Sunday, June 24, 2007

Nursemaid's elbow

I reduced my first Nursemaid's elbow this week.

I've been jealous of my (non-medical) husband who reduced my daughter around when she was three. Our eldest had been through the experience and necessitated a trip to the ER (I was a medical student, and could diagnose the problem, but was too scared to do anything about it.) So he looked it up on the internet and reduced it, then called me and told me about it.

A Nursemaid's elbow is a common condition in toddlers, where the elbow dislocates to some degree. A simple procedure reduces it, and tho the procedure is painful, relief is immediate.

My patient was under a year old, which gave me an advantage: she was not apprehensive about me touching her. It didn't work the first time, but the second (this time with her seated in my lab facing away from me) worked like a charm. I was expecting a "clunk", but it was definitely just a "click".

She immediately began to play with her toys again, ambidextrously. Baby's happy, mom's happy, Dr. Smak's happy.

1 comment:

Ten out of Ten said...

Congrats on getting it back in!

FWIW, I think the two most important parts of the reduction are:
1. Pulling the forearm out towards you while providing countertraction at the elbow with your off hand.
2. Really aggressive pronation (hard and fast).

Not that I'm any kind of expert, one year out of residency and all, but when our midlevels can't get one back in and I'm able to, I think the above makes the difference.