Nursemaid's elbow

A radial head subluxation (also Chassaignac paralysis or Pronatio dolorosa; Latin: subluxation capituli radii or subluxation of the radius perianularis, English: Nursemaid 's elbow or Pulled elbow - German: nursemaid 's elbow or Sonntagsarm; French: pronation douloureuse ) is an in infants up exceeding five years frequently occurring Pronationsblockade, often as Teilausrenkung ( subluxation ) of the spoke little head is called. It is caused by strong, unprepared and sudden train at the fully extended and pronated ( internally rotated ) forearm or hand. The most common situation is to pull the screaming, struggling child by the hand from the floor. It can also be triggered if the child holds with one or both hands and pulling it away vigorously, or it is held by both hands quickly turned in a circle. Similarly, it has been described as judo, rarely by direct trauma ..

The exact cause is not known, generally is thought that this ( anular ligament of the radius ) the spoke head partially forward and distally from its retaining ring band slides out, and that it is then clamped humeri upon release of the train between the radial head and the capitellum. The event itself is very painful, then there are usually little or no pain when not moving or pulling the arm. The child holds the forearm in pronation in posture ( pronation ) and slight flexion, so that the arm paralyzed acts ( pseudo- paresis ), hence the name Chassaignac paralysis. Occasionally can be heard or felt when the subluxation a click.

The first description was in 1671 by the French surgeon D. Fournier. A symptom of the radial head subluxation ( the Chassaignac 's palsy ) and the Repositionsmaneuver ( Chassaignac - handle) is named after the French surgeon Charles Marie Edouard Chassaignac ( 1805-1879 ).

The radial head subluxation is one of the most common injuries in children under 4 years. It occurs mostly in children 1-4 years, in children over 5 years, it practically does not exist anymore. This is explained by the fact that the ring band ( annular ligament ) is stronger, and is anchored distally fixed at the radial neck, although it is unknown what role does the ring band exactly.

Diagnosis

For the experienced physician's diagnosis on the basis of the appeal and image of the previous event is simple. The arm is paralyzed and held no longer used to play. The elbow is usually slightly bent and the forearm always turned inward ( pronated ). In quiet and cooperative children a painless flexion and extension of the elbow is possible, but no rotation of the forearm.

When not directly preceded by trauma and delayed conception with for several hours or a day or two existing complaints or posture may rarely also be a septic elbow arthritis, which also carried a conservation in slight flexion and pronation clearer.

X-ray

Whether a radiograph of the elbow joint is necessary in two levels, is controversial. On one hand, an obligate radiograph is required to rule out concomitant fractures of the radial head and distal humerus ( the subject of an actual frequency not specified ). Other experts consider radiographs other hand dispensable and unnecessary if the medical history and the findings are unique and typical, and there are no more complaints after reduction.

A radiograph of a radial head subluxation is unremarkable, there is no visible movement of the radial head to the capitellum, in contrast to the real radial head dislocation. Echo Graphically no effusion is detected.

It is described that may already by the X - Wizard Wiedereinrenkung ( reduction ), as for an exact frontal (AP ) Recording of the elbow, the forearm in full extension and full external rotation ( supination ) must be kept.

Therapy

There are several reduction techniques, all include a considerable supination. A reduction technique is the simultaneous stretching under train and outward rotation ( supination ) of the forearm. Occasionally exerted by the thumb print of radiodorsal on the radial head of the forearm ( Chassaignac Handle ) - although not a true dislocation is present and thus only a higher pressure on the folded-back ring band instead of the radial head is exercised. Another technique is the powerful and rapid supination of the diffracted at 90 ° elbow.

An anesthetic is not necessary. The improvement occurs - to the amazement of relatives - just one: The arm is back to normal moves and used. In rare cases it may happen that an edge of the ring band collapses and thus becomes the " Repositionshindernis ". A subsequent immobilization or other control is not necessary.

Occasionally, the idea occurs only after a delay, sometimes more than 24 hours later. Then an immediate symptom-free after reduction is often impossible to achieve, even it can be easy, even in sleep, come to re- subluxation. Then a long arm plaster in supination for a few days to two weeks is recommended for conservation.

The risk of recurrent radial head subluxation is 5%, so the parents should be strongly advised the child not to pull up on the hand. Frequently recurring subluxations are also regarded as an indication for a three-to six-week immobilization in a long arm plaster - in addition to the serious discussion of subluxations cause with the parents.

Sources and References

• Pediatric traumatology
• Disease in orthopedic and trauma surgery
• Disease in pediatric surgery