Ultrasound as a Diagnostic Tool for Nursemaid’s Elbow with Typical Sonographic “J Sign”

Background: Nursemaid’s elbow is a common upper extremity injury with a peak incidence between 2 and 3 years of age. Sometimes, the exact injury mechanism is not always distinct, making it difficult to differentiate whether it is a fracture or pulled elbow. Objectives: Here, we examine the efficacy and accuracy of ultrasonography as an objective diagnostic and verifying tool for pulled elbows before and after manipulation. Materials and Methods: Eleven children with suspected nursemaid’s elbow based on their clinical history and physical findings were examined from October 2021 to August 2022 by one pediatricorthopedic physician in one medical center. Portable ultrasonography was performed before and after pulled elbow reduction and observe the findings on echo images. Results: The specific “J sign” was detected in all patients before manipulation under evaluation of portable echo. After successful reduction, the “J sign” was not seen under portable echo, and the annular ligament was back to its normal anatomic position. Conclusions: We suggest the use of ultrasound examination regularly before any reduction attempts in every case, which is a more objective, fast, noninvasive, and convenient way to identify the pulled elbow.