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Obscure pathology of pulled elbow: dynamic high-resolution ultrasound-assisted classification

Hossam S Diab, Manal M S Hamed, Yasser Allam

    Journal of Children'S Orthopaedics
    |December 2, 2011
    PubMed

    Insights

    Ultrasound can classify pulled elbow injuries by identifying an interposed or torn radial annular ligament (RAL), aiding in management and explaining varied recovery times in children.

    Area of Science:

    • Pediatric Orthopedics
    • Musculoskeletal Imaging
    • Radiology

    Background:

    • Pulled elbow (nursemaid's elbow) is a common radial head subluxation in children.
    • Clinical presentation and recovery can vary, lacking clear pathological explanations.
    • Sudden pull on a pronated, extended forearm causes this injury.

    Purpose of the Study:

    • To propose an explanation for varying clinical responses in pulled elbow.
    • To classify underlying pathology using ultrasound.
    • To assess ultrasound's impact on management decisions.

    Main Methods:

    • Fifty children with pulled elbow underwent static and dynamic ultrasound.
    • The radial annular ligament (RAL) was assessed for integrity and interposition.
    • Reduction techniques and postreduction splinting were guided by ultrasound findings.

    Main Results:

    • Type I: 78% had intact but interposed RAL.
    • Type II: 22% had torn RAL, requiring 7 days of splinting.
    • Ultrasound demonstrated 76.9% sensitivity and 92.3% specificity for torn RAL.

    Conclusions:

    • Pulled elbow can be classified into Type I (interposed RAL) and Type II (torn RAL).
    • Ultrasound classification aids in understanding varied clinical responses.
    • This classification impacts post-reduction management strategies.
    Abstract

    Keywords:
    Annular ligamentClassificationPulled elbowUltrasound

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