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Subluxation of Radial Head - Nursemaid's Elbow

Subluxation is an injury caused when the normal position of a joint (or other part of the body) is partially or incompletely dislocated.

Subluxation can be caused by injuries and impact to the joint or from instability of the joint due to laxed muscles, tendons, or ligaments that usually support or hold the joint in place.

Although not a complete dislocation, subluxation can be as painful and disruptive as a dislocation. Diagnosis occurs after x-ray of the painful joint is reviewed and treatment for sublimation is the same as dislocation with one exception, which may include manipulation, to put the joint back in its normal anatomical location and immobilization such as a sling or brace to hold the joint in place while healing occurs. However, healing time for a sublimation may be less than it is for an actual dislocation.

If repetitive sublimation of the same joint is a problem, physical therapy may be ordered to strengthen the surrounding muscles, ligaments, and tendons to create an atmosphere of support rather than weakness.

Where Is It Located: Radial Head

The radial head is the most proximal aspect of the radius bone. This area is mobile within the annular ligament and allows probation and supranational of the forearm.

Nursemaid's Elbow

Nursemaid's elbow is another term for sublimation of the radial head or a pulled elbow. This is the most common upper extremity injury in infants and young children presenting to the ER or Urgent Care. Although it can be seen in infants as young as six months, it is rare.

Cause:  A quick tug of the arm, swinging the child around by their hands, or picking them up by their hands can very easily cause a sublimation of the radial head. The annular ligament is not fully fused in young children, which makes it easy for the radial head to slip or tear through this ligament and become subleased or dislocated. It is more common than you think. Caregivers rarely understand what caused the patient to have a sudden onset of pain in the arm because there is no obvious etiology. The funny thing, is that the majority of radial head sublimation occur on the left side and this is thought to possibly be because the caregivers are right handed, holding the child's left arm.

Diagnosis:  Patient's with sublimation of the radial head may complain of wrist pain, won't use the wrist or arm, and tend to hold their wrist with their good hand. All indications are that there is a wrist injury, when in fact, there is an elbow injury. If swelling is present then x-rays must be done to rule out a more serious injury, but as this is a very common injury, it is generally easily diagnosed.

Treatment:  Mild but constant traction of the arm with supranational and then probation with flex ion and extension should return the radial head to its proper anatomical location. To see how this works, click on the following link to watch a You Tube video showing a toddler having her radial head reduced.

To see this technique demonstrated, click on the YouTube link:  http://www.youtube.com/watch?v=tJb5rGOFiTY

CPT Coding:  24640
ICD-9-CM:  832.2

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Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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