Approach to Pediatric Patients With Elbow Injuries in the Emergency Department (Trauma CME and Risk Management)

Publication Date: October 2026 (Volume 23, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 10/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits and 0.25 Risk Management credits, subject to your state and institutional approval.

Authors

Chad McCalla, MD

Assistant Professor, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC

Crick Watkins, DO

Assistant Professor, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC

Nicole J. Prendergast, MD, CAQSM

Assistant Professor, Department of Emergency Medicine, Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC

Adam B. Johnson, MD

Assistant Professor, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC

Abstract

Pediatric elbow injuries are a common complaint presenting to emergency departments. The unique anatomy and skeletal immaturity in children can make the elbow particularly difficult to evaluate and manage. Additionally, many healthcare institutions have limited or no access to pediatric orthopedic specialists, leaving management decisions to the clinician at the bedside. This review highlights the nuances of the pediatric elbow examination, addressing both acute and subacute (overuse) injuries. Common fracture types are reviewed, and key principles of x-ray interpretation are demonstrated, including recognition of normal variants and ossification centers. Management strategies are outlined, with an emphasis on identifying which patients can be safely managed without orthopedic consultation and which require more urgent care at a pediatric center with access to pediatric orthopedic specialists.

Case Presentations

CASE 1

A 9-year-old previously healthy boy, active in baseball, presents with worsening discomfort in his right elbow for the last month...

The boy says he started noticing pain toward the beginning of the baseball season, about 4 weeks ago. He is right-handed and complains of pain only in the right elbow. He says the pain was initially mild and only seemed to be present after his baseball games, but he now feels the pain apart from physical activity. He is also worried his pitches are not as fast as they were at the beginning of the season.
On examination, the child is afebrile and nontoxic. His vital signs are: temperature, 37.2°C; heart rate, 95 beats/min; blood pressure, 100/70 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 99% on room air. You do not notice any gross deformities or bruising to his right arm.
What conditions are on your differential diagnosis and what physical examination maneuvers may help make the diagnosis?

CASE 2

A 6-year-old girl with left elbow pain and deformity is brought in by her mother...

The mother states that the girl was in her usual state of health and was playing with her older siblings in the living room. As they were playing on the couch, the girl lost her balance and fell about 3 feet to the ground, landing on an outstretched hand. She did not lose consciousness and cried immediately. The mother says the girl has been acting like herself, just complaining of left elbow pain. The girl’s left elbow is more swollen than the unaffected side. The patient has no prior injuries.
On examination, the child is in visible pain and discomfort and is anxious about you needing to move her arm. Her vital signs are: temperature, 37.1°C; heart rate, 130 beats/min; blood pressure, 110/68 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 98% on room air.
What initial clinical maneuvers and radiographic imaging are needed?

CASE 3

A 2-year-old boy presents with an inability to move his left arm after playing with an older sibling...

The boy was playing with his 5-year-old brother in a separate room when the injury happened. His parents did not hear any falls or loud noises. When the child came into the room where his parents were, they noticed him holding his left arm limp, with little movement present. The older brother did not say any specific injury happened during their play.
On examination, the child is resting comfortably. His vital signs are: temperature, 36.8°C; heart rate, 132 beats/min; blood pressure, 90/58 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 99% on room air. The patient is moving his right arm without difficulty but keeps his left arm by his side, with no visible spontaneous movement. There are no gross deformities, bruising, or visible injuries present on the initial evaluation.
What is your next step in managing this patient?

Accreditation:

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