Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
  1. Home
  2. Urgent care
  3. Children
  4. Pulled elbow
● Urgent care clinic · 30-minute consult

Pulled elbow

Typical story, no X-ray, reduce and watch them play.

Typical consult⏱ 15 min
Investigations🔬 None if typical
Usual outcome💊 Reduction + reassurance
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
If you find……then
Fall or direct blow (not a pull)Supracondylar fracture — X-ray first
Swelling, bruising, deformity, point bony tendernessFracture — X-ray
Older than 5 or inconsistent story, delayed presentationConsider fracture and safeguarding
Still not using the arm 30 min after reductionX-ray, and review
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
InvestigationOnly if…
NoneTypical history and examination — X-ray not needed
5Treat & send home

Management & advice

  • Reduce: hyperpronation (hold elbow, pronate the forearm firmly) — or supination then flexion
  • A click is often felt; child usually uses the arm within 15–30 min
  • Watch them reach for a toy before discharge
  • Advise lifting under the armpits, not by the hands; recurrence is common until about age 5

Refer / follow-up

  • Not using the arm after 2 attempts / 30 min → X-ray and senior review
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
DrugDoseDuration / notes
Paracetamol or ibuprofenWeight-based per BNFcOnly if sore after reduction
6Safety-net
Say it like this

The elbow had slipped slightly, which is common at this age, and it’s now back in place. You can see they’re using the arm again. To stop it happening again, lift them under the arms rather than by the hands. Come back if they stop using the arm again or it becomes swollen.

Come back / call 111 — or 999 if severe — if:

  • Not using the arm normally by tomorrow
  • Swelling, bruising or more pain
7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

There’s no national NHS page for pulled elbow. Use your trust’s patient leaflet.

8Document

Pulled elbow — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — PULLED ELBOW PRESENTING COMPLAINT: HISTORY Age (typically 1–4): Mechanism: pulled up by the hand/arm, swung, rolled over: Immediate refusal to use the arm: Previous pulled elbow: Any fall: RED FLAGS (record present / absent) [ ] Fall or direct blow (not a pull) [ ] Swelling, bruising, deformity, point bony tenderness [ ] Older than 5 or inconsistent story, delayed presentation [ ] Still not using the arm 30 min after reduction PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Arm held slightly flexed and pronated by the side: No swelling, bruising or deformity: Feel clavicle, humerus, elbow, forearm, wrist for bony tenderness: Neurovascular check: INVESTIGATIONS: none required / None — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): local leaflet Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Not using the arm normally by tomorrow - Swelling, bruising or more pain Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.