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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The doctor will obtain the history of how the injury happened by asking what occurred just before the event or what activities were being performed. Additional history specifically about the use of the arm, positions in which the arm has been held, and anything that has made the condition worse or better is very important.

• The doctor will feel the arm and look for any evidence of other injuries. The doctor will be looking for tenderness over any portions of the bones being felt in the arm. There may be some slight tenderness over the radial head.



• X-rays are typically not obtained or required unless another condition, such as a fracture (broken bone), is suspected, or if the reduction attempts are not successful. Indications for possible fracture include significant swelling or bruising of the elbow area or a mechanism of injury not consistent with nursemaid elbow (for example, fall from a chair). X-rays appear normal in 95%-100% of children with radial head subluxation and thus are not helpful in diagnosis.

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