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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 move the bones back into place (the subluxation will be reduced) in this manner:

• The child will sit on the parent or guardian's lap facing the doctor. While gently feeling the radial head with one hand, the doctor will hold the affected hand and turn it palm upward (causing supination) while fully bending (flexing) at the elbow. Alternatively, the forearm may be fully straightened with the palm inward (pronation). Often a click will be felt by the doctor and rarely may be heard.



• Your child will probably cry briefly during the procedure. After the reduction, movement will generally be pain free, and the child will quickly revert to using his or her arm as if nothing were ever wrong.



• If this procedure does not produce the expected results, it may be repeated using the same technique. After several attempts, if the child has not improved, X-rays may be ordered to check for bone fractures. There are many reports of relocating the radial head during the X-ray process due to positioning the elbow by the technologist.



• If the reduction is not possible in the emergency department, the child may have a temporary splint placed on the arm with close follow-up arranged. This situation may occur more often if the parent has delayed medical attention for the condition and the annular ligament is thus overly stretched. On follow-up examination, the elbow has often reduced itself spontaneously or will be more likely to succeed on reattempt. It is very rare to need an operation to restore the proper elbow anatomy.

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