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Related Experiment Video

Updated: Jun 19, 2026

A Standardized Method for Measurement of Elbow Kinesthesia
07:56

A Standardized Method for Measurement of Elbow Kinesthesia

Published on: October 10, 2020

Manipulative interventions for reducing pulled elbow in young children.

Marjolein Krul1, Johannes C van der Wouden, Lisette Wa van Suijlekom-Smit

  • 1Department of General Practice, Erasmus MC, University Medical Center, PO Box 1738, Rotterdam, Zuid-Holland, Netherlands, 3000 DR.

The Cochrane Database of Systematic Reviews
|October 13, 2009
PubMed
Summary

The pronation technique for reducing pulled elbow (nursemaid's elbow) in children appears more effective and less painful than the supination method. However, more high-quality research is needed to confirm these findings.

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Area of Science:

  • Pediatrics
  • Orthopedics
  • Musculoskeletal Trauma

Background:

  • Pulled elbow, or nursemaid's elbow, is a common radial head subluxation in young children caused by a sudden pull on the arm.
  • Treatment typically involves manual reduction of the radial head, with various maneuvers described.

Purpose of the Study:

  • To compare the effectiveness and painfulness of different manipulative interventions for pulled elbow in young children.

Main Methods:

  • A systematic review of randomized and quasi-randomized controlled trials was conducted.
  • Searches included major databases (Cochrane, MEDLINE, EMBASE, etc.) up to January 2009.
  • The primary outcome was treatment failure on the first attempt.

Main Results:

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Last Updated: Jun 19, 2026

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  • Three low-quality trials with 313 participants compared pronation and supination techniques.
  • Pronation showed a statistically significant lower failure rate compared to supination (RR 0.53).
  • Two trials suggested pronation was less painful, but data were not pooled.

Conclusions:

  • Limited evidence from small, low-quality trials suggests pronation may be more effective and less painful for reducing pulled elbow.
  • A small difference in effectiveness was observed.
  • High-quality randomized trials are recommended to strengthen the evidence base.