Pulled elbow is a dislocation of the elbow joint in a young child which is usually caused by an adult, or taller person, suddenly pulling or tugging on the child's arm when it is straight; or when a child pulls away from an adult impulsively. The child immediately complains of pain and cannot use their arm.
Treatment usually consists of manipulating the arm to get the bones of the elbow back into their correct position. It is usually treated by manual intervention. In the typical manoeuvre, called supination, the forearm is twisted or rotated outwards (palm of child’s hand faces upwards), sometimes followed by bending of the elbow. While this has become standard practice, it is not always successful. Other methods, particularly the use of pronation, where the forearm is twisted or rotated inwards (palm of child’s hand faces downwards), have also been used. These methods are generally safe, although bruising can occur and they can be painful.
This review included four small, low quality trials involving a total of 379 children, all of whom were younger than seven years old. The evidence suggests that the pronation method (with the hand downward) is more successful in repositioning and less painful for children with a pulled elbow.