Rosh Pediatrics Practice Exam

What injury is indicated by elbow pain in a 4-year-old following being twirled by the arms?

1. Fracture of the radial head

2. Posterior elbow dislocation

3. Radial head subluxation

4. Supracondylar fracture

The correct answer is: Radial head subluxation

Elbow pain in a 4-year-old child following being twirled by the arms suggests a specific injury known as radial head subluxation, often referred to as "nursemaid's elbow." This condition occurs when there is a slight displacement of the radial head from its normal position in the elbow joint. When a child is yanked or pulled by the arms, the radial head, which is a bony structure in the elbow, can slip out of place, particularly in younger children whose ligaments are more lax and less able to hold the joint in position. The child typically presents with pain, reluctance to use the affected arm, and sometimes holding the arm in a specific position that minimizes discomfort. Understanding the mechanics of this injury is key; the motion of being twirled can create a force that exceeds what the surrounding soft tissues can manage, leading to this subluxation. While other injuries such as fractures can occur in the elbow region, they are less common in this specific context of being twirled and typically involve different symptoms or mechanisms of injury. Thus, the characteristic presentation and the mechanism of injury make radial head subluxation the most likely diagnosis in this situation.