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Evidence summaries

Manipulative Interventions for Reducing Pulled Elbow in Young Children

Pronation method for reducing pulled elbow in young children may be more successful and less painful than supination method. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (lack of or unclear allocation concealment and lack of blinding), and by imprecise results (few patients).

Summary

A Cochrane review [Abstract] 1 included 4 studies evaluating manipulative interventions for pulled elbow with a total of 379 subjects, all younger than seven years old. All trials compared pronation versus supination. Pronation resulted in statistically significantly less failure than supination (21/177 versus 47/181; RR 0.45, 95% Cl 0.28 to 0.73). Pain perception was reported by two trials but data were unavailable for pooling. Both studies concluded that the pronation technique was less painful than the supination technique.

Clinical comment

Although not assessed by trials, the best practice might be to use both pronation and supination: starting with pronation, followed by immediate supination.

    References

    • Krul M, van der Wouden JC, van Suijlekom-Smit LW et al. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev 2012;(1):CD007759. [PubMed].

Primary/Secondary Keywords