Treatment of recurrent pulled elbows
Date First Published:
June 23, 2008
Last Updated:
August 4, 2009
Report by:
Mr Graham Ellis , Specialist Registrar Emergency Medicine (Royal Preston Hospital)
Search checked by:
Dr Alison Robinson, Royal Preston Hospital
Three-Part Question:
In a [child presenting with pulled elbow] does [manipulation followed by immobilisation] prevent [recurrent episodes]?
Clinical Scenario:
A 3 year old child accompanied by his mother presents to the emergency department with symptoms of pulled elbow following a minor slip on the stairs where he grabbed the bannister. Mum is quite annoyed when you examine the child as you reduced the same elbow 5 days previously. Happy that the elbow was in full use before the initial discharge you wonder if splinting the elbow in some way would have prevented recurrence.
Search Strategy:
Medline(R) Ovid interface 1950- date
EMBASE 1974-date
Google Scholar
EMBASE 1974-date
Google Scholar
Search Details:
[(pulled adj elbow) OR (nursemaids adj elbow) OR (nurse adj elbow) OR(ligament, annular) OR (radial head subluxation)] AND [(exp.splints) OR (plastercast.mp) OR (casts,surgical) OR (plaster of paris.mp) OR (immobilisation) OR (immobilization)] AND [(exp.recurrence) OR (recur$)]
Limited to humans and English
Limited to humans and English
Outcome:
75 articles found
1 paper relevant to clinical scenario
1 paper relevant to clinical scenario
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The treatment of pulled elbow: a prospective randomised study. Assad M Taha 2000 Lebanon | 64 consecutive children diagnosed with pulled elbow who all had manipulative reduction. Those with first names starting A-M had POP with elbow flexed and suppinated for 2 days. Names N-Z control group. All assessed by author at 2,5 and 10 days, | Randomised Control Trial | Recurrence or persistence of pulled elbow when examined at 2,5 or 10 days. | Children A-M no recurrence/persistence<br><br>N-Z 1 on day2, 3 on day5, 0 day 10 | Small numbers in study. Randomisation by name could lead to inclusion bias. Researcher not blinded at recruitment into trial. No record of reduction technique or clinician(s) carrying out reduction. |
Author Commentary:
Only one study with a small population of children diagnosed with pulled elbow. Over the study period of 3 years recurrence was seen in only 4 children. If all children were splinted with a POP then it would seem there would be a financial burden and also the distress to the child from having a cast and requiring follow up, that would not benefit the majority.
Bottom Line:
The evidence is not strong enough to start splinting all pulled elbows following manipulation. The number of children suffering recurrence in the available study over a fairly long period of time would not suggest treatment other than manipulative reduction should be carried out at present.
References:
- Assad M Taha. The treatment of pulled elbow: a prospective randomised study.