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Evaluation of the immobile arm in children

Author
Sara Schutzman, MD
Section Editor
George A Woodward, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will discuss the approach to the child with an immobile arm.

Radial head subluxation (nursemaid’s elbow) is discussed separately. (See "Radial head subluxation (nursemaid's elbow)".)

BACKGROUND

An immobile arm is a relatively common complaint in pediatrics evaluated in both the emergency department and primary care provider office. An infant or child is not moving the limb either due to current or recently resolved pain or weakness and can be considered to have an upper extremity equivalent of a "limp". Since many of these children are preverbal and fearful of strangers, the evaluation may be challenging. Radial head subluxation ("nursemaid's elbow") is by far the most common cause of arm immobility in children younger than six years of age, however, children with much more serious pathology may present with this complaint [1]. By using historical information, physical findings, selective radiologic studies, and laboratory tests, children with an immobile arm can be appropriately diagnosed and managed.

DIFFERENTIAL DIAGNOSIS

An immobile arm most frequently results from radial head subluxation or an injury after a fall. The causes of an immobile arm are presented in the table (table 1).

Life and limb-threatening causes — Although these causes of an immobile arm are presented first and should always be considered, other than trauma, they are quite rare.

                                    

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 11 00:00:00 GMT+00:00 2016.
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