USMLE Nursemaid elbow

[usmleswot]

An 18-month-old boy is brought to the emergency department because he has not used his left arm since he fell while walking and holding hands with his 8-year-old sister 2 hours ago. On examination, he holds his left upper extremity at his side with his forearm pronated. There is no tenderness of the left lower extremity, but there is restricted movement of the elbow. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate initial step in management?

A ) Passive hypersupination of the forearm

B ) Application of figure-of-8 strap

C ) Administration of analgesics and application of ice

D ) Aspiration of the elbow joint

E ) In-place splint immobilization of the elbow

The answer given is A

I thought it was hyperPRONATION for Nursemaid elbow. Any thoughts?

---

Members don't see this ad.

 

[tvelocity514]

In this case, the arm is hypersupinated pulling the head of the radius from the annular ligament which causes the pronated presentation.


Sent from my iPhone using SDN mobile

 

[usmleswot]

In this case, the arm is hypersupinated pulling the head of the radius from the annular ligament which causes the pronated presentation.


Sent from my iPhone using SDN mobile

I'm sorry, but I really didn't understand why. Why in this particular case is the arm hypersupinated? Because the child keeps it in a pronated position?

 

[Ismet]

There are 2 ways to correct nursemaid's elbow. The most common that I've seen/done is supination and flexion, but you can also hyperpronate.

In these answer choices, B-E are not appropriate initial steps in management.

 

[usmleswot]

There are 2 ways to correct nursemaid's elbow. The most common that I've seen/done is supination and flexion, but you can also hyperpronate.

In these answer choices, B-E are not appropriate initial steps in management.

Ok thanks! I guess it really is about picking the BEST choice if not entirely correct/fitting.