Pronation may be more effective than supination in correcting pulled elbow

January 01, 0001

Pronation may be more effective than supination in correcting pulled elbow

Clinical Question:How effective is manual reduction in pronation (palm facing downwards) and supination (palm facing upwards) in correcting pulled elbow (radial head subluxation) in young children (younger than 7 years)?

Bottom line: There was limited evidence pronation might be more effective and less painful than supination. However, only a small difference in effectiveness was found. Pain perception was reported by 2 trials but data were unavailable for pooling. Both studies concluded the pronation technique was less painful than the supination technique.

Caveat: The methodological quality of all 3 trials was low because of incomplete reporting and high risk of bias resulting from lack of assessor blinding.

Context: Pulled elbow is a partial dislocation of the radial head at the elbow joint in a young child, usually caused by an adult or taller person suddenly pulling or tugging on the childÕs arm when it is straight; or when a child pulls away from an adult impulsively. The child immediately complains of pain and cannot use their arm. Many textbooks recommend supination as the preferred method in correcting pulled elbow, which is not supported by the findings of this systematic review.

Cochrane Systematic Review: Krul M et al. Manipulative interventions for reducing pulled elbow in young children. Cochrane Reviews 2009, Issue 4. Article No. CD007759. DOI: 10.1002/14651858.CD007759.pub2. This review contains 3 studies involving 313 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 226, January 2010.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: M. Musculoskeletal. Keywords: radial head subluxation, children, pronation, supination

Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 June 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.