Upper Extremity Pseudoparalysis: A Case Report of Bilateral Nursemaid’s Elbows

Radial head subluxation (RHS), commonly known as 'nursemaid's elbow,' typically presents in pediatric patients with acute-onset unilateral arm pain and pseudoparalysis. The classic mechanism of injury involves a longitudinal traction force pulling the radial head through the annular ligament. Bilateral RHS is exceedingly rare, with only a few cases documented in the literature; notably, all cases with a provided history and physical exam presented with the classic mechanism of injury, aiding in diagnosis and treatment. Here, we report the case of a two-year-old male with bilateral RHS who presented to the emergency department with bilateral upper extremity pain and weakness following an unwitnessed injury. This case required a broad differential diagnosis, including musculoskeletal injury, central cord syndrome, and spinal cord injury without radiographic abnormality (SCIWORA). It underscores the importance of considering RHS in differential diagnoses, even in atypical presentations, to ensure prompt and effective management.