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A Clinical Trial of Pronation Versus Supination Maneuvers for the Reduction of the Pulled Elbow

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified March 2012 by Instituto Tecnologico y de Estudios Superiores de Monterey.
Recruitment status was:  Not yet recruiting
Information provided by (Responsible Party):
Carlos Alberto Cuello-Garcia, Instituto Tecnologico y de Estudios Superiores de Monterey Identifier:
First received: March 21, 2012
Last updated: March 23, 2012
Last verified: March 2012
Nursemaid elbow or pulled elbow is a condition commonly seen in the emergency department. It is the sudden pull of the radial head (a bone in the elbow) in toddlers. Usually occur when a parent tries to pull the child by the arm and a "clic" or "clunk" is felt with immediate pain and unwilling to move the arm. It is not a dangerous condition although it is distressing for kids and their parents/caretakers.

Condition Intervention
Nursemaid Elbow
Pulled Elbow
Other: Pronation
Other: Supination

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized Clinical Trial of Pronation Versus Supination Maneuvers for the Reduction of the Pulled Elbow

Further study details as provided by Instituto Tecnologico y de Estudios Superiores de Monterey:

Primary Outcome Measures:
  • Successful reduction [ Time Frame: 10 to 20 minutes ]
    ✦ Patient can move his/her arm without pain in the next 20 minutes after the technique is applied: i.e., the mother asks the child to hold an object (toy) and the toddler can hold it without problem.

Secondary Outcome Measures:
  • Pain of the procedure [ Time Frame: 1 to 5 min ]
    The mother will asses after the protocol is completed the perceived pain on her child from the maneuver. This will be assessed in a Likert scale.

Estimated Enrollment: 90
Study Start Date: June 2012
Estimated Study Completion Date: September 2013
Estimated Primary Completion Date: June 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pronation group
In this group, participants will receive the pronation procedure. The technique is described below
Other: Pronation
In this technique the arm is flexed 90 degrees and a gentle pronation is applied to the arm; then the arm is further flexed to 45 degrees until the clinician feels a "click" in the elbow meaning the re-accommodation of the radial head has been accomplished.
Other Name: Hyper-pronation technique
Active Comparator: Supination group
Participants in this group will be performed the supination technique. Description below.
Other: Supination
The affected arm is in a 90 degrees flexion. The clinician will hold the arm by the elbow and then makes a gentle supination of the affected arm and flexion of the elbow until feeling the "click" and the child is able to move the arm without pain.
Other Name: Supination technique

Detailed Description:

The usual therapy consists of one of two maneuvers: supination maneuver or pronation maneuver. They both are safe to perform but none of them have been statistically superior over the other. More studies are needed to confirm or discard the tendency of the studies to favor the pronation maneuver.

The investigators intend to perform a randomized trial evaluating which of these techniques is better than the other in terms of returning the mobility of the affected arm and decreasing pain.


Ages Eligible for Study:   6 Months to 6 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Pulled elbow suspected in any child presenting one of the following:

    1. History of an adult or bigger person that had pulled the child's elbow non-intentionally
    2. Presence of intense pain at the arrival at the emergency department and unwilling to move the arm.

Exclusion Criteria:

  • Any suspect of injury that could be intentional (child abuse)
  • Any suspicion child of suffering a possible fracture (the mechanism of the injury was not from pulling the child's arm, the arm presents obvious deformity, ecchymoses, edema, etc.)
  • The mechanism was from multiple trauma
  • Any chronic disease affecting the adequate bone mineralization (vitamin D deficiency, osteogenesis, etc.)
  Contacts and Locations
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Please refer to this study by its identifier: NCT01562535

Contact: Carlos A Cuello-Garcia, MD +52(81)-81430200

School of Medicine and Health Sciences Not yet recruiting
Monterrey, Nuevo Leon, Mexico, 64710
Contact: Carlos A Cuello-Garcia, MD    1-81430200   
Sub-Investigator: Yetiani M Roldan-Benitez, MD         
Sub-Investigator: Teresa Lopez, MD         
Sub-Investigator: Susana Villarreal, MD         
Sponsors and Collaborators
Instituto Tecnologico y de Estudios Superiores de Monterey
Principal Investigator: Carlos A Cuello-Garcia, MD Instituto Tecnologico y de Estudios Superiores de Monterey
  More Information

Responsible Party: Carlos Alberto Cuello-Garcia, Director of the Center for Evidence Based Medicine & Knowledge Translation, Instituto Tecnologico y de Estudios Superiores de Monterey Identifier: NCT01562535     History of Changes
Other Study ID Numbers: CMBE-ITESM-2
Study First Received: March 21, 2012
Last Updated: March 23, 2012

Keywords provided by Instituto Tecnologico y de Estudios Superiores de Monterey:
pulled elbow
nursemaid elbow

Additional relevant MeSH terms:
Wounds and Injuries processed this record on April 26, 2017