Child refuses to move their arm

Medgeeks with Andrew Reid

Medgeeks

Education, Medicine, Health & Fitness

4.8 • 997 Ratings

🗓️ 9 February 2018

⏱️ 11 minutes

🔗️ Recording | iTunes | RSS

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Summary

Today, we're going to discuss Nurse Maid Elbow. Specifically, we'll review:

The anatomy of the elbow
How this injury occurs
How the patient presents
Imaging studies to consider
Treatment
A case study of a patient he had presenting to the ER
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I once had a mother who came into the ER with her two-year old son extremely upset with herself and very emotional.

She was upset because she had just put her son in day care and gone back to work recently because she said money was really tight

And that, something like this wouldn't have happened if she were still the one taking care of her son.

The mother wasn't exactly sure what happened, but she was told that while at daycare someone stepped on her son's hand and then he wouldn't use his whole arm since.

Now the mother could not believe that this is what actually happened and she sincerely asked me if I thought that someone could have physically assaulted her child.

So, we'll go through this case in more detail.
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Transcript

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0:00.0	What's up guys? Today we're going to talk about nurse maid's elbow.
0:03.4	We're briefly going to review some anatomy, talk about how this injury occurs,
0:06.7	how these patients are going to present, what imaging studies to consider ordering,
0:10.4	how to treat these patients, and then I'm going to tell you a personal story in
0:13.6	mind which is probably why I love taking care of these patients so much. So quickly
0:17.4	let's go over some anatomy of the elbow and the normal individual because it will
0:21.0	soon prove to be of importance in understanding the
0:23.4	mechanism behind this injury. The elbow is a hinge joint and it's made up of the
0:27.8	distal aspect of the humorous and the proximal portions of the radius and the
0:32.2	ulna. Then you have the annular ligament
0:34.8	which encircles the proximal head of the radius and it helps keep in contact with the
0:39.2	radial notch of the ulna. So in Nursemaid's elbow, which is also called radial head
0:44.6	subluxation, a portion of this annular ligament slips over the head of
0:49.4	the radius and gets trapped in between the radial
0:53.2	humoral joint. But how does this most commonly occur?
0:56.6	Well, it most commonly occurs in children between the ages of one and four.
1:01.2	And interesting enough, it is more frequent in in girls and it's going to be more
1:04.8	frequent in the left arm but I'm not sure why. The mechanism behind this injury
1:09.9	often results from an actualial traction, however,
1:12.5	to a pronated forearm with an extended elbow.
1:15.4	So more simply put, let's say you have a three-year-old girl
1:18.3	and she's holding your hand as you wait
	...

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