A Clinical Trial of Pronation Versus Supination Maneuvers for the Reduction of the Pulled Elbow
A Clinical Trial of Pronation Versus Supination Maneuvers for the Reduction of the Pulled Elbow
Nursemaid elbow or pulled elbow is a condition commonly seen in the emergency department. It
 is the sudden pull of the radial head (a bone in the elbow) in toddlers. Usually occur when a
 parent tries to pull the child by the arm and a "clic" or "clunk" is felt with immediate pain
 and unwilling to move the arm. It is not a dangerous condition although it is distressing for
 kids and their parents/caretakers.
The usual therapy consists of one of two maneuvers: supination maneuver or pronation
 maneuver. They both are safe to perform but none of them have been statistically superior
 over the other. More studies are needed to confirm or discard the tendency of the studies to
 favor the pronation maneuver.

 The investigators intend to perform a randomized trial evaluating which of these techniques
 is better than the other in terms of returning the mobility of the affected arm and
 decreasing pain.
Inclusion Criteria:

 -  Pulled elbow suspected in any child presenting one of the following:

 1. History of an adult or bigger person that had pulled the child's elbow
 non-intentionally

 2. Presence of intense pain at the arrival at the emergency department and unwilling
 to move the arm.

 Exclusion Criteria:

 -  Any suspect of injury that could be intentional (child abuse)

 -  Any suspicion child of suffering a possible fracture (the mechanism of the injury was
 not from pulling the child's arm, the arm presents obvious deformity, ecchymoses,
 edema, etc.)

 -  The mechanism was from multiple trauma

 -  Any chronic disease affecting the adequate bone mineralization (vitamin D deficiency,
 osteogenesis, etc.)