Radiusköpfchen-Subluxation

Chronische,

mutmaßlich schon seit der Kindheit bestehende Luxationsstellung des Radiusköpfchens bei einer 55-jährigen. Das Radiusköpfchen steht weit ventral vor dem Capitulum humeri. Es ist ungewöhnlich konvex gerundet, was dafür spricht, das die Luxation lange besteht.

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The elbow:

review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Sagittal FS PD-weighted MRI (a) and consecutive coronal FS PD-weighted MRI (b, c) showing a posterolateral subluxation of the radial head (white arrowhead), proximal disruption of the lateral ulnar collateral ligament (white arrow), partial proximal disruption of the radial collateral ligament (yellow arrow), proximal disruption of the anterior bundle of the medial collateral ligament (blue arrow), radial head and posterior capitellar contusions (white asterisks), and joint effusion (black asterisks)

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The elbow:

review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Coronal T1-weighted MRI (a) and coronal FS PD-weighted MRI (b) showing an acute proximal common avulsion of the lateral ulnar collateral ligament and radial collateral ligament (white arrows), an acute avulsion of the anterior bundle of the medial collateral ligament complex (white arrowheads), a radial head fracture (white asterisks), a partial tear of the proximal common extensor tendon (yellow arrows), and joint effusion

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Pulled elbow (also known as nursemaid's elbow) is a subluxation of the radial head into the annular ligament, which usually spontaneously or easily reduces and rarely demonstrates abnormal radiographic features. It should be distinguished from dislocation of the radial head.

Epidemiology

Pulled elbows are encountered in young children (typically between 6 months and 3 years of age), as a result of pulling on the arm longitudinally, as occurs when yanking a child away from something the parents would rather they not touch, or lifting the child in play (fathers are much more likely to do this).

Clinical presentation

Children with a pulled elbow will hold the elbow flexed and the forearm in the prone position, unwilling to supinate it .

Pathology

The propensity of young children to develop pulled elbows most likely stems for a generalized ligamentous laxity, which also affects the annular ligament, allows the radial head to sublux into it. In the younger children, this results in no ligamentous damage, whereas in older children partial tears are thought to occur, accounting for the persistence of pain a number of days following reduction .

Radiographic features

Radiography is unhelpful in making the diagnosis, but may inadvertently result in reduction of the subluxation as the radiographer supinates the elbow to obtain an AP view .

Treatment and prognosis

Supination with the elbow flexed almost always results in reduction, and in infants almost immediate cessation of symptoms. Older children may have a number of days of ongoing discomfort. Only rarely is closed reduction unsuccessful.

A number of patients will have recurrent episodes, however, with growth, these occur less and less frequently .