OVERVIEW

What does radial head subluxation mean?

Radial head subluxation most commonly occurs in young children and is often caused by forceful pulling of the forearm. When subluxation occurs, the child typically refuses to move the elbow.

The radius is the long bone on the thumb side of the forearm, and the radial head is part of the elbow joint.
In children aged 2–3, the radial head is relatively small and can easily slip out of the joint through the ligament when pulled by external force, resulting in radial head subluxation.

Radial head subluxation often occurs when an adult pulls a resisting child forward by the forearm or when an adult grabs a child's wrist to prevent a fall.

SYMPTOMS

What are the symptoms of radial head subluxation?

There will be pain and tenderness. When the dislocation first occurs, the child may cry but then calm down. Young children usually cannot describe their symptoms themselves, so they simply show reluctance to move their arm. The arm may hang at their side or remain bent toward the body.

CAUSES

What causes radial head subluxation?

Radial head subluxation mainly occurs in children under 5 years old because their radial head is underdeveloped and their ligaments are not fully formed.

The dislocation is primarily related to incorrect force or stress application. When an adult pulls a resisting child forward by the forearm, or when an adult grabs a child's wrist to prevent a fall, or lifts the child by the wrist (especially with the body suspended), it can easily lead to radial head subluxation.

DIAGNOSIS

Can X-rays detect radial head subluxation? How is radial head subluxation diagnosed?

X-rays cannot detect radial head subluxation, so its diagnosis primarily relies on:

• Medical history: A history of the child's arm being pulled.

• Symptoms: Elbow pain, and the child's reluctance to move the forearm.

• Physical examination: Tenderness on the lateral side of the elbow.

TREATMENT

How to treat radial head subluxation?

Manual reduction is generally sufficient.

First, the parent holds the child while the injured limb faces the doctor. The doctor grasps the wrist of the affected limb with one hand, slightly rotating it forward, while the other hand holds the upper part of the elbow and applies gentle counter-traction. Simultaneously, the forearm is rotated slightly backward.

Successful reduction relies mainly on the doctor's sensation—a click may be heard or felt, followed by restored rotation and flexion-extension of the elbow, indicating success. If unsuccessful, the final step involves pronating the forearm.

After reduction, no cast or fixation is needed since it is only a subluxation.

Is anesthesia required for radial head subluxation reduction?

Because the procedure is simple and children have underdeveloped muscles, reduction is relatively easy and usually does not require anesthesia. The child experiences only a few seconds of pain. In fact, anesthesia involves an injection, which itself causes discomfort.

DIET & LIFESTYLE

What should be noted after reduction of radial head subluxation?

After reduction, young children can freely move their elbow joint within 10-20 minutes. If free movement is not possible, an elbow X-ray should be performed to assess for other abnormalities.

If the child experiences pain or inability to move the arm for more than 24 hours, incomplete reduction or occult fracture should be highly suspected, and further examination should be conducted promptly.

Can radial head subluxation recur?

If not careful, it may recur. About 20%-40% of young children may experience dislocation again.

PREVENTION

How to prevent radial head subluxation?

• Do not forcibly pull a child forward.

• When lifting or pulling a child's hand, always hold the sleeve simultaneously.

• Prevent young children from falling.