Management of radial head subluxation (pulled elbow) in children 6 months to 5 years of age*

* For management of infants <6 months or children ≥5 years, refer to UpToDate content on radial head subluxation (pulled elbow).
¶ In cases where a history of pull injury is absent and the physical examination is otherwise consistent with radial head subluxation, performing reduction without first obtaining plain radiographs is still appropriate.
Δ The hyperpronation method is suggested for reduction of radial head subluxation for initial and repeat attempts because the success rate may be higher. For a description of this technique, refer to the UpToDate content on radial head subluxation (pulled elbow).
◊ Patients with full arm mobility at follow-up can be presumed to have had a radial head subluxation that spontaneously reduced and require no further care. Patients who have persistent immobility of the arm at follow-up warrant splinting and, if the follow-up visit was with the primary care provider, orthopedic referral.