A 3-year-old male toddler complains of sudden arm pain. The mother indicated that pain occurred suddenly while his 9-year-old sister was helping him get dressed. The child presents with the arm flexed while protecting his elbow
On physical examination, there is tenderness along the radius with no swelling or evidence of trauma. This is a typical history of:
A. Nursemaid's elbow
B. Epicondylitis
C. Smith fracture
D. Nursery pseudo-fracture
ANS: A
Also known as pulled elbow or toddler's elbow, nursemaid's elbow involves the head of the radius slipping under the annular ligament in children, usually between 1 and 4 years of age. The condition occurs when traction is applied to the young child's hand or wrist. There is a history of sudden onset of pain associated with sudden immobility of the affected arm as the child protects the elbow. The parent may be able to identify a situation in which the child's hand was held and traction applied. The child may have moved in an opposite direction or injury could occur while pulling the arm through clothing. There is no associated swelling or inflammation. Examination is otherwise normal with the exception of resistance to attempts to move the arm, elbow, and, possibly, wrist. There may be tenderness along the upper margin of the radius.
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