows are common. Usually occurs in children between 1 and 4 years of age, although it can occur until the age of 7 years.

Video Pulled elbow

Signs and symptoms

Symptoms include:

• The child stops using the arm, which is held in an extension (or slightly bent) and palms down.
• Minimal swelling.
• All movements are allowed except supination.
• Caused by longitudinal traction with wrists in pronation, although in the course of only 51% of people reported to have this mechanism, with 22% reporting falling, and patients less than 6 months of age recorded injury after rolling on the bed.

Maps Pulled elbow

Cause

This injury has also been reported in infants younger than six months and in older children until the age of preteens. There is little predilection for this injury to occur in girls and in the left arm. The classic mechanism of injury is the longitudinal pull on the arm with the wrist in pronation, as it happens when the child is lifted by the wrist. There is no support for the general assumption that the relatively small head of the radius is compared to the neck of the young predisposes of the fingers for this injury.

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Pathophysiology

The distal attachment of the annular ligaments covering the radial head is weaker in children than in adults, making it easier to tear. The older child will usually point to the proximal forearm dorsal aspect when asked where the pain is. It may mislead someone to suspect a fracture of the proximal radius buckle. There is no tear in the soft tissues (probably due to the elasticity of young connective tissue).

The lower arm contains two bones: the fingers and the ulna. These bones attach to each other either at the proximal end, or elbow, and also at the distal, or the wrist, the tip. Among other movements, the forearm is capable of pronation and supination, which says a rotation about the long axis of the forearm. In this movement the ulna, which is connected to the humerus by a simple hinge joint, remains silent, while the fingers rotate, carrying the wrist and hand with it. To allow this rotation, the proximal end (elbow) of the radius is held near the ulna by a ligament known as the annular ligament. This is a circular ligament structure in which the fingers are free, with the constraints that exist elsewhere in the forearm, to rotate. The proximal end of the fingers in cone-shaped young children, with the wider end of the cone nearest the elbow. With the passage of time, the shape of this bone changes, becoming more cylindrical but with widened proximal ends.

If the forearm of a small child is withdrawn, it is possible for this traction to pull the radius into the annular ligament with enough force to cause a standstill inside. This causes significant pain, partial restriction of flexion/elbow extension and total loss of pronation/supination on affected arm. This situation is rare in adults, or in older children, because changes in the shape of the fingers associated with growth prevent it.

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Diagnosis

Diagnosis is often based on symptoms. Xray can be done to override other problems.

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Treatment

To solve the problem, the affected arm is removed in a way that causes the joints to return to their normal position. The two main methods are hyperpronation and a combination of supination and flexion. Hyperpronation has a higher success rate and is less painful than supine-flexion maneuvers.

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References

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External links

• FPNotebook

Source of the article : Wikipedia